Comprehensive Health Insurance and access to maternal healthcare services among Peruvian women: a cross-sectional study using the 2021 national demographic survey.

BACKGROUND: The government-subsidized health insurance scheme Seguro Integral de Salud ("SIS") was introduced in Peru initially to provide coverage to uninsured and poor pregnant women and children under five years old and was later extended to cover all uninsured members of the population following the Peruvian Plan Esencial de Aseguramiento Universal - "PEAS" (Essential UHC Package). Our study aimed to analyze the extent to which the introduction of SIS has increased equity in access and quality by comparing the utilization of maternal healthcare services among women with different insurance coverages. METHODS: Relying on the 2021 round of the nationally-representative survey "ENDES" (Encuesta Nacional Demográfica y de Salud Familiar), we analyzed data for 19,181 women aged 15-49 with a history of pregnancy in the five years preceding the survey date. We used a series of logistic regressions to explore the association between health insurance coverage (defined as No Insurance, SIS, or Standard Insurance) and a series of outcome variables measuring access to and quality of all services along the available maternal healthcare continuum. RESULTS: Only 46.5% of women across all insurance schemes reported having accessed effective ANC prevention. Findings from the adjusted logistic regression confirmed that insured women were more likely to have accessed ANC services compared with uninsured women. Our findings indicate that women in the "SIS" group were more likely to have accessed six ANC visits (aOR = 1.40; 95% CI 1.14-1.73) as well as effective ANC prevention (aOR = 1.32; 95% CI 1.17-1.48), ANC education (aOR = 1.59; 95% CI 1.41-1.80) and ANC screening (aOR = 1.46; 95% CI 1.27-1.69) during pregnancy, compared with women in the "Standard Insurance" group [aOR = 1.35 (95% CI 1.13-1.62), 1.22 (95% CI 1.04-1.42), 1.34 (95% CI 1.18-1.51) and 1.31(95% CI 1.15-1.49)] respectively. In addition, women in the "Standard Insurance" group were more likely to have received skilled attendance at birth (aOR = 2.17, 95% CI 1.33-3.55) compared with the women in the "SIS" insurance group (aOR = 2.12; 95% CI 1.41-3.17). CONCLUSIONS: Our findings indicate the persistence of inequities in access to maternal healthcare services that manifest themselves not only in the reduced utilization among the uninsured, but also in the lower quality of service coverage that uninsured women received compared with women insured under "Standard Insurance" or "SIS". Further policy reforms are needed both to expand insurance coverage and to ensure that all women receive the same access to care irrespective of their specific insurance coverage.

Cost supervision mining from EMR based on artificial intelligence technology.

BACKGROUND: To effectively monitor medical insurance funds in the era of big data, the study tries to construct an inpatient cost rationality judgement model by designing a virtuous cycle of inpatient cost supervision information system and exploring a complete set of inpatient cost supervision methods. OBJECTIVE: To lay the foundation for applying artificial intelligence (AI) technology in medical insurance cost control supervision and provide feasible paths and available tools for medical insurance cost control managers. METHODS: By way of collecting and cleaning electronic medical record (EMR) data from 2016 to 2018 of a city in East China, focusing on basic patient information and cost information, and using a combination of machine learning modeling and information system construction, the study tries to form a feasible inpatient cost supervision method and operation path. RESULTS: The set of the regulatory method, applied in nursing homes of a city in East China, is compelling. The accuracy rates of rationality judgement in different main diseases are stable up to 80%, the false positive rate is steady within 10%, and rehabilitation fee days of hospitalization, and the number of complications are important factors affecting the rationality of the inpatient cost. CONCLUSION: The model construction and optimization method combining machine learning and information system can make practical cost rationality judgement on medical institution's inpatient cost data, which can directly reflect the key influencing factors of relevant inpatient costs, and achieve the effect of guiding medical behavior and improving the efficiency of medical insurance fund use.

Impact of Comprehensive Health Insurance on Quality of Life in Low-Income Hispanic Men with Prostate Cancer.

OBJECTIVE: To evaluate the effect of the transition from IMPACT, a disease-focused treatment program, to comprehensive health insurance under Medicaid through the Affordable Care Act (ACA) on general and prostate cancer-specific quality of life (QoL) on a cohort of previously uninsured low-income men. We hypothesize that general QoL would improve and prostate cancer-specific QoL would remain the same after the transition to comprehensive health insurance. METHODS: We assessed and compared general QoL using the RAND SF-12v2™ (12-Item Short Form Survey, version 2) and prostate cancer-specific QoL using the UCLA PCI (Prostate Cancer Index) one year before, at, and one year after the transition between 30 men who transitioned to comprehensive insurance (newly insured/Medicaid group) and 54 men who remained in the prostate cancer program (uninsured/IMPACT group). We assessed the independent effects of Medicaid coverage on QoL outcomes using repeated-measures regression. RESULTS: Our cohort was composed primarily of Hispanic men (82%). At transition, patient demographics and clinical characteristics were similar between the groups. General and prostate cancer-specific QoL did not differ between the groups and remained stable over time, Radical prostatectomy as primary treatment and shorter time since treatment were associated with worse urinary and sexual function across both groups and over all three time points. CONCLUSION: Those who transitioned to full-scope insurance and those who remained in the free prostate cancer-focused treatment program had stable general and prostate cancer-specific QoL. High-touch navigation aspects of a disease-focused program may have contributed to stability in outcomes.

Function-based rehabilitation model: An initial step towards universal health coverage

Objective@#As part of the thrust towards Universal Health Care, the Philippines has enhanced health insurance coverage for rehabilitation with recent introductions of benefits for disabilities in children, prostheses, and orthoses. The project aimed to develop a functionality-based framework to guide comprehensive benefits for rehabilitation services for adult Filipinos. @*Methods@#Scoping review was conducted to identify common rehabilitation conditions, frameworks for clinical assessment, and essential services for rehabilitation. Key informant interviews and focus group discussions were conducted with targeted rehabilitation service providers and experts to validate the information collected. A unified pathway of care and essential services for the provision of rehabilitation medicine services was developed through triangulation. The study was conducted from October 2018 to September 2019, with activities done in Metro Manila. @*Results@#The results summarized treatment pathways for four major disease categories: neurologic, musculoskeletal, chronic pain, and activities of daily living/ cardiopulmonary. Impairments were identified reflecting the principles from the International Classification of Function. Disabilities were categorized based on function: mobility, self-care, cognitive-behavioral, and communication. A unified care pathway was developed to harmonize rehabilitation assessment, management, and care. A framework to simplify financial coverage was likewise provided. The extent of management (e.g., duration of therapy) depends on the severity of the disability classified as mild, moderate, or severe. Based on this classification, essential management modalities included physiatry interventions, medications, and rehabilitation sessions, supported by outcomes evaluation.@*Conclusion@#A framework is proposed to guide the design and implementation of benefits and health insurance coverage. Awareness and application of this approach among rehabilitation practitioners and health facilities are essential steps for successful uptake and implementation of the upcoming expansion in PhilHealth coverage.

Evaluation of economic burden with biologic treatments in Crohn's disease patients: A mirror image study using an insurance database in Japan.

Biologics are recommended in Japan to treat moderate to severe Crohn's Disease (CD). Although CD is associated with high direct costs in Japan, updated information after ustekinumab's approval is unavailable. We aimed to evaluate the healthcare resource utilization (HRU) and associated direct costs from the payer's perspective in Japan. Claims data (2010-2018) were retrospectively analyzed to identify patients with CD. HRU and associated costs were evaluated for 12 months before and after biologic initiation and followed-up till 36 months post-initiation. Outcomes were reported using descriptive statistics. Among the included patients (n = 3,496), 1,783 were on biologics and 1,713 were on non-biologics. Mean (SD) age was 36.4 (13.2) years and patients were predominantly male (76.1%). Patients aged 18-39 years were affected with CD the most (55.3%). Biologic initiation was associated with a reduction in inpatient stay, length of stay, outpatient visits, and associated costs; and an increase in pharmacy costs and total costs after 12 months. Extended follow-up showed a decreasing trend in HRU and costs till 24 months but an increase after 36 months. These findings demonstrated reduction in clinical burden and slight increase in economic burden with biologics. However, indirect costs also need to be evaluated.

Hubei's Core Response Policies in the Early Stage of COVID-19.

BACKGROUND: This study is aimed at confirming the effectiveness of nonpharmaceutical interventions during the COVID-19 outbreak in Hubei, China. METHODS: The data are all from the epidemic information released by the National Health Commission of the People's Republic of China and the Health Commission of Hubei Province. We used the multivariable linear regression by the SPSS 19.0 software: the cumulative number of confirmed cases, the cumulative number of cured cases, and the number of daily severe cases were taken as dependent variables, and the six policies, including the Joint Prevention and Control Mechanism of the State Council, lockdown Wuhan city, the first-level response to public health emergencies, the expansion of medical insurance coverage to suspected patients, mobile cabin hospitals, and counterpart assistance in Hubei province, were gradually entered into multiple linear regression models as independent variables. RESULTS: The factors influencing the cumulative number of diagnosed cases ranged from large to small: mobile cabin hospitals and the expansion of medical insurance coverage to suspected patients. The factors influencing the cumulative number of cured cases ranged from large to small: counterpart support medical teams in Hubei province and mobile cabin hospitals. The factors influencing the number of daily severe cases ranged from large to small: mobile cabin hospitals and the expansion of medical insurance coverage to suspected patients. CONCLUSION: The mobile cabin hospital is a major reason for the successfully defeating COVID-19 in China. As COVID-19 pandemic spreads globally, the mobile cabin hospital is a successful experience in formulating policies to defeat COVID-19 for other countries in the outbreak phase.

Moral Risk in the Behavior of Doctors of the Comprehensive Health Insurance in the Province of San Román, Puno-Peru, 2021.

Objective: The objective of the research was to determine which socioeconomic factors are the ones that most influence the moral hazard in the behavior of the doctors of the Comprehensive Health Insurance in the province of San Román and to identify the attitude of the doctor to a gift and its influence in moral hazard. Methods: The methodology used has a mixed, non-experimental and correlational approach, the Binomial Probit econometric model was used, applying a survey to 32 active doctors who work in the different SIS centers. Results: It is concluded that the factors that influenced the moral hazard and the behavior of the doctors were the bad reputation with a positive relation (27%), the social pressure with a negative relation (98%) and the behavioral attitude with a positive relation (94 %). Conclusion: Of the survey carried out, 40.6% of doctors reject the offer of a gift or bribe, reducing the influence of moral hazard by 94%.

Effect of the catastrophic medical insurance on household catastrophic health expenditure: evidence from China / El efecto del seguro médico para enfermedades catastróficas o de alto coste sobre el gasto doméstico en salud: la evidencia en China

OBJECTIVE: China launched an innovative program of catastrophic medical insurance (CMI) to protect households from catastrophic health expenditure (CHE) and impoverishment. This article assesses the effect of CMI on relieving CHE and impoverishment from catastrophic illnesses in urban and rural China. METHOD: In total, 8378 cases are included in the analysis. We employed descriptive statistical analysis to compare the incidence and intensity of CHE at five health expenditure levels, from 1 June 2014 to 31 May 2015. To illustrate the different protection of the policy, we analyzed the data in two lines, the covered medical expenses and the total medical expenses. RESULTS: CMI drop down CHE incidence from 4.8% to 0.1% and the mean catastrophic payment gap from 7.9% to zero when only considering covered medical expenses. CMI drop down CHE incidence from 15.5% to 7.9% and the mean catastrophic payment gap from 31.2% to 14.7% when considering total medical expenses. If CMI reimburse uncovered medical expenses at 30%, the mean catastrophic payment gap could be 7.9% and insured person's annual premium will increase US$2.19. CONCLUSIONS: China CMI perfectly meet the pursued policy objectives when only considering the covered medical expenses. However, when considering the total medical expenses, the CMI is only partially effective in protecting households from CHE. The considerable gap is the result of the limitation of CMI list

OBJETIVO: China lanzó un innovador programa de Seguro Catastrófico de Salud (SCS) para proteger a los hogares del gasto sanitario catastrófico (GSC) y el empobrecimiento. Este artículo evalúa el efecto del SCS para aliviar el GSC y el empobrecimiento a causa de las enfermedades catastróficas en zonas urbanas y rurales de China. MÉTODO: En total, se incluyen 8378 casos en el análisis. Se emplearon análisis estadísticos descriptivos para comparar la incidencia y la intensidad del GSC en cinco niveles de gastos de salud, del 1 de junio de 2014 al 31 de mayo de 2015. Para ilustrar la diferente protección de la política se analizaron los datos en dos líneas: los gastos sanitarios cubiertos por el seguro y los gastos sanitarios totales. RESULTADOS: Considerando los gastos cubiertos por el seguro, se redujeron los hogares con gastos catastróficos del 4,8% al 0,1%, y la brecha de pago catastrófico media cayó del 7,9% al 0,0% en promedio. Cuando consideramos el gasto sanitario total, los hogares con gasto catastrófico se redujeron del 15,5% al 7,9%, y la brecha de pago catastrófico media cayó del 31,2% al 14,7% en promedio. Esta cantidad podría reducirse al 7,9% si se reembolsara el 30% a los gastos no cubiertos por el SCS, lo que supondría un aumento de la prima del seguro por persona de US$ 2,19. CONCLUSIONES: El SCS de China cumple perfectamente los objetivos de la política perseguida cuando solo se consideran los gastos cubiertos por el seguro. Si se consideran los gastos totales, el SCS solo es parcialmente efectivo para proteger a los hogares del gasto sanitario catastrófico. El motivo de este desfase es la limitación existente en la lista de servicios cubiertos por el SCS

Proton beam therapy utilization in adults with primary brain tumors in the United States.

The utilization of proton beam therapy (PBT) as the primary treatment of adults with primary brain tumors (APBT) was evaluated through query of the National Cancer Database (NCDB) between the years 2004 and 2015. International Classification of Diseases for Oncology code for each patient was stratified into six histology categories; high-grade gliomas, medulloblastomas, ependymomas, other gliomas, other malignant tumors, or other benign intracranial tumors. Demographics of the treatment population were also analyzed. A total of 1,296 patients received PBT during the 11-year interval for treatment of their primary brain tumor. High-grade glioma, medulloblastoma, ependymoma, other glioma, other malignant, and other benign intracranial histologies made up 39%, 20%, 13%, 12%, 13%, and 2% of the cohort, respectively. The number of patients treated per year increased from 34 to 300 in years 2004 to 2015. Histologies treated with PBT varied over the 11-year interval with high-grade gliomas comprising 75% and 45% at years 2004 and 2015, respectively. The majority of the patient population was 18-29 years of age (59%), Caucasian race (73%), had median reported income of over $63,000 (46%), were privately insured (68%), and were treated at an academic institution (70%). This study characterizes trends of malignant and benign APBT histologies treated with PBT. Our data from 2004 through 2015 illustrates a marked increase in the utilization of PBT in the treatment of APBT and shows variability in the tumor histology treated over this time.

Prediction of Prolonged Length of Stay for Stroke Patients on Admission for Inpatient Rehabilitation Based on the International Classification of Functioning, Disability, and Health (ICF) Generic Set: A Study from 50 Centers in China.

BACKGROUND This study aimed to develop a risk prediction model for prolonged length of stay (LOS) in stroke patients in 50 inpatient rehabilitation centers in 20 provinces across mainland China based on the International Classification of Functioning, Disability, and Health (ICF) Generic Set case mix on admission. MATERIAL AND METHODS In this cohort study, 383 stroke patients were included from inpatient rehabilitation settings of 50 hospitals across mainland China. Independent predictors of prolonged LOS were identified using multivariate logistic regression analysis. A prediction model was established and then evaluated by receiver operating characteristic (ROC) curve analysis and the Hosmer-Lemeshow test. RESULTS Multivariate logistic regression analysis showed that the type of medical insurance and the performance of daily activities (ICF, d230) were associated with prolonged LOS (P<0.05). Age and mobility level measured by the ICF Generic Set demonstrated no significant predictive value. The prediction model showed acceptable discrimination shown by an area under the curve (AUC) of 0.699 (95% CI, 0.646-0.752) and calibration (χ²=11.66; P=0.308). CONCLUSIONS The risk prediction model for prolonged LOS in stroke patients in 50 rehabilitation centers in China, based on the ICF Generic Set, showed that the scores for the type of medical insurance and the performance of daily activities (ICF, d230) on admission were independent predictors of prolonged LOS. This prediction model may allow stakeholders to estimate the risk of prolonged LOS on admission quantitatively, facilitate the financial planning, treatment regimens during hospitalization, referral after discharge, and reimbursement.

Economic Burden of Non-Infectious Inflammatory Eye Disease (NIIED) in a Commercially-Insured Population in the United States.

Purpose: To assess the economic burden of non-infectious inflammatory eyedisease (NIIED) in a commercially-insured population in the United StatesMethods: Adult patients with a NIIED diagnosis between 2006 and 2015 were selected from a de-identified, privately insured claims database and were matched 1:1 to a non-NIIED control. Ophthalmologic complications, direct healthcare resource use and costs, and indirect work loss (from the payer perspective) were calculated for a 12-month period and compared across the 2 cohorts.Results: Among the 14 876 matched pairs, NIIED patients were significantly more likely than controls to experience ocular complications, including glaucoma and cataracts (p < 0.001). NIIED patients had significantly higher healthcare resource utilization and costs compared with matched controls (relative difference 40%, p < 0.001). NIIED patients missed 12.2 days of work ($2925 annual work-loss costs), 46% more than non-NIIED patients (p < 0.001).Conclusion: NIIED imposes a significant clinical and economic burden, suggesting an unmet need for expanded access to alternative treatment options.

Individual vs household: How do different calculation patterns of catastrophic health expenditure matter? New evidence from China's critical illness insurance programme.

Reducing the incidence and severity of catastrophic health expenditure (CHE) has been considered to be one of the most fundamental goals of the global health care financing system. China, the second largest economy and the most populous country in the world, established a critical illness insurance (CII) programme in 2012 in an effort to protect Chinese residents from CHE shocks. This paper attempts to address whether the different calculation patterns (namely, individuals vs household) of CHE matter under China's CII programme. We compare two CII models built with the World Health Organization's (WHO's) standard and the Chinese standard. Exploiting the latest China family panel studies (CFPS) dataset, we demonstrate that using household as the calculation pattern is more effective in alleviating CHE under a tight premium budget, which is consistent with the international view. This finding raises concerns about the appropriate calculation pattern of CHE in policy making.

[System and human resources for occupational health in the republic of the Philippines: Management of occupational health activities at overseas workplaces for Japanese enterprises].

OBJECTIVES: This study aimed to consider the appropriate occupational health system for Japanese enterprises in the Philippines based on information on the regulations and development of specialists. METHODS: We collected information using an information-gathering checklist. Along with literature and internet surveys, we conducted interviews by visiting local business sites, central government agencies in charge of medical and health issues, and educational institutions with specialized occupational physician training curricula. RESULTS: Occupational health administration in the Philippines is managed by the Department of Labor and Employment, which issues the Occupational Safety and Health Standards that specify the legal requirements for occupational health. A new law(Republic Act 11058),enacted in 2018 to strengthen the Occupational Safety and Health Standards, has newly established a penalty provision in case of violations. Professional personnel responsible for occupational health are grouped as safety officers and occupational health personnel, including occupational physicians and occupational nurses; training is conducted at the Occupational Safety and Health Center of the Department of Labor and Employment and educational institutions. The basic medical insurance system and the workers' compensation system are operated by the Philippine Health Insurance Corporation and Social Security Committee, respectively, both of which are government agencies. CONCLUSIONS: We confirmed that occupational health activities in the Philippines are based on government regulations, namely, the Occupational Safety and Health Standards. In addition, the enactment of a new law calls for strict compliance with corporate occupational health activities. To manage proper occupational health activities at overseas workplaces, Japanese corporations should clarify corporate-wide policies and support local employers in complying with regulations and utilizing highly specialized personnel.

High risk of gastrointestinal hemorrhage in patients with systemic sclerosis.

BACKGROUND: Systemic sclerosis (SSc), a life-threatening autoimmune disease characterized by vasculopathy. Numerous SSc patients demonstrate gastrointestinal (GI) involvement but the delicate GI bleeding risk remains sparse. We aimed to explore the role of SSc in determining the long-term risk of GI bleeding, including bleedings of upper (peptic and non-peptic ulcers) and lower GI tracts. METHODS: Patients with SSc diagnosis were identified from the Catastrophic Illness Patient Database and the National Health Insurance Research Database from 1998 to 2007. Each SSc patient was matched with five SSc-free individuals by age, sex, and index date. All individuals (case = 3665, control = 18,325) were followed until the appearance of a GI bleeding event, death, or end of 2008. A subdistribution hazards model was assessed to evaluate the GI bleeding risk with adjustments for age, sex, and time-dependent covariates, comorbidity, and medications. RESULTS: The incidence rate ratios of GI bleeding were 2.38 (95% confidence interval [CI], 2.02-2.79), 2.06 (95% CI, 1.68-2.53), and 3.16 (95% CI, 2.53-3.96) for over-all, upper, and lower GI bleeding events in SSc patients. In the competing death risk in the subdistribution hazards model with time-covariate adjustment, SSc was an independent risk factor for over-all GI bleeding events (subdistribution hazard ratio [sHR] 2.98, 95% CI, 2.21-4.02), upper GI bleeding events (sHR 2.80, 95% CI, 1.92-4.08), and lower GI bleeding events (sHR 3.93, 95% CI, 2.52-6.13). CONCLUSION: SSc patients exhibited a significantly higher risk of over-all and different subtype GI bleeding events compared with the SSc-free population. The prevention strategy is needed for these high GI bleeding risk groups.

Reduction in Comorbid Conditions Over 5 Years Following Bariatric Surgery in Medicaid and Commercially Insured Patients.

OBJECTIVE: This study sought to determine changes in the prevalence of comorbid disease following bariatric surgery in Medicaid patients compared with commercially insured patients. METHODS: Data were obtained from the Longitudinal Assessment of Bariatric Surgery, an observational cohort study of adults undergoing bariatric surgery at one of six geographically diverse centers in the United States. A total of 1,201 patients who underwent Roux-en-Y gastric bypass with 5 years of follow-up were identified. Poisson mixed models were used to estimate relative risks (RRs) and compare changes in common comorbidities between insurance groups within 0-1 and 1-5 years post surgery. Propensity scores were used to achieve balance in the baseline comorbidity burden between Medicaid and commercial patients. RESULTS: In the first year, risk of all six comorbidities decreased substantially over time in both groups, ranging from a 32% to a 69% decrease from baseline. After 1 year post surgery, the risk of disease was stable in both groups (RRs ranged from 1.0 to 1.1). After propensity score weighting, the RRs in the first year were more similar in magnitude, while the RRs in the 1- to 5-year period were unchanged. CONCLUSIONS: These results suggest that Medicaid patients experience a medium-term reduction in comorbid disease after bariatric surgery.

A comprehensive assessment of patient reported symptom burden, medical comorbidities, and functional well being in patients initiating direct acting antiviral therapy for chronic hepatitis C: Results from a large US multi-center observational study.

BACKGROUND: Symptom burden, medical comorbidities, and functional well-being of patients with chronic hepatitis C virus (HCV) initiating direct acting antiviral (DAA) therapy in real-world clinical settings are not known. We characterized these patient-reported outcomes (PROs) among HCV-infected patients and explored associations with sociodemographic, liver disease, and psychiatric/substance abuse variables. METHODS AND FINDINGS: PROP UP is a large US multicenter observational study that enrolled 1,600 patients with chronic HCV in 2016-2017. Data collected prior to initiating DAA therapy assessed the following PROs: number of medical comorbidities; neuropsychiatric, somatic, gastrointestinal symptoms (PROMIS surveys); overall symptom burden (Memorial Symptom Assessment Scale); and functional well-being (HCV-PRO). Candidate predictors included liver disease markers and patient-reported sociodemographic, psychiatric, and alcohol/drug use features. Predictive models were explored using a random selection of 700 participants; models were then validated with data from the remaining 900 participants. The cohort was 55% male, 39% non-white, 48% had cirrhosis (12% with advanced cirrhosis); 52% were disabled or unemployed; 63% were on public health insurance or uninsured; and over 40% had markers of psychiatric illness. The median number of medical comorbidities was 4 (range: 0-15), with sleep disorders, chronic pain, diabetes, joint pain and muscle aches being present in 20-50%. Fatigue, sleep disturbance, pain and neuropsychiatric symptoms were present in over 60% and gastrointestinal symptoms in 40-50%. In multivariable validation models, the strongest and most frequent predictors of worse PROs were disability, unemployment, and use of psychiatric medications, while liver markers generally were not. CONCLUSIONS: This large multi-center cohort study provides a comprehensive and contemporary assessment of the symptom burden and comorbid medical conditions in patients with HCV treated in real world settings. Pain, fatigue, and sleep disturbance were common and often severe. Sociodemographic and psychiatric markers were the most robust predictors of PROs. Future research that includes a rapidly changing population of HCV-infected individuals needs to evaluate how DAA therapy affects PROs and elucidate which symptoms resolve with viral eradication. TRIAL REGISTRATION: (Clinicaltrial.gov: NCT02601820).

Membership In Seguro Popular In Mexico Linked To A Small Reduction In Catastrophic Health Expenditure.

In 2004 the government of Mexico initiated an ambitious program, Seguro Popular, to extend health insurance coverage to poor and informal-sector workers. While the program had a protective effect during its early stages, its impact on out-of-pocket health spending over time is unclear. This study used two waves of the Encuesta Nacional de Salud y Nutricion (from 2006 and 2012) to analyze the protective effects of Seguro Popular and social security programs on out-of-pocket and catastrophic health spending. While, given the endogeneity of Seguro Popular enrollment, we found no link between membership and out-of-pocket health care spending in the study period, we did find a robust, albeit small, link between membership and a reduction in catastrophic health spending. A significant part of overall out-of-pocket health spending goes to purchase medications. Policy decisions are necessary to address gaps in coverage and access to medicines. Improving the quality of care as well as including more clinically effective and cost-effective medicines in the Seguro Popular package could significantly reduce out-of-pocket health care spending in Mexico.

Patterns and predictors of off-label prescription of psychiatric drugs.

Off-label prescribing of psychiatric drugs is common, despite lacking strong scientific evidence of efficacy and potentially increasing risk for adverse events. The goal of this study was to characterize prevalence of off-label prescriptions of psychiatric drugs and examine patient and clinician predictors of off-label use. This manuscript presents a retrospective, cross-sectional study using data from the 2012 and 2013 National Ambulatory Medical Care Surveys (NAMCS). The study examined all adult outpatient visits to psychiatric practices for chronic care management with a single listed visit diagnosis in which at least one psychiatric drug was prescribed. The main outcome measure was off-label prescribing of at least one psychiatric drug, defined as prescription for a condition for which it has not been approved for use by the FDA. Among our sample representative of 1.85 billion outpatient visits, 18.5 million (1.3%) visits were to psychiatrists for chronic care management in which at least one psychiatric drug was prescribed. Overall, the rate of off-label use was 12.9% (95% CI: 12.2-15.7). The most common off-label uses were for manic-depressive psychosis treated with citalopram and primary insomnia treated with trazodone. Several patient and clinician characteristics were positively associated with off-label prescribing, including seeing a psychiatrist (OR: 1.06, 95% CI, 1.01-1.12; p = 0.03) instead of another type of clinician, the office visit taking place in the Western region of the country (OR: 1.09, 95% CI, 1.01-1.17; p = 0.02), and the patient having 3 or more chronic conditions (OR: 1.12, 95% CI, 1.02-1.14; p = 0.003). In contrast, having Medicare coverage (OR: 0.93, 95% CI, 0.84-0.97; p = 0.04) and receiving payment assistance from a medical charity (OR: 0.91, 95% CI, 0.88-0.96; p = 0.03) instead of private insurance were negatively associated with off-label prescribing. These results suggest that certain classes of psychiatric medications are being commonly prescribed to treat conditions for which they have not been determined by the FDA to be clinically efficacious and/or safe.

Private health insurance and catastrophic health expenditures of households with cancer patients in South Korea.

This study examines the effects of private health insurance (PHI) on the incidence of catastrophic health expenditures (CHE) for households with a patient with cancer. This study uses 1-year data from 2013 and households with cancer patients as the unit of research rather than individual household members. The sample thus includes 468 households with members with cancer who also used emergency, outpatient and hospitalisation services. Households with PHI had a lower incidence of CHE for all thresholds than those without did. At the 10% threshold, the incidence became significantly lower, by 0.59 and 0.60 times, respectively, if householders had higher education and income levels. Moreover, the incidence of CHE was higher by 8.71 times if the householders are female, and lower by 0.84 times if the householders did not have a spouse at the 20% threshold. From the analysis of households with cancer patients that hold PHI as the key variable, these households showed a lower incidence of CHE than the others did. PHI provides healthcare payments not secured through national health insurance (NHI) and protects households from health expenditures, thereby complementing NHI to a certain degree.