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1.
Plast Reconstr Surg ; 145(2): 545-554, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985657

RESUMO

BACKGROUND: Following bariatric surgery, patients develop problems related to lax abdominal skin that may be addressed by contouring procedures. Third-party insurers have subjective requirements for coverage of these procedures that can limit patient access. The authors sought to determine how well third-party payers cover abdominal contouring procedures in this population. METHODS: The authors conducted a cross-sectional analysis of insurance policies for coverage of panniculectomy, lower back excision, and circumferential lipectomy. Abdominoplasty was evaluated as an alternative to panniculectomy. Insurance companies were selected based on their market share and state enrolment. A list of medical necessity criteria was abstracted from the policies that offered coverage. RESULTS: Of the 55 companies evaluated, 98 percent had a policy that covered panniculectomy versus 36 percent who would cover lower back excision (p < 0.0001), and one-third provided coverage for circumferential lipectomy. Of the insurers who covered panniculectomy, only 30 percent would also cover abdominoplasty. Documentation of secondary skin conditions was the most prevalent criterion in panniculectomy policies (100 percent), whereas impaired function and secondary skin conditions were most common for coverage of lower back excision (73 percent and 73 percent, respectively). Frequency of criteria for panniculectomy versus lower back excision differed most notably for (1) secondary skin conditions (100 percent versus 73 percent; p = 0.0030), (2) weight loss (45 percent versus 7 percent; p = 0.0106), and (3) duration of weight stability (82 percent versus 53 percent; p = 0.0415). CONCLUSIONS: For the postbariatric population, panniculectomy was covered more often and had more standardized criteria than lower back excision or circumferential lipectomy. However, all have vast intracompany and interpolicy variations in coverage criteria that may reduce access to procedures, even among patients with established indications.


Assuntos
Abdominoplastia/economia , Cirurgia Bariátrica/economia , Contorno Corporal/economia , Cobertura do Seguro/economia , Seguro Saúde/estatística & dados numéricos , Abdominoplastia/estatística & dados numéricos , Dorso/cirurgia , Estudos Transversais , Humanos , Seguradoras/economia , Seguradoras/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/economia , Lipectomia/economia , Lipectomia/estatística & dados numéricos , Cuidados Pós-Operatórios/economia , Estados Unidos
4.
Med Care ; 57(10): 788-794, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31513138

RESUMO

BACKGROUND: Previous studies suggest the newly Medicaid insured are more likely to use the emergency department (ED) however they did not differentiate between patients established or not established with primary care. OBJECTIVES: To understand where Oregon Medicaid beneficiaries sought care after the Patient Protection and Affordable Care Act (PPACA) Medicaid expansion (ED, primary care, or specialist) and the interaction between primary care establishment and outpatient care utilization. RESEARCH DESIGN: A retrospective cohort study. SUBJECTS: Adults continuously insured from 2014 through 2015 who were either newly, returning, or continuously insured post-PPACA. MEASURES: Site of first and last outpatient visit, established with primary care status, and outpatient care utilization. RESULTS: The odds of being established with primary care at their first visit were lower among newly [odds ratio (OR), 0.18; 95% confidence interval (CI), 0.18-0.19] and returning insured (OR, 0.22; 95% CI, 0.22-0.23) than the continuously insured. Continuously insured, new patients with primary care had higher odds of visiting the ED (OR, 2.15; 95% CI, 2.01-2.30) at their first visit than newly or returning insured. Patients established with a single primary care provider in all insurance groups had lower rates of ED visit, whereas those established with multiple primary care providers had the highest ED visit rates. CONCLUSIONS: Most newly and returning insured Medicaid enrollees sought primary care rather than ED services and most became established with primary care. Our findings suggest that both insurance and primary care continuity play a role in where patients seek health care services.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Continuidade da Assistência ao Paciente , Feminino , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/legislação & jurisprudência , Masculino , Medicaid/legislação & jurisprudência , Pessoa de Meia-Idade , Oregon , Estudos Retrospectivos , Estados Unidos
6.
J Bone Joint Surg Am ; 101(16): 1451-1459, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31436652

RESUMO

BACKGROUND: There is variability in access to and utilization of orthopaedic care, particularly for those with Medicaid insurance. One potential contributor is perceived unwillingness of surgeons and hospitals to accept underinsured patients. We used administrative data to examine the payer mix for select inpatient orthopaedic surgical procedures at all hospitals within a single region, hypothesizing that the delivery of orthopaedic surgery to Medicaid beneficiaries varies highly at the hospital level. METHODS: Using administrative data, we analyzed inpatient hospitalizations for elective cases (total knee or hip arthroplasty; spinal decompression or fusion) and trauma cases (hip hemiarthroplasty; femoral or tibial and fibular fracture repair) among 22 hospitals in a single region from 2011 to 2016 for patients who were 18 to 64 years of age. The primary outcome was the percentage of each hospital's caseload with Medicaid listed as the primary payer. The secondary outcome measured each hospital's Medicaid percentage against the percentage of Medicaid-insured individuals within 10 miles of the hospital (Medicaid share ratio), using a ratio of 1 as a benchmark. To quantify variation, we calculated a weighted coefficient of variation of the Medicaid share ratio for all cases combined, elective cases only, and trauma cases only. RESULTS: For all cases (n = 19,204), the mean percentage of Medicaid-funded surgical procedures was 7.6% (range, 0.2% to 57.3%). The mean Medicaid share ratio was 1.0 (range, 0.05 to 4.20). Across 22 hospitals, the weighted coefficient of variation for Medicaid share was 69, indicating very high variation. For elective cases alone, the mean percentage of Medicaid-funded surgical procedures was 5.5% (range, 0.2% to 64.6%). The mean Medicaid share ratio was 0.71 (range, 0.05 to 4.73), and the weighted coefficient of variation was 93. For trauma cases alone, Medicaid-funded surgical procedures were 14.7% (range, 0.0% to 35.7%). The mean Medicaid share ratio was 2.0 (range, 0 to 3.93), and the weighted coefficient of variation was 34. CONCLUSIONS: Delivery of care was highly variable when benchmarking against the insurance composition of each hospital's surrounding community. Although generalizability to other regions is limited, our findings support previously asserted notions that delivery of orthopaedic care may differ on the basis of socioeconomic markers (such as insurance status). If not addressed, these inequities may exacerbate existing racially and socioeconomically based disparities in care.


Assuntos
Assistência à Saúde/economia , Acesso aos Serviços de Saúde/economia , Disparidades em Assistência à Saúde/economia , Medicaid/economia , Procedimentos Ortopédicos/economia , Adolescente , Adulto , Fatores Etários , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Cobertura do Seguro/economia , Masculino , Medicaid/estatística & dados numéricos , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Medição de Risco , Estados Unidos , Adulto Jovem
7.
Tex Med ; 115(8): 30-31, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369134

RESUMO

When Senate Bill 1264 was first introduced in February, insurers had the bases loaded, threatening to score a lopsided surprise-billing victory on one swing. With some deft pitching in the Texas Legislature, medicine worked its way out of the jam. The "baseball-style arbitration" measure by Sen. Kelly Hancock (R-North Richland Hills) isn't perfect, and like a hitter who's getting busted inside, physicians will have adjustments to make. But the improved SB 1264 passed with a framework that's fairer to everyone involved.


Assuntos
Contratos/legislação & jurisprudência , Cobertura do Seguro/economia , Administração da Prática Médica/economia , Humanos , Médicos/economia , Texas
8.
J Bone Joint Surg Am ; 101(14): 1245-1252, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31318803

RESUMO

BACKGROUND: Little is known about the effect of orthopaedic trauma on the financial health of patients. We hypothesized that some patients who sustain musculoskeletal trauma experience considerable financial hardship during treatment, and we also assessed for factors associated with increased personal financial burden. METHODS: We surveyed 236 of 393 consecutive patients who were approached at 1 of 2 American College of Surgeons level-I trauma centers between 2016 and 2017 following the completion of treatment for a musculoskeletal injury (60% response rate). Two validated measures (financial burden composite score and dichotomized worry score) were used to assess the financial hardship that patients experienced with the injury. RESULTS: There were 236 participants in the study, the mean age was 56.3 years (range, 19 to 94 years), and 48.7% of patients were male. Of the 236 patients, 97.9% had medical insurance, yet the mean financial burden composite score (and standard deviation) was 2.4 ± 2.2 (0 indicated low and 6 indicated high). In this study, 25.0% of patients had high levels of worry about financial problems that resulted from the injury. Fifty-four percent of patients used their savings to pay for their care, and 23% of patients borrowed money or took out a loan. Twenty-three percent of patients missed payment on other bills. Fifty-seven percent of patients were required to cut expenses in general. Patients with higher composite financial burden scores had a significantly increased likelihood of high financial worry (odds ratio [OR], 1.8 [95% confidence interval (CI), 1.5 to 2.2]; p < 0.001). Factors associated with increased financial hardship were high-deductible health plan insurance (coefficient, 0.3 [95% CI, 0.002 to 0.528]; p = 0.048), Medicaid insurance (coefficient, 0.6 [95% CI, 0.342 to 0.863]; p < 0.001), failure to complete high school (coefficient, 0.475 [95% CI, 0.033 to 0.918]; p = 0.035), increased number of surgical procedures (coefficient, 0.067 [95% CI, 0.005 to 0.129]; p = 0.035), and prior medical or student loans (coefficient, 0.769 [95% CI, 0.523 to 1.016]; p < 0.001). CONCLUSIONS: Despite a high rate of insurance, patients with orthopaedic trauma in our study had high rates of worry and financial distress. Asking about financial hardship may help to identify those patients with a higher personal financial burden and may promote allocation of additional social support and services.


Assuntos
Efeitos Psicossociais da Doença , Financiamento Pessoal , Sistema Musculoesquelético/lesões , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Custos de Cuidados de Saúde , Gastos em Saúde , Humanos , Cobertura do Seguro/economia , Masculino , Pessoa de Meia-Idade , Estados Unidos
9.
Value Health ; 22(7): 762-767, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277821

RESUMO

OBJECTIVES: To evaluate the relationship between cancer history and cost-related medication nonadherence (CRN) as well as cost-coping strategies, by health insurance coverage. METHODS: We used the 2013 to 2016 National Health Interview Survey to identify adults aged 18 to 64 years with (n = 3599) and without (n = 56 909) a cancer history. Cost-related changes in medication use included (1) CRN, measured as skipping, taking less, or delaying medication because of cost, and (2) cost-coping strategies, measured as requesting lower cost medication or using alternative therapies to save money. Separate multivariable logistic regressions were used to calculate the adjusted odds ratios (AORs) of CRN and cost-coping strategies associated with cancer history, stratified by insurance. RESULTS: Cancer survivors were more likely than adults without a cancer history to report CRN (AOR 1.26; 95% confidence interval [CI] 1.10-1.43) and cost-coping strategies (AOR 1.10; 95% CI 0.99-1.19). Among the privately insured, the difference in CRN by cancer history was the greatest among those enrolled in high-deductible health plans (HDHPs) without health savings accounts (HSAs) (AOR 1.78; 95% CI 1.30-2.44). Among adults with HDHP and HSA, cancer survivors were less likely to report cost-coping strategies (AOR 0.62; 95% CI 0.42-0.90). Regardless of cancer history, CRN and cost-coping strategies were the highest for those uninsured, enrolled in HDHP without HSA, and without prescription drug coverage under their health plan (all P<.001). CONCLUSIONS: Cancer survivors are prone to CRN and more likely to use cost-coping strategies. Expanding options for health insurance coverage, use of HSAs for those with HDHP, and enhanced prescription drug coverage may effectively address CRN.


Assuntos
Antineoplásicos/economia , Antineoplásicos/uso terapêutico , Sobreviventes de Câncer/psicologia , Gastos em Saúde , Cobertura do Seguro/economia , Seguro Saúde/economia , Adesão à Medicação , Neoplasias/tratamento farmacológico , Neoplasias/economia , Adolescente , Adulto , Redução de Custos , Dedutíveis e Cosseguros/economia , Substituição de Medicamentos/economia , Medicamentos Genéricos/economia , Medicamentos Genéricos/uso terapêutico , Feminino , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Poupança para Cobertura de Despesas Médicas , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/psicologia , Fatores de Tempo , Estados Unidos/epidemiologia , Adulto Jovem
10.
Value Health ; 22(7): 799-807, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277827

RESUMO

OBJECTIVES: In theory, a successful coverage with evidence development (CED) scheme is one that addresses the most important uncertainties in a given assessment. We investigated the following: (1) which uncertainties were present during the initial assessment of 3 Dutch CED cases, (2) how these uncertainties were integrated in the initial assessments, (3) whether CED research plans included the identified uncertainties, and (4) issues with managing uncertainty in CED research and ways forward from these issues. METHODS: Three CED initial assessment dossiers were analyzed and 16 stakeholders were interviewed. Uncertainties were identified in interviews and dossiers and were categorized in different causes: unavailability, indirectness, and imprecision of evidence. Identified uncertainties could be mentioned, described, and explored. Issues and ways forward to address uncertainty in CED schemes were discussed during the interviews. RESULTS: Forty-two uncertainties were identified. Thirteen (31%) were caused by unavailability, 17 (40%) by indirectness, and 12 (29%) by imprecision. Thirty-four uncertainties (81%) were only mentioned, 19 (45%) were described, and the impact of 3 (7%) uncertainties on the results was explored in the assessment dossiers. Seventeen uncertainties (40%) were included in the CED research plans. According to stakeholders, research did not address the identified uncertainty, but CED research should be designed to focus on these. CONCLUSIONS: In practice, uncertainties were neither systematically nor completely identified in the analyzed CED schemes. A framework would help to systematically identify uncertainty, and this process should involve all stakeholders. Value of information analysis, and the uncertainties that are not included in this analysis should inform CED research design.


Assuntos
Custos de Medicamentos , Medicina Baseada em Evidências/economia , Cobertura do Seguro/economia , Seguro Saúde/economia , Mecanismo de Reembolso/economia , Incerteza , Tomada de Decisão Clínica , Análise Custo-Benefício , Humanos , Modelos Econômicos , Modelos Estatísticos , Países Baixos , Seleção de Pacientes , Rituximab/economia , Rituximab/uso terapêutico , Participação dos Interessados , Trastuzumab/economia , Trastuzumab/uso terapêutico , alfa-Glucosidases/economia , alfa-Glucosidases/uso terapêutico
11.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31270139

RESUMO

OBJECTIVES: To explore parent attitudes toward discussing their child's health care costs in the inpatient setting and to identify strategies for health care providers to engage in cost discussions with parents. METHODS: Using purposeful sampling, we conducted semistructured interviews between October 2017 and February 2018 with parents of children with and without chronic disease who received care at a tertiary academic children's hospital. Researchers coded the data using applied thematic analysis to identify salient themes and organized them into a conceptual model. RESULTS: We interviewed 42 parents and identified 2 major domains. Categories in the first domain related to factors that influence the parent's desire to discuss health care costs in the inpatient setting, including responsibility for out-of-pocket expenses, understanding their child's insurance coverage, parent responses to financial stress, and their child's severity of illness on hospital presentation. Categories in the second domain related to parent preference regarding the execution of cost discussions. Parents felt these discussions should be optional and individualized to meet the unique values and preferences of families. They highlighted concerns regarding physician involvement in these discussions; their preference instead was to explore financial issues with a financial counselor or social worker. CONCLUSIONS: Parents recommended that cost discussions in the inpatient setting should be optional and based on the needs of the family. Families expressed a desire for physicians to introduce rather than conduct cost discussions. Specific recommendations from parents for these discussions may be used to inform the initiation and improvement of cost discussions with families during inpatient encounters.


Assuntos
Comportamento do Consumidor/economia , Custos de Cuidados de Saúde , Hospitalização/economia , Hospitais Pediátricos/economia , Pais/psicologia , Adulto , Feminino , Custos de Cuidados de Saúde/tendências , Gastos em Saúde/tendências , Hospitalização/tendências , Hospitais Pediátricos/tendências , Humanos , Pacientes Internados , Cobertura do Seguro/economia , Cobertura do Seguro/tendências , Masculino , Pessoa de Meia-Idade , Adulto Jovem
13.
Surgery ; 166(2): 211-217, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31202473

RESUMO

BACKGROUND: Insurance type has been reported to be an independent predictor of overall survival in lung cancer patients. We studied the effect of insurance type on patient outcomes after minimally invasive pulmonary lobectomy for lung cancer. METHODS: We retrospectively analyzed 433 consecutive patients who underwent robotic-assisted pulmonary lobectomy by one surgeon during an 80-month period. Perioperative outcomes and intraoperative and postoperative complications were noted. Disposition at discharge after surgery (favorable, eg, transfer to home with self-care or with home health nursing and/or physical therapy, versus unfavorable, eg, long-term acute care or rehabilitation facility, hospice, or death) and 5-year overall survival (5-years OS) were also recorded. We used Pearson χ2, analysis of variance (ANOVA), and Kruskal-Wallis test to compare variables and Cox regression for survival analysis. RESULTS: There were 107 patients (mean age 57.5 years) with private insurance, 118 (mean age 70.3 years) with public insurance (Medicare or Medicaid), 196 (mean age 71.8 year; P < .001) with combination insurance plans (Medicare plus a privately supplied supplemental), and 12 patients with no insurance (excluded owing to low sample size). There were more current smokers in the public insurance group, more former smokers in the combination insurance group, and more nonsmokers in the private insurance group (P = .03). There were more comorbidities in the public and combination insurance groups versus the private insurance group, including gastroesophageal reflux disease (P = .003), hypertension (P = .01), and hyperlipidemia (P < .001). The groups had no differences in tumor size or pathologic stage. There were higher numbers of intraoperative conversions to open lobectomy in the private and public insurance groups versus the combination insurance group (P = .001). Also, the private and combination insurance groups had more cases of favorable disposition at discharge after surgery compared with the public insurance group (P < .001). Multivariable regression analyses identified private insurance type as an independent predictor of favorable disposition at discharge (public versus private plan; odds ratio, 0.43; 95% confidence interval [CI], 0.22-0.85, P = .02) and 5-year OS (combination versus private plan; hazard ratio, 2.68; 95% CI, 1.26-5.67, P = .01; public versus private plan; HR, 2.84; 95% CI, 1.37-5.89; P = .01). CONCLUSION: Although public or combination insurance type was associated with greater risk of all-cause mortality, and public insurance type was associated with less favorable disposition at discharge after surgery and overall conversion to open lobectomy, insurance type was not associated with increased intraoperative complications, hospital duration of stay, or in-hospital mortality after minimally invasive robotic-assisted pulmonary lobectomy.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/cirurgia , Cobertura do Seguro/economia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Procedimentos Cirúrgicos Robóticos/mortalidade , Idoso , Carcinoma Pulmonar de Células não Pequenas/mortalidade , Carcinoma Pulmonar de Células não Pequenas/patologia , Bases de Dados Factuais , Intervalo Livre de Doença , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Medicaid/economia , Medicare/economia , Pessoa de Meia-Idade , Assistência Perioperatória/métodos , Pneumonectomia/mortalidade , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Procedimentos Cirúrgicos Robóticos/métodos , Análise de Sobrevida , Cirurgia Torácica Vídeoassistida/métodos , Cirurgia Torácica Vídeoassistida/mortalidade , Estados Unidos
17.
Fertil Steril ; 112(1): 105-111, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31043233

RESUMO

OBJECTIVE: To investigate factors associated with early IVF treatment discontinuation. DESIGN: Retrospective cohort study. SETTING: Academic medical center. PATIENT(S): Six hundred sixty-nine first-attempt IVF patients who did not have a live birth. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Treatment discontinuation and time to return for a second IVF cycle. RESULT(S): Women without IVF insurance coverage were more likely to discontinue treatment than women with insurance coverage (adjusted odds ratio [aOR] = 3.12; 95% confidence interval [CI], 2.22-4.40). African-American women were more likely to discontinue treatment (aOR = 2.95; 95% CI, 1.54-5.66) and returned for treatment more slowly (adjusted hazard ratio [aHR] = 0.44; 95% CI, 0.28-0.71) than non-Hispanic white women, regardless of IVF insurance coverage or income. Women with a poor prognosis were more likely to discontinue treatment than women with a good prognosis. Older women with IVF insurance coverage or a good prognosis had a shorter time to return for a second IVF cycle than older women without IVF insurance coverage or with a poor prognosis. Estimated income, distance to clinic, fertility diagnosis, number of oocytes retrieved, and history of previous live birth were not associated with treatment discontinuation or time to return for a second IVF cycle after adjustment for covariates. CONCLUSION(S): IVF insurance coverage, race, age, and future treatment prognosis are associated with IVF treatment discontinuation and time to return.


Assuntos
Fertilização In Vitro , Conhecimentos, Atitudes e Prática em Saúde , Infertilidade/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Tempo para o Tratamento , Adulto , Fatores Etários , Feminino , Fertilização In Vitro/efeitos adversos , Fertilização In Vitro/economia , Fertilização In Vitro/psicologia , Custos de Cuidados de Saúde , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Acesso aos Serviços de Saúde/economia , Humanos , Infertilidade/economia , Infertilidade/etnologia , Infertilidade/psicologia , Cobertura do Seguro/economia , Seguro Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Gravidez , Prognóstico , Retratamento , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tempo para o Tratamento/economia , Adulto Jovem
18.
J Manag Care Spec Pharm ; 25(5): 612-620, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039058

RESUMO

BACKGROUND: Chronic disease is associated with increased health care resource utilization and costs. Effective development and implementation of health care management and clinical intervention programs require an understanding of health plan member enrollment and disenrollment behavior. OBJECTIVE: To examine the health plan enrollment and disenrollment behavior of commercially insured and Medicare Advantage members with established chronic disease compared with matched members without the disease of interest, using data from a large national health insurer in the United States. METHODS: This retrospective matched cohort study used administrative claims data from the HealthCore Integrated Research Database from January 1, 2006, to November 30, 2015, to identify adults with chronic disease (type 2 diabetes mellitus [T2DM], cardiovascular disease [CVD], chronic obstructive pulmonary disease [COPD], rheumatoid arthritis [RA], and breast cancer [BC]). Members with no established chronic disease (controls) were directly matched to members with established chronic disease (cases) on demographic characteristics. The earliest date on which members met the criteria for a given disease was defined as the index date. Controls had the same index date as the matched cases. All members had ≥ 12 months of continuous health plan enrollment before the index date. Outcomes included health plan member disenrollment and enrollment duration. Incidence rates per 1,000 member-years for member disenrollment were evaluated along with incidence rate ratios (relative risk) using a Poisson model. Time to disenrollment was analyzed by Cox proportional hazard models and Kaplan-Meier survival curves. Sensitivity analyses were conducted where death was included as a disenrollment event. RESULTS: 70,907 health plan members with BC (99.7% female, mean age 60.5 years); 28,883 members with COPD (52.3% female, mean age 66.7); 835,358 members with CVD (50.5% female, mean age 62.7 years); 210,936 members with T2DM (45.2% female, mean age 53.6 years); and 31,954 members with RA (72.0% female, mean age 55.5 years) were matched to controls and met the study criteria. The incidence rates of health plan disenrollment ranged from 155 to 192 members per 1,000 members per year. Compared with controls, members with chronic disease were 30%-40% less likely to disenroll from a health plan (P < 0.001 for all comparisons). Among those who disenrolled, enrollment duration ranged from 2.3 to 2.7 years among cases and 1.5 to 1.8 years among matched controls (P ≤ 0.001 for all comparisons). CONCLUSIONS: This real-world study demonstrated that members with chronic disease had a significantly lower rate of disenrollment and a longer duration of enrollment compared with matched controls and were continuously enrolled for almost a year longer than members without a diagnosed chronic disease. Understanding health plan enrollment and disenrollment behavior may provide a valuable context for determining the time frame for the effect of health care programs and initiatives. DISCLOSURES: Funding for this study was provided by HealthCore, a wholly owned subsidiary of Anthem. Chung, Deshpande, Zolotarjova, Quimbo, and Willey are employees of HealthCore. Kern and Cochetti are former employees of HealthCore. Quimbo, Cochetti, and Willey are shareholders of Anthem. HealthCore receives funding from multiple pharmaceutical companies to perform various research studies outside of the submitted work. The preliminary results of this study were presented at AMCP Nexus 2015; March 26-29, 2015; Orlando, FL, and the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 2017 Conference; May 20-24, 2017; Boston, MA.


Assuntos
Artrite Reumatoide/economia , Comércio/estatística & dados numéricos , Diabetes Mellitus Tipo 2/economia , Medicare Part C/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/economia , Adulto , Idoso , Artrite Reumatoide/terapia , Doença Crônica/economia , Doença Crônica/terapia , Comércio/economia , Diabetes Mellitus Tipo 2/terapia , Feminino , Custos de Cuidados de Saúde , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Masculino , Medicare Part C/economia , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/terapia , Estudos Retrospectivos , Estados Unidos
20.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31092588

RESUMO

OBJECTIVES: Most states have passed insurance mandates requiring health plans to cover services for children with autism spectrum disorder (ASD). Research reveals that these mandates increased treated prevalence, service use, and spending on ASD-related care. As employer-sponsored insurance shifts toward high-deductible health plans (HDHPs), it is important to understand how mandates affect children with ASD in HDHPs relative to traditional, low-deductible plans. METHODS: Insurance claims for 2008-2012 for children covered by 3 large US insurers (United Healthcare, Aetna, and Humana) available through the Health Care Cost Institute were used to compare the effects of mandates on ASD-related spending for children in HDHPs and traditional health plans. RESULTS: Relative to children in traditional plans, mandates were associated with higher average monthly spending increases for children in HDHPs. Mandate-attributable spending differences between children enrolled in HDHPs relative to traditional plans were $77 for ASD-specific services (95% confidence interval [CI]: $10 to $144), $125 for outpatient health services (95% CI: $26 to $223), and $144 for all health services (95% CI: $36 to $253). These spending differentials were driven by differences in plan spending and not out-of-pocket (OOP) spending. CONCLUSIONS: Spending on ASD-related services attributable to autism mandates was higher among children in HDHPs, but higher spending did not translate into a greater OOP burden. For families with consistently high health care expenditures on ASD-related services, high-deductible products may be worth considering in the context of mandate laws. Families in mandate states with children with ASD enrolled in HDHPs were able to increase service use without paying more OOP.


Assuntos
Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/terapia , Dedutíveis e Cosseguros/legislação & jurisprudência , Cobertura do Seguro/legislação & jurisprudência , Seguro Saúde/legislação & jurisprudência , Programas Obrigatórios/legislação & jurisprudência , Transtorno do Espectro Autista/economia , Criança , Dedutíveis e Cosseguros/economia , Feminino , Humanos , Cobertura do Seguro/economia , Seguro Saúde/economia , Masculino , Programas Obrigatórios/economia , Estados Unidos/epidemiologia
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