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1.
N Engl J Med ; 381(6): 543-551, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31291511

RESUMO

BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) developed the Accountable Care Organization (ACO) Investment Model (AIM) to encourage the growth of Medicare Shared Savings Program (MSSP) ACOs in rural and underserved areas. AIM provides financial support to eligible MSSP ACOs by means of prepayment of shared savings. Estimation of the performance of AIM ACOs on measures of spending and utilization in their first performance year would be useful for understanding the viability of ACOs located in these areas. METHODS: We analyzed Medicare claims and enrollment data for a group of fee-for-service beneficiaries who had been attributed to 41 AIM ACOs and for a comparable group of beneficiaries who resided in the ACO markets but were served primarily by non-ACO providers. We used a difference-in-differences study design to compare changes in outcomes from the baseline period (2013 through 2015) to the performance period (2016) among beneficiaries attributed to AIM ACOs with concurrent changes among beneficiaries in the comparison group. The primary outcome of interest was total Medicare Part A and B spending. RESULTS: Provider participation in AIM was associated with a differential reduction in total Medicare spending of $28.21 per beneficiary per month relative to the comparison group, which amounted to an aggregate decrease of $131.0 million. Over the same period, CMS made $76.2 million in prepayments and paid an additional $6.2 million in shared savings to ACOs in which shared savings exceeded the prepayments. After we accounted for this $82.4 million in CMS spending, the aggregate net reduction was $48.6 million, which corresponded to a net reduction of $10.46 per beneficiary per month. Decreases in the number of hospitalizations and use of institutional post-acute care contributed to the observed reduction in overall spending. CONCLUSIONS: With up-front investments, participation in ACO shared savings contracts by providers serving rural and underserved areas was associated with lower Medicare spending than that among non-ACO providers. (Funded by the Centers for Medicare and Medicaid Services.).


Assuntos
Organizações de Assistência Responsáveis/economia , Gastos em Saúde , Área Carente de Assistência Médica , Medicare/economia , Serviços de Saúde Rural/economia , Idoso , Idoso de 80 Anos ou mais , Redução de Custos , Feminino , Custos de Cuidados de Saúde , Humanos , Revisão da Utilização de Seguros , Masculino , Poupança para Cobertura de Despesas Médicas , Pessoa de Meia-Idade , Estados Unidos
2.
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
3.
Gac. sanit. (Barc., Ed. impr.) ; 33(2): 106-111, mar.-abr. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-183671

RESUMO

Objective: To assess the monetary savings resulting from a pharmacist intervention on the appropriateness of prescribed drugs in community-dwelling polymedicated (≥8 drugs) elderly people (≥70 years). Method: An evaluation of pharmaceutical expenditure reduction was performed within a randomised, multicentre clinical trial. The study intervention consisted of a pharmacist evaluation of all drugs prescribed to each patient using the "Good Palliative-Geriatric Practice" algorithm and the "Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment" criteria (STOPP/START). The control group followed the routine standard of care. A time horizon of one year was considered and cost elements included human resources and drug expenditure. Results: 490 patients (245 in each group) were analysed. Both groups experienced a decrease in drug expenditure 12 months after the study started, but this decrease was significantly higher in the intervention group than in the control group (−14.3% vs.−7.7%; p=0.041). Total annual drug expenditure decreased 233.75 Euros/patient (95% confidence interval [95%CI]: 169.83-297.67) in the intervention group and 169.40 Euros/patient (95%CI: 103.37-235.43) in the control group over a one-year period, indicating that 64.30 Euros would be the drug expenditure savings per patient a year attributable to the study intervention. The estimated return per Euro invested in the programme would be 2.38 Euros per patient a year on average. Conclusions: The study intervention is a cost-effective alternative to standard care that could generate a positive return of investment


Objetivo: Evaluar los ahorros monetarios resultantes de la intervención de un farmacéutico orientada a mejorar la adecuación de los fármacos prescritos en ancianos (≥70 años) polimedicados (≥8 medicamentos) de la comunidad. Método: Se evaluó la reducción del gasto farmacéutico en el marco de un ensayo clínico aleatorizado y multicéntrico. La intervención del estudio consistió en una evaluación de todos los fármacos prescritos a cada paciente utilizando el algoritmo Good Palliative-Geriatric Practice y los criterios Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START). El grupo control siguió la práctica clínica habitual. Se consideró un horizonte temporal de un año y los elementos de costes incluyeron los recursos humanos y el gasto en medicamentos. Resultados: Se analizaron 490 pacientes (245 por grupo). La disminución del gasto farmacéutico a los 12 meses fue significativamente mayor en el grupo de intervención que en el grupo control (−14,3% vs.−7,7%; p=0,041). El gasto anual en medicamentos disminuyó 233,75 Euros por paciente (intervalo de confianza del 95% [IC95%]: 169,83-297,67) en el grupo de intervención y 169,40 Euros por paciente (IC95%: 103,37-235,43) en el grupo control, indicando un ahorro farmacéutico de 64,30 Euros por paciente/año atribuible a la intervención del estudio. Se ha estimado un retorno de 2,38 Euros por cada euro invertido en el programa. Conclusiones: La intervención en estudio es una alternativa rentable a la atención estándar, que podría generar un retorno positivo de la inversión


Assuntos
Humanos , Idoso , Reconciliação de Medicamentos/organização & administração , Polimedicação , Assistência Farmacêutica/organização & administração , Prescrição Inadequada/prevenção & controle , Poupança para Cobertura de Despesas Médicas/organização & administração , Custos de Medicamentos/tendências , Avaliação de Eficácia-Efetividade de Intervenções , Estudos de Casos e Controles , Atenção Primária à Saúde/organização & administração
4.
Soc Work Public Health ; 34(2): 176-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30767654

RESUMO

Over a decade ago, Health Savings Accounts (HSAs) were deemed contrary to social work values, leading to greater inequality in access to health care. Using data from the 2015 National Health Interview Survey (NHIS) (n= 12,265), we examine whether HSA ownership is associated with unmet need for health care due to cost (financial barrier). HSA ownership was significantly associated with reduced financial barriers to health care (p< .001) in the regression model. Owning an HSA may be related to reducing financial barriers to health care access, which could inform improvements in HSA policy provisions for social work practice.


Assuntos
Acesso aos Serviços de Saúde/economia , Poupança para Cobertura de Despesas Médicas , Propriedade , Assistentes Sociais , Humanos , Estados Unidos
5.
J Immigr Minor Health ; 21(3): 664-667, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30066059

RESUMO

Little is known about mental health problems among newly arrived Syrian refugees in the US. It is important to determine the prevalence of common consequences of exposure to trauma and high stress, and provide needed interventions, as these conditions if untreated, can be detrimental to mental and physical health. Adult Syrian refugees (n = 157, 47.1% women, 52.9% men) were screened at one-month mandatory primary care health visit for Posttraumatic Stress Disorder (PTSD), anxiety and depression using PTSD Checklist, and Hopkins Symptoms Checklist. Prevalence of possible diagnoses was high for PTSD (32.2%), anxiety (40.3%), and depression (47.7%). Possible prevalence of depression and anxiety were higher among women, but there was no gender difference for possible PTSD. We found a high prevalence of possible psychiatric disorders related to trauma and stress among Syrian refugees newly resettled in the US. Due to the high prevalence and feasibility of brief screening tools in primary care facilities, we recommend mental health screening during primary care health visits for resettled Syrian refugees.


Assuntos
Transtornos Mentais/etnologia , Saúde Mental/etnologia , Atenção Primária à Saúde/estatística & dados numéricos , Refugiados/psicologia , Adolescente , Adulto , Idoso , Ansiedade/etnologia , Comorbidade , Estudos Transversais , Depressão/etnologia , Feminino , Humanos , Masculino , Poupança para Cobertura de Despesas Médicas , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , Transtornos de Estresse Pós-Traumáticos/etnologia , Síria/etnologia , Estados Unidos/epidemiologia , Guerra , Adulto Jovem
6.
Int J Equity Health ; 17(1): 170, 2018 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-30458792

RESUMO

BACKGROUND: Rotating savings and credit associations (ROSCAs) are highly active in many sub-Saharan African countries, serving as an important gateway for coping with financial risk. In light of the Kenya's National Hospital Insurance Fund's (NHIF's) strategy of targeting ROSCAs for membership enrolment, this study sought to estimate how ROSCA membership influences the determinants of voluntary health insurance enrolment. METHODS: A cross-sectional survey of 444 households was carried out in Kisumu City between July and August 2016. A structured questionnaire was administered on health insurance membership, household attributes, headship characteristics and health-seeking behaviour. We assessed the influence of ROSCA membership on the associations between NHIF enrolment and the explanatory variables using univariate logistic regression. RESULTS: The study found that education was associated with NHIF demand regardless of ROSCA membership. Both ROSCA and non-ROSCA households with high socioeconomic status showed stronger health insurance demand compared with poorer households; there was, however, no evidence that the strength of this association was influenced by ROSCA status (p-value = 0.47). Participants who were self-employed were significantly less likely to enrol into the NHIF if they did not belong to a ROSCA (interaction test p-value = 0.03). NHIF enrolment was found to be lower among female-headed households. There was a borderline effect of ROSCA membership on this association, with a lower odds ratio amongst non-ROSCA members (p-value = 0.09): the low treatment numbers amongst the insured infers that ROSCA membership may play a role on the association between gender and NHIF demand. CONCLUSIONS: Our findings suggest that ROSCA membership may play a role in increasing health insurance demand amongst some traditionally under-represented groups such as women and the self-employed. However, the strategy of targeting ROSCAs to increase national health insurance enrolment may yield exiguous results, given that ROSCA membership is itself influenced by several non-observable factors - such as time-availability and self-selection. It is therefore important to anchor outreach to ROSCAs within a broader, multi-pronged approach that targets households within their social, economic and political realities.


Assuntos
Financiamento Pessoal/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Poupança para Cobertura de Despesas Médicas/estatística & dados numéricos , Adulto , Informação de Saúde ao Consumidor/estatística & dados numéricos , Estudos Transversais , Características da Família , Feminino , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
7.
NCHS Data Brief ; (317): 1-8, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30156534

RESUMO

High-deductible health plans (HDHPs) are health insurance policies with higher deductibles than traditional insurance plans. Individuals with HDHPs pay lower monthly insurance premiums but pay more out of pocket for medical expenses until their deductible is met. An HDHP may be used with or without a health savings account (HSA). An HSA allows pretax income to be saved to help pay for the higher costs associated with an HDHP (1). This report examines enrollment among adults aged 18-64 with employmentbased private health insurance coverage by plan type and demographic characteristics. Approximately 60% of adults aged 18-64 have employmentbased coverage (2). All estimates in this report are based on data from the National Health Interview Survey (NHIS).


Assuntos
Dedutíveis e Cosseguros/tendências , Planos de Assistência de Saúde para Empregados/tendências , Poupança para Cobertura de Despesas Médicas/tendências , Adolescente , Adulto , Distribuição por Idade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Fatores Socioeconômicos , Adulto Jovem
8.
Am J Manag Care ; 24(4): e115-e121, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29668214

RESUMO

OBJECTIVES: To evaluate the impact of enrollment in a consumer-directed health plan (CDHP) on out-of-pocket (OOP) spending and on the financial burden associated with healthcare utilization. STUDY DESIGN: Using commercial claims data from 2011 through 2013, we estimated difference-in-differences models that compared changes in outcomes for individuals who switched to CDHPs (CDHP group) with outcome changes for individuals who remained in traditional plans (traditional plan group). METHODS: We estimated the impact of CDHP enrollment on OOP spending at the point of care and on having high financial burden, defined as whether an enrollee spent 3% or more of household income on OOP spending. Additionally, we assessed these outcomes for 2 subgroups: those with lower household income and those with chronic conditions. RESULTS: Within the first year of CDHP enrollment, CDHP enrollees experienced a mean marginal increase in OOP spending of $285 (41% increase; 95% CI, $271-$299; P <.001) relative to traditional plan enrollees. The lower-income and chronic conditions subgroups experienced mean marginal increases in OOP costs of $306 (44% increase; 95% CI, $257-$353; P <.001) and $387 (56% increase; 95% CI, $339-$435; P <.001), respectively. The probability of an enrollee having excessive financial burden increased by 4.3 percentage points (95% CI, 4.0-4.6; P <.001) for the full CDHP sample. These effects were about 3 times larger for the lower-income subgroup (12.3 percentage points; 95% CI, 10.7-13.8; P <.001) and 2 times larger for the chronic conditions subgroup (8.0 percentage points; 95% CI, 6.9-9.1; P <.001). CONCLUSIONS: CDHP enrollment led to a significant increase in financial burden associated with healthcare utilization, especially for those with lower incomes and those with chronic conditions.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adolescente , Adulto , Dedutíveis e Cosseguros , Feminino , Humanos , Revisão da Utilização de Seguros , Seguro Saúde/economia , Masculino , Poupança para Cobertura de Despesas Médicas/economia , Poupança para Cobertura de Despesas Médicas/estatística & dados numéricos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
12.
Am J Manag Care ; 23(12): 741-748, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29261240

RESUMO

OBJECTIVES: To assess the impact of consumer-directed health plan (CDHP) enrollment on low-value healthcare spending. STUDY DESIGN: We performed a quasi-experimental analysis using insurance claims data from 376,091 patients aged 18 to 63 years continuously enrolled in a plan from a large national commercial insurer from 2011 to 2013. We measured spending on 26 low-value healthcare services that offer unclear or no clinical benefit. METHODS: Employing a difference-in-differences approach, we compared the change in spending on low-value services for patients switching from a traditional health plan to a CDHP with the change in spending on low-value services for matched patients remaining in a traditional plan. RESULTS: Switching to a CDHP was associated with a $231.60 reduction in annual outpatient spending (95% CI, -$341.65 to -$121.53); however, no significant reductions were observed in annual spending on the 26 low-value services (--$3.64; 95% CI, -$9.60 to $2.31) or on these low-value services relative to overall outpatient spending (-$7.86 per $10,000 in outpatient spending; 95% CI, -$18.43 to $2.72). Similarly, a small reduction was noted for low-value spending on imaging (-$1.76; 95% CI, -$3.39 to -$0.14), but not relative to overall imaging spending, and no significant reductions were noted in low-value laboratory spending. CONCLUSIONS: CDHPs in their current form may represent too blunt an instrument to specifically curtail low-value healthcare spending.


Assuntos
Dedutíveis e Cosseguros/economia , Planos de Assistência de Saúde para Empregados/economia , Poupança para Cobertura de Despesas Médicas/economia , Mecanismo de Reembolso/economia , Adulto , Dedutíveis e Cosseguros/estatística & dados numéricos , Honorários e Preços/estatística & dados numéricos , Feminino , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Humanos , Masculino , Poupança para Cobertura de Despesas Médicas/estatística & dados numéricos , Pessoa de Meia-Idade , Mecanismo de Reembolso/estatística & dados numéricos , Estados Unidos , Adulto Jovem
13.
Cornell J Law Public Policy ; 27(1): 65-106, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29239587

RESUMO

President Donald J. Trump has said he will repeal the Affordable Care Act (ACA) and replace it with health savings accounts (HSAs). Conservatives have long preferred individual accounts to meet social welfare needs instead of more traditional entitlement programs. The types of "medical care" that can be reimbursed through an HSA are listed in section 213(d) of the Internal Revenue Code (Code) and include expenses "for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body." In spite of the broad language, regulations and court interpretations have narrowed this definition substantially. It does not include the many social factors that determine health outcomes. Though the United States spends over seventeen percent of gross domestic product (GDP) on "healthcare", the country's focus on the traditional medicalized model of health results in overall population health that is far beneath the results of other countries that spend significantly less. Precision medicine is one exceptional way in which American healthcare has focused more on individuals instead of providing broad, one-size-fits-all medical care. The precision medicine movement calls for using the genetic code of individuals to both predict future illness and to target treatments for current illnesses. Yet the definition of "medical care" under the Code remains the same for all. My proposal for precision healthcare accounts involves two steps-- the first of which requires permitting physicians to write prescriptions for a broader range of goods and services. The social determinants of health are as important to health outcomes as are surgical procedures and drugs--or perhaps more so according to many population health studies. The second step requires agencies and courts to interpret what constitutes "medical care" under the Code differently depending on the taxpayer's income level. Childhood sports programs and payments for fruits and vegetables may be covered for those in the lower income brackets who could not otherwise afford these items and would not choose to spend scarce resources on them if they could. This all assumes that the government takes funds previously used to subsidize the purchase of health insurance under the ACA (or allocates new funds) and puts the funds in individual accounts so the poor or near poor have money to pay for these expenses. Section I of this Article will explore the current definition of medical care, which excludes the social determinants of health from "healthcare" spending. I then address how precision medicine has changed the types of services and treatments that it makes sense to reimburse for each individual. If efficacy can vary from person to person based on genetic code, then it also can vary depending on environment. There is an opportunity to not only vary the types of "medical care" that can be reimbursed or deducted within the traditional range of services and drugs, but also outside of that range. Section II addresses the historical shift towards health financing through individual accounts, and specifically through HSAs. If this is the only avenue for health reform in the next few years, I advocate using it to engage in the type of experiments that are typically only possible under the cover of tax expenditures. My proposal for precision healthcare accounts moves the government to experiment with individual social spending that can lead to improved overall health outcomes. Finally, in Section III, I address two dichotomies that affect any healthcare proposal: (1) entitlement programs v. grants-in-aid, and (2) pooled insurance v. consumer-driven health plans (CDHPs). In the end, I argue that an entitlement method of funding precision HSAs along with pooled insurance subsidized by the government is the most realistic resolution to these dichotomies. Only a broad-based entitlement to funding for all healthcare expenses (medical and social) allows for significant improvements in overall population health.


Assuntos
Assistência à Saúde/legislação & jurisprudência , Poupança para Cobertura de Despesas Médicas/legislação & jurisprudência , Determinantes Sociais da Saúde/legislação & jurisprudência , Dedutíveis e Cosseguros , Planos de Assistência de Saúde para Empregados , Humanos , Cobertura do Seguro , Seguro Saúde , Patient Protection and Affordable Care Act , Medicina de Precisão , Estados Unidos
14.
East Mediterr Health J ; 23(5): 335-341, 2017 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-28730586

RESUMO

This cross-sectional study investigated the mediatory role of experiential avoidance in the relationship between perceived stress and alexithymia with mental health. We enrolled 440 students (age 18-30 years) at Kermanshah University of Medical Sciences through stratified random sampling method. The study tools were demographic checklist, GHQ-28, Toronto Alexithymia Scale-20 and Perceived Stress Scale. Data were analysed by SPSS-18 and AMOS-18 using Pearson correlation, hierarchical regression analysis and structural equation modelling (SEM). There was a significant positive correlation between perceived stress and experiential avoidance, and alexithymia and mental health problems (P < 0.001). SEM showed that the relationship between perceived stress and mental health problems by experiential avoidance was 0.19 [(ß = 0.19; standard error (SE) = 0.09; P = 0.001], and the relationship between alexithymia and mental health problems through experiential avoidance was 0.09 (ß = 0.09; SE = 0.43; P = 0.01). The mediatory role of experiential avoidance was confirmed in such a way that the effects of alexithymia and perceived stress decreased.


Assuntos
Sintomas Afetivos/epidemiologia , Aprendizagem da Esquiva , Saúde Mental/estatística & dados numéricos , Estresse Psicológico/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Poupança para Cobertura de Despesas Médicas , Percepção , Fatores Socioeconômicos , Adulto Jovem
18.
Eur J Health Econ ; 18(6): 773-785, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27650358

RESUMO

Although medical savings accounts (MSAs) have drawn intensive attention across the world for their potential in cost control, there is limited evidence of their impact on the demand for health care. This paper is intended to fill that gap. First, we built up a dynamic model of a consumer's problem of utility maximization in the presence of a nonlinear price schedule embedded in an MSA. Second, the model was implemented using data from a 2-year MSA pilot program in China. The estimated price elasticity under MSAs was between -0.42 and -0.58, i.e., higher than that reported in the literature. The relatively high price elasticity suggests that MSAs as an insurance feature may help control costs. However, the long-term effect of MSAs on health costs is subject to further analysis.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Poupança para Cobertura de Despesas Médicas/estatística & dados numéricos , Modelos Econômicos , Adulto , Fatores Etários , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Fatores Socioeconômicos
20.
Mod Healthc ; 47(2): 24, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30423239

RESUMO

Republicans seem intent on pursuing a disastrous Obamacare replacement plan that couples catastrophic coverage with subsidized health savings accounts.


Assuntos
Dedutíveis e Cosseguros , Seguro Saúde , Poupança para Cobertura de Despesas Médicas , Formulação de Políticas , Estados Unidos
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