Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.849
Filtrar
1.
Public Health Rep ; 135(1_suppl): 75S-81S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735184

RESUMO

Policies facilitating integration of public health programs can improve the public health response, but the literature on approaches to integration across multiple system levels is limited. We describe the efforts of the Massachusetts Department of Public Health to integrate its HIV, viral hepatitis, sexually transmitted infection (STI), and tuberculosis response through policies that mandated contracted organizations to submit specimens for testing to the Massachusetts State Public Health Laboratory; co-test blood specimens for HIV, hepatitis C virus (HCV), and syphilis; integrate HIV, viral hepatitis, and STI disease surveillance and case management in a single data system; and implement an integrated infectious disease drug assistance program. From 2014 through 2018, the number of tests performed by the Massachusetts State Public Health Laboratory increased from 16 321 to 33 674 for HIV, from 11 054 to 33 670 for HCV, and from 19 169 to 30 830 for syphilis. Service contracts enabled rapid response to outbreaks of HIV, hepatitis A, and hepatitis B. Key challenges included lack of a billing infrastructure at the Massachusetts State Public Health Laboratory; the need to complete negotiations with insurers and to establish a retained revenue account to receive health insurance reimbursements for testing services; and time to train testing providers in phlebotomy for required testing. Investing in laboratory infrastructure; creating billing mechanisms to maximize health insurance reimbursement; proactively engaging providers, community members, and other stakeholders; and building capacity to transform practices are needed. Using multilevel policy approaches to integrate the public health response to HIV, STI, viral hepatitis, and tuberculosis is feasible and adaptable to other public health programs.


Assuntos
Serviços Contratados/organização & administração , Seguro Saúde/organização & administração , Administração em Saúde Pública/métodos , Vigilância em Saúde Pública/métodos , Doenças Sexualmente Transmissíveis/diagnóstico , Serviços Contratados/economia , Serviços Contratados/normas , Política de Saúde , Acesso aos Serviços de Saúde , Hepatite/diagnóstico , Humanos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/normas , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/legislação & jurisprudência , Reembolso de Seguro de Saúde/normas , Relações Interinstitucionais , Massachusetts , Estudos de Casos Organizacionais , Avaliação de Programas e Projetos de Saúde , Administração em Saúde Pública/economia , Administração em Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/normas , Sífilis/diagnóstico
3.
J Vasc Surg ; 72(4): 1161-1165, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32360683

RESUMO

The appropriate focus in managing the COVID-19 pandemic in the United States has been addressing access and delivery of care to the population affected by the outbreak. All sectors of the U.S. economy have been significantly affected, including physicians. Physician groups of all specialties and sizes have experienced the financial effects of the pandemic. Hospitals have received billions of dollars to support and enable them to manage emergencies and cover the costs of the disruption. However, many vascular surgeons are under great financial pressure because of the postponement of all nonemergency procedures. The federal government has announced a myriad of programs in the form of grants and loans to reimburse physicians for some of their expenses and loss of revenue. It is more than likely that unless the public health emergency subsides significantly, many practices will experience dire consequences without additional financial assistance. We have attempted to provide a concise listing of such programs and resources available to assist vascular surgeons who are small businesses in accessing these opportunities.


Assuntos
Agendamento de Consultas , Compensação e Reparação , Infecções por Coronavirus/economia , Procedimentos Cirúrgicos Eletivos/economia , Renda , Reembolso de Seguro de Saúde/economia , Pandemias/economia , Pneumonia Viral/economia , Cirurgiões/economia , Procedimentos Cirúrgicos Vasculares/economia , Compensação e Reparação/legislação & jurisprudência , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Procedimentos Cirúrgicos Eletivos/legislação & jurisprudência , Financiamento Governamental/economia , Financiamento Governamental/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Formulação de Políticas , Cirurgiões/legislação & jurisprudência , Estados Unidos/epidemiologia , Procedimentos Cirúrgicos Vasculares/legislação & jurisprudência
4.
Plast Reconstr Surg ; 145(6): 1541-1551, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459783

RESUMO

BACKGROUND: Health insurance reimbursement structure has evolved, with patients becoming increasingly responsible for their health care costs through rising out-of-pocket expenses. High levels of cost sharing can lead to delays in access to care, influence treatment decisions, and cause financial distress for patients. METHODS: Patients undergoing the most common outpatient reconstructive plastic surgery operations were identified using Truven MarketScan databases from 2009 to 2017. Total cost of the surgery paid to the insurer and out-of-pocket expenses, including deductible, copayment, and coinsurance, were calculated. Multivariable generalized linear modeling with log link and gamma distribution was used to predict adjusted total and out-of-pocket expenses. All costs were inflation-adjusted to 2017 dollars. RESULTS: The authors evaluated 3,165,913 outpatient plastic and reconstructive surgical procedures between 2009 and 2017. From 2009 to 2017, total costs had a significant increase of 25 percent, and out-of-pocket expenses had a significant increase of 54 percent. Using generalized linear modeling, procedures performed in outpatient hospitals conferred an additional $1999 in total costs (95 percent CI, $1978 to $2020) and $259 in out-of-pocket expenses (95 percent CI, $254 to $264) compared with office procedures. Ambulatory surgical center procedures conferred an additional $1698 in total costs (95 percent CI, $1677 to $1718) and $279 in out-of-pocket expenses (95 percent CI, $273 to $285) compared with office procedures. CONCLUSIONS: For outpatient plastic surgery procedures, out-of-pocket expenses are increasing at a faster rate than total costs, which may have implications for access to care and timing of surgery. Providers should realize the increasing burden of out-of-pocket expenses and the effect of surgical location on patients' costs when possible.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/economia , Custo Compartilhado de Seguro/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Reembolso de Seguro de Saúde/economia , Procedimentos Cirúrgicos Reconstrutivos/economia , Adolescente , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , Redução de Custos/economia , Redução de Custos/legislação & jurisprudência , Custo Compartilhado de Seguro/economia , Custo Compartilhado de Seguro/legislação & jurisprudência , Custo Compartilhado de Seguro/tendências , Bases de Dados Factuais/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/economia , Planos de Pagamento por Serviço Prestado/legislação & jurisprudência , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/tendências , Feminino , Gastos em Saúde/legislação & jurisprudência , Gastos em Saúde/tendências , Preços Hospitalares/estatística & dados numéricos , Preços Hospitalares/tendências , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Reembolso de Seguro de Saúde/tendências , Masculino , Programas de Assistência Gerenciada/economia , Programas de Assistência Gerenciada/legislação & jurisprudência , Programas de Assistência Gerenciada/estatística & dados numéricos , Programas de Assistência Gerenciada/tendências , Medicare/economia , Medicare/legislação & jurisprudência , Medicare/estatística & dados numéricos , Medicare/tendências , Pessoa de Meia-Idade , Ambulatório Hospitalar/economia , Ambulatório Hospitalar/estatística & dados numéricos , Políticas , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
7.
Am J Law Med ; 45(2-3): 106-129, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31722633

RESUMO

Beginning on inauguration day, President Trump has attempted an executive repeal of the Affordable Care Act. In doing so, he has tested the limits of presidential power. He has challenged the force of institutional and non-institutional constraints. And, ironically, he has helped boost public support for the ACA's central features. The first two sections of this article respectively consider the use of the President's tools to advance and to subvert health reform. The final two sections consider the forces constraining the administration's attempted executive repeal. I argue that the most important institutional constraint, thus far, is found in multifaceted actions by states - and not only blue states. I also highlight the force of public voices. Personal stories, public opinion, and 2018 election results - bolstered by presidential messaging - reflect growing support for government-grounded options and statutory coverage protections. Indeed, in a polarized time, "refine and revise" seems poised to supplant "repeal and replace" as the conservative focus countering liberal pressure for a common option grounded in Medicare.


Assuntos
Pessoal Administrativo , Reforma dos Serviços de Saúde/legislação & jurisprudência , Patient Protection and Affordable Care Act/legislação & jurisprudência , Política , Governo Federal , Financiamento Governamental/legislação & jurisprudência , Financiamento Governamental/organização & administração , Regulamentação Governamental , Reforma dos Serviços de Saúde/história , História do Século XX , História do Século XXI , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Jurisprudência , Medicaid/legislação & jurisprudência , Medicaid/organização & administração , Medicare/legislação & jurisprudência , Medicare/organização & administração , Patient Protection and Affordable Care Act/organização & administração , Cobertura de Condição Pré-Existente , Opinião Pública , Governo Estadual , Estados Unidos
13.
Issue Brief (Commonw Fund) ; 2019: 1-11, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30990594

RESUMO

Issue: Pharmacy benefit managers (PBMs) are responsible for negotiating payment rates for a large share of prescription drugs distributed in the U.S. Recently, policymakers have expressed concern that certain PBMs' business practices may not be consistent with public policy goals to improve the value of pharmaceutical spending. Goal: We sought to explain key controversies related to PBM practices and their roles in driving value in the pharmaceutical market. Methods: Literature review and feedback from top experts on PBM business practices and potential policy solutions. Key Findings and Conclusion: In some cases, PBMs' use of rebates has contributed to high pharmaceutical costs, yet proposed solutions to the rebate controversy--including passing the rebate through to payers or patients--will not on their own reduce overall pharmaceutical spending without other policies that drive toward value. Policymakers seeking to reform pharmaceutical reimbursement beyond the practice of rebates will need to consider these changes in light of the recent mergers between PBMs and insurers and the entry of new market competitors.


Assuntos
Pessoal Administrativo/economia , Pessoal Administrativo/legislação & jurisprudência , Benefícios do Seguro/economia , Benefícios do Seguro/legislação & jurisprudência , Seguro de Serviços Farmacêuticos/economia , Seguro de Serviços Farmacêuticos/legislação & jurisprudência , Previsões , Formulários Farmacêuticos como Assunto , Setor de Assistência à Saúde/tendências , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/legislação & jurisprudência , Medicare Part D/economia , Medicare Part D/legislação & jurisprudência , Estados Unidos
16.
Tex Med ; 115(3): 20-25, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30855697

RESUMO

Molina Healthcare of Texas isn't the only insurer to give physicians prompt-pay problems, and it won't be the last. Some of the practices trying to recover payments blame not just the health plan, but also the extended response time from the state regulator overseeing insurance products and conduct: the Texas Department of Insurance, which says it's hiring staff and making other changes to improve that response.


Assuntos
Sistemas Pré-Pagos de Saúde/legislação & jurisprudência , Revisão da Utilização de Seguros/legislação & jurisprudência , Reembolso de Seguro de Saúde/estatística & dados numéricos , Médicos/economia , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Governo Estadual , Texas , Fatores de Tempo
19.
AIDS ; 33(5): 913-918, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30649053

RESUMO

OBJECTIVE: As a proxy for undiagnosed HIV, the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance (NHBS) monitors participants who report being unaware of their infection, defined as self-reporting an HIV-negative or unknown status during the interview but testing positive for HIV infection. We validated the NHBS measure of awareness among MSM in 2014. DESIGN: We tested dried blood spots from MSM who reported being unaware of their infection for seven antiretrovirals (ARVs). MSM unaware with at least one ARV detected were defined as misreporters. METHODS: Weighted percentages and 95% confidence intervals were calculated to compare characteristics among misreporters, nonmisreporters, and those who self-reported as HIV-positive. Viral load was quantified with a validated assay using dried blood spots. RESULTS: Of 1818 HIV-positive MSM, 299 (16%) self-reported as HIV-negative or unknown infection status. Of these 299, 145 (49%) were considered misreporters based on ARV detection. Among the unaware, misreporters were more likely than nonmisreporters to be older and have health insurance. Compared with self-reported HIV-positive MSM, misreporters were more likely to be black, be bisexual, and have perceived discrimination. Of 138 misreporters with viral load data, 116 (84%) had an undetectable viral load. CONCLUSION: ARV testing revealed that half of MSM classified as unaware of their infection misreported their status. Although off-label preexposure prophylaxis use might explain the presence of ARVs, it is unlikely as many misreporters were virally suppressed, suggesting they were on HIV therapy. Biomarker validation of behavioral data can improve data quality and usefulness in NHBS and other studies.


Assuntos
Decepção , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Homossexualidade Masculina/estatística & dados numéricos , Revelação da Verdade , Adulto , Teste em Amostras de Sangue Seco , Infecções por HIV/psicologia , Homossexualidade Masculina/psicologia , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Masculino , Pessoa de Meia-Idade , Vigilância da População , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...