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2.
Schmerz ; 33(5): 466-470, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31478143

RESUMO

Since the adoption of the law of March 6, 2017, any German physician can prescribe medical cannabis flowers and cannabis-based magistral and finished medicinal products. No specific indications for prescriptions are provided in the law. The statutory health insurance companies bear the costs once an application for cost coverage has been approved by the Medical Service of the Health Funds. The German associations of psychiatry (child, adolescents, and adults), neurology, palliative care, addictology, and pain medicine are watching these developments in the media, politics, and medical world with concern due to: the option to prescribe cannabis flowers despite the lack of sound evidence and against the recommendations of the German Medical Association; the lack of distinction between medical cannabis flowers and cannabis-based magistral and finished medical products; the indiscriminately positive reports on the efficacy of cannabis-based medicines for chronic pain and mental disorders; the attempts by the cannabis industry to influence physicians; the increase in potential indications by leaders of medical opinion paid by manufacturers of cannabis-based medicines. The medical associations make the following appeal to journalists: To report on the medical benefits and risks of cannabis-based medicines in a balanced manner. To physicians: to prescribe cannabis-based medicines with caution; to prefer magistral and finished medicinal products over cannabis flowers. To politicians: to consider data according to the standards of evidence-based medicine when making decisions and provide financial support for medical research into cannabis-based medicines.


Assuntos
Cannabis , Dor Crônica , Seguro Saúde , Jornalismo , Maconha Medicinal , Política , Padrões de Prática Médica , Dor Crônica/tratamento farmacológico , Alemanha , Humanos , Seguro Saúde/ética , Seguro Saúde/normas , Maconha Medicinal/uso terapêutico , Médicos/ética , Médicos/normas , Padrões de Prática Médica/ética , Padrões de Prática Médica/normas
3.
Pan Afr Med J ; 33: 29, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31384344

RESUMO

Introduction: In February 2011, the Togolese Government established a compulsory health insurance for public officials and assimilated employees. Four years later, this study investigated the satisfaction of beneficiaries of this insurance plan in Lomé. Methods: The survey was conducted among a sample of beneficiaries using an anonymous face to face questionnaire outside eight health care facilities. The analysis of survey responses allowed measuring the degree of satisfaction. Quantitative data were described using median and extended interquartile range (IQR) and qualitative data were transcribed verbatim. Results: Out of 288 subjects invited to participate, 279 agreed to participate of whom 58% were women and 88% were officials in active employment. The average age of the participants was 38 years (IQR: 30-47). A very large majority of respondents (93.5%) considered this health insurance "satisfactory". The mean overall satisfaction score was 6/10 (min: 5, max: 9). The main elements of dissatisfaction involved the refusal of care to those people with long-term illnesses (84% dissatisfied), the complexity of administrative formalities (84% dissatisfied) and care delays (67% dissatisfied). Conclusion: The very high level of satisfaction promotes the maintenance and the development of this health insurance in Togo. However, the elements of dissatisfaction should receive prompt attention and genuine efforts should be made to correct them.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Seguro Saúde/normas , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Togo
4.
J Med Econ ; 22(5): 478-487, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30757934

RESUMO

BACKGROUND: Both public and private insurers provide drug coverage in Canada. All payers are under pressure to contain costs. It has recently been proposed that private plans leverage the public health technology assessment (HTA) evaluation process in their decision-making. OBJECTIVES: The objectives of the current study were to examine use of public health technology assessments (HTAs) for private payer decision-making in the literature, to gather the perspectives of experts from both public and private insurers on this practice, and to summarize which value parameters of public evaluations can be used for private payer decision-making. METHODS: A targeted literature review was conducted to identify publications on the use of public HTA or cost-effectiveness data for private payer decision-making on pharmaceutical reimbursement. Concurrently, a roundtable meeting was organized with invited panelists, including private payer representatives and health economic consultants (total n = 9). The findings from both were synthesized and expressed in qualitative terms using the PICO framework. RESULTS: The targeted review identified 20 studies meeting the inclusion criteria, primarily originating from the US and Canada. The panelists felt that, despite some similarities, there were substantial differences between both systems. The PICO framework highlighted the issues with transferability between the two systems. Most of the value parameters were either not applicable, needed to be added, needed to be adjusted, or their applicability to private payer systems needed to be confirmed. CONCLUSION: Some components of public HTA may be relevant for private payers, however there are reservations that still exist on whether the HTA process in Canada, designed for a public system, can address the informational needs of private payers. Private insurers need to use caution in assessing which value parameters from public HTAs can be used and which need to be confirmed, ignored, enhanced, or adjusted. One size HTA does not fit all applications.


Assuntos
Tomada de Decisões , Seguro Saúde/organização & administração , Setor Privado/organização & administração , Setor Público/organização & administração , Avaliação da Tecnologia Biomédica/organização & administração , Canadá , Análise Custo-Benefício , Humanos , Seguro Saúde/normas , Medicamentos sob Prescrição/economia , Setor Privado/normas , Setor Público/normas , Avaliação da Tecnologia Biomédica/normas
5.
Diabetes Res Clin Pract ; 147: 47-54, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30118748

RESUMO

AIMS: This study aimed to evaluate the impact of diabetes education and access to healthcare coverage on disease management and outcomes in Latin America. METHODS: Data were obtained from a sub-analysis of 2693 patients with type 1 diabetes mellitus recruited from 9 Latin American countries as part of the International Diabetes Mellitus Practices Study (IDMPS), a multinational, observational survey of diabetes treatment in developing regions. RESULTS: Results from the Latin American cohort show that only 25% of participants met HbA1c target value (< 7% [53 mmol/mol]). Attainment of this target was significantly higher among participants who had received diabetes education than those who hadn't (28% vs. 19%, p < 0.001), and among those who practiced self-management (27% vs. 21% no self-management, p = 0.001). Multivariate analysis showed that participants who had received diabetes education were more likely to manage their diabetes (OR:1.65 [95% CI: 1.24, 2.19]; p = 0.001), and to attain HbA1c target values (OR:1.48 [95% CI: 1.14, 1.93]; p = 0.003). CONCLUSIONS: Given the association between uncontrolled diabetes and long-term complications, health authorities and care providers should increase efforts to ensure widespread healthcare coverage and access to self-management education to reduce the socioeconomic and humanistic burden of type 1 diabetes.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Educação em Saúde/métodos , Seguro Saúde/normas , Qualidade da Assistência à Saúde/normas , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 1/patologia , Feminino , Humanos , América Latina , Masculino
6.
BMC Health Serv Res ; 18(1): 832, 2018 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-30400978

RESUMO

BACKGROUND: In a health care system based on managed competition it is important that health insurers are able to channel their enrolees to preferred care providers. However, enrolees are often very negative about financial incentives and any limitations in their choice of care provider. Therefore, a Dutch health insurance company conducted an experiment to study the effectiveness of a new method of channelling their enrolees. This method entails giving enrolees advise on which physiotherapists to choose when they call customer service. Offering this advice as an extra service is supposed to improve service quality ratings. Objective of this study is to evaluate this channelling method on effectiveness and the impact on service quality ratings. METHODS: In this experiment, one of the health insurer's customer service call teams (pilot team) began advising enrolees on their choice of physiotherapist. Three data sources were used. Firstly, all enrolees who called customer service received an online questionnaire in order to measure their evaluation of the quality of service. Enrolees who were offered advice received a slightly different questionnaire which, in addition, asked about whether they intended to follow the advice they were offered. Multilevel regression analysis was conducted to analyse the difference in service quality ratings between the pilot team and two comparable customer service teams before and after the implementation of the channelling method. Secondly, employees logged each call, registering, if they offered advice, whether the enrolee accepted it, and if so, which care provider was advised. Thirdly, data from the insurance claims were used to see if enrolees visited the recommended physiotherapist. RESULTS: The results of the questionnaire show that enrolees responded favorably to being offered advice on the choice of physiotherapist. Furthermore, 45% of enrolees who received advice and then went on to visit a care provider, followed the advice. The service quality ratings were higher compared to control groups. However, it could not be determined whether this effect was entirely due to the intervention. CONCLUSIONS: Channelling enrolees towards preferred care providers by offering advice on their choice of care provider when they call customer service is successful. The effect on service quality seems positive, although a causal relationship could not be determined.


Assuntos
Seguradoras/normas , Seguro Saúde/normas , Competição em Planos de Saúde/normas , Modalidades de Fisioterapia/normas , Comportamento de Escolha , Aconselhamento , Assistência à Saúde , Feminino , Humanos , Seguradoras/economia , Seguro Saúde/economia , Seguro Saúde/organização & administração , Masculino , Competição em Planos de Saúde/economia , Competição em Planos de Saúde/organização & administração , Pessoa de Meia-Idade , Motivação , Países Baixos , Modalidades de Fisioterapia/economia , Distribuição Aleatória , Inquéritos e Questionários
7.
Obesity (Silver Spring) ; 26(12): 1834-1840, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30426721

RESUMO

OBJECTIVE: This study examined changes in coverage for adult obesity treatment services in Medicaid and state employee health insurance programs between 2009 and 2017. METHODS: Administrative materials from Medicaid and state employee health insurance programs in all 50 states and the District of Columbia were reviewed for indications of coverage and payment policies specific to evidence-based treatment modalities for adults (≥ 21 years of age) with obesity, including nutritional counseling, pharmacotherapy, and bariatric surgery. RESULTS: From 2009 to 2017, the proportion of state employee programs indicating coverage increased by 75% for nutritional counseling (from 24 to 42 states), 64% for pharmacotherapy (from 14 to 23 states), and 23% for bariatric surgery (from 35 to 43 states). The proportion of Medicaid programs indicating coverage increased by 133% for nutritional counseling (from 9 to 21 states) and 9% for bariatric surgery (from 45 to 49 states), with no net increase for pharmacotherapy (16 states in both plan years). CONCLUSIONS: Coverage for adult obesity care improved substantially in Medicaid and state employee insurance programs since 2009. However, recommended treatment modalities are still not covered in many states. Where coverage has expanded, educating providers and beneficiaries on the availability and proper use of evidence-based obesity treatments may improve health outcomes.


Assuntos
Acesso aos Serviços de Saúde/normas , Cobertura do Seguro/normas , Seguro Saúde/normas , Medicaid/normas , Obesidade/economia , Obesidade/prevenção & controle , Feminino , Humanos , Masculino , Estados Unidos
8.
Isr J Health Policy Res ; 7(1): 48, 2018 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-30318017

RESUMO

BACKGROUND: The study documents a direct relationship between individuals' health and patterns of healthcare expenditure by isolating single-person households and creating a new reference group in which household healthcare expenditure is based on one person's expenditure patterns in accordance with his or her own state of health. METHOD: The study matched two surveys using Propensity Score Matching based on single-person household, age, and gender. Structural Equation Modeling (SEM) explores paths of relation between the population's income and socioeconomic level and its health self-assessment and expenditure. RESULTS: Single-person households' health expenditure increases with age and the differences in most expenditure categories are significant. The current study looks into the direct and indirect effects of income, gender, and SES on health insurance and other out-of-pocket health expenses among single-person households. A direct link exists between income, gender, and socioeconomic status (SES) and several aspects of health expenditure, depending on the specific age group. The indirect effects are attested via health status assessment, in which a negative correlation is found between self-assessed health status and various health-expenditure categories. CONCLUSIONS: The last-mentioned result may support the general perception that single-person households who feel that they are doing better than their near-equals enjoy better health. This line of inquiry yields a better examination of how a single-person household's state of health affects expenditure patterns without assuming ab initio that expenditure patterns attest to state of health.


Assuntos
Características da Família , Gastos em Saúde/estatística & dados numéricos , Pessoa Solteira/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Renda/estatística & dados numéricos , Seguro Saúde/normas , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Fatores Socioeconômicos , Inquéritos e Questionários
9.
BMJ Open ; 8(9): e023013, 2018 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-30209158

RESUMO

OBJECTIVE: This study was performed to explore the factors associated with accumulation of multiple problems in accessing healthcare among women in Tanzania as an example of a low-income country. DESIGN: Population-based cross-sectional survey. SETTING: Nationwide representative data for women of reproductive age obtained from the 2015-2016 Tanzania Demographic and Health Survey were analysed. PRIMARY OUTCOME MEASURES: A composite variable, 'problems in accessing healthcare', with five (1-5) categories was created based on the number of problems reported: obtaining permission to go to the doctor, obtaining money to pay for advice or treatment, distance to a health facility and not wanting to go alone. Respondents who reported fewer or more problems placed in lower and higher categories, respectively. RESULTS: A total of 13 266 women aged 15-49 years, with a median age (IQR) of 27 (20-36) years were interviewed and included in the analysis. About two-thirds (65.53%) of the respondents reported at least one of the four major problems in accessing healthcare. Furthermore, after controlling for other variables included in the final model, women without any type of health insurance, those belonging to the poorest class according to the wealth index, those who had not attended any type of formal education, those who were not employed for cash, each year of increasing age and those who were divorced, separated or widowed were associated with greater problems in accessing healthcare. CONCLUSION: This study indicated the additive effects of barriers to healthcare in low-income countries such as Tanzania. Based on these results, improving uptake of health insurance and addressing social determinants of health are the first steps towards reducing women's problems associated with accessing healthcare.


Assuntos
Acesso aos Serviços de Saúde , Saúde da Mulher/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Seguro Saúde/normas , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Melhoria de Qualidade , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Tanzânia/epidemiologia
12.
Pediatrics ; 142(2)2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29987166

RESUMO

BACKGROUND AND OBJECTIVES: Thirty million children are currently covered by public insurance; however, the future funding and structure of public insurance are uncertain. Our objective was to determine the number, estimated costs, and demographic characteristics of hospitalizations that would become ineligible for public insurance reimbursement under 3 federal poverty level (FPL) eligibility scenarios. METHODS: In this retrospective cohort study using the 2014 State Inpatient Databases, we included all pediatric (age <18) hospitalizations in 14 states from January 1, 2014, to December 31, 2014, with public insurance as the primary payer. We linked each patient's zip code to the American Community Survey to determine the likelihood of the patient being below 3 different public insurance income eligibility thresholds (300%, 200%, and 100% of the FPL). Multiple simulations were used to describe newly ineligible hospitalizations under each threshold. RESULTS: In 775 460 publicly reimbursed hospitalizations in 14 states, reductions in eligibility limits to 300%, 200%, or 100% of the FPL would have resulted in large numbers of newly ineligible hospitalizations (∼155 000 [20% of hospitalizations] for 300%, 440 000 [57%] for 200%, and 650 000 [84%] for 100% of the FPL), equaling $1.2, $3.1, and $4.4 billion of estimated child hospitalization costs, respectively. Patient demographics differed only slightly under each eligibility threshold. CONCLUSIONS: Reducing public insurance eligibility limits would have resulted in numerous pediatric hospitalizations not covered by public insurance, shifting costs to families, other insurers, or hospitals. Without adequately subsidized commercial insurance, this reflects a potentially substantial economic hardship for families and hospitals serving them.


Assuntos
Hospitalização/economia , Renda , Cobertura do Seguro/economia , Seguro Saúde/economia , Pobreza/economia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais/economia , Bases de Dados Factuais/tendências , Feminino , Hospitalização/tendências , Humanos , Renda/tendências , Lactente , Recém-Nascido , Cobertura do Seguro/normas , Cobertura do Seguro/tendências , Seguro Saúde/normas , Seguro Saúde/tendências , Masculino , Pobreza/tendências , Estudos Retrospectivos , Estados Unidos/epidemiologia
13.
J Med Internet Res ; 20(6): e209, 2018 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-29925498

RESUMO

BACKGROUND: The rate of uninsured people has decreased dramatically since the Affordable Care Act was passed. To make an informed decision, consumers need assistance to understand the advantages and disadvantages of health insurance plans. The Show Me Health Plans Web-based decision support tool was developed to improve the quality of health insurance selection. In response to the promising effectiveness of Show Me Health Plans in a randomized controlled trial (RCT) and the growing need for Web-based health insurance decision support, the study team used expert recommendations for dissemination and implementation, engaged external stakeholders, and made the Show Me Health Plans tool available to the public. OBJECTIVE: The purpose of this study was to implement the public dissemination of the Show Me Health Plans tool in the state of Missouri and to evaluate its impact compared to the RCT. METHODS: This study used a cross-sectional observational design. Dissemination phase users were compared with users in the RCT study across the same outcome measures. Time spent using the Show Me Health Plans tool, knowledge, importance rating of 9 health insurance features, and intended plan choice match with algorithm predictions were examined. RESULTS: During the dissemination phase (November 2016 to January 2017), 10,180 individuals visited the SMHP website, and the 1069 users who stayed on the tool for more than one second were included in our analyses. Dissemination phase users were more likely to live outside St. Louis City or County (P<.001), were less likely to be below the federal poverty level (P<.001), and had a higher income (P=.03). Overall, Show Me Health Plans users from St. Louis City or County spent more time on the Show Me Health Plans tool than those from other Missouri counties (P=.04); this association was not observed in the RCT. Total time spent on the tool was not correlated with knowledge scores, which were associated with lower poverty levels (P=.009). The users from the RCT phase were more likely to select an insurance plan that matched the tool's recommendations (P<.001) compared with the dissemination phase users. CONCLUSIONS: The study suggests that a higher income population may be more likely to seek information and online help when making a health insurance plan decision. We found that Show Me Health Plans users in the dissemination phase were more selective in the information they reviewed. This study illustrates one way of disseminating and implementing an empirically tested Web-based decision aid tool. Distributing Web-based tools is feasible and may attract a large number of potential users, educate them on basic health insurance information, and make recommendations based on personal information and preference. However, using Web-based tools may differ according to the demographics of the general public compared to research study participants.


Assuntos
Tomada de Decisões/fisiologia , Seguro Saúde/normas , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
14.
J Cancer Surviv ; 12(5): 639-646, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29943170

RESUMO

PURPOSE: Survivors of childhood cancer require life-long outpatient healthcare, which may be impacted by health insurance. This study sought to understand survivors' utilization of outpatient healthcare provider services. METHODS: The study examined cross-sectional survey data using an age-stratified sample from the Childhood Cancer Survivor Study of self-reported annual use of outpatient services. Multivariable logistic regression analyses were used to identify risk factors associated with utilization of services. RESULTS: Six hundred ninety-eight survivors were surveyed, median age 36.3 years (range 22.2-62.6), median time from diagnosis 28.8 years (range 23.1-41.7). Almost all (93%) of survivors had at least one outpatient visit during the previous year; 81.3% of these visits were with a primary care providers (PCP), 54.5% were with specialty care physicians, 30.3% were with nurse practitioner/physician's assistants (NP/PA), and 14.2% were with survivorship clinic providers. Survivors with severe to life-threatening chronic health conditions had greater odds of utilizing a specialty care physician (OR = 5.15, 95% CI 2.89-9.17) or a survivorship clinic (OR = 2.93, 95% CI 1.18-7.26) than those with no chronic health conditions. Having health insurance increased the likelihood of seeking care from NP/PA (private, OR = 2.76, 95% CI 1.37-5.58; public, OR = 2.09, 95% CI 0.85-5.11), PCP (private, OR = 7.82, 95% CI 3.80-13.10; public, OR = 7.24, 95% CI 2.75-19.05), and specialty care (private, OR = 2.96, 95% CI 1.48-5.94; public, OR = 2.93, 95% CI 1.26-6.84) compared to without insurance. CONCLUSION: Most childhood cancer survivors received outpatient care from a PCP, but a minority received care from a survivorship clinic provider. Having health insurance increased the likelihood of outpatient care. IMPLICATIONS FOR CANCER SURVIVORS: Targeted interventions in the primary care setting may improve risk-based, survivor-focused care for this vulnerable population.


Assuntos
Assistência Ambulatorial/métodos , Doença Crônica/epidemiologia , Seguro Saúde/normas , Neoplasias/epidemiologia , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
15.
Gynecol Oncol ; 150(1): 67-72, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29751992

RESUMO

OBJECTIVE: To evaluate the impact of insurance status on the stage of cervical cancer diagnosed and treated at a tertiary care center in Massachusetts and review the preceding screening history. METHODS: An IRB approved retrospective cohort study was conducted of patients with a diagnosis of cervical cancer treated at Brigham and Women's Hospital (BWH) between January 2011 and June 2016. Clinical and demographic data was extracted from the longitudinal medical record. Statistical analysis was performed using SAS. RESULTS: 117 cases of cervical cancer met the inclusion criteria during the study period. Most patients (76%) were diagnosed with stage I disease. On univariate analysis, compared to patients with private insurance, patients with public insurance or no documented insurance presented at older ages, were more likely to be non-white races, and present with advanced stage disease. In an adjusted model, the risk of being diagnosed with advanced stage disease persisted among women with public or no documented insurance, adjusted odds ratio (aOR) 4.13 (1.37-12.45). There was no difference in screening history among women with private vs. public insurance, p = 0.30. CONCLUSIONS: Despite access to insurance, patients with public issued insurance had an increased risk of presenting with advanced stage cervical cancer in this cohort. These data suggest that additional barriers to screening and prevention may exist and are important for future investigation.


Assuntos
Cobertura do Seguro/normas , Seguro Saúde/normas , Neoplasias do Colo do Útero/diagnóstico , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Massachusetts , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Centros de Atenção Terciária , Neoplasias do Colo do Útero/patologia
16.
Cancer ; 124(12): 2645-2652, 2018 06 15.
Artigo em Inglês | MEDLINE | ID: mdl-29663343

RESUMO

BACKGROUND: The Patient Protection and Affordable Care Act extends Medicaid coverage to millions of low-income adults, including many survivors of cancer who were unable to purchase affordable health insurance coverage in the individual health insurance market. METHODS: Using data from the 2011 to 2015 Behavioral Risk Factor Surveillance System, the authors compared changes in coverage and health care access measures for low-income cancer survivors in states that did and did not expand Medicaid. RESULTS: The study population of 17,381 individuals included adults aged 18 to 64 years, and was predominantly female, white, and unmarried. The authors found a relative reduction in the uninsured rate of 11.7 percentage points and a relative increase in the probability of having a personal physician of 5.8 percentage points. Stratifying by whether states expanded Medicaid by 2015, the authors found that relative gains in coverage and access were larger among those individuals residing in states with expanded Medicaid compared with those residing in nonexpansion states. CONCLUSIONS: The results of the current study suggest that the Patient Protection and Affordable Care Act Medicaid expansion has improved coverage and access for cancer survivors. Cancer 2018;124:2645-52. © 2018 American Cancer Society.


Assuntos
Sobreviventes de Câncer/estatística & dados numéricos , Cobertura do Seguro/tendências , Seguro Saúde/tendências , Medicaid/economia , Neoplasias/economia , Adolescente , Adulto , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Humanos , Cobertura do Seguro/economia , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/economia , Seguro Saúde/normas , Masculino , Medicaid/estatística & dados numéricos , Medicaid/tendências , Pessoa de Meia-Idade , Neoplasias/mortalidade , Neoplasias/terapia , Patient Protection and Affordable Care Act/economia , Pobreza/economia , Pobreza/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , Adulto Jovem
18.
J Aging Soc Policy ; 30(3-4): 259-281, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29634455

RESUMO

This paper discusses Republican efforts to repeal the 2010 Patient Protection and Affordable Care Act (ACA) over President Trump's first year in office (2017) and their impact on near-elderly Americans (50-64 years old). We describe how the ACA's provisions for strengthening health care coverage were particularly advantageous for near-elderly Americans: The law shored up employer-sponsored health care, expanded Medicaid, and-most important-created conditions for a strong individual health insurance market. We then describe Republican efforts to undermine the ACA in the years immediately following its passage, followed by detailed discussion of Republican proposals to repeal and replace the ACA during 2017. We conclude by discussing factors informing the fate of Republican legislation in this area, the potential consequences of the legislation that ultimately passed, and the prospects for future attempts to repeal and replace the ACA through the legislative process.


Assuntos
Reforma dos Serviços de Saúde/tendências , Seguro Saúde/normas , Patient Protection and Affordable Care Act/legislação & jurisprudência , Assistência à Saúde , Humanos , Seguro Saúde/economia , Pessoa de Meia-Idade , Política , Estados Unidos
19.
Health Aff (Millwood) ; 37(4): 523-524, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29528699

RESUMO

The Trump administration proposed liberalizing rules governing non-ACA-compliant, short-term coverage; responding to state guidance, Blue Cross of Idaho filed health plans not meeting ACA requirements.


Assuntos
Trocas de Seguro de Saúde/tendências , Cobertura do Seguro/normas , Seguro Saúde/normas , Patient Protection and Affordable Care Act , Humanos , Idaho
20.
BMC Palliat Care ; 17(1): 45, 2018 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-29514632

RESUMO

BACKGROUND: This study investigates the effects of a new medical insurance payment system for hospice patients in palliative care programs and analyzes length of survival (LoS) determinants. METHOD: At the Pusan National University Hospital hospice center, between January 2015 and April 2016, 276 patients were hospitalized with several diagnosed types of terminal stage cancer. This study separated patients into two groups, "old" and "new," by admission date, considering the new system has been applied from July 15, 2015. The study subsequently compared LoS, total cost, and out-of-pocket expenses for the two groups. RESULTS: Overall, 142 patients applied to the new medical insurance payment system group, while the old medical insurance payment system included 134 patients. The results do not show a significantly negative difference in LoS for the new system group (p = 0.054). Total cost is higher within the new group (p <  0.001); however, the new system registers lower patient out-of-pocket expenses (p <  0.001). CONCLUSION: The novelty of this study is proving that the new medical insurance payment system is not inferior to the classic one in terms of LoS. The total cost of the new system increased due to a multidisciplinary approach toward palliative care. However, out-of-pocket expenses for patients overall decreased, easing their financial burden.


Assuntos
Seguro Saúde/normas , Neoplasias/economia , Cuidados Paliativos/economia , Sistema de Pagamento Prospectivo/normas , Idoso , Feminino , Humanos , Seguro Saúde/economia , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , República da Coreia , Análise de Sobrevida
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