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4.
BMC Health Serv Res ; 19(1): 580, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426781

RESUMO

BACKGROUND: Care-seeking behavior is widely acknowledged to have strong influences on health outcomes among individuals with chronic conditions including diabetes. Despite its dynamic nature, care seeking behavior are often considered as time invariant in most studies. The likelihood of patients changing their regularity and source of chronic care over time is often neglected. This study aimed to determine the long-term trajectories of care-seeking patterns of both care-seeking regularity and health provider choices; and their associated factors among patients with type 2 diabetes under the National Health Insurance (NHI) program in Taiwan. METHODS: We utilized population-based data from the National Health Insurance Research Database (NHIRD) in Taiwan. Three thousand, nine hundred and eighty-seven adult patients with newly diagnosed type 2 diabetes in 1999 were enrolled in the cohort. We assessed their trajectories of regular care visits and sources of diabetes care from 2000 to 2010. A group-based trajectory model was applied. RESULTS: Seven distinct groups of long-term care-seeking patterns were identified. Only 51.44% of patients with newly diagnosed diabetes had regularly visited their providers over time. Among them, 56.41 and 16.09% had persistently sought care from generalized and specialized providers, respectively. 27.50% had sought care from different levels of providers. Patients who were male, elderly, low-income, and had a higher baseline diabetes severity were significantly more likely to either continue with their irregular care-seeking behavior or fail to maintain their regular care seeking behavior over time. Those who were younger, had a higher socioeconomic status, and lived in an urban area were significantly more likely to persistently seek care from specialized care settings. CONCLUSIONS: This study is the first population-based assessment of long-term care-seeking behaviors of type 2 diabetes patients under a single-payer system with a comprehensive benefit coverage. The most alarming finding was that, despite the existence of the comprehensive universal health insurance coverage in Taiwan, almost 50% of patients did not seek or maintain regular visits to providers over time as recommended. Understanding variations in the long-term trajectories of care adherence and sources of care may help to identify gaps in diabetes care management.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sistema de Fonte Pagadora Única/estatística & dados numéricos , Adulto , Idoso , Doença Crônica , Diabetes Mellitus Tipo 2/economia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Pobreza/economia , Pobreza/estatística & dados numéricos , Estudos Retrospectivos , Taiwan , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adulto Jovem
7.
Issue Brief (Commonw Fund) ; 2019: 1-10, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30990595

RESUMO

Issue: When discussing universal health insurance coverage in the United States, policymakers often draw a contrast between the U.S. and high-income nations that have achieved universal coverage. Some will refer to these countries having "single payer" systems, often implying they are all alike. Yet such a label can be misleading, as considerable differences exist among universal health care systems. Goal: To compare universal coverage systems across three areas: distribution of responsibilities and resources between levels of government; breadth of benefits covered and extent of cost-sharing in public insurance; and role of private insurance. Methods: Data from the Organisation for Economic Co-operation and Development, the Commonwealth Fund, and other sources are used to compare 12 high-income countries. Key Findings and Conclusion: Countries differ in the extent to which financial and regulatory control over the system rests with the national government or is devolved to regional or local government. They also differ in scope of benefits and degree of cost-sharing required at the point of service. Finally, while virtually all systems incorporate private insurance, its importance varies considerably from country to country. A more nuanced understanding of the variations in other countries' systems could provide U.S. policymakers with more options for moving forward.


Assuntos
Países Desenvolvidos , Sistema de Fonte Pagadora Única/organização & administração , Cobertura Universal do Seguro de Saúde/organização & administração , Custo Compartilhado de Seguro , Gastos em Saúde , Humanos , Benefícios do Seguro , Reembolso de Seguro de Saúde , Setor Privado , Setor Público , Estados Unidos
8.
Eur J Health Econ ; 20(6): 869-878, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30953217

RESUMO

BACKGROUND: Research has shown that a small proportion of patients account for the majority of health care spending. The objective of this analysis was to determine the amount and proportion of preventable acute care spending among high-cost patients. METHODS: We examined a population-based sample of all adult high-cost patients using linked administrative health care data housed at ICES in Toronto, Ontario. High-cost patients were defined as those in and above the 90th percentile of the cost distribution. Preventable acute care (emergency department visits and hospitalisations) was defined using validated algorithms. We estimated costs of preventable and non-preventable acute care for high- and non-high-cost patients by category of visit/condition. We replicated our analysis for persistent high-cost patients and high-cost patients under 65 years and those 65 years and older. RESULTS: We found that 10% of all acute care spending among high-cost patients was considered preventable; this figure was higher for non-high-cost patients (25%). The proportion of preventable acute care spending was higher for persistent high-cost patients (14%) and those 65 years and older (12%). Among ED visits, the largest portion of preventable care spending was for primary care treatable conditions; for hospitalisations, the highest proportions of preventable care spending were for COPD, bacterial pneumonia and urinary tract infections. CONCLUSIONS: Although high-cost patients account for a substantial proportion of health care costs, there seems to be limited scope to prevent acute care spending among this patient population. Nonetheless, care coordination and improved access to primary care, and disease prevention may prevent some acute care.


Assuntos
Doença Aguda/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Medicina Preventiva/economia , Sistema de Fonte Pagadora Única/economia , Idoso , Estudos Transversais , Bases de Dados Factuais , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário
11.
PLoS One ; 14(2): e0212519, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30785925

RESUMO

INTRODUCTION: Hungary has a single payer health insurance system offering free healthcare for acute cerebrovascular disorders. Within the capital, Budapest, however there are considerable microregional socioeconomic differences. We hypothesized that socioeconomic deprivation reflects in less favorable stroke characteristics despite universal access to care. METHODS: From the database of the National Health Insurance Fund, we identified 4779 patients hospitalized between 2002 and 2007 for acute cerebrovascular disease (hereafter ACV, i.e. ischemic stroke, intracerebral hemorrhage, or transient ischemia), among residents of the poorest (District 8, n = 2618) and the wealthiest (District 12, n = 2161) neighborhoods of Budapest. Follow-up was until March 2013. RESULTS: Mean age at onset of ACV was 70±12 and 74±12 years for District 8 and 12 (p<0.01). Age-standardized incidence was higher in District 8 than in District 12 (680/100,000/year versus 518/100,000/year for ACV and 486/100,000/year versus 259/100,000/year for ischemic stroke). Age-standardized mortality of ACV overall and of ischemic stroke specifically was 157/100,000/year versus 100/100,000/year and 122/100,000/year versus 75/100,000/year for District 8 and 12. Long-term case fatality (at 1,5, and 10 years) for ACV and for ischemic stroke was higher in younger District 8 residents (41-70 years of age at the index event) compared to D12 residents of the same age. This gap between the districts increased with the length of follow-up. Of the risk diseases the prevalence of hypertension and diabetes was higher in District 8 than in District 12 (75% versus 66%, p<0.001; and 26% versus 16%, p<0.001). DISCUSSION: Despite universal healthcare coverage, the disadvantaged district has higher ACV incidence and mortality than the wealthier neighborhood. This difference affects primarily the younger age groups. Long-term follow-up data suggest that inequity in institutional rehabilitation and home-care should be investigated and improved in disadvantaged neighborhoods.


Assuntos
Acidente Vascular Cerebral/epidemiologia , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Transtornos Cerebrovasculares/economia , Transtornos Cerebrovasculares/epidemiologia , Transtornos Cerebrovasculares/mortalidade , Estudos de Coortes , Comorbidade , Feminino , Humanos , Hungria/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Pobreza , Características de Residência , Estudos Retrospectivos , Sistema de Fonte Pagadora Única , Fatores Socioeconômicos , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/mortalidade
12.
BMC Health Serv Res ; 18(1): 990, 2018 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-30572899

RESUMO

BACKGROUND: Single disease payment program based on clinical pathway (CP-based SDP) plays an increasingly important role in reducing health expenditure in china and there is a clear need to explore the scheme from different perspectives. This study aimed at evaluating the effect of the scheme in rural county public hospitals within Anhui, a typical province of China,using uterine leiomyoma as an example. METHODS: The study data were extracted from the data platform of the New Rural Cooperative Medical Office of Anhui Province using stratified-random sampling. Means, constituent ratios and coefficients of variations were calculated and/or compared between control versus experiment groups and between different years. RESULTS: The total hospitalization expenditure (per-time) dropped from 919.08 ± 274.92 USD to 834.91 ± 225.29 USD and length of hospital stay reduced from 9.96 ± 2.39 days to 8.83 ± 1.95 days(P < 0.01), after CP-based SDP had implemented. The yearly total hospitalization expenditure manifested an atypical U-shaped trend. Medicine expense, nursing expense, assay cost and treatment cost reduced; while the fee of operation and examination increased (P < 0.05). The expense constituent ratios of medicine, assay and treatment decreased with the medicine expense dropped the most (by 4.4%). The expense constituent ratios of materials, ward, operation, examination and anesthetic increased,with the examination fee elevated the most (by 3.9%).The coefficient of variation(CVs) of treatment cost declined the most (- 0.360); while the CV of materials expense increased the most (0.186). CONCLUSION: There existed huge discrepancies in inpatient care for uterine leiomyoma patients. Implementation of CP-based SDP can help not only in controlling hospitalization costs of uterine leiomyoma in county-level hospitals but also in standardizing the diagnosis and treatment procedures.


Assuntos
Procedimentos Clínicos/economia , Hospitalização/economia , Leiomioma/economia , Sistema de Fonte Pagadora Única/economia , Neoplasias Uterinas/economia , China , Feminino , Custos de Cuidados de Saúde , Gastos em Saúde , Custos Hospitalares , Hospitais , Hospitais de Condado/economia , Humanos , Leiomioma/terapia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Saúde da População Rural/economia , Neoplasias Uterinas/terapia
14.
Public Health ; 163: 141-152, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30193174

RESUMO

OBJECTIVES: Healthcare systems worldwide are actively exploring new approaches for cost containment and efficient use of resources. Currently, in a number of countries, the critical decision to introduce a single-payer over a multipayer healthcare system poses significant challenges. Consequently, we have systematically explored the current scientific evidence about the impact of single-payer and multipayer health systems on the areas of equity, efficiency and quality of health care, fund collection negotiation, contracting and budgeting health expenditure and social solidarity. STUDY DESIGN: This is a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS: A search for relevant articles published in English was performed in March 2015 through the following databases: Excerpta Medica Databases, Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online through PubMed and Ovid, Health Technology Assessment Database, Cochrane database and WHO publications. We also searched for further articles cited by eligible papers. RESULTS: A total of 49 studies were included in the analysis; 34 studied clinical outcomes of patients enrolled in different health insurances, while 15 provided a qualitative assessment in this field. CONCLUSION: The single-payer system performs better in terms of healthcare equity, risk pooling and negotiation, whereas multipayer systems yield additional options to patients and are harder to be exploited by the government. A multipayer system also involves a higher administrative cost. The findings pertaining to the impact on efficiency and quality are rather tentative because of methodological limitations of available studies.


Assuntos
Assistência à Saúde/economia , Seguro Saúde/estatística & dados numéricos , Sistema de Fonte Pagadora Única , Equidade em Saúde , Humanos , Cobertura Universal do Seguro de Saúde
15.
Ann Intern Med ; 169(5): 353-354, 2018 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-30178011
16.
17.
JAMA Intern Med ; 178(9): 1250-1255, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30083756

RESUMO

With single-payer public health insurance again on the political radar in the United States at both the state (California) and federal (Democrat party) levels, the performance of the Canadian health care system during the last 50 years and the lessons it may offer should be considered. Canadians are proud of their universal approach to health insurance based on need rather than income. The system has many strengths, such as the ease of obtaining care, relatively low costs, and low administrative costs, with effectiveness and safety roughly on par with other countries, including those, such as the United States, that spend considerably more per capita. There are increasing frustrations, however, with system performance, especially with issues related to access and coordination of care. Medicine has changed dramatically since the introduction of Canadian Medicare in the late 1960s, which primarily covered acute care physician and hospital services-the needs of the time. Meaningful reforms that match coverage and services to changing needs, especially those of community-based patients with multiple chronic conditions, have been difficult to implement. The status quo represents a compromise struck decades ago between payers and physicians and organizations that provide health care, and the current system works just well enough for those who both need it and vote. Enacting substantial change simply carries too much risk. Perhaps the most important lesson that the United States can learn from Canada's experience during the last 50 years is that a single-payer health care system solves a lot of problems, but it does not equate to an integrated, well-managed system that can readily meet the changing health care needs of a population.


Assuntos
Acesso aos Serviços de Saúde/economia , Seguro Saúde/economia , Sistema de Fonte Pagadora Única/organização & administração , Canadá , Humanos
18.
Int J Med Inform ; 116: 18-23, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29887231

RESUMO

OBJECTIVE: Taiwan's single health insurer introduced a medication record exchange platform, the PharmaCloud program, in 2013. This study aimed to evaluate the effects of the medication record inquiry rate on medication duplication among patients with diabetes. MATERIALS AND METHODS: A retrospective pre-post design with a comparison group was conducted using nationwide health insurance claim data of diabetic patients from 2013 to 2014. Patients whose medication record inquiry rate fell within the upper 25th percentile were classified as the high-inquiry group, and the others as the low-inquiry group. The dependent variables were the likelihood of receiving duplicated medication and the overlapped medication days of the study subjects. Generalized estimation equations with difference-in-difference analysis were calculated to examine the net effect of the PharmaCloud inquiry rate for a matched sub-sample. RESULTS: In total, 106,508 patients with diabetes were randomly selected. From 2013 to 2014, the medication duplication rate was reduced 7.76 percentile (54.12%-46.36%) for the high-inquiry group and 9.58 percentile (63.72%-54.14%) for the low-inquiry group; the average medication overlap periods were shortened 4.36 days (8.49-4.13) and 6.29 days (11.28-4.99), respectively. The regression models showed patients in the high-inquiry group were more likely to receive duplicated medication (OR = 1.11, 95% C.I. = 1.07-1.16) and with longer overlapped days (7.53%, P = 0.0081) after the program. CONCLUSION: The medication record sharing program has reduced medication duplication among diabetes patients. However, higher inquiry rate did not lead to greater reduction in medication duplication; the overall effect might be due to enhanced internal control via prescription alert system in hospitals rather physician's review of the records.


Assuntos
Diabetes Mellitus/tratamento farmacológico , Registros Médicos , Sistema de Fonte Pagadora Única , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan
19.
Int J Health Serv ; 48(3): 568-585, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29925286

RESUMO

Described as "universal prepayment," the national health insurance (or single-payer) model of universal health coverage is increasingly promoted by international actors as a means of raising revenue for health care and improving social risk protection in low- and middle-income countries. Likewise, in the United States, the recent failed efforts to repeal and replace the Affordable Care Act have renewed debate about where to go next with health reform and arguably opened the door for a single-payer, Medicare-for-All plan, an alternative once considered politically infeasible. Policy debates about single-payer or national health insurance in the United States and abroad have relied heavily on Canada's system as an ideal-typical single-payer system but have not systematically examined health system performance indicators across different universal coverage models. Using available cross-national data, we categorize countries with universal coverage into those best exemplifying national health insurance (single-payer), national health service, and social health insurance models and compare them to the United States in terms of cost, access, and quality. Through this comparison, we find that many critiques of single-payer are based on misconceptions or are factually incorrect, but also that single-payer is not the only option for achieving universal coverage in the United States and internationally.


Assuntos
Custos de Cuidados de Saúde , Acesso aos Serviços de Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Sistema de Fonte Pagadora Única/organização & administração , Cobertura Universal do Seguro de Saúde/organização & administração , Acesso aos Serviços de Saúde/economia , Humanos , Modelos Organizacionais , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/organização & administração , Satisfação do Paciente , Qualidade da Assistência à Saúde/economia , Sistema de Fonte Pagadora Única/economia , Estados Unidos , Cobertura Universal do Seguro de Saúde/economia
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