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1.
BMC Res Notes ; 15(1): 5, 2022 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-35000586

RESUMO

OBJECTIVE: To provide current estimates of the number of patients with prevalent systemic lupus erythematosus (SLE) by major health insurance types in the US and to describe patient characteristics. Four large US health insurance claims databases were analyzed to represent different types of insurance coverage, including private insurance, Medicaid, and Medicare Supplemental. RESULTS: Overall unadjusted SLE prevalence per 100,000 persons in the US ranged from 150.1 (private insurance) to 252.9 (Medicare Supplemental insurance). Extrapolating to the US civilian population in 2016, we estimated roughly 345,000 to 404,000 prevalent SLE patients with private/Medicare insurance and 99,000 prevalent SLE patients with Medicaid insurance. Comorbidities, including renal failure/dialysis were commonly observed across multiple organ systems in SLE patients (8.4-21.1%). We estimated a larger number of prevalent SLE cases in the US civilian population than previous reports and observed extensive disease burden based on a 1-year cross-sectional analysis.


Assuntos
Lúpus Eritematoso Sistêmico , Medicare , Idoso , Estudos Transversais , Humanos , Seguro Saúde , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Prevalência , Estados Unidos/epidemiologia
2.
J Pediatr Orthop ; 42(2): 65-69, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34995256

RESUMO

BACKGROUND: Patients with public health insurance have greater difficulty obtaining orthopaedic care than their privately insured counterparts because of lower reimbursements. However, the relationship between insurance status and financial burden for patients and treating institutions is unknown. We compared patient medical debt and uncompensated hospital costs by insurance type for pediatric patients who received nonoperative treatment for distal radius fractures (DRFs). METHODS: We reviewed medical records of 100 pediatric patients (above 18 y) treated nonoperatively at our US academic hospital for DRFs from 2016 to 2020. Patients were grouped according to insurance type at the time of treatment: preferred-provider organization (PPO), n=30; health maintenance organization (HMO), n=29; Medicaid, n=28; and uninsured, n=13. These groups were matched by number of encounters, total original charge, and total number of charges. The primary outcomes were patient medical debt and uncompensated costs to the hospital, comprising unpaid balance, uncollectible debt, and self-adjustments offered by the hospital. χ2 tests and analysis of variance were used to compare financial outcomes among subgroups (alpha=0.05). RESULTS: Patient medical debt (ie, uncollectible debt) was generated by 20% of PPO, 7.7% of uninsured, and 6.9% of HMO patients (P=0.06). Medicaid patients generated no patient medical debt, whereas PPO patients generated a mean (±SD) of $15±$39 and HMO patients generated $26±$130, which was not significantly different than that of uninsured patients ($25±$89) (P<0.0001). Uncompensated costs were generated by 54% of uninsured, 20% of PPO, 6.9% of HMO, and 0% of Medicaid patients (P<0.0001). Uncompensated costs were the same as uncollectible debt for privately insured and Medicaid patients, whereas uninsured patients generated an additional $550±$600 from self-adjustments (P<0.0001). CONCLUSION: Unlike the Medicaid group, the privately insured and uninsured groups incurred patient medical debt and uncompensated costs after nonoperative DRF treatment. Thus, orthopaedic providers should be cost conscious with privately insured patients, while publicly insured patients may provide more consistent-albeit lower-reimbursement for the hospital. LEVEL OF EVIDENCE: Level III.


Assuntos
Medicaid , Fraturas do Rádio , Criança , Estresse Financeiro , Humanos , Cobertura do Seguro , Seguro Saúde , Pessoas sem Cobertura de Seguro de Saúde , Estados Unidos
3.
BMC Health Serv Res ; 22(1): 22, 2022 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-34983522

RESUMO

BACKGROUND: The public's perception of the health system provides valuable insights on health system performance and future directions of improvement. While China's health care reform was a response to people's discontent in the health care system due to the lack of accessibility and affordability, little is known on changes in public perception of China's health system. This paper examines trends in public perception of the health system between 2006 and 2019 and assesses determinants of public perception in China's health system. METHODS: Seven waves of the China Social Survey, a nationally representative survey, were used to examine trends in public satisfaction with health care and perceived fairness in health care. Chi-square tests were used to examine differences across waves. Logistic regression models were used to explore determinants of public perception, including variables on sociodemographic characteristics, health system characteristics, and patient experience. RESULTS: Satisfaction with health care increased from 57.76% to 77.26% between 2006 and 2019. Perceived fairness in health care increased from 49.79% to 72.03% during the same period. Both indicators showed that the major improvement occurred before 2013. Sociodemographic characteristics are weakly associated with public perception. Financial protection and perceived medical safety are strongly associated with public perception, while accessibility is weakly associated with public perception. Patient experience such as perceived affordability and quality in the last medical visit are strongly associated with public perception of the health care system, while the accessibility of the last medical visit shows no impacts. CONCLUSION: Public satisfaction on health care and perceived fairness in health care in China improved over 2006-2019. The main improvement occurred in accordance with huge financial investments in public health insurance before 2013. Financial protection and perceived quality play significant roles in determining public perception, whereas accessibility and sociodemographic characteristics have limited influence on people's perception of China's health system. To achieve higher satisfaction and a higher sense of fairness in health care, China's health system needs to continue its reforms on hospital incentives and integrated delivery system to control health expenditure and improve health care quality.


Assuntos
Reforma dos Serviços de Saúde , Satisfação Pessoal , China , Gastos em Saúde , Humanos , Seguro Saúde
4.
Int J Health Serv ; 52(1): 168-173, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34668424

RESUMO

The COVID-19 pandemic has wrought fundamental changes in the US workplace, placing employer-sponsored health insurance (ESI) in disarray. Before the pandemic, ESI was the single largest share of private health insurance in the country, including some 150 million Americans. Even before the pandemic, however, ESI had become increasingly volatile and more unaffordable for both employers and employees. During the pandemic, many workers found that they could work at home remotely. Job losses during the pandemic left many millions uninsured, with many jobs lost indefinitely. Today, many Americans are rethinking how and where they want to be involved in the workplace, while many businesses are considering a future when more people are working from home or being replaced by robots, placing ESI in further jeopardy. This article brings historical perspective to these problems, showing how the private health insurance industry has failed the public interest by being too fragmented and unreliable to be afforded or depended upon. Three major reform alternatives are described, only 1 of which-single-payer improved Medicare for All-can provide stable universal coverage that meets the needs of all Americans while being affordable for patients, families, and taxpayers.


Assuntos
COVID-19 , Planos de Assistência de Saúde para Empregados , Humanos , Cobertura do Seguro , Seguro Saúde , Medicare , Pandemias , SARS-CoV-2 , Medicina Estatal , Estados Unidos , Cobertura Universal do Seguro de Saúde
5.
Int J Health Serv ; 52(1): 89-98, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-32819182

RESUMO

This study aims to address the question: Why did transition countries enact laws related to social health insurance (SHI) at different times, even though they experienced dissolution of the Soviet Union at the same time in the early 1990s? We used Ragin's fuzzy-set qualitative comparative analysis to investigate the configurations of causal conditions that affected the speed of developing SHI-related legislation in 24 post-socialist countries. The potential causal conditions were health status, economic status, level of governance, level of democracy, issue salience, and number of medical professionals. We found 3 pathways that led to the enactment of SHI-related laws and 1 pathway that inhibits enactment. The key factors impacting enactment of SHI-related laws were non-corrupt governments and realization of democracy. In addition, medical professionals' involvement in policymaking could be the factor to enact SHI-related laws. Further research is needed for more in-depth analysis regarding what the laws specifically include, type of health insurance systems that were adopted based on the laws, and if the legislation contributed toward achieving universal health coverage.


Assuntos
Seguro Saúde , Cobertura Universal do Seguro de Saúde , Humanos , Previdência Social , Fatores Socioeconômicos , U.R.S.S.
6.
Int J Pharm Pract ; 30(1): 59-66, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34962576

RESUMO

OBJECTIVES: To determine the prescribing patterns and identify potentially inappropriate prescribing practices among general practitioners in the private primary care sector by analysing a large electronic health insurance claims database. METHODS: Medical claims records from February 2019 to February 2020 were extracted from a health insurance claims database. Data cleaning and data analysis were performed using Python 3.7 with the Pandas, NumPy and Matplotlib libraries. The top five most common diagnoses were identified, and for each diagnosis, the most common medication classes and medications prescribed were quantified. Potentially inappropriate prescribing practices were identified by comparing the medications prescribed with relevant clinical guidelines. KEY FINDINGS: The five most common diagnoses were upper respiratory tract infection (41.5%), diarrhoea (7.7%), musculoskeletal pain (7.6%), headache (6.7%) and gastritis (4.0%). Medications prescribed by general practitioners were largely as expected for symptomatic management of the respective conditions. One area of potentially inappropriate prescribing identified was inappropriate antibiotic choice. Same-class polypharmacy that may lead to an increased risk of adverse events were also identified, primarily involving multiple paracetamol-containing products, non-steroidal anti-inflammatory drugs (NSAIDs), and antihistamines. Other areas of non-adherence to guidelines identified included the potential overuse of oral corticosteroids and oral salbutamol, and inappropriate gastroprotection for patients receiving NSAIDs. CONCLUSIONS: While prescribing practices are generally appropriate within the private primary care sector, there remain several areas where some potentially inappropriate prescribing occurs. The areas identified should be the focus in continuing efforts to improve prescribing practices to obtain the optimal clinical outcomes while reducing unnecessary risks and healthcare costs.


Assuntos
Clínicos Gerais , Humanos , Prescrição Inadequada , Seguro Saúde , Malásia , Polimedicação , Padrões de Prática Médica
7.
Health Aff (Millwood) ; 41(1): 13-25, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34910596

RESUMO

US health care spending increased 9.7 percent to reach $4.1 trillion in 2020, a much faster rate than the 4.3 percent increase seen in 2019. The acceleration in 2020 was due to a 36.0 percent increase in federal expenditures for health care that occurred largely in response to the COVID-19 pandemic. At the same time, gross domestic product declined 2.2 percent, and the share of the economy devoted to health care spending spiked, reaching 19.7 percent. In 2020 the number of uninsured people fell, while at the same time there were significant shifts in types of coverage.


Assuntos
COVID-19 , Gastos em Saúde , Atenção à Saúde , Humanos , Seguro Saúde , Medicare , Pandemias/prevenção & controle , Patient Protection and Affordable Care Act , SARS-CoV-2 , Estados Unidos
8.
J Manag Care Spec Pharm ; 28(1): 85-90, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34949110

RESUMO

BACKGROUND: Community pharmacists are well positioned to improve patient access to care, which may assist value-based care programs in reaching patients. While pharmacy accessibility is broadly acknowledged, much of the research supporting accessibility claims is poor quality. OBJECTIVE: To quantify the accessibility of pharmacists in comparison with physicians or qualified health care professionals (QHP) in a commercially insured population. METHODS: IBM MarketScan claims data from 2018 were used for this cross-sectional study. Beneficiaries included in the primary analysis were aged 18-64 years, enrolled with pharmacy benefits in 2018 for 12 months, and had at least 1 valid prescription drug claim or evaluation and management (E&M) code in 2018. Unique pharmacy visits were defined using a 6-day fill window for prescription fill dates, while visits to physicians or other QHP were defined as unique service dates tied to an E&M code. We assessed differences in visit frequency for the full sample, those with multiple chronic conditions (MCC), and "superutilizers" (top 5% based on total cost of care). Our statistical approach included descriptive statistics and the Wilcoxon sign rank test. RESULTS: After applying the inclusion criteria, 11,720,958 beneficiaries were included in the full sample. The MCC cohort contained 13.8% of the total sample (mean [SD] age: 50.8 [10.8]; 908,880 [56.1%] female). Finally, the superutilizers were 57.3% female with an average age of 48.4 years and comprised 5.3% of the total sample. The median number of pharmacy and physician or QHP visits for the full sample were 5 and 3 (P < 0.0001), yielding a pharmacy to physician or QHP visit ratio of 1.7:1. The MCC cohort had a median of 13 pharmacy visits and 7 physician or QHP visits (ratio 1.9:1; P < 0.0001), and the superutilizers had a median of 14 pharmacy visits and 9 physician or QHP visits (ratio 1.6:1; P < 0.0001). CONCLUSIONS: This study found that patients visit their community pharmacies almost twice as often as they visit their physicians or other QHP. Study findings emphasize the accessibility of community pharmacists and highlight the role of community pharmacists in improving patient engagement in all care programs, including value-based care programs. DISCLOSURES: The database infrastructure used for this project was funded by the Department of Epidemiology, University of North Carolina (UNC) Gillings School of Global Public Health; the Cecil G. Sheps Center for Health Services Research, UNC; the CER Strategic Initiative of UNC's Clinical Translational Science Award (UL1TR001111); and the UNC School of Medicine. All authors are employed by the UNC School of Pharmacy. Urick declares consulting fees from Cardinal Health. The other authors have no conflicts of interest to disclose. Portions of this work were previously presented at the AMCP 2021 Virtual, April 12-16, 2021.


Assuntos
Acesso aos Serviços de Saúde , Farmacêuticos , Adolescente , Adulto , Serviços Comunitários de Farmácia , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Adulto Jovem
9.
J Manag Care Spec Pharm ; 28(1): 7-15, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34949113

RESUMO

BACKGROUND: High-deductible health plans (HDHPs) are characterized by higher deductibles and lower monthly premiums compared with a typical health plan. HDHPs may reduce, or delay, needed care, which will ultimately lead to poorer access to care for chronically affected participants. OBJECTIVES: To (1) investigate the HDHP enrollment trend and (2) determine the effects of HDHPs on financial access problems for individuals with self-reported cognitive impairment. METHODS: Data between 2010 and 2018 were obtained from the National Health Interview Survey (NHIS). Individuals with cognitive impairment were identified if they were limited by memory difficulties. Problems regarding financial access to health care were assessed based on 6 survey questions from the Centers for Disease Control and Prevention. Multivariable logistic regressions were implemented to evaluate the effects of HDHPs. RESULTS: This study identified 1,148 individuals with cognitive impairment, representing 3.9 million individuals in the United States from 2010 to 2018. A nearly 2-fold increase in HDHP enrollment with cognitive impairment was observed from 2010 (20.9%) to 2018 (41.9%). This increase is similar to that reported for noncognitively impaired individuals. After controlling for possible confounding variables, cognitively impaired individuals with HDPHs were more likely to have overall financial access difficulties compared with those without HDHPs (OR = 1.17, 95% CI = 0.88-1.56, P = 0.271), but this likelihood was not statistically significant. CONCLUSIONS: HDHPs are intended to support effective care options and reduce health care costs. However, our research found that among individuals with cognitive impairment, those with HDHPs experienced some financial access problems, such as affording medical care, follow-up care, and specialists, than those without HDHPs, indicating that HDHPs might have unintended consequences for health care usage. DISCLOSURES: No outside funding supported this study. The authors have no conflicts of interest or financial interests to disclose.


Assuntos
Disfunção Cognitiva , Dedutíveis e Cosseguros/economia , Dedutíveis e Cosseguros/tendências , Seguro Saúde/economia , Seguro Saúde/tendências , Adolescente , Adulto , Doença Crônica/tratamento farmacológico , Disfunção Cognitiva/tratamento farmacológico , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/tendências , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
10.
J Manag Care Spec Pharm ; 28(1): 26-38, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34949116

RESUMO

BACKGROUND: Most patients with schizophrenia are diagnosed in their early twenties and often have commercial insurance at diagnosis. These young adults can experience changes in insurance coverage, that is, "churn," which can lead to disruptions in care. OBJECTIVE: To examine the frequency, speed, and type of insurance churn events in a young adult schizophrenia population with commercial insurance coverage at diagnosis. METHODS: The Colorado All-Payer Claims Database, containing insurance claims data from commercial and public insurers for Colorado residents, was used for the study. Eligible patients were required to have at least 1 inpatient or 2 outpatient claims for schizophrenia or schizoaffective disorder, be of age 18-34 years at index, have previous insurance coverage for 12 consecutive months, and have commercial insurance at diagnosis. These patients were 1:5 propensity score matched (PSM) with nonschizophrenia members. Percentages of members on different insurance types were calculated monthly to assess churn events. Cohorts were compared using descriptive statistics, Cox proportional hazards, and generalized estimating equation models. RESULTS: The matched schizophrenia and nonschizophrenia cohorts comprised 501 and 2,510 members, respectively. Before PSM, cohorts were imbalanced (schizophrenia cohort had a younger median age and higher proportion of males). After matching, the cohorts were similar in terms of the matched baseline characteristics. Previous mental health disorders were more common in the schizophrenia cohort (75%) than in the nonschizophrenia cohort (26%). The proportion of members with at least 1 churn event for the schizophrenia and nonschizophrenia cohorts, respectively, were 53.8% vs 36.5% after 12 months and 84.6% vs 69.2% after 48 months. Time to first churn event was significantly shorter in the schizophrenia cohort (16 months) than the nonschizophrenia cohort (23 months; P < 0.001). Schizophrenia cohort members had 64.1 and 56.8 churn events per 1,000 members per month vs 43.0 (P ≤ 0.001) and 42.8 (P = 0.011) churn events for nonschizophrenia cohort members in the first and second 6-month periods, respectively. Proportions of members in the schizophrenia and nonschizophrenia cohorts on public insurance, respectively, were 22.9% vs 6.9% after 12 months and 52.4% and 10.7% after 48 months. In the schizophrenia cohort, the most common churn event type was from commercial to public insurance rather than to a different commercial insurance; notably, 41% of members were still on a commercial plan 4 years after diagnosis. CONCLUSIONS: Young adults with schizophrenia experienced churn events more rapidly and more frequently than those without schizophrenia for the first 4 years studied after the index date. These disruptions may be associated with reduced access to care and treatment gaps in this vulnerable patient population. DISCLOSURES: This research was sponsored by Janssen Scientific Affairs, LLC. Pesa, Benson, and Patel are employees of Janssen Scientific Affairs, LLC, and are stockholders of Johnson & Johnson. Potluri, Rotter, and Papademetriou are employees of SmartAnalyst Inc, and their work on this study was funded by Janssen Pharmaceuticals. A version of this study was presented as a poster at the Psych Congress 2020 Virtual Experience, September 10-13, 2020.


Assuntos
Cobertura do Seguro , Seguro Saúde , Esquizofrenia/tratamento farmacológico , Adolescente , Adulto , Colorado , Bases de Dados Factuais , Feminino , Custos de Cuidados de Saúde , Humanos , Cobertura do Seguro/tendências , Masculino , Pontuação de Propensão , Estudos Retrospectivos , Adulto Jovem
11.
BMC Health Serv Res ; 21(1): 1328, 2021 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-34895213

RESUMO

BACKGROUND: Health care systems around the world struggle with high prices for new cancer drugs. The purpose of this study was to conduct a gedankenexperiment and calculate how much health expenditures would change if a cure for cancer through pharmaceutical treatment were made available. The cancer cure was conceived to eliminate both cancer deaths and the underlying morbidity burden of cancer. Furthermore, the cure was hypothesized to arrive in incremental steps but at infinitesimally small time intervals (resulting, effectively, in an immediate cure). METHODS: The analysis used secondary data and was conducted from the viewpoint of the German social health insurance. As its underlying method, it used a cause-elimination life-table approach. To account for the age distribution of the population, the study weighted age-specific increases in remaining life expectancy by age-specific population sizes. It considered drug acquisition costs as well as savings and life extension costs from eliminating cancer. All cancer drugs that underwent a mandatory early benefit assessment in Germany between 2011 and 2015/16 and were granted an added benefit were included. Data on age- and gender-specific probabilities of survival, population sizes, causes of death, and health expenditures, as well as data on cancer costs were taken from the German Federal Office of Statistics and the German Federal Social Insurance Office. RESULTS: Based on the cause-elimination life-table approach and accounting for the age structure of the German population, curing cancer in Germany yields an increase in average remaining life expectancy by 2.66 life years. Based on the current incremental cost-effectiveness ratio of new cancer drugs, which is on average €101,493 per life year gained (€39,751/0.39 life years), the German social health insurance would need to pay €280,497 per insuree to eliminate cancer. Dividing this figure by current average remaining lifetime health expenditures yields a ratio of 2.07, which represents a multiplier of current health expenditures. CONCLUSIONS: Eliminating cancer at current price levels would more than triple total health expenditures in Germany. As the current price of a cure requires a drastic reduction of non-health consumption, it appears that current prices for cancer drugs already on the market (i.e., small steps towards a cure) need careful reconsideration.


Assuntos
Neoplasias , Pré-Escolar , Análise Custo-Benefício , Custos de Medicamentos , Gastos em Saúde , Humanos , Seguro Saúde , Neoplasias/tratamento farmacológico , Neoplasias/epidemiologia
12.
Pan Afr Med J ; 40: 127, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34909095

RESUMO

Introduction: health insurance is in the fore front of health financing and achievement of universal health coverage for all. It provides a means of coping with some of the risks faced by individuals in achieving optimal healthcare. Women are vital in the family especially when it comes to the health of their children. We therefore set out in this study to assess the healthcare payment method of women in the informal sector and their awareness of the National health insurance scheme (NHIS) in Nigeria. Methods: the study was a cross sectional descriptive survey involving women traders who were aged 18 years and above. Three hundred and fifty-three (353) womens were recruited using semi-structured interviewer questionnaire and data was analyzed using SPSS version 22. Results: the prevalence of awareness of NHIS among the women was 57.5% and educational status was contributor to awareness of the scheme. Also, only 9.9% of the women were registered under the NHIS and out of pocket payment for healthcare was practiced by as much as 88.7% of the respondents. Most respondents had poor perception about the scheme with 60% believing that the government cannot be trusted to keep its end of the bargain with regards to the NHIS. Conclusion: the need for awareness of the NHIS especially in the informal sector for women is brought to fore. The policy -makers should take into account how women in informal sectors should be captured to enrol in the NHIS in order to expand its coverage and this enrolment should be compulsory.


Assuntos
Seguro Saúde , Programas Nacionais de Saúde , Criança , Estudos Transversais , Atenção à Saúde , Feminino , Humanos , Nigéria , Percepção
13.
BMJ Open Diabetes Res Care ; 9(Suppl 1)2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34933873

RESUMO

INTRODUCTION: Access to care is essential for patients with diabetes to maintain health and prevent complications, and is important for health equity. New York State's Health Homes (HHs) provide care management services to Medicaid-insured patients with chronic conditions, including diabetes, and aim to improve quality of care and outcomes. There is inconsistent evidence on the impact of HHs, and care management programs more broadly, on access to care. RESEARCH DESIGN AND METHODS: Using a cohort of patients with diabetes derived from electronic health records from the INSIGHT Clinical Research Network, we analyzed Medicaid data for HH enrollees and a matched comparison group of HH non-enrollees. We estimated HH impacts on several access measures using natural experiment methods. RESULTS: We identified and matched 11 646 HH enrollees; patients were largely non-Hispanic Black (29.9%) and Hispanic (48.7%), and had high rates of dual eligibility (33.0%), Supplemental Security Income disability enrollment (49.1%), and multiple comorbidities. In the 12 months following HH enrollment, HH enrollees had one more month of Medicaid coverage (p<0.001) and 4.6 more outpatient visits than expected (p<0.001, evenly distributed between primary and specialty care). There were also positive impacts on the proportions of patients with follow-up visits within 7 days (4 percentage points (pp), p<0.001) and 30 days (6pp, p<0.001) after inpatient care, and on the proportion of patients with follow-up visits within 30 days after emergency department (ED) care (4pp, p<0.001). We did not find meaningful differences in continuity of care. We found small positive impacts on the proportion of patients with an inpatient visit and the proportion with an ED visit. CONCLUSIONS: New York State's HH program improved access to care for Medicaid recipients with diabetes. These findings have implications for New York State Medicaid as well as other providers and care management programs.


Assuntos
Diabetes Mellitus , Seguro Saúde , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Acesso aos Serviços de Saúde , Humanos , Medicaid , New York/epidemiologia , Estados Unidos/epidemiologia
14.
BMC Health Serv Res ; 21(1): 1362, 2021 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-34952585

RESUMO

BACKGROUND: Multidisciplinary biopsychosocial rehabilitation (MBR) is highly recommended for chronic lower back pain (CLBP) treatment, but its economic benefit remains to be clearly demonstrated. The purpose of this study is to analyse the effect of a 12-month MBR programme of behavioural change coaching and device-supported exercise on direct medical costs, sick leave and health-related quality of life (HRQOL) at 24 months. METHODS: An incremental cost-effectiveness analysis was conducted in Germany from a private health insurance perspective using data from a multi-centre, two-arm randomised controlled trial with parallel-group Zelen's randomisation and 24-month follow-up. After removing dissimilarities in characteristics between MBR and usual care (control) via propensity score matching, treatment effects were calculated using a difference-in-difference approach. RESULTS: Base-case analysis of the MBR (n=112) and usual care group (n=111) showed an incremental cost-effectiveness ratio (ICER) of €8,296 per quality-adjusted life year (QALY) gained, indicating that the intervention was cost-effective. Compared to the controls, MBR reduced economically unaccounted sick leave due to back pain in the last six months by 17.5 days (p = 0.001) and had a positive effect on health-related quality of life (HRQOL) (0.046, p=0.026). Subgroup analysis of participants with major impairment demonstrated that a dominant intervention was possible, as reflected by an ICER of - €7,302 per QALY. Savings were driven by a - €1,824 reduction in back pain-specific costs. Moreover, sick leave was 27 days (p = 0.006) less in the MBR group. CONCLUSIONS: This first cost-effectiveness study with combined data from a private health insurer and a controlled trial in Germany demonstrated that long term MBR for the treatment of CLBP is cost-effective. Subgroups with major impairment from back pain benefitted more from the intervention than those with minor impairment. MBR significantly reduced sick leave in all participants. Hence, it is a profitable intervention from a societal point of view. TRIAL REGISTRATION: The trial of the evaluation study was retrospectively registered in the German Clinical Trials Register under trial number DRKS00015463 retrospectively (dated 4 Sept 2018).


Assuntos
Dor nas Costas , Qualidade de Vida , Dor nas Costas/terapia , Análise Custo-Benefício , Alemanha , Humanos , Seguro Saúde
15.
Artigo em Inglês | MEDLINE | ID: mdl-34949006

RESUMO

Total Knee Arthroplasty (TKA) is one of the most commonly performed surgeries worldwide since it can improve pain, quality of life, and functional outcome. Due to the expansion of hospitals specialized in joint surgery, the topography of TKA implementation in Korea is changing. This study analyzed longitudinal trends of TKA based on changes in age distribution, sex, hospital, and region based on the Health Insurance Review and Assessment Service (HIRA) of Korea database. Data were collected from the National Health Insurance Service (NHIS), the Korean Statistical Information Service (KOSIS), and the Health Insurance Review and Assessment Service (HIRA) in Korea for the period 2011-2018. Results show the total number of surgeries increased and the number of patients by age decreased in those under the age of 70, while the number of patients over 70 years of age increased. A remarkable increase in women was found, and there was no significant difference between regions. TKA is spreading in a more universal and easily accessible form in Korea and has increased more in other relatively small medical institutions compared to tertiary referral medical centers. Due to the increase of orthopedics' specialized hospitals and clinics, TKA is becoming more prominent in those hospitals.


Assuntos
Artroplastia do Joelho , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Seguro Saúde , Programas Nacionais de Saúde , Qualidade de Vida
16.
Inquiry ; 58: 469580211064118, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34919462

RESUMO

Decision support techniques and online algorithms aim to help individuals predict costs and facilitate their choice of health insurance coverage. Self-reported health status (SHS), whereby patients rate their own health, could improve cost-prediction estimates without requiring individuals to share personal health information or know about undiagnosed conditions. We compared the predictive accuracy of several models: (1) SHS only, (2) a "basic" model adding health-related variables, and (3) a "full" model adding measures of healthcare access. The Medical Expenditure Panel Survey was used to predict 2015 health expenditures from 2014 data. Relative performance was assessed by comparing adjusted-R2 values and by reporting the predictive accuracy of the models for a new cohort (2015-2016 data). In the SHS-only model, those with better SHS were less likely to incur expenditures. However, after accounting for health variables, those with better SHS were more likely to incur expenses. In the full model, SHS was no longer predictive of incurring expenses. Variables indicating better access to care were associated with higher likelihood of spending and higher spending. The full model (R2 = 0.290) performed slightly better than the basic model (R2 = 0.240), but neither performed well at the upper tail of the cost distribution. While our SHS-based models perform well in the aggregate, predicting population-level risk well, they are not sufficiently accurate to guide individuals' insurance shopping decisions in all cases. Policies that rely heavily on health insurance consumers making individually optimal choices cannot assume that decision tools can accurately anticipate high costs.


Assuntos
Gastos em Saúde , Seguro Saúde , Acesso aos Serviços de Saúde , Humanos , Estudos Longitudinais , Autorrelato
17.
J Insur Med ; 49(s1): 1-31, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34788842

RESUMO

OBJECTIVE.­: To propose an insurance product called special needs insurance. The insurance will pay parents a lump sum up to $100,000 if they have a child that is born with or develops a special needs condition such as Down syndrome, cerebral palsy or autism. BACKGROUND.­: Raising a child is expensive; raising a child with a special need can be hundreds of thousands of dollars more expensive. These additional costs include direct costs that are not covered by health insurance and indirect costs such as the loss of earnings when a working parent must tend to a special needs child. METHOD.­: We analyze a gamut of birth and early childhood disabilities, both physical and cognitive, from the medico-actuarial perspective. We describe each condition using relevant medical literature and calculate prevalence rates from epidemiological studies (appendix A1-A15). After accounting for multiple births, we develop a final premium. RESULTS.­: We find that physical impairments are sufficiently well understood to guarantee a fixed payout, whereas cognitive impairments such as autism are less understood, and so for these we propose a cognitive fund that does not guarantee a fixed payout. We find that an average single premium of $4,600 allows the insurer to profitably pay out the proposed benefits. CONCLUSIONS.­: Raising a special needs child can put a significant strain on the affected family's budget. We propose an insurance product that provides relief through a large lump sum payout. Although no new insurance product can be guaranteed success, our analysis of this product gives an interested insurer reasonable justification to take on this new risk.


Assuntos
Paralisia Cerebral , Seguro Saúde , Criança , Pré-Escolar , Família , Humanos , Renda , Pais
18.
Acad Pediatr ; 21(8S): S146-S153, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34740422

RESUMO

Over the past 20 years, the United States greatly expanded eligibility for public health insurance under the Medicaid and Child Health Insurance Program programs. This expansion improved children's access to health care and their health, ultimately lowering preventable hospitalizations, chronic conditions, and mortality rates in the most vulnerable children at a cost that is 4 times lower than the average per capita cost for the elderly. They also had broader antipoverty effects, increasing economic security, children's educational attainments, and their eventual employment and earnings opportunities. However, in recent years, this progress has been rolled back in many states. Remarkably, although income eligibility cutoffs have remained largely constant, states have reduced child coverage through a number of administrative measures ranging from increased paperwork, to reduced outreach, new parental work requirements, changes to public charge rules for immigrants, and waivers of federal requirements to provide retroactive coverage to new applicants. The number of uninsured children was rising for the first time in decades even prior to the pandemic. With rising numbers who have lost their jobs in the pandemic-induced recession, it is more important than ever to defend and restore and improve access to public health insurance for our children.


Assuntos
Serviços de Saúde da Criança , Medicaid , Idoso , Criança , Saúde da Criança , Acesso aos Serviços de Saúde , Humanos , Seguro Saúde , Pobreza , Estados Unidos
19.
Yonsei Med J ; 62(12): 1155-1161, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34816646

RESUMO

PURPOSE: This study analyzed the changes in the number of surgeries and surgical patterns due to the adoption and diffusion of new medical technology while focusing on radical prostatectomy. MATERIALS AND METHODS: Medical equipment status report data and the National Health Insurance claims data from 2007 to 2019 were used. A total of 62798 radical prostatectomies from 135 medical facilities were analyzed. Radical prostatectomy was classified into open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), and robot-assisted laparoscopic radical prostatectomy (RARP) using the fee schedule codes. A linear mixed model was used to determine whether the adoption of a robotic surgical system had an effect on the number of surgeries and surgical patterns after adjusting for medical characteristics. RESULTS: The number of radical prostatectomies performed in Korea increased from 1756 in 2007 to 8475 in 2019. During this period, the proportion of RARP in total surgery increased from 17.5% to 74.3%. The mean number of surgeries at medical facilities adopting the robotic surgical system was 128.3, which was higher compared to 18.5 cases in medical facilities that did not adopt it. The adoption of a robotic surgical system increased the number of radical prostatectomy surgeries by 12.1 cases and the RARP share by 47.2% in a linear mixed model. CONCLUSION: The adoption and diffusion of robotic surgical systems in Korea increased the number of surgeries as well as the share of robotic surgery. It is necessary to manage a technology that is widely used in a state where its clinical effectiveness is uncertain.


Assuntos
Laparoscopia , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Humanos , Seguro Saúde , Masculino , Prostatectomia , Neoplasias da Próstata/cirurgia , Resultado do Tratamento
20.
Artigo em Inglês | MEDLINE | ID: mdl-34769847

RESUMO

The aim of this study was to identify regional disparities in generic drug usage and to examine related factors. The database used for the analysis was the 2018 national health insurance claims data published on the Japanese Ministry of Health, Labour, and Welfare. The drugs that were targeted were a combination of brand-name and generic tetracycline ointments for periodontal treatment and lidocaine injection solution used for dental anesthesia. The usage of generic drugs was calculated and compared by prefecture based on the number of health insurance claims. The comparison of related factors was conducted using data from other national statistical survey. The results showed that the mean generic drug usage of tetracycline for periodontal treatment in all prefectures was 71.2 ± 8.1%, ranging from 45.8% to 85.3%. The mean generic lidocaine used for dental anesthesia was 47.6 ± 10.0%, ranging from 30.5% to 66.2%. The rank correlation coefficient between the two was 0.359 (p < 0.05), and the tendency of using both generic drugs was low in major metropolitan areas. Generic drug usage in Japan is low; thus, in order to reduce healthcare costs, generic drugs need to be actively used in dentistry.


Assuntos
Medicamentos Genéricos , Custos de Cuidados de Saúde , Odontologia , Seguro Saúde , Japão
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