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1
Farrow, Freeman L. « The Anti-Patient Psychology of Health Courts : Prescriptions from a Lawyer-Physician ». American Journal of Law & ; Medicine 36, no 1 (mars 2010) : 188–220. http://dx.doi.org/10.1177/009885881003600104.
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Critics of the current medical malpractice tort system claim that adjudication of malpractice claims before generalist judges and lay juries contributes to rising costs of medical malpractice insurance premiums and medical care. They claim that properly deciding issues in this realm requires specialized knowledge of medicine and medical technology that juries, and even judges of general jurisdiction, do not possess. One lobbying group alleges there is a continuing medical malpractice litigation crisis in the United States, evidenced by increasing medical costs, deaths from needless medical errors, departure of physicians from the practice of medicine due to increasing medical malpractice insurance premiums, and random medical justice in medical malpractice cases. Whether there is a direct, causal correlation between the increasing cost of medical malpractice insurance premiums and medical malpractice litigation is debatable.
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Parker, Christine W. « Practice Guidelines and Private Insurers ». Journal of Law, Medicine & ; Ethics 23, no 1 (1995) : 57–61. http://dx.doi.org/10.1111/j.1748-720x.1995.tb01331.x.
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Practice guidelines are an increasingly relevant feature of health insurance. One hundred and seventy-eight million people in the United States have some form of private health insurance coverage; coverage for 150 million of them is employment-related. Traditionally, this coverage was provided by employers purchasing a group contract under which an insurance carrier provided indemnity coverage for employees—that is, the insurance company paid all usual, customary, and reasonable charges incurred by an employee for medical care, subject in some cases to an annual deductible and to a percentage of covered expenses, co-paid by the employee, for each service. In recent years, however, employers in greater numbers have switched to so-called self-insurance plans in which employees’ health care claims are paid directly by the employer (although an insurance company or other third party may be retained to administer the claim payment process).
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Williams, Jackson. « Health Insurance in an Era of Declining Social Capital ». World Affairs 183, no 4 (17 novembre 2020) : 343–58. http://dx.doi.org/10.1177/0043820020964220.
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Putnam’s seminal work on social capital focused on early forms of health insurance as both a result, and accelerator, of the norms of reciprocity and social trust that foster cooperation. Yet, while social capital has been studied as a factor supporting community-based health insurance in developing countries, there has been no analysis of its role in U.S. health insurance. With repeal of the mandate to carry health insurance, this product is once again a purely voluntary purchase, and bears analysis as a cooperation problem. Putnam later documented a sharp decline in social capital in the United States. If social capital undergirds participation in health insurance, we can expect reduced reciprocity to lower willingness to cross-subsidize the sick. Waning social capital could also manifest itself in reduced trust that other healthy people will purchase insurance and lack of trust in the providers and manufacturers who make claims on the insurance pool.
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Heller, Thomas Allan. « An Overview of Medical Malpractice Law in the United States Including Legislative and the Health Care Industry’s Responses to Increased Claims ». Medicine, Law & ; Society 10, no 2 (25 octobre 2017) : 139–63. http://dx.doi.org/10.18690/2463-7955.10.2.139-163.2017.
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Medical Malpractice claims are frequently asserted in the United States. At various time and places, an extraordinarily high number of claims and payouts led to what some have called medical malpractice crises. Consequently, in some geographical locations physicians either could not purchase malpractice insurance as carriers withdrew from the market, or, insurance became increasingly expensive and the overall costs associated with the delivery of health care continued to rise. Other undesirable consequences of these crises included a shortage of qualified physicians in certain parts of the country. Many of the states responded to these problems legislatively through a long series of tort reform measures. The health care industry itself has evolved in numerous ways. In particular, many health care providers have turned away from traditional private insurance models to self-insured models such as captives. Further, the industry has continued to consolidate, with fewer, but larger hospitals and clinics, and with an increasing number of physicians employed directly by hospitals and large clinics. The results of all of these changes have had mixed results.
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Unalp-Arida, Aynur, et Constance E. Ruhl. « Burden of gallstone disease in the United States population : Prepandemic rates and trends ». World Journal of Gastrointestinal Surgery 16, no 4 (27 avril 2024) : 1130–48. http://dx.doi.org/10.4240/wjgs.v16.i4.1130.
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BACKGROUND Gallstone disease is one of the most common digestive disorders in the United States and leads to significant morbidity, mortality, and health care utilization. AIM To expand on earlier findings and investigate prepandemic rates and trends in the gallstone disease burden in the United States using national survey and claims databases. METHODS The National Ambulatory Medical Care Survey, National Inpatient Sample, Nationwide Emergency Department Sample, Nationwide Ambulatory Surgery Sample, Vital Statistics of the United States, Optum Clinformatics® Data Mart, and Centers for Medicare and Medicaid Services Medicare 5% Sample and Medicaid files were used to estimate claims-based prevalence, medical care including cholecystectomy, and mortality with a primary or other gallstone diagnosis. Rates were age-adjusted (for national databases) and shown per 100000 population. RESULTS Gallstone disease prevalence ( claims-based, 2019) was 0.70% among commercial insurance enrollees, 1.03% among Medicaid beneficiaries, and 2.09% among Medicare beneficiaries and rose over the previous decade. Recently, in the United States population, gallstone disease contributed to approximately 2.2 million ambulatory care visits, 1.2 million emergency department visits, 625000 hospital discharges, and 2000 deaths annually. Women had higher medical care rates with a gallstone disease diagnosis, but mortality rates were higher among men. Hispanics had higher ambulatory care visit and hospital discharge rates compared with Whites, but not mortality rates. Blacks had lower ambulatory care visit and mortality rates, but similar hospital discharge rates compared with whites. During the study period, ambulatory care and emergency department visit rates with a gallstone disease diagnosis rose, while hospital discharge and mortality rates declined. Among commercial insurance enrollees, rates were higher compared with national data for ambulatory care visits and hospitalizations, but lower for emergency department visits. Cholecystectomies performed in the United States included 605000 ambulatory laparoscopic, 280000 inpatient laparoscopic, and 49000 inpatient open procedures annually. Among commercial insurance enrollees, rates were higher compared with national data for laparoscopic procedures. CONCLUSION The gallstone disease burden in the United States is substantial and increasing, particularly among women, Hispanics, and older adults with laparoscopic cholecystectomy as the mainstay treatment. Current practice patterns should be monitored for better health care access.
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Hodge, James G., Erin C. Fuse Brown, Daniel G. Orenstein et Sarah O'Keefe. « Congress, Courts, and Commerce : Upholding the Individual Mandate to Protect the Public's Health ». Journal of Law, Medicine & ; Ethics 39, no 3 (2011) : 394–400. http://dx.doi.org/10.1111/j.1748-720x.2011.00609.x.
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Despite historic efforts to enact the Patient Protection and Affordable Care Act (PPACA) in 2010, national health reform is threatened by multiple legal challenges grounded in constitutional law. Premier among these claims is the premise that PPACA’s “individual mandate” (requiring all individuals to obtain health insurance by 2014 or face civil penalties) is constitutionally infirm. Attorneys General in Virginia and Florida (joined by 25 other states) allege that Congress’ interstate commerce powers do not authorize federal imposition of the individual mandate because Congress lacks the power to regulate commercial “inactivity.” Stated simply, Congress cannot regulate individuals who choose not to obtain health insurance because they are not engaged in a commercial venture. Several courts initially considering this argument have rejected it, but two federal district courts in Virginia and Florida have concurred, leading to numerous appeals and the near promise of United States Supreme Court review.
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Nelson, Lorene M., Mitchell T. Wallin, Ruth Ann Marrie, W. J. Culpepper, Annette Langer-Gould, Jon Campbell, Stephen Buka et al. « A new way to estimate neurologic disease prevalence in the United States ». Neurology 92, no 10 (15 février 2019) : 469–80. http://dx.doi.org/10.1212/wnl.0000000000007044.
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ObjectiveConsiderable gaps exist in knowledge regarding the prevalence of neurologic diseases, such as multiple sclerosis (MS), in the United States. Therefore, the MS Prevalence Working Group sought to review and evaluate alternative methods for obtaining a scientifically valid estimate of national MS prevalence in the current health care era.MethodsWe carried out a strengths, weaknesses, opportunities, and threats (SWOT) analysis for 3 approaches to estimate MS prevalence: population-based MS registries, national probability health surveys, and analysis of administrative health claims databases. We reviewed MS prevalence studies conducted in the United States and critically examined possible methods for estimating national MS prevalence.ResultsWe developed a new 4-step approach for estimating MS prevalence in the United States. First, identify administrative health claim databases covering publicly and privately insured populations in the United States. Second, develop and validate a highly accurate MS case-finding algorithm that can be standardly applied in all databases. Third, apply a case definition algorithm to estimate MS prevalence in each population. Fourth, combine MS prevalence estimates into a single estimate of US prevalence, weighted according to the number of insured persons in each health insurance segment.ConclusionsBy addressing methodologic challenges and proposing a new approach for measuring the prevalence of MS in the United States, we hope that our work will benefit scientists who study neurologic and other chronic conditions for which national prevalence estimates do not exist.
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Xu, Xiao, Stephen J. Spurr, Bin Nan et A. Mark Fendrick. « The effect of medical malpractice liability on rate of referrals received by specialist physicians ». Health Economics, Policy and Law 8, no 4 (26 mars 2013) : 453–75. http://dx.doi.org/10.1017/s1744133113000157.
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AbstractUsing nationally representative data from the United States, this paper analyzed the effect of a state's medical malpractice environment on referral visits received by specialist physicians. The analytic sample included 12,839 ambulatory visits to specialist care doctors in office-based settings in the United States during 2003–2007. Whether the patient was referred for the visit was examined for its association with the state's malpractice environment, assessed by the frequency and severity of paid medical malpractice claims, medical malpractice insurance premiums and an indicator for whether the state had a cap on non-economic damages. After accounting for potential confounders such as economic or professional incentives within practices, the analysis showed that statutory caps on non-economic damages of $250,000 were significantly associated with lower likelihood of a specialist receiving referrals, suggesting a potential impact of a state's medical malpractice environment on physicians’ referral behavior.
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Eppink, Samuel T., Sagar Kumar, Kathryn Miele et Harrell W. Chesson. « Lifetime Medical Costs of Genital Herpes in the United States : Estimates From Insurance Claims ». Sexually Transmitted Diseases 48, no 4 (26 janvier 2021) : 266–72. http://dx.doi.org/10.1097/olq.0000000000001371.
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Owusu-Edusei, Kwame, Camille E. Introcaso et Harrell W. Chesson. « Hospitalization Cost of Congenital Syphilis Diagnosis From Insurance Claims Data in the United States ». Sexually Transmitted Diseases 40, no 3 (mars 2013) : 226–29. http://dx.doi.org/10.1097/olq.0b013e31827c5b9f.
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Isenhour, Cheryl J., Samuel J. Crowe et Lucy A. McNamara. « Differences in meningococcal disease incidence by health insurance type and among persons experiencing homelessness—United States, 2016–2019 ». PLOS ONE 18, no 10 (19 octobre 2023) : e0293070. http://dx.doi.org/10.1371/journal.pone.0293070.
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Meningococcal disease is a serious but rare disease in the United States. Prior publications suggest incidence differs among privately vs publicly-insured persons, and that incidence is higher among persons experiencing homelessness (PEH) than persons not known to be experiencing homelessness (non-PEH). Using insurance claims data for persons aged <1 to 64 years, we calculated meningococcal disease incidence among a population with employer-sponsored commercial insurance and persons enrolled in state Medicaid programs nationwide. We also examined meningococcal disease incidence by PEH status in Medicaid data. From 2016 through 2019, persons who met our study inclusion criteria contributed a total of 84,460,548 person-years (PYs) to our analysis of commercial insurance data and 253,496,622 PYs to our analysis of Medicaid data. Incidence was higher among persons enrolled in Medicaid (0.12 cases per 100,000 PYs) than persons with commercial insurance (0.06 cases per 100,000 PYs). Incidence was 3.17 cases per 100,000 PYs among PEH in Medicaid, 27 times higher than among non-PEH in Medicaid. Understanding the underlying drivers of the higher meningococcal disease incidence among PEH and persons enrolled in Medicaid may inform prevention strategies for populations experiencing a higher burden of disease.
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Carroll, Aaron E., Parul Divya Parikh et Jennifer L. Buddenbaum. « The Impact of Defense Expenses in Medical Malpractice Claims ». Journal of Law, Medicine & ; Ethics 40, no 1 (2012) : 135–42. http://dx.doi.org/10.1111/j.1748-720x.2012.00651.x.
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Whenever health care reform is debated, the state of the medical professional liability (MPL) system (i.e., medical malpractice system) in the United States re-emerges as an issue of importance. What exactly is broken with the MPL system and what the implications are is a point of contention among different stakeholder groups. Recent data demonstrate that medical liability premiums have been improving in recent years and the majority of premiums remained flat in 2010. General agreement still exists, however, that medical professional liability insurance premiums have become unaffordable for many physicians, and coverage has become less available, especially for certain medical specialties and in specific areas of the country.Multiple factors go into the determination of medical professional liability insurance premiums including return on investments, reinsurance costs, claims frequency, average amount paid out on malpractice claims, defense expenses, and administrative costs such as underwriting expense.
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Merrill, Ray M. « Medical Claims According to Wellness Program Participation for a Large Insurance Company in the United States ». Journal of Occupational and Environmental Medicine 60, no 11 (novembre 2018) : 985–89. http://dx.doi.org/10.1097/jom.0000000000001417.
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Galaznik, A., A. Shilnikova, E. Rusli, J. Ransom, B. Lempernesse et M. Berger. « PCN93 HEALTH RESOURCE UTILIZATION IN ADVANCED OVARIAN AND ENDOMETRIAL CANCER IN A UNITED STATES INSURANCE CLAIMS DATABASE ». Value in Health 22 (novembre 2019) : S454. http://dx.doi.org/10.1016/j.jval.2019.09.290.
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Dawson, April L., Elizabeth C. Ailes, Suzanne M. Gilboa, Regina M. Simeone, Jennifer N. Lind, Sherry L. Farr, Cheryl S. Broussard et al. « Antidepressant Prescription Claims Among Reproductive-Aged Women With Private Employer-Sponsored Insurance — United States 2008–2013 ». MMWR. Morbidity and Mortality Weekly Report 65, no 3 (29 janvier 2016) : 41–46. http://dx.doi.org/10.15585/mmwr.mm6503a1.
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Geyman, John P. « Myths and Memes about Single-Payer Health Insurance in the United States : A Rebuttal to Conservative Claims ». International Journal of Health Services 35, no 1 (janvier 2005) : 63–90. http://dx.doi.org/10.2190/xk59-v3cc-1f4n-1c4x.
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Wilson, Fernando A., Sankeerth Rampa, Kate E. Trout et Jim P. Stimpson. « Telehealth Delivery of Mental Health Services : An Analysis of Private Insurance Claims Data in the United States ». Psychiatric Services 68, no 12 (décembre 2017) : 1303–6. http://dx.doi.org/10.1176/appi.ps.201700017.
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S.C. « Michigan Court Clarifies Liability for COB Provisions in ERISA and Auto Plans ». Journal of Law, Medicine & ; Ethics 24, no 1 (mars 1996) : 72. http://dx.doi.org/10.1017/s1073110500004587.
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In Campbell Soup Co. v. Allstate Insurance Co. (913 F. Supp. 451 (W.D. Mich. Jan. 9, 1996)), the United States District Court for the Western District of Michigan, Southern Division, held that a health plan's coordination of benefits (COB) clause, covered under the Employee Retirement Income Security Act (ERISA), does not preempt a similar no-fault automobile insurance clause in the absence of irreconcilable conflict. The court found that ERISA's policy of shielding plans from unanticipated claims could only be furthered when the plan had expressly disavowed such claims. Because the ERISA plan in this case did not specifically subordinate itself to the no-fault policy, the district court found that the no-fault COB clause controlled. However, to escape this ruling, ERISA plans need only redraft their COB clauses specifically to disclaim liability in case of conflict with provisions of no-fault insurance policies. This caveat substantially limits the scope of the court's ruling.
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Pettingill, Bernard F., et Federico R. Tewes. « Proven Solution to Reducing Medical Malpractice Claims Nationwide ». Journal of Medical Research and Surgery 3, no 3 (28 mai 2022) : 44–45. http://dx.doi.org/10.52916/jmrs224076.
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Medical errors often lead to injury and sometimes death, as these serve as the basis for all medical malpractice claims in the United States. In 2021, over 250,000 deaths occurred as a direct result of medical errors [1]. However, one New England Journal of Medicine article reported that in 2016 a comprehensive study which analyzed 15 years of malpractice claims concluded: “Just one out of every 100 U.S. doctors is responsible for 32% of all malpractice claims that result in monetary payouts to patients” [2]. The majority of human errors that occur in medicine are unintentional. Consequently, the challenges in medical malpractice policymaking center on the interactions of three relevant systems, each with its own complex rules and regulations: health care, tort, and insurance [3].
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Marx, Grace E., Amy M. Schwartz, Camay On et Alison F. Hinckley. « 1614. Single-Dose Doxycycline as Lyme Disease Post-Exposure Prophylaxis in a National Commercial Insurance Claims Database―the United States, 2014–2017 ». Open Forum Infectious Diseases 6, Supplement_2 (octobre 2019) : S589. http://dx.doi.org/10.1093/ofid/ofz360.1478.
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Abstract Background Approximately 300,000 cases of Lyme disease occur annually in the UNITED STATES, with children aged 5–9 years disproportionately affected. A single dose of doxycycline administered within 72 hours of a high-risk tick bite is recommended for post-exposure prophylaxis (PEP) to prevent Lyme disease in areas of high incidence. However, it is not known how often or for which patients PEP is used. We aimed to describe recent patterns of single-dose doxycycline medication claims in states with high and low Lyme disease incidence, and the associated patient and prescription characteristics in a large national commercial insurance claims database. Methods Outpatient medication claims in the IBM Watson Health MarketScan Database®, a large nation-wide database of de-identified insurance claims filed between January 1, 2014–December 31, 2017 were reviewed. Claims of single-dose doxycycline were identified and associated patient demographics and medication characteristics were analyzed. Results During 2014–2017, 66,210 medication claims for single-dose doxycycline were filed by 63,112 enrollees; mean annual incidence of receiving at least one single-dose doxycycline prescription was 56 per 100,000 enrollees. Mean patient age was 43 years (IQR 33–56 years); only 8% were for children aged <18 years. About half (46%) were male patients. Most claims (71%) were made by patients residing in the 14 states with high Lyme disease incidence, defined as an average annual incidence of ≥ 10 confirmed Lyme disease cases per 100,000 population. The majority (80%) of medication claims were during the 6 months of peak tick activity (April–July for nymphal ticks and October–November for adult ticks). Conclusion Single-dose doxycycline medication claims are common in states with high Lyme disease incidence and are highest during months of peak tick activity, consistent with the assumption that most single-dose doxycycline is used for Lyme disease PEP. Use of single-dose doxycycline to prevent Lyme disease is infrequent in children, despite being a group at high risk for Lyme disease. Efforts to educate pediatric healthcare providers and parents should be made to increase Lyme disease PEP access for children. Disclosures All authors: No reported disclosures.
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Cragin, Lori A., A. Scott Laney, Cortland J. Lohff, Brennan Martin, John A. Pandiani et Lynn Z. Blevins. « Use of Insurance Claims Data to Determine Prevalence and Confirm a Cluster of Sarcoidosis Cases in Vermont ». Public Health Reports 124, no 3 (mai 2009) : 442–46. http://dx.doi.org/10.1177/003335490912400314.
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Objectives. In 2006, the Vermont Department of Health was asked to respond to a potential cluster of sarcoidosis cases related to a Vermont office building. Sarcoidosis prevalence has not been formally described for the United States. A range of <1–40/100,000 is commonly reported; however, we have not identified primary sources supporting this conclusion. Because of the wide prevalence range and lack of a local estimate, confirming existence of a cluster was difficult. Methods. We ascertained the prevalence of sarcoidosis cases in Vermont by using insurance claims data to determine whether or not a cluster of sarcoidosis cases was related to the office building. We calculated county and state annual prevalence proportions for sarcoidosis for 2004 and 2005 and annual building prevalences for 1992–2006. Results. The pooled sarcoidosis case prevalence for Vermont was 66.1/100,000. The pooled building annual prevalence (1,128/100,000) was statistically different from the county in which the building is located (odds ratio = 15.5, 95% confidence interval 3.0, 50.3). Conclusions. We reported the first statewide sarcoidosis prevalence in the United States. This prevalence exceeded previous limited and unsubstantiated U.S. reports. Even with Vermont's elevated sarcoidosis prevalence, the presence of a cluster in this building was apparent.
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Wen, Shiran. « Health insurance claim amount prediction using statistical methods ». Applied and Computational Engineering 73, no 1 (5 juillet 2024) : 94–99. http://dx.doi.org/10.54254/2755-2721/73/20240370.
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Healthcare can be costly in the United States. In 2021, the average cost of health insurance for a family of four was $22,221 per year. The average cost of health insurance for an individual was $7,739 per year (Keiser Family Foundation). With the aim of helping the public know more about what factors contribute the most to the expensive cost of their health insurance, this study conducted the analysis to identify the top contributing factors that increase health insurance claim amounts. Various statistical and machine learning tools were used to answer the proposed question: data conversion, correlation, partial correlation, k-means clustering, principal component analysis, multiple regression, lasso regression, support vector machine, and random forest. Consistent results that BMI (Body Mass Index), blood pressure, and smoking are the three variables that contribute the most to the increase in health insurance claim amount were found.
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Harris, Aaron M., Cheryl Isenhour, Sarah Schillie et Claudia Vellozzi. « Hepatitis B Virus Testing and Care among Pregnant Women Using Commercial Claims Data, United States, 2011–2014 ». Infectious Diseases in Obstetrics and Gynecology 2018 (2018) : 1–9. http://dx.doi.org/10.1155/2018/4107329.
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Introduction. Pregnant women should receive hepatitis B virus (HBV) testing with hepatitis B surface antigen (HBsAg), but it is unclear whether HBV-infected pregnant women are linked to care. Methods. We analyzed MarketScan™ commercial insurance claims. We included pregnant women, aged 10–50 years, with 42 weeks of continuous enrollment before (predelivery) and 6 months after (postdelivery) the first delivery claim for each unique pregnancy between 1/1/2011 and 6/30/2014. We identified claims for HBsAg testing by CPT code and described the care continuum among pregnancies with an associated ICD-9 HBV diagnosis code by demographic and clinical characteristics, including HBV-directed care ([HBV DNA or hepatitis B e antigen] and ALT test codes) and antiviral treatment (claims for tenofovir, entecavir, lamivudine, adefovir, or telbivudine) pre- and postdelivery. Results. There were 870,888 unique pregnancies (819,752 women) included. Before delivery, 714,830 (82%) pregnancies had HBsAg test claims, but this proportion decreased with subsequent pregnancies (p<0.0001): second (80%), third (71%), and fourth (61%). We identified 1,190 (0.14%) pregnancies with an associated HBV diagnosis code: most were among women aged ≥ 30 years (76%) residing in the Pacific (34%) or Middle Atlantic (18%) regions. Forty-two percent of pregnancies with an HBV diagnosis received HBV-directed care (42% predelivery and 39% postdelivery). Antiviral treatment was initiated before delivery in 128 (13%) of 975 pregnancies and postdelivery in 16 (1.6%) pregnancies. Conclusions. While most of these commercially insured pregnant women received predelivery HBV screening, we identified gaps in HBV testing and the HBV care continuum which highlight potential targets for public health interventions.
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Lewis, Carmen E. « Appeals Court Rejects Federal Jurisdiction over Chiropractors Challenge to Medicare Coverage – Am. Chiropractic Ass'n, Inc. v. Leavitt ». Journal of Law, Medicine & ; Ethics 34, no 2 (2006) : 472–74. http://dx.doi.org/10.1111/j.1748-720x.2006.00056.x.
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The United States Court of Appeals for the District of Columbia Circuit (“Appeals Court”) held that the district court did not have jurisdiction over the American Chiropractor's Association's (“ACA”) federal question claims brought under the Medicare Act, despite affirming the ACA's prudential standing to pursue its claims. The Appeals Court reversed the lower court's decision allowing a doctor of medicine or osteopathy to perform manual manipulations of the spine on Medicare beneficiaries to correct a subluxation.The Medicare program “subsidizes medical insurance for elderly and disabled persons.” An enrollee selects a physician or obtains medical services through a managed-care provider, such as a health maintenance organization (“HMO”).
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Hellander, Ida. « The Deepening Crisis in U.S. Health Care : A Review of Data, Spring 2008 ». International Journal of Health Services 38, no 4 (octobre 2008) : 607–23. http://dx.doi.org/10.2190/hs.38.4.b.
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This report presents information on the state of U.S. health care in early 2008. The numbers of uninsured and underinsured continue to rise, and the proportion of people covered by employer-sponsored private coverage decreases. For 29 percent of low- and middle-income households with credit card debt, medical bills are a contributor to their current balance. Health spending in the United States is on the increase, and projected spending in 2008 will consume 16.6 percent of gross domestic product. Health insurance premiums grew 78 percent between 2002 and 2007. Meanwhile, safety-net hospitals are facing deep deficits and service cuts across the country. Pharmaceutical and insurance companies spend millions lobbying Congress. Health industry CEOs continue to be richly rewarded, even as companies come under investigation or face fines for claims denials, manipulation of data, or violations of claims-handling regulations. Average monthly premiums for Medicare Part D increase while plans are reducing coverage for high-cost drugs. And research shows how private plans such as Medicare Advantage hurt Medicare. According to opinion polls, the majority of Americans and physicians support a single-payer health care system.
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Sepe-Forrest, Linnea, Richard Meraz, Brian M. D’Onofrio et Patrick D. Quinn. « 28 Mental health and antipsychotic prescription receipt among youth : A nation-wide healthcare insurance claims study ». Journal of Clinical and Translational Science 7, s1 (avril 2023) : 8. http://dx.doi.org/10.1017/cts.2023.125.
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OBJECTIVES/GOALS: In 2010, an estimated 65% of antipsychotic prescriptions were given to youth for off-label indications. It is unclear whether subsequent calls for reduced pediatric prescribing led to a decrease in off-label use. This study examined the diagnostic characteristics of the current pediatric population using antipsychotics in the United States. METHODS/STUDY POPULATION: Data from the Clinformatics Data Mart, a database containing longitudinal patient information between 2010-2019 from commercial healthcare insurance claims in the United States was used in this study. We conducted a case-control study, in which antipsychotic initiators were matched 1:1 to non-initiators on age, sex, and insurance enrollment. There were 26,375 included antipsychotic initiators with matched non-initiator controls between the ages of 6-17. Conditional logistic regression was used to examine the odds of being an antipsychotic user among those with past-year psychiatric diagnoses that have been previously found to be associated with antipsychotic use. RESULTS/ANTICIPATED RESULTS: Disorders with psychotic features were associated with the greatest differences in odds of antipsychotic prescription receipt. Specifically, children with bipolar or manic disorders had 145-fold greater odds of antipsychotic receipt than did those without bipolar or manic disorders (OR = 145.45, 95% CI = [95.64, 221.22]), whereas those with schizophrenia had 106-fold greater odds (OR = 105.89, CI = [67.40, 166.37]). However, these disorders occurred in only 12% and 8%, respectively, of the antipsychotic recipients. The most common disorders among those with antipsychotic receipt were depressive disorders and ADHD, which occurred in 46% and 43% of the recipients, respectively. Additionally, conduct disorder was present in 20% of recipients. DISCUSSION/SIGNIFICANCE: As expected, bipolar disorder and schizophrenia were strongly associated with initiation of pediatric antipsychotic treatment. Yet, most initiators did not have a diagnosis for either psychotic disorder or any other FDA-approved indications. This study highlights the critical need for further research on antipsychotic use among youth.
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Löfgren, Hans. « The economic crisis, the Pharmaceutical Benefits Scheme, and the dilemmas of medicines policy ». Australian Health Review 33, no 2 (2009) : 171. http://dx.doi.org/10.1071/ah090171.
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AS THIS SPECIAL ISSUE of Australian Health Review was finalised, the media reported daily on the global financial debacle and its deepening into a crisis in the real economy. The causes of the crisis are hazy ? but its impact, across the globe, on people?s lives is real and distressing. Many people are affected by worsening poverty and deteriorating access to health services and medicinal drugs. In the United States, unemployment often means the loss of health insurance, reinforcing risks of financial and social disaster for many families who would have previously considered themselves comfortable middle class. For those lucky enough to retain jobs, the cost of health insurance may rapidly become unaffordable; ?Healthcare a Budget-Buster for Families; Even County?s Middle Class Can?t Afford It?, ran a typical recent headline in a non-metropolitan newspaper.1 Even before the present crisis, tens of millions of Americans were excluded from health insurance. Those not excluded pay premiums to insurance companies that spend vast resources trying to insure the healthy, avoid the sick, and deny payment for claims wherever possible. Gaining power partly on a wave of resentment against the excesses of neo-liberalism, President Barak Obama has promised public health insurance for those not otherwise covered. Should this reform be successfully implemented, it will belatedly bring to US citizens a level of security approximating what Australians, and many Europeans, have had for decades.
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Kreizenbeck, Karma L., Catherine R. Fedorenko, Kristine Stickney, Cara L. McDermott, Ted Conklin, Bruce Smith, Gary H. Lyman et Scott David Ramsey. « Using cancer registry records linked with health insurance records to measure costs and services at end-of-life. » Journal of Clinical Oncology 34, no 26_suppl (9 octobre 2016) : 186. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.186.
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186 Background: Studies suggest that end-of-life (EOL) care for persons with cancer in the United States is variable and often misaligned with patient and family preferences. To better understand these issues, we developed reports on high-priority quality indicators and costs at EOL. Methods: Surveillance, Epidemiology, and End Results (SEER) records for solid tumor patients diagnosed with cancer in Western Washington state between 1/1/2007 and 12/31/2015 were linked with enrollment and claims from two regional commercial insurers. Using claims, we then developed algorithms to characterize EOL care for breast, colorectal, and non-small cell lung cancer (NSCLC), including costs of care at 90- and 30-days prior to death. Costs include all claims paid for ED, hospital, outpatient, and pharmacy care. We estimated patient out-of-pocket costs as the difference between allowed and paid claim amounts. Results: See Table. Across the largest 10 clinics in the region there was considerable variability in the average costs of cancer care in the last 90 days of life. The clinic-specific average ranged from $24,532 to $72,931 for breast cancer, $30,495 to $65,975 for colorectal cancer and $23,320 to $59,641 for NSCLC. Conclusions: At the end of life, care for patients with advanced breast, lung, and colorectal cancer is highly variable, costly to patients, and may be misaligned with the goals and preferences for patients and their family members. While the results may reflect both appropriate and unnecessary care, the large variation across clinics suggests opportunities for improvement. Further research is needed to identify factors associated with use of low-value, high-cost services at the end of life. [Table: see text]
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Nogueira, Leticia Maciel, Jason A. Efstathiou, Helmneh M. Sineshaw, K. Robin Yabroff et Ahmedin Jemal. « Trends in the use of proton beam therapy among newly diagnosed cancer patients in the United States. » Journal of Clinical Oncology 37, no 15_suppl (20 mai 2019) : 6551. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.6551.
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6551 Background: Proton Beam Therapy (PBT) is a potentially superior radiotherapy technology for tumors with complex anatomy surrounded by sensitive tissues and for childhood cancers where sparing surrounding normal tissue is better achieved than with photon radiotherapy. The first conditions for payment of PBT claims went into effect in 2009. In 2014, the American Society of Radiation Oncology categorized PBT clinical indications into Group 1, for which health insurance coverage is recommended, and Group 2, for which coverage is recommended only if additional requirements are met. Methods: We evaluated 21,920 newly diagnosed patients in the National Cancer Database (NCDB) who received PBT between 2004 and 2016. Joinpoint analyses were used to evaluate the Annual Percent Change (APC) in the number and characteristics of patients treated with PBT. Results: The number of patients treated with PBT in NCDB facilities increased from 1,114 in 2004 to 3,173 in 2016 (APC = 8.78, p < .001), due mainly to increases in Group 1 cancers after 2010 (from 271 patients in 2010 to 1,124 in 2016, APC = 26.4, p < .001). The number of Group 2 patients treated with PBT increased slower (from 937 in 2004 to 2,049 in 2016, APC = 6.1, p < .05). Breast and prostate cancers were most common, although trends varied substantially by cancer site. Between 2010 and 2016, receipt of PBT increased for breast cancer patients from 40 in 2010 to 405 in 2016 (APC = 48.5, p < .001), but decreased for prostate cancer patients from 1,205 in 2011 to 680 in 2016 (APC = -14.06, p < .001). While most of Group 1 patients had private insurance coverage (59.3% of patients treated in 2016), Medicare was the most common primary insurance type among Group 2 patients (50% of patients treated in 2016). Conclusions: The number of newly diagnosed cancer patients treated with PBT has increased between 2004 to 2016 in the US, with a sharp increase for cancers with clinical indications for health insurance coverage since 2010. While most of these patients have private insurance coverage, the steady increase in the number of patients being treated with PBT for cancers with additional requirements for health insurance coverage is primarily in those with Medicare coverage.
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Du Boff, Richard B. « The Welfare State, Pensions, Privatization : The Case of Social Security in the United States ». International Journal of Health Services 27, no 1 (janvier 1997) : 1–23. http://dx.doi.org/10.2190/5y6x-xv96-hmbc-tvcx.
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In all high-income nations, the welfare state is under challenge, with particular concern voiced about the burden of retirement pensions on the public fisc and on younger workers. The strongest drive against social insurance is taking place in the United States, which has less of it than other nations and appears to be in the best position to meet future entitlement claims. In this article, the author examines the liabilities that the U.S. Social Security system is likely to incur over the next 35 years and finds that there is little danger that the system will fall into insolvency. Privatizing Social Security is not necessary to assure the integrity of future pension benefits. Furthermore, the cost-benefit ratio of privatization appears to be unfavorable, as borne out by the mandatory private pension plan in effect in Chile. Some wealthy nations will face greater demographic strains than the United States, but all need to retain the welfare state as a foundation for future changes in the world of work.
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Haynes, George, et Tim Dunnagan. « Comparing Changes in Health Risk Factors and Medical Costs over Time ». American Journal of Health Promotion 17, no 2 (novembre 2002) : 112–21. http://dx.doi.org/10.4278/0890-1171-17.2.112.
Texte intégralRésumé :
Purpose. This study was designed to examine the association between health status/behaviors and changes in these measures over time with health costs. Design. This study employed a 6-year (1993–1998) retrospective cohort design to examine the relationship between health indicator variables, health insurance costs, and utilization. The outcome variables of interest were measures of health insurance costs and utilization of health care services. Setting. Public employer located in the northeastern United States. Subjects. In all, 1940 employees were included in the study on the basis of their membership in the worksite health plan and their having complete health indicator data collected during each of the two time periods (1993–1995 and 1996–1998). Measures. The health insurance data were obtained directly from the organization's Third Party Administrator. The health indicator variables included blood pressure, cholesterol, body mass index, and smoking status. Results. At-risk employees had a greater probability of submitting health insurance claims than did no-risk employees in approximately 70% of the 18 Major Diagnostic Codes that were examined. Higher costs were associated with the at-risk classification (mean = $3237 and median = $433) over time, and lower costs (mean = $1626 and median = $49) were associated with maintaining a no-risk status over time. Conclusions. These findings support the notions that lower health risk and maintaining a no-risk status over time are associated with lower health insurance costs.
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PAINTER, J. E., S. A. COLLIER et J. W. GARGANO. « Association between Giardia and arthritis or joint pain in a large health insurance cohort : could it be reactive arthritis ? » Epidemiology and Infection 145, no 3 (19 septembre 2016) : 471–77. http://dx.doi.org/10.1017/s0950268816002120.
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SUMMARYThis study aimed to assess the association between giardiasis and subsequent development of arthritis or joint pain using a retrospective cohort of individuals from a large administrative claims database in the United States. Using 2006–2010 data from MarketScan Commercial Claims and Encounters, we conducted a retrospective cohort study in people with an ICD-9-CM code for giardiasis (n = 3301) and persons without giardiasis (n = 14 612) individually matched on age, sex, and enrolment length. We used conditional logistic regression to model the association between giardiasis and arthritis or joint pain documented in the 6 months following initial giardiasis diagnosis or index date for matched controls. After adjusting for healthcare utilization rate, giardiasis was associated with a 51% increase in claims for arthritis or joint pain (odds ratio 1·51, 95% confidence interval 1·26–1·80). In age- and sex-stratified adjusted analyses, the association remained significant across all subgroups (age 0–19 years, age 20–64 years, males, and females). Findings from this study lend epidemiological support for the association between giardiasis and subsequent development of arthritis. Reactive arthritis might occur more frequently than has been reported in the literature. Further research is necessary to determine the mechanisms by which giardiasis could lead to arthritis.
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Wallin, Mitchell T., William J. Culpepper, Jonathan D. Campbell, Lorene M. Nelson, Annette Langer-Gould, Ruth Ann Marrie, Gary R. Cutter et al. « The prevalence of MS in the United States ». Neurology 92, no 10 (15 février 2019) : e1029-e1040. http://dx.doi.org/10.1212/wnl.0000000000007035.
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ObjectiveTo generate a national multiple sclerosis (MS) prevalence estimate for the United States by applying a validated algorithm to multiple administrative health claims (AHC) datasets.MethodsA validated algorithm was applied to private, military, and public AHC datasets to identify adult cases of MS between 2008 and 2010. In each dataset, we determined the 3-year cumulative prevalence overall and stratified by age, sex, and census region. We applied insurance-specific and stratum-specific estimates to the 2010 US Census data and pooled the findings to calculate the 2010 prevalence of MS in the United States cumulated over 3 years. We also estimated the 2010 prevalence cumulated over 10 years using 2 models and extrapolated our estimate to 2017.ResultsThe estimated 2010 prevalence of MS in the US adult population cumulated over 10 years was 309.2 per 100,000 (95% confidence interval [CI] 308.1–310.1), representing 727,344 cases. During the same time period, the MS prevalence was 450.1 per 100,000 (95% CI 448.1–451.6) for women and 159.7 (95% CI 158.7–160.6) for men (female:male ratio 2.8). The estimated 2010 prevalence of MS was highest in the 55- to 64-year age group. A US north-south decreasing prevalence gradient was identified. The estimated MS prevalence is also presented for 2017.ConclusionThe estimated US national MS prevalence for 2010 is the highest reported to date and provides evidence that the north-south gradient persists. Our rigorous algorithm-based approach to estimating prevalence is efficient and has the potential to be used for other chronic neurologic conditions.
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Birger, Maxwell, Alexander S. Kaldjian, Gregory A. Roth, Andrew E. Moran, Joseph L. Dieleman et Brandon K. Bellows. « Spending on Cardiovascular Disease and Cardiovascular Risk Factors in the United States : 1996 to 2016 ». Circulation 144, no 4 (27 juillet 2021) : 271–82. http://dx.doi.org/10.1161/circulationaha.120.053216.
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Background: Spending on cardiovascular disease and cardiovascular risk factors (cardiovascular spending) accounts for a significant portion of overall US health care spending. Our objective was to describe US adult cardiovascular spending patterns in 2016, changes from 1996 to 2016, and factors associated with changes over time. Methods: We extracted information on adult cardiovascular spending from the Institute for Health Metrics and Evaluation’s disease expenditure project, which combines data on insurance claims, emergency department and ambulatory care visits, inpatient and nursing care facility stays, and drug prescriptions to estimate >85% of all US health care spending. Cardiovascular spending (2016 US dollars) was stratified by age, sex, type of care, payer, and cardiovascular cause. Time trend and decomposition analyses quantified contributions of epidemiology, service price and intensity (spending per unit of utilization, eg, spending per inpatient bed-day), and population growth and aging to the increase in cardiovascular spending from 1996 to 2016. Results: Adult cardiovascular spending increased from $212 billion in 1996 to $320 billion in 2016, a period when the US population increased by >52 million people, and median age increased from 33.2 to 36.9 years. Over this period, public insurance was responsible for the majority of cardiovascular spending (54%), followed by private insurance (37%) and out-of-pocket spending (9%). Health services for ischemic heart disease ($80 billion) and hypertension ($71 billion) led to the most spending in 2016. Increased spending between 1996 and 2016 was primarily driven by treatment of hypertension, hyperlipidemia, and atrial fibrillation/flutter, for which spending rose by $42 billion, $18 billion, and $16 billion, respectively. Increasing service price and intensity alone were associated with a 51%, or $88 billion, cardiovascular spending increase from 1996 to 2016, whereas changes in disease prevalence were associated with a 37%, or $36 billion, spending reduction over the same period, after taking into account population growth and population aging. Conclusions: US adult cardiovascular spending increased by >$100 billion from 1996 to 2016. Policies tailored to control service price and intensity and preferentially reimburse higher quality care could help counteract future spending increases caused by population aging and growth.
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Brenner, E., X. Zhang, M. Long, M. Dubinsky et M. Kappelman. « DOP25 Contraceptive method use according to Inflammatory Bowel Disease status among young women in the United States ». Journal of Crohn's and Colitis 17, Supplement_1 (30 janvier 2023) : i88—i90. http://dx.doi.org/10.1093/ecco-jcc/jjac190.0065.
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Abstract Background Inflammatory bowel disease (IBD) and estrogen-based contraceptives both increase thromboembolism risk, leading gastroenterologists to recommend long-acting reversible contraceptives (LARCs) over estrogen-based methods for women with IBD. No study has evaluated whether young women with IBD follow this guidance, especially as many patients lack awareness of estrogen-related risks, and young women generally prefer estrogen-based methods. We evaluated contraceptive use patterns for young women with versus without IBD, including odds of estrogen-based contraceptive use. Methods Using the IQVIA Pharmetrics Plus Database, a United States (US) health insurance claims database, we identified US women ages 15-25 with ≥1 prescription contraceptive and ≥6 months continuous enrollment from enrollment start to first contraceptive code (intake period). We excluded patients with ≥1 hysterectomy/sterilization claim during intake. The independent variable was IBD diagnosis, defined as ≥3 codes for Crohn’s disease (CD) or ulcerative colitis (UC), 2 CD and/or UC codes and 1 IBD medication code, or 1 CD or UC code and 2 IBD medication codes during intake. The dependent variable was estrogen-based contraceptive use (estrogen-based contraceptive pill, patch, and ring) versus non-estrogen-based (progestin-only pill, injectable, implant, and intrauterine device [IUD]), based on the first contraceptive claim. We generated descriptive statistics for contraceptive sub-type and covariates stratified by IBD status and performed bivariate comparisons. Using multivariable logistic regression, we determined adjusted odds ratios (aOR) with 95% confidence intervals (CI) for estrogen-based contraceptive use, adjusting for age, region, year, and insurance. Results We identified 802,932 young women on contraceptives, of whom 1,083 had IBD. Demographics were similar across IBD status except more women with IBD had commercial insurance (Table). Use of the estrogen-based pill, patch, and ring was similar or marginally lower for women with IBD versus without IBD (67.6% vs 68.8%, 2.7 vs 3.1%, and 1.5 vs 1.4%). Women with IBD had a slightly higher proportion of implant use and similar IUD use versus those without IBD (16.1% vs 14.2%; 1.8% vs 1.7%,) (Table, Figure). After adjustment, young women with IBD were 0.82 times as likely to use estrogen-based contraceptives compared to those without IBD (aOR 0.82; 95% CI 0.71-0.94). Conclusion Young women with IBD on contraceptives are only slightly less likely to use estrogen-based methods as those without IBD, despite the recommendation for LARC over estrogen-based contraceptives in IBD. This finding suggests a need for reproductive health education efforts and contraceptive safety studies specific to young women with IBD.
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DaCosta Byfield, Stacey, Philip O. Buck, Cori Blauer-Peterson, Sara A. Poston, Stacey DaCosta Byfield, Philip O. Buck, Cori Blauer-Peterson et Sara A. Poston. « ReCAP : Treatment Patterns and Cost of Care Associated With Initial Therapy Among Patients Diagnosed With Operable Early-Stage Human Epidermal Growth Factor Receptor 2-Overexpressed Breast Cancer in the United States : A Real-World Retrospective Study ». Journal of Oncology Practice 12, no 2 (février 2016) : 159–60. http://dx.doi.org/10.1200/jop.2015.004747.
Texte intégralRésumé :
QUESTION ASKED: This study assessed real-world treatment patterns, health care use, and costs associated with initial treatment of resected nonmetastatic human epidermal growth factor receptor 2–overexpressing (HER2+) breast cancer in the United States. SUMMARY ANSWER: Although trastuzumab-based therapy is considered standard of care among patients with HER2+ early-stage breast cancer, approximately 28% of these patients did not receive HER2-targeted therapy; in addition, receipt of HER2-targeted therapy differed by hormone receptor status. METHODS: Oncology registry data linked to a large US commercial administrative claims database were used to identify and examine treatment patterns, health care use, and costs of commercially insured patients with operable HER2+ breast cancer during the initial phase of care. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Claims data are appropriate for evaluating treatment patterns and health care costs; however, they typically lack important clinical information (eg, history of cardiac disease) that may influence treatment decisions and, ultimately, study outcomes. The follow-up period for many patients was censored, which limited the ability to determine when the initial phase of care should be considered completed. Also, newer therapies may not have been adequately captured. For example, pertuzumab was approved for neoadjuvant use after the end of the study period. Finally, the results of this study are limited to the patient sample examined and may not be generalizable to other populations such as patients older than 65 years, those with no or different types of insurance coverage, or patients outside the United States. REAL-LIFE IMPLICATIONS: Although HER2-targeted therapy is the standard of care for patients with HER2+ breast cancer, HER2-based therapy may be underused among patients with nonmetastatic HER2+ breast cancer in the United States. [Table: see text]
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Zimmerman Savill, Kristin M., Andrew J. Klink, Djibril Liassou, Dhruv Chopra, Jalyna Laney et Ajeet Gajra. « Real-World Treatment of Patients with Large B-Cell Lymphoma in the United States with Chimeric Antigen Receptor T-Cell Therapy ». Blood 138, Supplement 1 (5 novembre 2021) : 4096. http://dx.doi.org/10.1182/blood-2021-150723.
Texte intégralRésumé :
Abstract Introduction: The advent of chimeric antigen receptor (CAR) T-cell therapy has represented one of the most innovative therapeutic advances in oncology in recent years. Impressive clinical responses to CAR T-cell therapy observed in patients in clinical trials have led to the Food and Drug Administration (FDA) approval of five CAR T-cell therapies in the US since 2017 to treat large B-cell, mantle cell, and follicular lymphomas, as well as acute lymphoblastic leukemia (ALL) and multiple myeloma. The first two CAR T-cell therapies approved by the FDA, axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel), have now been on the US market for the treatment of patients with large B-cell lymphoma (LBCL) since 2017 and 2018, respectively, allowing for assessment of their use in real-world clinical practice. Given the complex logistics of the manufacturing, distribution, administration and unique toxicity of CAR T-cell therapies, initial use was limited to larger centers with prior experience with CAR T-cell therapy clinical trials. With greater use and availability of multiple CAR T-cell therapies, real-world evaluation of the clinical profiles, treatment patterns, and outcomes of LBCL patients treated with CAR T-cell therapies may inform clinical, regulatory, and drug development decision making, ultimately helping to improve patient outcomes. This real-world claims-based study aimed to describe characteristics and treatment outcomes of patients with diffuse LBCL (DLBCL) treated with the CAR T-cell therapies axi-cel or tisa-cel in the non-trial setting. Methods: Patients with at least 1 claim for axi-cel or tisa-cel made prior to 03/31/21 and a diagnosis code of DLBCL were identified from the Symphony Integrated Dataverse (IDV), a large US claims database containing linked longitudinal prescription, medical, and hospital claims. The IDV contains claims for 280 million active unique patients representing over 63% of prescriptions with full lifecycle data, 62% of medical claims, and 25% of hospital claims volume in the US. Patients were excluded from analysis if axi-cel or tisa-cel was the first therapy identified for the patient since diagnosis of DLBCL within the claims database, if treatment was received as a part of a clinical trial, if there were no supporting claims around CAR T-cell therapy in the claims database, if next line of therapy was received within 30 days of a sole claim for axi-cel or tisa-cel, or if data supported a diagnosis of ALL. Patient characteristics and treatment patterns were summarized using descriptive statistics. Results: Among a total of 88 eligible patients with DLBCL identified in this study, 52% (n=46) received axi-cel and 48% (n=42) received tisa-cel. At the time of treatment with axi-cel or tisa-cel therapy, median patient age was 63 years (range, 20-78 years) and commercial insurance was the primary payer for 83% of patients (n=73). The majority (n=59, 67%) of patients were male. Patients with DLBCL treated with axi-cel or tisa-cel were distributed across each of the 4 US census regions, with 27% from the Northeast, 11% from the South, 32% from the Midwest, and 30% from the West. . Axi-cel or tisa-cel was received a median of 14 months following patients' initial diagnosis of DLBCL and for the majority (n=54, 61%) of patients, axi-cel or tisa-cel-related claims were associated with administration of CAR T-cell therapy in the outpatient setting (Table). Prior to axi-cel or tisa-cel, 57% of patients (n=50) received 2 or more lines of systemic therapy. Within a median follow-up period of 7.8 months, 17% of patients (n=15) received systemic therapy following axi-cel or tisa-cel treatment. Conclusions: In the first few years of US market availability, the CAR T-cell therapies axi-cel and tisa-cel have been used to treat patients with LBCL outside of the clinical trial setting. While the majority of patients in this real-world claims-based study received axi-cel or tisa-cel in an outpatient setting, hospital claims are underrepresented in the database utilized. Despite short follow-up (less than 8 months from initiation of these CAR T-cell therapies), approximately one in 6 patients appear to have relapsed disease, based on the need for subsequent systemic therapy. Further research is warranted to understand real-world clinical outcomes among patients treated with CAR T-cell therapy outside the trial setting. Figure 1 Figure 1. Disclosures Zimmerman Savill: Roche/Genentech: Ended employment in the past 24 months; Cardinal Health: Current Employment. Klink: Cardinal Health: Current Employment, Current holder of stock options in a privately-held company. Liassou: Cardinal Health: Current Employment. Chopra: Cardinal Health: Current Employment. Laney: Cardinal Health: Current Employment. Gajra: Cardinal Health: Current Employment, Current equity holder in publicly-traded company.
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Chokkalingam, Anand P., Jennifer Hayden, Jason D. Goldman, Hu Li, Julius Asubonteng, Essy Mozaffari, Christopher Bush et al. « Association of Remdesivir Treatment With Mortality Among Hospitalized Adults With COVID-19 in the United States ». JAMA Network Open 5, no 12 (1 décembre 2022) : e2244505. http://dx.doi.org/10.1001/jamanetworkopen.2022.44505.
Texte intégralRésumé :
ImportanceSARS-CoV-2, which causes COVID-19, poses considerable morbidity and mortality risks. Studies using data collected during routine clinical practice can supplement randomized clinical trials to provide needed evidence, especially during a global pandemic, and can yield markedly larger sample sizes to assess outcomes for important patient subgroups.ObjectiveTo evaluate the association of remdesivir treatment with inpatient mortality among patients with COVID-19 outside of the clinical trial setting.Design, Setting, and ParticipantsA retrospective cohort study in US hospitals using health insurance claims data linked to hospital chargemaster data from December 1, 2018, to May 3, 2021, was conducted among 24 856 adults hospitalized between May 1, 2020, and May 3, 2021, with newly diagnosed COVID-19 who received remdesivir and 24 856 propensity score–matched control patients.ExposureRemdesivir treatment.Main Outcomes and MeasuresAll-cause inpatient mortality within 28 days of the start of remdesivir treatment for the remdesivir-exposed group or the matched index date for the control group.ResultsA total of 24 856 remdesivir-exposed patients (12 596 men [50.7%]; mean [SD] age, 66.8 [15.4] years) and 24 856 propensity score–matched control patients (12 621 men [50.8%]; mean [SD] age, 66.8 [15.4] years) were included in the study. Median follow-up was 6 days (IQR, 4-11 days) in the remdesivir group and 5 days (IQR, 2-10 days) in the control group. There were 3557 mortality events (14.3%) in the remdesivir group and 3775 mortality events (15.2%) in the control group. The 28-day mortality rate was 0.5 per person-month in the remdesivir group and 0.6 per person-month in the control group. Remdesivir treatment was associated with a statistically significant 17% reduction in inpatient mortality among patients hospitalized with COVID-19 compared with propensity score–matched control patients (hazard ratio, 0.83 [95% CI, 0.79-0.87]).Conclusions and RelevanceIn this retrospective cohort study using health insurance claims and hospital chargemaster data, remdesivir treatment was associated with a significantly reduced inpatient mortality overall among patients hospitalized with COVID-19. Results of this analysis using data collected during routine clinical practice and state-of-the-art methods complement results from randomized clinical trials. Future areas of research include assessing the association of remdesivir treatment with inpatient mortality during the circulation of different variants and relative to time from symptom onset.
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Noone, Anne-Michelle, Clara J. K. Lam, Angela B. Smith, Matthew E. Nielsen, Eric Boyd, Angela B. Mariotto et Mousumi Banerjee. « Machine Learning Methods to Identify Missed Cases of Bladder Cancer in Population-Based Registries ». JCO Clinical Cancer Informatics, no 5 (juin 2021) : 641–53. http://dx.doi.org/10.1200/cci.20.00170.
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PURPOSE Population-based cancer incidence rates of bladder cancer may be underestimated. Accurate estimates are needed for understanding the burden of bladder cancer in the United States. We developed and evaluated the feasibility of a machine learning–based classifier to identify bladder cancer cases missed by cancer registries, and estimated the rate of bladder cancer cases potentially missed. METHODS Data were from population-based cohort of 37,940 bladder cancer cases 65 years of age and older in the SEER cancer registries linked with Medicare claims (2007-2013). Cases with other urologic cancers, abdominal cancers, and unrelated cancers were included as control groups. A cohort of cancer-free controls was also selected using the Medicare 5% random sample. We used five supervised machine learning methods: classification and regression trees, random forest, logic regression, support vector machines, and logistic regression, for predicting bladder cancer. RESULTS Registry linkages yielded 37,940 bladder cancer cases and 766,303 cancer-free controls. Using health insurance claims, classification and regression trees distinguished bladder cancer cases from noncancer controls with very high accuracy (95%). Bacille Calmette-Guerin, cystectomy, and mitomycin were the most important predictors for identifying bladder cancer. From 2007 to 2013, we estimated that up to 3,300 bladder cancer cases in the United States may have been missed by the SEER registries. This would result in an average of 3.5% increase in the reported incidence rate. CONCLUSION SEER cancer registries may potentially miss bladder cancer cases during routine reporting. These missed cases can be identified leveraging Medicare claims and data analytics, leading to more accurate estimates of bladder cancer incidence.
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Mahic, Milada, Ali Bozorg, Jan Rudnik, Piotr Zaremba et Anna Scowcroft. « Healthcare resource use in myasthenia gravis : a US health claims analysis ». Therapeutic Advances in Neurological Disorders 16 (janvier 2023) : 175628642211503. http://dx.doi.org/10.1177/17562864221150327.
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Background: There are limited data on the impact of myasthenia gravis (MG) on real-world healthcare resource use (HCRU) and patient burden in the United States. Objectives: This study aims to assess HCRU in patients with MG using data from a US health claims database. Design: A retrospective, database study of adult patients newly diagnosed with MG, using the IBM® MarketScan® Commercial Claims and Encounters and Medicare supplemental health insurance claims database. Methods: Patients with ⩾2 MG International Classification of Disease diagnosis codes ⩾3 months apart were followed from the date of their first MG diagnosis record or start of treatment. HCRU and use of immunoglobulins and plasma exchange during follow-up was assessed, as well as comorbidities, hospitalizations, emergency room (ER) visits, intensive care unit (ICU) admissions, and specialist visits per year after diagnosis, and compared with age- and sex-matched non-MG controls. Results: During 2010–2019, 7194 patients were followed for up to 10 years (median = 2.3 years). During follow-up, patients with MG were 2.6-fold more likely than controls to be hospitalized, and 4.5-fold more likely to be admitted to an ICU. Risk and numbers of ER admission, hospitalization, and ICU visits were the highest in the 12 months post-diagnosis of MG and were consistently higher than controls during follow-up. MG was the main cause for most hospitalizations. Conclusion: Patients with MG have higher HCRU, compared with the age- and sex-matched non-MG controls. The early years after MG diagnosis are a period of particularly high healthcare burden, with many patients requiring hospitalization and ICU care to manage serious exacerbations.
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Yang, Rundi. « A Financial Analysis and Valuation of Elevance Health, Inc. » Journal of Education, Humanities and Social Sciences 30 (19 avril 2024) : 83–90. http://dx.doi.org/10.54097/p8f0wb18.
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After the pandemic, the treatment of COVID19 and the response of “Long COVID” have brought more attention to the healthcare industry. Elevance Health, Inc. (ELV) is a United States company in the healthcare industry that provides services including insurance and managed care services. In this paper, ELV is studied using financial reports as of 31 December 2022, and information on competitors in the same industry. The company is first introduced in terms of its company profile, including its business content, strategy, and recent situation. Secondly, the accounting methods of its accounting policies for revenue recognition, medical claims payable, and intangible assets and goodwill are examined. Thereafter, based on relevant financial indicators, three companies of similar market capitalization in the same industry, CVS Health Corporation, Pfizer Inc. and McKesson Corporation, are selected for comparative analyses in four aspects: liquidity, solvency, profitability and market performance. Finally, a strategy and strengths analysis and risk prediction are conducted, and a recommendation is made on whether to buy or not to buy the company's stock.
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Valluri, S., S. D. Sullivan, S. Ramsey, C. Kreilick, S. Foltz-Boklage et B. Seal. « PCN55 Total Health Care Expenditures in Newly Diagnosed Colorectal Cancer Adults With Private Insurance in a Claims Database in the United States ». Value in Health 15, no 4 (juin 2012) : A217. http://dx.doi.org/10.1016/j.jval.2012.03.1172.
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Manchikanti, Laxmaiah. « Obamacare 2012 : Prognosis Unclear for Interventional Pain Management ». Pain Physician 5;15, no 5;9 (14 septembre 2012) : E629—E640. http://dx.doi.org/10.36076/ppj.2012/15/e629.
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The Patient Protection and Affordable Care Act (ACA), informally referred to as ObamaCare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. ACA has substantially changed the landscape of medical practice in the United States and continues to influence all sectors, in particular evolving specialties such as interventional pain management. ObamaCare has been signed into law amidst major political fallouts, has sustained a Supreme Court challenge and emerged bruised, but still very much alive. While proponents argue that ObamaCare will provide insurance for almost everyone, with an improvement in the quality of and reduction in the cost of health care, opponents criticize it as being a massive bureaucracy laden with penalties and taxes, that will ultimately eliminate personal medicine and individual practices. Based on the 2 years since the passage of ACA in 2010, the prognosis for interventional pain management is unclear. The damage sustained to interventional pain management and the majority of medicine practices is irreparable. ObamaCare may provide insurance for all, but with cuts in Medicare to fund ObamaCare, a limited expansion of Medicaid, the inadequate funding of exchanges, declining employer health insurance coverage and skyrocketing disability claims, the coverage will be practically nonexistent. ObamaCare is composed of numerous organizations and bureaucracies charged with controlling the practice of medicine through the extension of regulations. Apart from cutting reimbursements and reducing access to interventional pain management, administration officials are determined to increase the role of midlevel practitioners and reduce the role of individual physicians by liberalizing the scope of practice regulations and introducing proposals to reduce medical education and training. Key words: Patient Protection and Affordable Care Act, ObamaCare, interventional pain management, Patient-Centered Outcomes Research Institute, Independent Payment Advisory Board, Centers for Medicare and Medicaid Services, Accountable Care Organizations, Medicare, Medicaid
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Bull-Otterson, Lara, Ya-Lin A. Huang, Weiming Zhu, Hope King, Brian R. Edlin et Karen W. Hoover. « Human Immunodeficiency Virus and Hepatitis C Virus Infection Testing Among Commercially Insured Persons Who Inject Drugs, United States, 2010–2017 ». Journal of Infectious Diseases 222, no 6 (30 janvier 2020) : 940–47. http://dx.doi.org/10.1093/infdis/jiaa017.
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Abstract Background We assessed prevalence of testing for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection among persons who inject drugs (PWID). Methods Using a nationwide health insurance database for claims paid during 2010–2017, we identified PWID by using codes from the International Classification of Diseases, Current Procedural Terminology, and National Drug Codes directory. We then estimated the percentage of PWIDs tested for HIV or HCV within 1 year of an index encounter, and we used multivariate logistic regression models to assess demographic and clinical factors associated with testing. Results Of 844 242 PWIDs, 71 938 (8.5%) were tested for HIV and 65 188 (7.7%) were tested for HCV infections. Missed opportunities were independently associated with being male (odds ratios [ORs]: HIV, 0.50 [95% confidence interval {CI}, 0.49–0.50], P < .001; HCV, 0.66 [95% CI, 0.65–0.72], P < .001), rural residence (ORs: HIV, 0.67 [95% CI, 0.65–0.69], P < .001; HCV, 0.75 [95% CI, 0.73–0.77], P < .001), and receiving services for skin infections or endocarditis (adjusted ORs: HIV, 0.91 [95% CI, 0.87–0.95], P < .001; HCV, 0.90 [95% CI, 0.86–0.95], P < .001). Conclusions Approximately 90% of presumed PWIDs missed opportunities for HIV or HCV testing, especially male rural residents with claims for skin infections or endocarditis, commonly associated with injection drug use.
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Malik, G., C. H. Tsai et S. E. Congly. « A101 TRENDS IN MEDICAID SPENDING FOR HEPATITIS C TREATMENT FROM 2012-2021 ». Journal of the Canadian Association of Gastroenterology 7, Supplement_1 (14 février 2024) : 73–74. http://dx.doi.org/10.1093/jcag/gwad061.101.
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Abstract Background Hepatitis C virus (HCV) infection is a pervasive disease that reduces quality and quantity of life. Medicaid is the largest health insurance program in the United States that provides coverage to individuals with low income including children, pregnant individuals, and people with disabilities. Due to the impact of HCV on individuals and the world goal for elimination of HCV by 2030, an analysis of healthcare costs attributed to hepatitis C medications is imperative to guide further policy and coverage changes. Aims To analyze Medicaid spending and utilization for hepatitis C treatment from 2012 to 2021 and provide a reflection on the impact it has on healthcare costs in the USA. Methods The Centers for Medicare & Medicaid Services public database was accessed to obtain Medicaid spending on Hepatitis C medications from 2012-2021. Data extracted included brand and generic drugs to treat HCV, total annual spending, total dosage units prescribed, total number of claims, and average spending per dosage unit and claim. Microsoft Excel was used for data analysis and creation of graphs. Results A total of 20 oral medications were included in this study. Total spending on all medications per year increased from $184 million in 2012 and peaked in 2016 at $3.3 billion. In 2021, the highest amount of Medicaid spending was on Mavyret ($658 million) followed by generic sofosbuvir-velpatasvir ($389 million) and Epclusa ($262 million). The total number of claims decreased from 135,542 in 2012 to 121,101 in 2021 with a peak in 2016 at 159,826. During the same time, the average spending per claim increased from 2012 ($6,518) to 2021 ($146,792). In 2021, the highest average spending per claim was seen with Harvoni ($30,941) followed by Sovaldi ($27,247), Vosevi ($23,877), and Epclusa ($22,917). In the same year, Mavyret had the greatest number of claims at 51,500 followed by generic sofosbuvir-velpatasvir (50,115), Epclusa (11,437), and Vosevi (2,177). Conclusions Despite the number of claims declining from 2012 to 2021, the average spending has increased due to the significant cost of HCV medications on Medicaid spending. The highest spending was noted to be with originator medications while generic formulations had the highest number of claims. Understanding the trends in spending on HCV medications can help guide insurance coverage changes for those depending on Medicaid. Lastly, shifting policies towards increased use of generic medications can help with increasing access and reducing costs to the population. Figure 1. Total annual spending per year in billions ($ USD, blue bars) and total number of claims (orange line) per year from 2012 to 2021. Funding Agencies None
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Wilkinson, D. Andrew, Kyle Johnson, Hugh J. L. Garton, Karin M. Muraszko et Cormac O. Maher. « Trends in surgical treatment of Chiari malformation Type I in the United States ». Journal of Neurosurgery : Pediatrics 19, no 2 (février 2017) : 208–16. http://dx.doi.org/10.3171/2016.8.peds16273.
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OBJECTIVE The goal of this analysis was to define temporal and geographic trends in the surgical treatment of Chiari malformation Type I (CM-I) in a large, privately insured health care network. METHODS The authors examined de-identified insurance claims data from a large, privately insured health care network of over 58 million beneficiaries throughout the United States for the period between 2001 and 2014 for all patients undergoing surgical treatment of CM-I. Using a combination of International Classification of Diseases (ICD) diagnosis codes and Current Procedural Terminology (CPT) codes, the authors identified CM-I and associated diagnoses and procedures over a 14-year period, highlighting temporal and geographic trends in the performance of CM-I decompression (CMD) surgery as well as commonly associated procedures. RESULTS There were 2434 surgical procedures performed for CMD among the beneficiaries during the 14-year interval; 34% were performed in patients younger than 20 years of age. The rate of CMD increased 51% from the first half to the second half of the study period among younger patients (p < 0.001) and increased 28% among adult patients between 20 and 65 years of age (p < 0.001). A large sex difference was noted among adult patients; 78% of adult patients undergoing CMD were female compared with only 53% of the children. Pediatric patients undergoing CMD were more likely to be white with a higher household net worth. Regional variability was identified among rates of CMD as well. The average annual rate of surgery ranged from 0.8 surgeries per 100,000 insured person-years in the Pacific census division to 2.0 surgeries per 100,000 insured person-years in the East South Central census division. CONCLUSIONS Analysis of a large nationwide health care network showed recently increasing rates of CMD in children and adults over the past 14 years.
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Chasteen, Joseph E., Gretchen Murphy, Arden Forrey et David Heid. « The Health Insurance Portability & ; Accountability Act and the Practice of Dentistry in the United States : Electronic Transactions ». Journal of Contemporary Dental Practice 4, no 4 (2003) : 108–20. http://dx.doi.org/10.5005/jcdp-4-4-108.
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Abstract This article reviews the kinds of electronic transactions required under the Health Insurance Portability & Accountability Act (HIPAA) and relates them to relevant data contained in an electronic oral health record (EOHR). It also outlines the structure of HIPAA transactions using the claim transaction as an example. The relationship of the HIPAA resource management function to those of patient care are discussed. The discussion points out potential future uses of other existing resource management transactions to realize the maximum potential of linking the primary patient care functions to those functions related to managing resources in support of that care. This is needed in all aspects of oral health using the informatics standards activities in which the American Dental Association (ADA) actively participates. The article concludes by providing the dentist a perspective on how to relate these capabilities to his/her individual practice setting. Citation Chasteen JE, Murphy G, Forrey A, et. al. The Health Insurance Portability & Accountability Act and the Practice of Dentistry in the United States: Electronic Transactions. J Contemp Dent Pract 2003 November;(4)4: 108-120.
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McDermott, Cara L., Catherine Fedorenko, Karma Kreizenbeck, Qin Sun, Bruce Smith, J. Randall Curtis, Ted Conklin et Scott D. Ramsey. « End-of-Life Services Among Patients With Cancer : Evidence From Cancer Registry Records Linked With Commercial Health Insurance Claims ». Journal of Oncology Practice 13, no 11 (novembre 2017) : e889-e899. http://dx.doi.org/10.1200/jop.2017.021683.
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Purpose: Despite guidelines emphasizing symptom management over aggressive treatment, end-of-life care for persons with cancer in the United States is highly variable. In consultation with a regional collaboration of patients, providers, and payers, we investigated indicators of high-quality end-of-life care to describe patterns of care, identify areas for improvement, and inform future interventions to enhance end-of-life care for patients with cancer. Methods: We linked insurance claims to clinical information from the western Washington SEER database. We included persons ≥ 18 years of age who had been diagnosed with an invasive solid tumor between January 1, 2007, and December 31, 2015, and who had a recorded death date, were enrolled in a commercial plan for the last month of life, and made at least one insurance claim in the last 90 days of life. Results: In the last month of life, among 6,568 commercially insured patients, 56.3% were hospitalized and 48.6% underwent at least one imaging scan. Among patients younger than 65 years of age, 31.4% were enrolled in hospice; of those younger than 65 years of age who were not enrolled in hospice, 40.5% had received an opioid prescription. Over time, opioid use in the last 30 days of life among young adults not enrolled in hospice dropped from 44.7% in the period 2007 to 2009 to 42.5% in the period 2010 to 2012 and to 36.7% in the period 2013 to 2015. Conclusion: Hospitalization and high-cost imaging scans are burdensome to patients and caregivers at the end of life. Our findings suggest that policies that facilitate appropriate imaging, opioid, and hospice use and that encourage supportive care may improve end-of-life care and quality of life.
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Cahill, Michael T., et Peter D. Jacobson. « Pegram’s Regress : A Missed Chance for Sensible Judicial Review of Managed Care Decisions ». American Journal of Law & ; Medicine 27, no 4 (2001) : 421–38. http://dx.doi.org/10.1017/s0098858800008200.
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Managed care was designed to bring stability and balance to healthcare delivery in the United States, but its experience in the legal system has involved only moderate stability and very little balance. There has been a trend toward broad deference to the industry, so that managed care organizations (MCOs) are largely immune from liability. At the same time, some courts have suggested that the entire managed care model rests on sketchy legal ground. Meanwhile, commentators have disagreed on such fundamental questions as whether legal disputes arising under managed care should be resolved according to contract law or tort law. Moreover, the extent to which the Employee Retirement Income Security Act of 1974 (ERISA) governs, or moots, patients’ claims against MCOs has never been entirely clear—and because ERISA controls a vast number of health insurance plans, this legal issue is extremely significant.
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Gross, Alan E., Katie J. Suda, Jifang Zhou, Gregory Calip, Susan A. Rowan, Ronald Hershow, Rose Perez, Charlesnika T. Evans et Jessina C. McGregor. « 1895. Serious Antibiotic-Related Adverse Effects Following Unnecessary Dental Prophylaxis in the United States ». Open Forum Infectious Diseases 6, Supplement_2 (octobre 2019) : S56. http://dx.doi.org/10.1093/ofid/ofz359.122.
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Abstract Background Dentists prescribe 10% of outpatient antibiotics in the United States, with a significant portion of these being for prophylaxis. We previously found that 80% of prescriptions for prophylaxis prescribed prior to dental visits are unnecessary; however, the sequelae of these unnecessary antibiotics have not been characterized. Our objective was to assess the harms of unnecessary antibiotic prophylaxis using Truven, a national health claims database. Methods This was a retrospective cohort study of patients with dental visits from 2011 to 2015 linked to medical and prescription claims. Patients with commercial dental insurance without a hospitalization or extra-oral infection 14 days prior to antibiotic prophylaxis (≤2 days supply dispensed within 7 days before a dental visit) were assessed for inclusion. Patients with unnecessary antibiotic prophylaxis (defined as antibiotic prophylaxis in patients who both did not undergo a procedure that manipulated the gingiva/tooth periapex and did not have an appropriate cardiac diagnosis) were included and assessed for serious antibiotic-related adverse effects (AAE). The primary endpoint was the cumulative incidence of any AAE within 14 days post-prescription (composite of allergy, anaphylaxis, C. difficile infection, or ED visit). The secondary analyses were the cumulative incidence of each individual AAE and the risk difference of the primary endpoint between amoxicillin and clindamycin. Results Of the 168,420 dental visits with antibiotic prophylaxis, 136,177 (80%) were unnecessary and included for analysis. 3.8% of unnecessary prescriptions were associated with an AAE; primary and secondary endpoints are listed in the Table. ED visits (1.2%) and new allergies (2.9%) were most frequent. Clindamycin was associated with more AAE than amoxicillin (risk difference 322.1 per 1000 person-years, 95% CI: 238.5 - 405.8). Conclusion Even though antibiotic prophylaxis is prescribed for a short duration (≤2 days), it is not without risk. Since most AAE are diagnosed in medical settings, dentists may not be aware of these adverse effects. These data provide further impetus to decrease unnecessary prescribing of antibiotic prophylaxis prior to dental procedures. Disclosures All Authors: No reported Disclosures.