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Noone, Anne-Michelle, Clara J. K. Lam, Angela B. Smith, Matthew E. Nielsen, Eric Boyd, Angela B. Mariotto, and Mousumi Banerjee. "Machine Learning Methods to Identify Missed Cases of Bladder Cancer in Population-Based Registries." JCO Clinical Cancer Informatics, no. 5 (June 2021): 641–53. http://dx.doi.org/10.1200/cci.20.00170.
Повний текст джерелаАнотація:
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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Noguchi, Yoshihiro, Shunsuke Yoshizawa, Tomoya Tachi, and Hitomi Teramachi. "Effect of Dipeptidyl Peptidase-4 Inhibitors vs. Metformin on Major Cardiovascular Events Using Spontaneous Reporting System and Real-World Database Study." Journal of Clinical Medicine 11, no. 17 (August 25, 2022): 4988. http://dx.doi.org/10.3390/jcm11174988.
Повний текст джерелаАнотація:
Background: Metformin had been recommended as the first-line treatment for type 2 diabetes since 2006 because of its low cost, high efficacy, and potential to reduce cardiovascular events, and thus death. However, dipeptidyl peptidase-4 (DPP-4) inhibitors are the most commonly prescribed first-line agents for patients with type 2 diabetes in Japan. Therefore, it is necessary to clarify the effect of DPP-4 inhibitors on preventing cardiovascular events, taking into consideration the actual prescription of antidiabetic drugs in Japan. Methods: This study examined the effect of DPP-4 inhibitors on preventing cardiovascular events. The Japanese Adverse Drug Event Report (JADER) database, a spontaneous reporting system in Japan, and the Japanese Medical Data Center (JMDC) Claims Database, a Japanese health insurance claims and medical checkup database, were used for the analysis. Metformin was used as the DPP-4 inhibitor comparator. Major cardiovascular events were set as the primary endpoint. Results: In the analysis using the JADER database, a signal of major cardiovascular events was detected with DPP-4 inhibitors (IC: 0.22, 95% confidence interval: 0.03–0.40) but not with metformin. In the analysis using the JMDC Claims Database, the hazard ratio of major cardiovascular events for DPP-4 inhibitors versus metformin was 1.01 (95% CI: 0.84–1.20). Conclusions: A comprehensive analysis using two different databases in Japan, the JADER and the JMDC Claims Database, showed that DPP-4 inhibitors, which are widely used in Japan, have a non-inferior risk of cardiovascular events compared to metformin, which is used as the first-line drug in the United States and Europe.
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Broder, Michael S., Qiufei Ma, Tingjian Yan, Eunice Chang, Lamis K. Eldjerou, Yanni Hao, David Kuzan, and Jie Zhang. "Economic Burden of Neurologic Toxicities Associated with Treating Relapsed Refractory Diffuse Large B-Cell Lymphoma in the United States." Blood 134, Supplement_1 (November 13, 2019): 4719. http://dx.doi.org/10.1182/blood-2019-122587.
Повний текст джерелаАнотація:
Introduction: Chimeric antigen receptor T (CAR-T) cell therapies targeting CD19 antigen can yield durable remissions in relapsed or refractory diffuse large B-cell lymphoma (r/r DLBCL). Yet the use of CAR-T can be limited by potentially severe toxicities, principally cytokine release syndrome (CRS) and neurologic toxicities. Management of neurologic toxicities requires vigilant monitoring, supportive treatment and resource allocation. We found no studies reporting healthcare costs associated with treatment-related neurologic adverse events (NEAEs) in r/r DLBCL patients. The objective of this study was to develop an evidence-based list of r/r DLBCL treatment-related NEAEs and to estimate the healthcare costs associated with these NEAEs in a real-world setting. Methods: Grade 3 or higher NEAEs that occurred in ≥2% of patients were identified by reviewing U.S. drug prescribing information (PI), European Medicines Agency summaries of product characteristics, and published clinical trials for treatments of r/r DLBCL. Then, adult patients ≥18 years old with r/r DLBCL were identified from a U.S. administrative claims database containing de-identified claims for over 150 million people across over 11 years. Patients were included if they had: 1) evidence of treatment beyond first-line (2L+) during the identification period (07/01/14 - 12/31/18); and 2) ≥1 inpatient or ≥2 outpatient claims for DLBCL (ICD-9-CM codes: 200.7X; ICD-10-CM codes: C83.3X) during the study period (01/01/14 - 12/31/18) with ≥1 having occurred prior to or on the date when the 2L+ treatment was received. 2L+ treatments were selected based on National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines and clinical expert input. To maximize the identification of patients treated with CAR-T, treatments were categorized hierarchically into 4 groups: CAR-T therapy (axicabtagene ciloleucel, or tisagenlecleucel), high-intensity cytotoxic therapy (carboplatin, cisplatin, cyclophosphamide, or ifosfamide), low-intensity cytotoxic therapy (bendamustine, lenalidomide, or gemcitabine), and targeted monotherapy (rituximab, ibrutinib, or brentuximab vedotin). The index date was defined as the start date of the 2L+ treatment. Patients in the cytotoxic and targeted therapy groups were also required to have evidence of an earlier line of cytotoxic or targeted therapy. All patients were required to have ≥6-months continuous enrollment before the index date. The outcomes of interest were the rates of NEAEs and total healthcare costs for patients with and without NEAEs during the 30-day post index period. Costs were inflated to 2018 US dollars. Descriptive statistics were reported. Results: Twenty-three NEAEs were identified based on the review: 17 for CAR-T, 10 for conventional immunochemotherapy regimens, and 4 for both. In the claims database, a total of 349 adult patients with r/r DLBCL were identified, including 27 CAR-T therapy, 262 high-intensity cytotoxic therapy, 50 low-intensity cytotoxic therapy, and 10 targeted therapy users. Mean (median, SD) patient age was 72.3 (73; 10.3) years, with 47.9% being female and 83.4% having Medicare insurance. Patients were mainly from the South (44.1%) and the Midwest (31.5%). The mean (SD) Charlson comorbidity index was 4.4 (3.6) and mean (SD) number of chronic conditions was 7.3 (2.2). Forty-five (12.9%) patients had ≥1 NEAE at some point during the 30-day post-index period. Of these, 14 (31.1%) were CAR-T users. Eleven (40.7%) of the CAR-T users had encephalopathy. Mean total healthcare costs were $99,611 higher for patients with NEAEs [mean (SD): $153,435 (227,771)] than those without any NEAEs [$53,824 (96,170)]. Among patients with NEAEs, 72% of the healthcare costs were accrued in the inpatient setting. Among patients without NEAEs, 63% of the healthcare costs were for outpatient medical services. The trend of higher costs in patients with NEAEs was consistent across treatment groups. Conclusion: This is the first study of the economic burden of NEAEs associated with treating r/r DLBCL in a real-world setting with data that reflects the current range of treatment options. Patients with r/r DLBCL who have NEAEs incur substantially higher costs than those without such events. In this analysis, CAR-T is overrepresented for NEAEs, although the sample size is small. We intend to repeat the analysis when more claims data becomes available in the near future. Disclosures Broder: Partnership for Health Analytic Research (PHAR), LLC: Other: I am an employee of the Partnership for Health Analytic Research (PHAR), LLC, which was paid by Novartis to conduct the research described in this abstract.. Ma:Novartis Pharmaceuticals Corporation: Employment. Yan:Partnership for Health Analytic Research (PHAR), LLC: Other: T. Yan is an employee of Partnership for Health Analytic Research (PHAR), LLC, a health services research company paid to conduct this research.. Chang:Partnership for Health Analytic Research (PHAR), LLC: Other: E. Chang is an employee of Partnership for Health Analytic Research (PHAR), LLC, a health services research company paid to conduct this research.. Eldjerou:Novartis Pharmaceuticals Corporation: Employment. Hao:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership. Kuzan:Novartis Pharmaceuticals Corporation: Employment. Zhang:Novartis Pharmaceuticals Corporation: Employment, Equity Ownership.
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Muara Lysta Sirait, Muhammad Alfarisi, Zievan Ananta Pahlevi, and Maria Yus Trinity Irsan. "Claim Reserves Estimation Using Chain Ladder Method in Casualty Insurance for the Period 2010 - 2019." International Journal of Management and Business Economics 2, no. 3 (March 26, 2024): 35–40. http://dx.doi.org/10.58540/ijmebe.v2i3.515.
Повний текст джерелаАнотація:
In a work environment, the presence of risk or unforeseeable events is inevitable, as employees certainly seek to get a sense of security in doing work. Therefore, insurance is responsibility to provide sense of security to employees by providing protection in the form of claim payments to employees who get accidents. To meet the claim payment, insurance companies need to prepare funds. With the chain ladder method, insurance companies can estimate how much funds must be prepared to make claim payments. This study used the secondary data from general insurance companies in the United States published by the National Association of Insurance Commissioners under the title "Statistical Compilation of Annual Statement Information for Property/Casualty Insurance Companies in 2019". Data in the form of cumulative run-off triangle with accident period 2010-2019. Through this calculation, claim reserves that must be prepared by insurance companies for 2020 amounted to USD 1,553,906.
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Williams, PhD, MS, Rachel E., Timothy J. Sampson, BS, Linda Kalilani, MBBS, PhD, John I. Wurzelmann, MD, MPH, and Stephen W. Janning, PharmD. "Epidemiology of opioid pharmacy claims in the United States." Journal of Opioid Management 4, no. 3 (January 30, 2018): 145. http://dx.doi.org/10.5055/jom.2008.0019.
Повний текст джерелаАнотація:
Objective: To describe opioid pharmacy claims patterns in the United States among an insured population.Design: Information was obtained from the US insurance claims database, IMS Lifelink™, between 1997 and 2002. Descriptive statistics of opioid claims patterns were described with stratification by gender, age, and year of use.Results: The prevalence of insured people with opioid claims increased from 17.1 percent in 1997 to 18.4 percent in 2002. Among people with an opioid claim, 24 percent had ≥30 days and 10 percent had ≥90 days of days supplied based on the insurance claims. Prevalence varied by type of opioid; 56 percent of people with a claim received propoxyphene, 43 percent received codeine, 23 percent received oxycodone, and 17 percent received hydrocodone. Sustained-release opioids were found among 6 percent of those with a claim. With respect to the dose of opioids in the pharmacy claims (expressed as morphine equivalent total daily dose), 71 percent had claims for <50 mg, 55 percent had claims for 50-99 mg, and 24 percent had claims for ≥100 mg. Women, individuals with cancer, and older patients had significantly more pharmacy claims as well as claims for higher doses of opioids (p < 0.05). Internal medicine and family practice specialists were responsible for 22.4 percent and 20.9 percent of all opioid claims.Conclusions: Opioid pharmacy claims increased slightly over time. Older patients, women and patients with a cancer diagnosis had significantly more opioid claims and claims for higher doses than the younger patients, men, and those without cancer.
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Wen, Shiran. "Health insurance claim amount prediction using statistical methods." Applied and Computational Engineering 73, no. 1 (July 5, 2024): 94–99. http://dx.doi.org/10.54254/2755-2721/73/20240370.
Повний текст джерелаАнотація:
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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Rejesus, Roderick M., Ashley C. Lovell, Bertis B. Little, and Mike H. Cross. "Determinants of Anomalous Prevented Planting Claims: Theory and Evidence from Crop Insurance." Agricultural and Resource Economics Review 32, no. 2 (October 2003): 244–58. http://dx.doi.org/10.1017/s1068280500006018.
Повний текст джерелаАнотація:
This study examines the factors that determine the likelihood of submitting a potentially fraudulent prevented planting claim. A theoretical model is developed and the theoretical predictions are empirically verified by utilizing a binary choice model and crop insurance data from the southern United States. The empirical results show that insured producers with higher prevented planting coverage, lower dollar value of expected yield, and a history of submitting prevented planting claims are more likely to submit an anomalous prevented planting claim. The empirical model also suggests revenue insurance plans may be more vulnerable to prevented planting fraud than the traditional yield-based insurance plan. Results of this study can be valuable to compliance offices in their efforts to find “indicators” of fraudulent behavior in crop insurance, especially with regard to prevented planting.
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Pascale, Joanne. "Measurement Error in Health Insurance Reporting." INQUIRY: The Journal of Health Care Organization, Provision, and Financing 45, no. 4 (November 2008): 422–37. http://dx.doi.org/10.5034/inquiryjrnl_45.04.422.
Повний текст джерелаАнотація:
In the United States, surveys serve as the only source of data for the number of uninsured people; they also provide rich data for exploring the relationships between health insurance coverage and individuals' life circumstances, such as employment, income, and health status, enabling researchers to assess the effectiveness of various aspects of the health care system. The Current Population Survey (CPS) is one of the most influential surveys measuring health insurance, but it is not without critics. To address outstanding questions about the data quality of the CPS health insurance questions, qualitative testing was conducted to assess various aspects of the questionnaire from the respondent's perspective. A testing protocol was developed largely based on previous health survey methods literature, and test subjects were probed about their comprehension of the questions, particular terms and phrases, and their strategies for formulating an answer. Several design features were identified as problematic, including the overall questionnaire structure, the calendar year reference period, the household-level design, and the wording of questions on public coverage.
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Farrow, Freeman L. "The Anti-Patient Psychology of Health Courts: Prescriptions from a Lawyer-Physician." American Journal of Law & Medicine 36, no. 1 (March 2010): 188–220. http://dx.doi.org/10.1177/009885881003600104.
Повний текст джерелаАнотація:
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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Owusu-Edusei, Kwame, Carla A. Winston, Suzanne M. Marks, Adam J. Langer, and Roque Miramontes. "Tuberculosis Test Usage and Medical Expenditures from Outpatient Insurance Claims Data, 2013." Tuberculosis Research and Treatment 2017 (2017): 1–9. http://dx.doi.org/10.1155/2017/3816432.
Повний текст джерелаАнотація:
Objective. To evaluate TB test usage and associated direct medical expenditures from 2013 private insurance claims data in the United States (US). Methods. We extracted outpatient claims for TB-specific and nonspecific tests from the 2013 MarketScan® commercial database. We estimated average expenditures (adjusted for claim and patient characteristics) using semilog regression analyses and compared them to the Centers for Medicare and Medicaid Services (CMS) national reimbursement limits. Results. Among the TB-specific tests, 1.4% of the enrollees had at least one claim, of which the tuberculin skin test was most common (86%) and least expensive ($9). The T-SPOT® was the most expensive among the TB-specific tests ($106). Among nonspecific TB tests, the chest radiograph was the most used test (78%), while chest computerized tomography was the most expensive ($251). Adjusted average expenditures for the majority of tests (≈74%) were above CMS limits. We estimated that total United States medical expenditures for the employer-based privately insured population for TB-specific tests were $53.0 million in 2013, of which enrollees paid 17% ($9 million). Conclusions. We found substantial differences in TB test usage and expenditures. Additionally, employer-based private insurers and enrollees paid more than CMS limits for most TB tests.
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Seamon, Erich, Paul E. Gessler, John T. Abatzoglou, Philip W. Mote, and Stephen S. Lee. "Climatic Damage Cause Variations of Agricultural Insurance Loss for the Pacific Northwest Region of the United States." Agriculture 13, no. 12 (November 29, 2023): 2214. http://dx.doi.org/10.3390/agriculture13122214.
Повний текст джерелаАнотація:
Agricultural crop insurance is an important component for mitigating farm risk, particularly given the potential for unexpected climatic events. Using a 2.8 million nationwide insurance claim dataset from the United States Department of Agriculture (USDA), this research study examines spatiotemporal variations of over 31,000 agricultural insurance loss claims across the 24-county region of the inland Pacific Northwest (iPNW) portion of the United States from 2001 to 2022. Wheat is the dominant insurance loss crop for the region, accounting for over USD 2.8 billion in indemnities, with over USD 1.5 billion resulting in claims due to drought (across the 22 year time period). While fruit production generates considerably lesser insurance losses (USD 400 million) as a primary result of freeze, frost, and hail, overall revenue ranks number one for the region, with USD 2 billion in sales, across the same time range. Principal components analysis of crop insurance claims showed distinct spatial and temporal differentiation in wheat and apples insurance losses using the range of damage causes as factor loadings. The first two factor loadings for wheat accounts for approximately 50 percent of total variance for the region, while a separate analysis of apples accounts for over 60 percent of total variance. These distinct orthogonal differences in losses by year and commodity in relationship to damage causes suggest that insurance loss analysis may serve as an effective barometer in gauging climatic influences.
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Hoffmann, Jeffrey. "Preemption and the MLR Provision of the Affordable Care Act." American Journal of Law & Medicine 40, no. 2-3 (June 2014): 280–97. http://dx.doi.org/10.1177/009885881404000207.
Повний текст джерелаАнотація:
This Note focuses on the medical loss ratio provision (“MLR Provision”) of the Patient Protection and Affordable Care Act (ACA). The MLR Provision states that health insurance companies must spend at least a certain percentage of their premium revenue on “activities that improve healthcare quality” (in other words, meet a minimum threshold medical loss ratio) and comply with reporting requirements determined by the Secretary of the United States Department of Health and Human Services (HHS). Because states have historically had authority over the regulation of health insurance, there is an outstanding question as to whether or not the MLR Provision has legal authority to preempt conflicting state MLR regulations.Part II of this Note outlines the major requirements in the MLR Provision and discusses the history of MLR regulation in the United States. Part III discusses the likelihood that the courts will soon resolve the question of preemption regarding the MLR Provision.
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Bellerose, Meghan, Jamie R. Daw, and Maria W. Steenland. "Differences in Self-Reported and Billed Postpartum Visits Among Medicaid-Insured Individuals." JAMA Network Open 6, no. 12 (December 27, 2023): e2349457. http://dx.doi.org/10.1001/jamanetworkopen.2023.49457.
Повний текст джерелаАнотація:
ImportanceState Medicaid programs have recently implemented several policies to improve access to health care during the postpartum period. Understanding whether these policies are succeeding will require accurate measurement of postpartum visit use over time and across states; however, current estimates of use vary substantially between data sources.ObjectivesTo examine disagreement between postpartum visit use reported in the Pregnancy Risk Assessment Monitoring System (PRAMS) and Medicaid claims and assess whether insurance transitions from Medicaid at the time of childbirth to other insurance types after delivery are associated with the degree of disagreement.Design, Setting, and ParticipantsThis cross-sectional study was conducted among individuals in South Carolina after delivery who had completed a PRAMS survey and for whom Medicaid was the payer of their delivery care. PRAMS responses from 2017 to 2020 were linked to inpatient, outpatient, and physician Medicaid claims; survey-weighted logistic regression models were then used to examine the association between postpartum insurance transitions and data source disagreement. Data were analyzed from February through October 2023.ExposureInsurance transition type: continuous Medicaid, Medicaid to private insurance, Medicaid to no insurance, and Emergency Medicaid to no insurance.Main Outcome and MeasureData source disagreement due to reporting a postpartum visit in PRAMS without a Medicaid claim for a visit or having a Medicaid claim for a visit without reporting a postpartum visit in PRAMS.ResultsAmong 836 PRAMS respondents enrolled in Medicaid at delivery (663 aged 20-34 years [82.9%]), a mean of 85.7% (95% CI, 82.1%-88.7%) reported a postpartum visit in PRAMS and a mean of 61.6% (95% CI, 56.9%-66.0%) had a Medicaid claim for a postpartum visit. Overall, 253 respondents (30.3%; 95% CI, 26.1%-34.7%) had data source disagreement: 230 individuals (27.2%; 95% CI, 23.2%-31.5%) had a visit in PRAMS without a Medicaid claim, and 23 individuals (3.1%; 95% CI, 1.8%-5.2%) had a Medicaid claim without a visit in PRAMS. Compared with individuals continuously enrolled in Medicaid, those who transitioned to private insurance after delivery and those who were uninsured after delivery and had Emergency Medicaid at delivery had an increase in the probability of data source agreement of 15.8 percentage points (95% CI, 2.6-29.1 percentage points) and 37.2 percentage points (95% CI, 19.6-54.8 percentage points), respectively.Conclusions and RelevanceThis study’s findings suggest that Medicaid claims may undercount postpartum visits among people who lose Medicaid or switch to private insurance after childbirth. Accounting for these insurance transitions may be associated with better claims-based estimates of postpartum care.
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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.
Повний текст джерелаАнотація:
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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Graham, Garth Nigel, and Rashida Dorsey. "A national study of the association between language use and health insurance coverage in the United States." Journal of Hospital Administration 2, no. 2 (January 25, 2013): 115. http://dx.doi.org/10.5430/jha.v2n2p115.
Повний текст джерелаАнотація:
Background: A significant proportion of individuals seen in US hospitals speak a language other than English. A number of reports have shown that individuals who speak a language other than English have diminished access to care, but few have examined specifically language barriers and its relationship to health insurance coverage. Objectives: To estimate the impact of language use on prevalence of reported health insurance coverage across multiple racial and ethnic groups and among persons living in the U.S. for varying periods of time. Design and participants: Cross sectional study using data from the 2010 National Health Interview Survey. Main measures: The main outcome measure is health insurance status. Key results: Persons who spoke Spanish or a language other than English were less likely to have insurance. Among Hispanics who speak Spanish or a language other than English, only 50.6% report having health insurance coverage compared to 76.7% of Hispanics who speak only or mostly English. For non-Hispanic whites who speak Spanish or a language other than English, 71.7% report having health insurance coverage compared to 83.4% of non-Hispanic whites who speak only or mostly English, this same pattern was observed across all racial/ethnic groups. Among those speaking only or mostly English living in the U.S. <15 years had significantly lower adjusted odds of reporting health insurance coverage compared to those born in the United States. Conclusions: This was a large nationally representative study describing language differences in insurance access using a multi-ethnic population. This data suggest that individuals who speak a language other than English are less likely to have insurance across all racial and ethnic groups and nativity and years in the United States groups, underscoring the significant independent importance of language as a predictor for access to insurance.
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Lebo, Nicole L., Diana Khalil, Adele Balram, Margaret Holland, Martin Corsten, James Ted McDonald, and Stephanie Johnson-Obaseki. "Influence of Socioeconomic Status on Stage at Presentation of Laryngeal Cancer in the United States." Otolaryngology–Head and Neck Surgery 161, no. 5 (June 11, 2019): 800–806. http://dx.doi.org/10.1177/0194599819856305.
Повний текст джерелаАнотація:
Objective Identify socioeconomic predictors of stage at diagnosis of laryngeal cancer in the United States. Study Design Retrospective analysis of the North American Association of Central Cancer Registries’ Incidence Data–Cancers in North America Deluxe Analytic File for expanded races. Setting All centers reporting to the US Centers for Disease Control and Prevention’s National Program of Cancer Registries. Subjects and Methods All cases of laryngeal cancer in adult patients from 2005 to 2013 were reviewed. Ordinal logistic regression models were used to evaluate odd ratios (ORs) for socioeconomic indicators potentially predictive of advancing American Joint Committee on Cancer stage at diagnosis. Results A total of 72,472 patients were identified and included. Analysis revealed significant correlation between advanced stage at diagnosis and: Medicaid insurance, lack of insurance, female sex, older age, black race, and certain states of residence. The strongest predictor of advanced stage was lack of insurance (OR, 2.212; P < .001; 95% CI, 2.035-2.406). The strongest protective factor was residing in the state of Utah (OR, 0.571; P < .001; 95% CI, 0.536-0.609). Once adjusted for regional price and wage disparities, relative income was not a significant predictor of stage at presentation across multiple analyses. Conclusion Multiple socioeconomic factors were predictive of severity of disease at presentation of laryngeal cancer in the United States. This study demonstrated that insurance type was strongly predictive, whereas relative income had surprisingly little influence.
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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 (February 15, 2019): 469–80. http://dx.doi.org/10.1212/wnl.0000000000007044.
Повний текст джерелаАнотація:
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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Chasteen, Joseph E., Gretchen Murphy, Arden Forrey, and 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.
Повний текст джерелаАнотація:
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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Yang, Qing, Xinyi Shen, Feifei Yang, Emmanouil N. Anagnostou, Kang He, Chongxun Mo, Hojjat Seyyedi, Albert J. Kettner, and Qingyuan Zhang. "Predicting Flood Property Insurance Claims over CONUS, Fusing Big Earth Observation Data." Bulletin of the American Meteorological Society 103, no. 3 (March 2022): E791—E809. http://dx.doi.org/10.1175/bams-d-21-0082.1.
Повний текст джерелаАнотація:
Abstract Each year throughout the contiguous United States (CONUS), flood hazards cause damage amounting to billions of dollars in homeowner insurance claims. As climate change threatens to raise the frequency and severity of flooding in vulnerable areas, the ability to predict the number of property insurance claims resulting from flood events becomes increasingly important to flood resilience. Based on random forest, we develop a flood property Insurance Claims model (iClaim) by fusing records from the National Flood Insurance Program (NFIP), including building locations, topography, basin morphometry, and land cover, with data from multiple sources of hydrometeorological variables, including flood extent, precipitation, and operational river-stage and oceanic water-level measurements. The model utilizes two steps—damage level classification and claim number regression—and subsampling strategies designed accordingly to reduce overfitting and underfitting caused by the flood claim samples, which are unevenly distributed and widely ranged. We evaluate the model using 446,446 grid samples identified from 589 flood events occurring from 2016 to 2019 over CONUS, overlapping 258,159 claims out of a total of 287,439 NFIP records of the same period. Our rigorous validation yields acceptable performance at the grid/event, county/event, and event accumulative level, with R2 over 0.5, 0.9, and 0.95, respectively. We conclude that the iClaim model can be used in many application scenarios, including assessing flood impact and improving flood resilience.
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Abramowitz, Joelle. "New Insights on Self-Employment of Older Adults in the United States." Innovation in Aging 4, Supplement_1 (December 1, 2020): 460. http://dx.doi.org/10.1093/geroni/igaa057.1490.
Повний текст джерелаАнотація:
Abstract This work examines the nature of self-employment arrangements of older adults in the United States. Many people engage in self-employment - in the 2016 Health and Retirement Study (HRS), 20 percent of respondents working for pay reported being self-employed - yet there exists a dearth of data on these arrangements. This lack of data prevents consideration of important questions relevant to employment, inequality, and policy. Who works in different types of self-employment? What resources facilitate some individuals obtaining higher quality self-employment arrangements? To what extent does the income from different types of arrangements keep people out of poverty? Are different types of arrangements associated with individuals being happier and having more job satisfaction? This work leverages novel restricted-access data collected in the HRS in 2016 on the employer names and locations for individuals reporting self-employment along with respondent narratives on industry and type of work to classify self-employment reports into three entrepreneurial roles (own/run; manage; independent) across 14 different types of work. Using the breadth of information collected in the HRS and linkage to administrative records, this work then presents differences in characteristics, such as demographics, income, wealth, savings, health insurance coverage, home ownership, health status, and expectations of working longer, associated with different classifications of self-employment. Exploring these questions provides unique insights into the changing nature of work and the transition to retirement relevant to policy considerations across the health, insurance, and retirement income dimensions, among others.
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Taha, Mohamad B., Javier Valero-Elizondo, Tamer Yahya, César Caraballo, Rohan Khera, Kershaw V. Patel, Hyeon Ju R. Ali, et al. "Cost-Related Medication Nonadherence in Adults With Diabetes in the United States: The National Health Interview Survey 2013–2018." Diabetes Care 45, no. 3 (January 11, 2022): 594–603. http://dx.doi.org/10.2337/dc21-1757.
Повний текст джерелаАнотація:
OBJECTIVE Health-related expenditures resulting from diabetes are rising in the U.S. Medication nonadherence is associated with worse health outcomes among adults with diabetes. We sought to examine the extent of reported cost-related medication nonadherence (CRN) in individuals with diabetes in the U.S. RESEARCH DESIGN AND METHODS We studied adults age ≥18 years with self-reported diabetes from the National Health Interview Survey (NHIS) (2013–2018), a U.S. nationally representative survey. Adults reporting skipping doses, taking less medication, or delaying filling a prescription to save money in the past year were considered to have experienced CRN. The weighted prevalence of CRN was estimated overall and by age subgroups (<65 and ≥65 years). Logistic regression was used to identify sociodemographic characteristics independently associated with CRN. RESULTS Of the 20,326 NHIS participants with diabetes, 17.6% (weighted 2.3 million) of those age <65 years reported CRN, compared with 6.9% (weighted 0.7 million) among those age ≥65 years. Financial hardship from medical bills, lack of insurance, low income, high comorbidity burden, and female sex were independently associated with CRN across age groups. Lack of insurance, duration of diabetes, current smoking, hypertension, and hypercholesterolemia were associated with higher odds of reporting CRN among the nonelderly but not among the elderly. Among the elderly, insulin use significantly increased the odds of reporting CRN (odds ratio 1.51; 95% CI 1.18, 1.92). CONCLUSIONS In the U.S., one in six nonelderly and one in 14 elderly adults with diabetes reported CRN. Removing financial barriers to accessing medications may improve medication adherence among these patients, with the potential to improve their outcomes.
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Olszewski, Adam J., Charles B. Eaton, and Amal N. Trivedi. "Association of Medicare Part D Coverage and Low-Income Subsidies with Use of Novel Oral Agents in Multiple Myeloma." Blood 128, no. 22 (December 2, 2016): 686. http://dx.doi.org/10.1182/blood.v128.22.686.686.
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Abstract Background: The introduction of novel parenteral (bortezomib) and oral (lenalidomide and thalidomide) agents in the mid-2000's radically improved the management and outcomes in multiple myeloma. The cost of these drugs typically exceeds $5000/month, posing a financial challenge for patients (pts), insurers and healthcare systems. Medicare beneficiaries in the United States have disparate coverage for parenteral and oral chemotherapy. Coverage for oral agents has been available since 2006 for those purchasing Part D prescription plans (PDP), but such plans impose substantial out-of-pocket expenses through the "donut hole" coverage gap and coinsurance required even in the "catastrophic" phase. Pts with low income can receive the Part D Low Income Subsidy (LIS) which largely eliminates this cost sharing. Our objective was to examine the association of Medicare part D and LIS policies with utilization of, and out-of-pocket burden for, the novel anti-myeloma agents. Methods: From the Surveillance, Epidemiology and End Results data base linked to Medicare claims (2000-2012), we selected pts ≥65 years old, diagnosed with myeloma in 2001-2011, and with fee-for-service Medicare insurance. Pts in the post-Part-D era (2006-2012) were classified according to their prescription coverage at diagnosis as those with: PDP without LIS, PDP with LIS, or no coverage. We identified first-line parenteral chemotherapy (using specific drug codes) and oral agents (assumed from generic follow-up codes for pts without PDP), as well as other relevant covariates: comorbidities, a claims-based performance status indicator, anemia, neuropathy, and use of health services. We then compared parenteral and oral chemotherapy use between pre-Part-D (2001-2005) and post-Part-D (2006-2011) eras, and use of lenalidomide/thalidomide among PDP pts with or without LIS, in multivariable robust Poisson models for relative risk (RR), reporting 95% confidence intervals (CI). Results: Among 19,434 pts (median age, 77 years; 46% women), 52% had a record of any chemotherapy within 1 year from myeloma diagnosis. This proportion increased from 42% in pre-Part-D era to 61% after Part D introduction (adjusted RR, 1.45; CI, 1.41-1.49; P<.0001), and bortezomib replaced other parenteral regimens. In the post-Part-D era, the proportion of pts receiving parenteral chemotherapy increased for those without prescription coverage (Fig. A, adjusted RR compared with pre-Part-D era, 1.30; CI, 1.23-1.38; P<.001), while it decreased, in favor of oral regimens, for those who acquired a PDP without LIS (RR, 0.90; CI, 0.85-0.95; P<.001), or PDP with LIS (RR, 0.85; CI, 0.78-0.92; P<.001). Among pts with no PDP coverage, 41% purchased it within 1 year from myeloma diagnosis. We then directly analyzed the upfront use of novel oral agents among treated pts with a PDP (and thus complete record of prescriptions, N=3,142). Lenalidomide largely replaced thalidomide between 2007 and 2011, but up to 40% of pts did not receive novel agents as part of their regimen (Fig. B). Pts with LIS had the same median age as those without LIS, but were more often female, non-white, with poor performance, or comorbidities (all P<.0001). Adjusting for clinical differences, recipients of LIS had a 17% higher probability of being treated with a novel oral agent (RR, 1.17; CI, 1.05-1.29; P=.0034). Median patient cost-sharing for the first prescription was $3 for pts with LIS and $3,120 without LIS. At the start of oral chemotherapy, 3% of pts were in the catastrophic phase of PDP coverage, while 79% reached it with the 2nd prescription. Median number of prescription fills was 6 (range, 1-27), and median gross cost of lenalidomide/thalidomide within the 1st year of therapy was $43,920. Conclusions: The proportion of Medicare beneficiaries actively treated with chemotherapy for myeloma increased after the introduction of Medicare Part D in 2006. Accounting for this, the availability of prescription coverage was associated with relatively increased use of oral regimens, and the use of novel agents was higher for those receiving Part D LIS which alleviates the out-of-pocket expenses. Our findings suggest concerning disparities in equitable access to novel, but expensive oral anti-myeloma agents based on insurance coverage for oral chemotherapy. Further research should determine if policies for oral chemotherapy coverage translate into disparities in survival or other outcomes. Figure. Figure. Disclosures Olszewski: TG Therapeutics: Research Funding; Genentech: Research Funding; Bristol-Myers Squibb: Consultancy.
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Barnes, Justin Michael, Eric Adjei Boakye, Mario Schootman, Evan Michael Graboyes, and Nosayaba Osazuwa-Peters. "Insurance coverage and care affordability in cancer survivors in 2016-2019." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): 1520. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.1520.
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1520 Background: The Affordable Care Act (ACA) led to improvements in insurance coverage and care affordability in cancer patients. However, the uninsured rate for the general US reached its nadir in 2016 and has been increasing since. We aimed to quantify the changes in insurance coverage and rate of care unaffordability in cancer survivors from 2016 to 2019. Methods: We queried data from the Behavioral Risk Factor Surveillance System (2016-2019) for cancer survivors ages 18-64 years. Outcomes of interest were the percentage of cancer survivors reporting insurance coverage and the percentage reporting cost-driven lack of care in the previous 12 months. Survey-weighted linear probability models adjusted for covariates (age, sex, race/ethnicity, income, education, marital status, and state Medicaid expansion status) were utilized to estimate the average yearly change (AYC) in the outcomes across 2016-2019. Mediation analyses evaluated the mediating effect of insurance coverage changes on changes in cost-driven lack of care. Results: A total of 178,931 cancer survivors were identified among the survey respondents. The percentage of insured cancer survivors between 2016 and 2019 decreased from 92.4% to 90.4% (AYC: -0.54, 95% CI = -1.03 to -0.06, P =.026). This translates to an estimated 164,638 cancer survivors in the United States who lost insurance coverage in the study period. There were decreases in private insurance coverage (AYC: -1.66, 95% CI = -3.1 to -0.22, P =.024) but increases in Medicaid coverage (AYC: 1.14, 95% CI = 0.03 to 2.25, P =.043). The decreases in any coverage were largest in individuals with income < 138% federal poverty level (FPL) (AYC: -1.14, 95% CI = -2.32 to 0.04, P =.059; compared to > 250% FPL, Pinteraction=.03). Cost-driven lack of care in the preceding 12 months among cancer survivors increased from 17.9% in 2016 to 20% in 2019 (AYC: 0.67, 95% CI = 0.06 to 1.27, P =.03), which translates to an estimated 167,184 survivors in the US who skipped care due to costs. Changes in insurance coverage mediated 27.5% of the observed change in care unaffordability overall (p =.028) and 65.7% in individuals with income < 138% FPL relative to > 250% FPL (p =.045). Conclusions: Between 2016 and 2019, about 165,000 cancer survivors in the United States lost their insurance coverage and a similar number may have skipped needed care due to cost. Loss of insurance coverage was mostly among individuals with low socioeconomic status. Interventions to improve health insurance coverage among cancer survivors, such as the recent executive order to strengthen the ACA and further efforts promoting Medicaid expansion in additional states, may be important factors to mitigate these trends.
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Brenner, E., X. Zhang, M. Long, M. Dubinsky, and 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 (January 30, 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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DEVI, AYU EKA FANNY, I. NYOMAN WIDANA, and KETUT JAYANEGARA. "PENENTUAN CADANGAN PREMI ASURANSI DWIGUNA MENGGUNAKAN METODE ILLINOIS BERDASARKAN HUKUM MORTALITAS WEIBULL." E-Jurnal Matematika 10, no. 4 (November 30, 2021): 229. http://dx.doi.org/10.24843/mtk.2021.v10.i04.p347.
Повний текст джерелаАнотація:
Endowment insurance provides protection benefit and saving benefits. In the endowment insurance the insured party (insurance participant) must be paid the premiums. In addition to premiums, there is also policy value, which is sum of money that must be collected by the company in preparation for claim payment. The purpose of this study was to determine calculation of policy value in endowment insurance using Illinois method based on Weibull Mortality Law. In this study used secondary data from United States Life Table in the form of mortality probability data. Calculation value using Weibull mortality law, then the policy value calculated by Illinois method. The result of this study is policy value using Illinois Method based on Weibull Mortality Law is bigger than policy value using Illinois method without Weibull mortality law in the first year until year 20th. After year 20th, the policy value using Illinois method based on Weibull mortality law is smaller than policy value using Illinois method without Weibull mortality law, while at the end of the insurance year which is year 30th, the policy value with or without Weibull mortality law generates the same value.
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Abass, Zeina Khdier, Hakeem Hammood Flayyih, and Sarah Isam Hasan. "The Relationship Between Audit Services and Non-Audit Actuarial Services in the Auditor’s Report." International Journal of Professional Business Review 7, no. 2 (September 6, 2022): e0455. http://dx.doi.org/10.26668/businessreview/2022.v7i2.455.
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Purpose: In view of the trend toward using international financial reporting standards when generating financial statements, we looked at the interaction between audit services and non-audit services for auditors in the context of actuarial services for insurance firms. CPAs are authorized to work in banks and insurance businesses, but those with a practicing license obtained after earning a higher academic degree are not.
Design/methodology/approach: A small number of auditing firms control the decisions issued by the Iraqi Accountants Association, monopolizing audit services in banks and insurance businesses. In the case of actuarial services used in reserve estimation, they are credited to an external party's account without any verification of the Reliability of the reserve estimation procedure.
Originality/value: In addition to audit services, a scale has been developed to examine the auditors' non-audit actuarial services. The financial reporting rules for insurance contracts 17 and the examinations for acquiring an actuarial certificate in the United States of America are used to create this scale.
Findings: The findings show that there is no substantial relationship between the two services supplied, and we recommend that the actuarial services be audited by specialist international companies that support the auditors' judgment on the computation of expected reserves in the financial accounts. Conducting specialist courses in the actuarial profession, and obtaining this credential is a requirement for auditing insurance companies.
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Desai, Raj, Eric A. Dietrich, Haesuk Park, and Steven M. Smith. "Out-of-Pocket Payment for Ambulatory Blood Pressure Monitoring Among Commercially Insured in the United States." American Journal of Hypertension 33, no. 11 (September 15, 2020): 999–1002. http://dx.doi.org/10.1093/ajh/hpaa120.
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Abstract Background Clinical guidelines increasingly recommended ambulatory blood pressure monitoring (ABPM) for hypertension diagnosis and management. Yet, ABPM is used infrequently in the United States, possibly because of low insurance coverage and high patient costs. We sought to analyze out-of-pocket payments (OPPs) for ABPM among privately insured patients. Methods We conducted a retrospective analysis using IBM® MarketScan® commercial claims of beneficiaries aged ≥18 years receiving ABPM from January 2012 to December 2018. The date of first ABPM claim (Healthcare Common Procedure Coding System codes 93784, 93786, 93788, or 93790) was considered the index date. Patients with 12 months of continuous enrollment preindex and 30-day postindex were included. Per beneficiary OPP was calculated by aggregating all ABPM-related OPPs within the 30-day postindex window (ABPM episode). Results Of 22,317 beneficiaries receiving ABPM, 62% had $0 OPP and 38% had OPP >$0. Among the latter, median OPP per beneficiary for an ABPM episode was $23 (interquartile range [IQR], $14, $32), driven primarily by full ABPM claims (median, $22; IQR, $14, $24). Among individual components, scan analysis and report claims (median, $25; IQR, $13, $49) had the greatest OPP. The median OPP per ABPM episode did not change substantively from 2012 through 2018. Conclusions Among commercially insured in the United States, nearly 4-in-10 have an OPP for ABPM. Though most OPPs are relatively modest, some patients incur substantial OPP. Our findings highlight the need for policymakers to ensure adequate ABPM coverage in the commercial insurance marketplace.
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Confer, Leanne M., John H. Boman, Cori Pryor, Thomas J. Mowen, and Paul Hemez. "Theft, Opioid Pills, Unemployment, and Insurance: A Longitudinal Analysis of American Counties in the Wake of the Opioids Crisis." Journal of Drug Issues 51, no. 3 (March 24, 2021): 504–17. http://dx.doi.org/10.1177/0022042621998690.
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This study examines the relationships between prescription opioid pills, unemployment, health insurance, and theft. Covering the years 2006–2012, our data are an aggregate of information from the Drug Enforcement Administration, the Federal Bureau of Investigation’s National Incident-Based Reporting System, and the American Community Survey (ACS). The unit of analysis is time nested within counties. Preliminary results demonstrate that there were approximately 46 prescription opioid pills distributed per person annually in the United States between 2006 and 2012. Multivariate results reveal that counties with higher numbers of prescription opioid pills tend to experience significantly higher patterns of theft. Interestingly, health insurance is positively associated with theft while unemployment appears to protect against theft. The relationship between pills and theft is also conditioned by both unemployment and health insurance. Future research should explore these relationships to better inform efforts at making responsible social policy in the midst of the opioids crisis.
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Lassman, Scott M., Olivia M. Shopshear, Ina Jazic, Jocelyn Ulrich, and Jeffrey Francer. "Clinical trial transparency: a reassessment of industry compliance with clinical trial registration and reporting requirements in the United States." BMJ Open 7, no. 9 (September 2017): e015110. http://dx.doi.org/10.1136/bmjopen-2016-015110.
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ObjectiveTo evaluate the accuracy of a 2015 cross-sectional analysis published in theBMJ Openwhich reported that pharmaceutical industry compliance with clinical trial registration and results reporting requirements under US law was suboptimal and varied widely among companies.DesignWe performed a reassessment of the data reported in Milleret alto evaluate whether statutory compliance analyses and conclusions were valid.Data sourcesInformation from the Dryad Digital Repository, ClinicalTrials.gov, Drugs@FDA and direct communications with sponsors.Main outcome measuresCompliance with the clinical trial registration and results reporting requirements under the Food and Drug Administration Amendments Act (FDAAA).ResultsIndustry compliance with FDAAA disclosure requirements was notably higher than reported by Milleret al.Among trials subject to FDAAA, Milleret alreported that, per drug, a median of 67% (middle 50% range: 0%–100%) of trials fully complied with registration and results reporting requirements. On reanalysis of the data, we found that a median of 100% (middle 50% range: 93%–100%) of clinical trials for a particular drug fully complied with the law. When looking at overall compliance at the trial level, our reassessment yields 94% timely registration and 90% timely results reporting among the 49 eligible trials, and an overall FDAAA compliance rate of 86%.ConclusionsThe claim by Milleret althat industry compliance is below legal standards is based on an analysis that relies on an incomplete dataset and an interpretation of FDAAA that requires disclosure of study results for drugs that have not yet been approved for any indication. On reanalysis using a different interpretation of FDAAA that focuses on whether results were disclosed within 30 days of drug approval, we found that industry compliance with US statutory disclosure requirements for the 15 reviewed drugs was consistently high.
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Saad, Ragy, Jed Black, Richard Bogan, Elizabeth Jensen, Prasheel Lillaney, Patricia Prince, Adina Estrin, et al. "0838 Diagnosed Prevalence of Idiopathic Hypersomnia Among Adults in the United States." SLEEP 46, Supplement_1 (May 1, 2023): A369. http://dx.doi.org/10.1093/sleep/zsad077.0838.
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Abstract Introduction Idiopathic hypersomnia (IH) is a rare neurologic disorder that can cause debilitating symptoms, including excessive daytime sleepiness, severe sleep inertia, prolonged nighttime sleep, long and unrefreshing naps, and cognitive dysfunction. Research reporting the burden of IH is scant. The objective of this study was to estimate the diagnosed prevalence of IH among US adults between 2019 and 2021. Methods Symphony Integrated Dataverse® administrative claims between November 2015 and December 2021 were analyzed. Eligible patients were aged ≥18 years and had 1 medical or prescription claim in the calendar year of interest (2019, 2020, or 2021) and in the year prior. Diagnosed prevalence included all IH cases observed in eligible patients through the last day of the year of interest. IH cases were defined as eligible patients with ≥1 medical claim containing an IH diagnosis code in any position before or during the calendar year of interest, and no history of cataplexy. Unweighted prevalence estimates were reported per 100,000 persons with 95% confidence intervals (CIs). Age- and sex-adjusted prevalence estimates were calculated using 2019 US Census Bureau data. Results Over 158, 168, and 187 million adults were eligible for assessment of diagnosed prevalence of IH in 2019, 2020, and 2021, respectively. The unweighted diagnosed prevalence of IH was 32.12 per 100,000 persons (CI: 31.84, 32.40), 35.71 per 100,000 persons (CI: 35.43, 36.00), and 37.03 per 100,000 persons (CI: 36.75, 37.30) in 2019, 2020, and 2021, respectively. The estimated standardized numbers of US adults diagnosed with IH were 80,603 (CI: 80,048, 81,161), 89,539 (CI: 88,954, 90,127), and 92,139 (CI: 91,545, 92,736) in 2019, 2020, and 2021, respectively. Conclusion To our knowledge, this is the most recent study to estimate diagnosed prevalence of IH in US adults. It is uncertain what proportion of IH cases remain undiagnosed considering the under-recognition of this condition, low utilization of sleep testing, and concerns over the reliability of multiple sleep latency testing. Furthermore, recent studies suggest only a subset of patients with IH actively seek medical care for their condition. Given its impact on patients’ lives, further research to improve surveillance of IH symptoms is needed. Support (if any) Jazz Pharmaceuticals.
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Reagan, John L., Thomas Ollila, Patrycja M. Dubielecka, and Adam J. Olszewski. "Survival of Patients with Del(5q) Syndrome in the Lenalidomide Era." Blood 128, no. 22 (December 2, 2016): 1994. http://dx.doi.org/10.1182/blood.v128.22.1994.1994.
Повний текст джерелаАнотація:
Abstract Background: Myelodysplastic syndrome with deletion 5q [del(5q) MDS] is characterized by higher incidence in older women, progressive anemia, and >70% rate of hematologic response to single-agent lenalidomide (Len). Len was approved for del(5q) MDS by the United States Food and Drug Administration (FDA) in 2005 on the basis of response rates, with uncertain effect on overall survival (OS). Our objective was to evaluate whether the availability of Len affected the frequency of del(5q) designation among newly diagnosed MDS cases in the US, and to compare OS of del(5q) MDS patients treated with upfront Len or with hypomethylating agents (HMA, azacitidine or decitabine), which were an alternative therapy for MDS available in the US. Methods: We selected cases of low-grade MDS diagnosed in 2001-2011 from the linked Surveillance, Epidemiology, and End Results-Medicare (SEER-Medicare) data base. Patients were >65 years of age at diagnosis. We identified treatment with Len or HMA in the subpopulation of del(5q) cases diagnosed in 2007-2011 who had complete records of injectable and oral chemotherapy drugs (i.e. with Medicare Part D coverage). Transfusion dependence was assessed by identifying all transfusions within 3 months before therapy, and in months 1-2, 3-4, or 5-6 after treatment initiation. We compared overall survival (OS) using log-rank tests, and in multivariable Cox models adjusting for available confounders, reporting adjusted hazard ratios (HR) with 95% confidence intervals (CI). Results: Among 21,384 low-grade MDS patients, the frequency of del(5q) MDS designation (N=655) doubled after approval of Len (2% in 2001-06 vs. 4% in 2007-11, P<.0001). Among del(5q) MDS patients with complete Medicare claims, those diagnosed in 2007-11 were slightly less likely to require transfusion at diagnosis compared with 2001-06 cases (73% vs. 82%, P=.056), and significantly more likely to receive chemotherapy (52% vs. 37%, P<.0001). There was no significant change in OS (from diagnosis) among del(5q) MDS patients between the two periods (P=.27), even after adjustment for age, socioeconomic factors, and baseline intensity of transfusions (adjusted HR, 0.96, CI, 0.77-1.19, P=.70). Median OS from diagnosis in del(5q) MDS was 2.3 years (CI, 2.0-2.6), not significantly different from other low-grade MDS (2.2 years, CI, 2.2-2.3, P=.09). OS at 3-years was 41% for del(5q) vs. 42% for other low-grade MDS. We compared outcomes of del(5q) MDS patients from 2007-2011 (N=157) who had complete record of oral prescriptions (i.e. enrollees in a Medicare Part D plan), including 114 patients treated with upfront Len and 43 treated with upfront HMA. Patients treated with Len were on average older (median age 81 years for Len vs. 78 for HMA, P=.007), more often female (75% vs. 51%, P=.007), with poor functional status (16% vs. 2%, P=.026) or with Medicaid co-insurance (24% vs. 9%, P=.046). There was no significant difference in time from diagnosis to treatment (median 3 months, P=.10), comorbidity index (P=.22), prior hospitalization (P=1.0) or prior transfusions (P=1.00). However, HMA-treated cases had a higher prevalence of pre-treatment G-CSF use (21% vs. 4%, P=.003) and more frequently a subsequent record of acute leukemia (12% vs. 2%, P=.017). OS was significantly better among patients treated with Len than with HMA (median 2.8 vs. 0.9 years, Fig. A), and remained so in a multivariable model adjusting for age, sex, race, baseline transfusion dependence, prior G-CSF, hospitalization, and poor functional status (adjusted HR, 0.27, CI, 0.16-0.43, P<.0001). Len was also associated with a significantly higher rate of transfusion independence within 6 months of therapy initiation (68% vs. 30%, P=.00002, Fig. B). Conclusions:In this first population-based assessment of survival outcomes among US patients with del(5q) MDS, the FDA approval of Len led to an increased designation of del(5q) among MDS cases, which will confound studies relying on historical cohort comparisons. Rates of transfusion independence after Len in del(5q) MDS were similar to experience from clinical trials. A significant proportion of del(5q) MDS patients do not receive Len, and state-subsidized co-insurance was associated with improved access to this expensive drug. Among del(5q) MDS patients who receive active therapy, upfront Len is associated with a significantly better OS and a higher rate of transfusion independence than upfront HMA. Figure Figure. Disclosures Reagan: Seattle Genetics: Membership on an entity's Board of Directors or advisory committees; Alexion: Honoraria. Olszewski:TG Therapeutics: Research Funding; Genentech: Research Funding; Bristol-Myers Squibb: Consultancy.
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Zhao, Jingxuan, Xuesong Han, Zhiyuan Zheng, Matthew P. Banegas, Donatus U. Ekwueme, and K. Robin Yabroff. "Health insurance literacy, financial hardship and financial sacrifices among cancer survivors in the United States." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 1560. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.1560.
Повний текст джерелаАнотація:
1560 Background: Rising costs of cancer care have imposed substantial financial burden on cancer survivors. To date, little is known about the associations between potentially modifiable patient characteristics, including health insurance literacy (HIL), on financial burden among cancer survivors. This study aimed to evaluate the associations between HIL and financial hardship and financial sacrifices among adult cancer survivors in the United States. Methods: We identified 914 adult cancer survivors from the 2016 Medical Expenditure Panel Survey Experiences with Cancer Questionnaire. HIL was measured based on the question “Did you ever have a problem understanding health insurance or medical bills related to your cancer, its treatment, or the lasting effects of that treatment?” Medical financial hardship was measured in three domains—1) material (e.g. problems paying medical bills); 2) psychological (e.g. worry about large medical bills); and 3) behavioral (e.g. delay or forego healthcare because of cost). Financial sacrifices were based on questions related to changes in spending on vacation or leisure activities. We used multivariable logistic regression modeling to separately evaluate the associations between HIL problems and 1) financial hardship and 2) financial sacrifices. Results: 18.9% cancer survivors aged 18-64 years and 14.6% survivors ≥65 years reported HIL problems. Regardless of age groups, cancer survivors with HIL problems were more likely to report any material (OR =3.2; 95% CI:1.9-5.2) or psychological (OR=7.2; 95% CI: 4.1-12.7) financial hardship than those without the problems, as well as more likely to delay or forgo multiple medical care due to cost, including prescription medicine (OR=3.6; 95% CI: 1.8-7.1), specialist visit (OR=2.6; 95% CI: 1.2-5.8), and follow-up care (OR=2.1, 95% CI 1.2-4.0). Higher likelihood of reporting all measures of financial sacrifices were observed among those with HIL problems in both age groups (all p<0.05). Conclusions: Cancer survivors with HIL problems were more likely to report financial hardship and financial sacrifices than those without the problems. Improving HIL may help mitigate financial hardship.
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Hawkins, Nikki A., Ashwini Soman, Natasha Buchanan Lunsford, Steven Leadbetter, and Juan L. Rodriguez. "Use of Medications for Treating Anxiety and Depression in Cancer Survivors in the United States." Journal of Clinical Oncology 35, no. 1 (January 1, 2017): 78–85. http://dx.doi.org/10.1200/jco.2016.67.7690.
Повний текст джерелаАнотація:
Purpose This study used population-based data to estimate the percentage of cancer survivors in the United States reporting current medication use for anxiety and depression and to characterize the survivors taking this type of medication. Rates of medication use in cancer survivors were compared with rates in the general population. Methods We analyzed data from the National Health Interview Survey, years 2010 to 2013, identifying cancer survivors (n = 3,184) and adults with no history of cancer (n = 44,997) who completed both the Sample Adult Core Questionnaire and the Adult Functioning and Disability Supplement. Results Compared with adults with no history of cancer, cancer survivors were significantly more likely to report taking medication for anxiety (16.8% v 8.6%, P < .001), depression (14.1% v 7.8%, P < .001), and one or both of these conditions combined (19.1% v 10.4%, P < .001), indicating that an estimated 2.5 million cancer survivors were taking medication for anxiety or depression in the United States at that time. Survivor characteristics associated with higher rates of medication use for anxiety included being younger than 65 years old, female, and non-Hispanic white, and having public insurance, a usual source of medical care, and multiple chronic health conditions. Survivor characteristics associated with medication use for depression were largely consistent with those for anxiety, with the exceptions that insurance status was not significant, whereas being widowed/divorced/separated was associated with more use. Conclusion Cancer survivors in the United States reported medication use for anxiety and depression at rates nearly two times those reported by the general public, likely a reflection of greater emotional and physical burdens from cancer or its treatment.
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Zhao, Qian, Vytaras Brazauskas, and Jugal Ghorai. "ROBUST AND EFFICIENT FITTING OF SEVERITY MODELS AND THE METHOD OF WINSORIZED MOMENTS." ASTIN Bulletin 48, no. 1 (November 2, 2017): 275–309. http://dx.doi.org/10.1017/asb.2017.30.
Повний текст джерелаАнотація:
AbstractContinuous parametric distributions are useful tools for modeling and pricing insurance risks, measuring income inequality in economics, investigating reliability of engineering systems, and in many other areas of application. In this paper, we propose and develop a new method for estimation of their parameters—the method of Winsorized moments (MWM)—which is conceptually similar to the method of trimmed moments (MTM) and thus is robust and computationally efficient. Both approaches yield explicit formulas of parameter estimators for log-location-scale families and their variants, which are commonly used to model claim severity. Large-sample properties of the new estimators are provided and corroborated through simulations. Their performance is also compared to that of MTM and the maximum likelihood estimators (MLE). In addition, the effect of model choice and parameter estimation method on risk pricing is illustrated using actual data that represent hurricane damages in the United States from 1925 to 1995. In particular, the estimated pure premiums for an insurance layer are computed when the lognormal and log-logistic models are fitted to the data using the MWM, MTM and MLE methods.
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Michel-Kerjan, Erwann O. "Catastrophe Economics: The National Flood Insurance Program." Journal of Economic Perspectives 24, no. 4 (November 1, 2010): 165–86. http://dx.doi.org/10.1257/jep.24.4.165.
Повний текст джерелаАнотація:
Hurricane Betsy, which hit Louisiana September 9, 1965, was one of the most intense, deadly, and costly storms ever to make landfall in the United States: it killed 76 people in Louisiana and caused $1.5 billion in damage—equal to nearly $10 billion in 2010 dollars. In 1965, no flood insurance was available, so victims had to rely on friends and family, charities, or federal relief. After that catastrophe, the U.S. government established a new program in 1968—the National Flood Insurance Program (NFIP)—to make flood insurance widely available. Now, after more than 40 years of operation, the NFIP is today one of the longest standing government-run disaster insurance programs in the world. In this paper, I present an overview of the 40 years of operation of the National Flood Insurance Program, starting with how and why it was created and how it has evolved to now cover $1.23 trillion in assets. I analyze the financial balance of the NFIP between 1969 and 2008. Excluding the 2005 hurricane season (which included Hurricane Katrina) as an outlier, policyholders have paid nearly $11 billion more in premiums than they have received in claim reimbursements over that period. However, the program has spent an average of 40 percent of all collected premiums on administrative expenses, more than three quarters of which were paid to private insurance intermediaries who sell and manage flood insurance policies on behalf of the federal government but do not bear any risk. I present challenges the NFIP faces today and propose ways those challenges might be overcome through innovative modifications.
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Dickman, Samuel L., Kari White, Gracia Sierra, and Daniel Grossman. "Financial Hardships Caused by Out-of-Pocket Abortion Costs in Texas, 2018." American Journal of Public Health 112, no. 5 (May 2022): 758–61. http://dx.doi.org/10.2105/ajph.2021.306701.
Повний текст джерелаАнотація:
Objectives. To identify financial hardships related to costs of obtaining abortion care in Texas, which has the highest uninsured rate in the United States and restricts insurance coverage for abortions. Methods. We surveyed patients seeking abortion at 12 Texas clinics in 2018 regarding costs and financial hardships related to abortion care. We compared mean out-of-pocket costs and the percentage reporting hardships across income and insurance categories. Results. Of 603 respondents, 42% were Latinx, 25% White, and 21% Black or African American, and most (62.0%) reported having low incomes (< 200% federal poverty level). Mean out-of-pocket costs were $634, which varied little across insurance groups. Patients with low incomes were more likely to obtain financial assistance from an abortion fund than were wealthier patients (12.3% vs 1.6%, respectively; P < .05). Financial hardships related to abortion costs were more common among uninsured (57.6%) and publicly insured (55.1%) patients than those with private insurance (48.2%). One in 5 (19.8%) uninsured respondents delayed buying food to pay for abortion care. Conclusions. Restrictions on insurance coverage for abortions result in high out-of-pocket costs and major financial hardships for most patients with low incomes in Texas. (Am J Public Health. 2022;112(5):758–761. https://doi.org/10.2105/AJPH.2021.306701 )
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Hu, Qinglin, Xiaobing Li, and Mercedes M. Morales-Alemán. "Pathway analysis to characterize the relationships between healthcare access and healthcare visits in the United States using the health information national trends survey." International Journal Of Community Medicine And Public Health 9, no. 5 (April 27, 2022): 1951. http://dx.doi.org/10.18203/2394-6040.ijcmph20221206.
Повний текст джерелаАнотація:
Background: Americans had fewer healthcare visits compared to their counterparts in other developed countries. The lack of regular check-ups can contribute to worsening health conditions. Insurance coverage, access to transportation to healthcare services, and having accessed health information via the internet are known to be associated with frequency of healthcare visits. However, there is limited literature detailing the direct and indirect influences of these variables on frequency of patients’ healthcare visits. We aimed to understand the interactive relationship between insurance coverage, access to transportation to healthcare services, and having accessed health information via the internet on frequency of patient healthcare visits.Methods: We used data from the 2018 Health Information National Trends Survey (N=3504), the only survey year providing the source for information on insurance coverage, access to transportation to healthcare services, and having accessed health information via the internet. We used descriptive statistics, random parameter binary logistic regression, and pathway analysis to describe and analyze the associations between these determinants of healthcare access and healthcare visits.Results: Results indicated that access to transportation to healthcare services (18.32%) and having insurance coverage (27.89%) were directly associated with healthcare visit frequency whereas the association between having accessed health information via the internet and reporting a healthcare visit, compare to the former two, was weaken (10.87%). Residential area (rural/urban), health conditions, age, race/ethnicity, employment status were directly associated with visit frequency whereas income status and education level were associated with healthcare visits indirectly through insurance.Conclusions: Better understanding interactive relationships between healthcare access determinants will be key to the development of healthcare access interventions aimed at reducing healthcare disparities.
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Alfatlah, Hussein. "MEASUREMENT OF VOLUNTARY REPORTING PRACTICES IN EMERGING MARKETS." مجلة اكد للدراسات المحاسبية المعاصرة 1, no. 3 (January 14, 2022): 152–66. http://dx.doi.org/10.55202/ajcas.v1i3.17.
Повний текст джерелаАнотація:
Financial reports are widely regarded as the basis for evaluating companies, as users heavily rely on them when making various decisions. Financial reports are prepared under a wide range of criteria, both internationally and locally. Moreover, interest in this area has increased in the aftermath of the collapse of several major companies. In the United States of America, this resulted in significant financial problems for insurance firms and stockholders, affecting the overall economic condition. The purpose of this research is to determine the degree of voluntary disclosure by examining the financial statements of a sample of businesses listed on the Iraqi Stock Exchange for the year 2015. The study sample included (58) firms listed on the primary market, with a market capitalization of (82 percent ). a scale consisting of (110) items has been developed To quantify the degree of Voluntary disclosure. According to the study's ranking, the average proportion of voluntary information sharing was 31.6 percent, a low figure. The research suggested that interest in voluntary disclosure be increased due to its critical role in broadening the definition of the business, attaining information symmetry, and attracting investments
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Hassan, Mohamat Sabri, Majella Percy, and Jenny Goodwin-Stewart. "The transparency of derivative disclosures by Australian firms in the extractive industries." Corporate Ownership and Control 4, no. 2 (2007): 257–70. http://dx.doi.org/10.22495/cocv4i2c2p2.
Повний текст джерелаАнотація:
This paper investigates the transparency of derivative disclosures of Australian firms in the extractive industries using 1998 to 2001 financial reports. The quality of financial reporting has become a major corporate governance issue since the collapse of prominent companies such as Enron in the United States, HIH Insurance in Australia, and, of particular relevance here, Barings PLC in the United Kingdom, where the losses were caused by derivative instruments. Disclosure transparency is an important component of the quality of financial reporting. We measure transparency based on a disclosure index developed from AASB 1033 Presentation and Disclosure of Financial Instruments. We examine the relationship between transparency and firm characteristics represented by size, performance, growth opportunities, auditor and type of extractive firm. The results indicate that the transparency of derivative disclosures among firms in the extractive industries has increased over the period. However, there is still evidence of non-compliance with the disclosure requirements, especially in relation to net fair value. We find that firm size, price-earnings ratio and debt-to-equity ratio, and to a lesser extent, market-to-book ratio and profitability are associated with disclosure transparency.
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Raval, Amit D., Orsolya Lunacsek, Matthew J. Korn, Natasha Littleton, Niculae Constantinovici, and Daniel J. George. "Real-world intensification beyond androgen deprivation therapy (ADT) in metastatic hormone sensitive prostate cancer (mHSPC) in the United States 2017-2023: An administrative claims database study." Journal of Clinical Oncology 42, no. 16_suppl (June 1, 2024): e17082-e17082. http://dx.doi.org/10.1200/jco.2024.42.16_suppl.e17082.
Повний текст джерелаАнотація:
e17082 Background: Severalguidelines recommended the use of androgen receptor pathway inhibitors (ARPIs) and/or docetaxel along with ADT for mHSPC based on improved clinical outcomes demonstrated in clinical trials. Given the evolving treatment landscape since 2016, there is a need to understand the translation of clinical evidence and guidelines into clinical practice. Therefore, we examined the use of, and factors associated with intensification beyond ADT in men with mHSPC. Methods: A retrospective cohort of men treated for mHSPC was selected from private insurance claims of the Komodo Research Dataset (Jan 2017-Sep 2023). Men with mHSPC were identified based on their earliest claim for metastasis on or after prostate cancer diagnosis date without evidence of castration resistance. Index date was the earliest claim of ADT following mHSPC. Continuous insurance coverage for ≥ 12 months pre- (baseline) and ≥ 4 months post-index was required. Intensification beyond ADT was defined as the addition of ARPIs, docetaxel or both within ±4 months of the index date. Multinomial regression was conducted to examine factors associated with ADT intensification. Results: The study cohort comprised of 10,717 men with mHSPC with a median age of 65 years. Most had de novo mHSPC (62%), bone-only metastases (49%), hypertension (68%), diabetes (29%), and received opioids (59%) at baseline. Overall, in addition to ADT, 28% received ARPI (abiraterone: 18%, androgen receptor inhibitors: 10%), 9% docetaxel and 2.5% ARPI + docetaxel. From 2017 to 2023, there has been an increase in the intensification of ADT with ARPI from 13% to 47% and with docetaxel + ARPI from 0.8% to 15%, while the use of ADT + docetaxel declined from 12% to 3% and ADT alone from 74% to 36%. Key factors (age, comorbidity, de novo mHSPC, bone metastases) associated with intensification with either docetaxel or ARPI are listed in Table. Conclusions: There was a linear increase in intensification with ARPI and/or docetaxel in mHSPC between 2017-2023 in the US. Findings highlight a gradual uptake of guideline-recommended treatment for men with mHSPC, while over a third are still receiving ADT alone. [Table: see text]
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Wilkinson, Larrell L., Alexis Long-Daniels, Mary Appah, Yusen Zhai, Dayna M. Watson, Kiera Walker, Kourtney Young-Bilbo, Anita Aboagye, Chelsea Tucker, and Shannon McCarthy. "The Association between Social Determinants of Health and Depressive Disorders: A 2017 Behavioral Risk Factor Surveillance System (BRFSS) Analysis." Psychiatry International 4, no. 2 (June 8, 2023): 147–59. http://dx.doi.org/10.3390/psychiatryint4020017.
Повний текст джерелаАнотація:
Background: Major Depressive Disorder is a leading cause of disability worldwide and one of the most common disorders in the United States. Contributors to an individual’s risk for experiencing depressive disorders include individual and social factors. Although the social determinants of health (SDOH) are conditions that contribute to healthy functioning, health outcomes, and quality of life, it is unclear to what extent adverse SDOH experiences are associated with self-reporting depressive disorder (DD). Methods: Data from the 2017 Behavioral Risk Factor Surveillance System (BRFSS), a population-based telephone survey of noninstitutionalized U.S. adults, was employed in this study. Lifetime diagnosis of DD was self-reported among survey participants who also completed the Social Determinants of Health optional module within 17 participating BRFSS states and entities. Rao-Scott chi-square analysis was used to determine the association of individual and SDOH measures with DD. Results: The prevalence of DD among participating states was 19.85%. Among respondents, significant proportional differences were observed for each SDOH indicator regarding DD status. However, significant differences in health insurance coverage were not observed. Conclusion: Survey respondents with a lifetime diagnosis of DD experienced adverse SDOH conditions in greater proportion than individuals not reporting DD. Individual and community-based approaches to address the contextual influences of depressive disorders should be aggressively implemented.
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Halfon, Neal, Paul W. Newacheck, David L. Wood, and Robert F. St Peter. "Routine Emergency Department Use for Sick Care by Children in the United States." Pediatrics 98, no. 1 (July 1, 1996): 28–34. http://dx.doi.org/10.1542/peds.98.1.28.
Повний текст джерелаАнотація:
Background. The use of the emergency departments as a regular source of sick care has been increasing, despite the fact that it is costly and is often an inappropriate source of care. This study examines factors associated with routine use of emergency departments by using a national sample of US children. Methods. Data from the 1988 National Health Interview Survey on Child Health, a nationally representative sample of 17 710 children younger than 18 years, was linked to county-level health resource data from the Area Resource File. Bivariate and multivariate analyses were used to assess the association between children's use of emergency departments as their usual sources of sick care and predisposing need and enabling characteristics of the families, as well as availability of health resources in their communities. Results. In 1988 3.4% or approximately 2 million US children younger than 18 years were reported to use emergency departments as their usual sources of sick care. Significant demographic risk factors for reporting an emergency department as a usual source of sick care included black versus white race (odds ratio [OR], 2.08), single-parent versus two-parent families (OR, 1.53), mothers with less than a high school education versus those with high school or more (OR, 1.76), poor versus nonpoor families (OR, 1.76), and living in an urban versus suburban setting (OR, 1.38). Specific indicators of need, such as recurrent health conditions (asthma, tonsillitis, headaches, and febrile seizures), were not associated with routine use of emergency departments for sick care. Furthermore, health insurance status and specifically Medicaid coverage had no association with use of the emergency department as a usual source of sick care. Compared with children who receive well child care in private physicians' offices or health maintenance organizations, children whose sources of well child care were neighborhood health centers were more likely to report emergency departments for sick care (OR, 2.01). Children residing in counties where the supply of primary care physicians was in the top quintile had half the odds (OR, 0.50) of reporting emergency departments as usual sources of sick care.
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Wallace, Katrine, Adrienne Landsteiner, Scott Bunner, Nicole Engel-Nitz, and Amy Luckenbaugh. "Epidemiology and mortality of metastatic castration-resistant prostate cancer (mCRPC) in a managed care population in the United States." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e13592-e13592. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e13592.
Повний текст джерелаАнотація:
e13592 Background: To date, there has been a paucity of information in the literature describing the epidemiology of mCRPC within the prostate cancer population. We present a real-world data study describing characteristics and mortality of patients with mCRPC within an administrative claims database of an insured population within the United States. Methods: In an administrative claims database of ≈18,000,000 covered lives, adult male patients were included if they had ≥1 claim for prostate cancer (ICD-9: 185 or 233.4; ICD-10: C61 or D075), underwent pharmacologic or surgical castration, and had a code for metastatic disease during the identification period (January 1, 2008–March 31, 2018). The index date was the first metastatic claim; 6 months of continuous enrollment (CE) prior to (baseline period) and after (follow-up period) the index date was required. Patients with metastatic claims in the baseline period were excluded. Patients were followed until the earliest of: death (unless prior to the 6-month CE), end of study period, or disenrollment. A claims-based algorithm was employed to identify locally advanced and distant mCRPC patients in the prostate cancer study population. Mortality data were sourced from the Social Security Administration Medicare data, and a claims algorithm. Results: 343,089 patients were identified with a claim for prostate cancer; of those, 3690 mCRPC cases (1.1%) were identified using the claims-based algorithm and met the study inclusion criteria. Median age was 75 years. Insurance type included commercial plans (27%) and Medicare (73%). Castration type included pharmacologic (99%) and surgical (1%). First claims for metastases were most commonly in the bone (65%) or lymph nodes (15%), with 20% in other sites. The study population averaged a Charlson comorbidity index score of 3.05 at baseline, with 16% of patients receiving a score of ≥5. The most common baseline comorbidities were hypertension (67%), urinary disease (58%), dyslipidemia (52%), and cardiac disease (45%). Median follow-up time among the mCRPC group was 538 days, during which 1834 deaths occurred; 50% of the population experienced mortality during the study period. Conclusions: This study provides valuable insights into the epidemiology, clinical characteristics, prevalence rate, and mortality of patients with mCRPC. Given the high mortality proportion of this disease, the development of novel therapies to prolong life in patients with mCRPC is warranted.
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Sun, Jingjing, Kevin D. Frick, Hailun Liang, Clifton M. Chow, Sofia Aronowitz, and Leiyu Shi. "Examining cancer screening disparities by race/ethnicity and insurance groups: A comparison of 2008 and 2018 National Health Interview Survey (NHIS) data in the United States." PLOS ONE 19, no. 2 (February 28, 2024): e0290105. http://dx.doi.org/10.1371/journal.pone.0290105.
Повний текст джерелаАнотація:
Background Pervasive differences in cancer screening among race/ethnicity and insurance groups presents a challenge to achieving equitable healthcare access and health outcomes. However, the change in the magnitude of cancer screening disparities over time has not been thoroughly examined using recent public health survey data. Methods A retrospective cross-sectional analysis of the 2008 and 2018 National Health Interview Survey (NHIS) database focused on breast, cervical, and colorectal cancer screening rates among race/ethnicity and insurance groups. Multivariable logistic regression models were used to assess the relationship between cancer screening rates, race/ethnicity, and insurance coverage, and to quantify the changes in disparities in 2008 and 2018, adjusting for potential confounders. Results Colorectal cancer screening rates increased for all groups, but cervical and mammogram rates remained stagnant for specific groups. Non-Hispanic Asians continued to report consistently lower odds of receiving cervical tests (OR: 0.42, 95% CI: 0.32–0.55, p<0.001) and colorectal cancer screening (OR: 0.55, 95% CI: 0.42–0.72, p<0.001) compared to non-Hispanic Whites in 2018, despite significant improvements since 2008. Non-Hispanic Blacks continued to report higher odds of recent cervical cancer screening (OR: 1.98, 95% CI: 1.47–2.68, p<0.001) and mammograms (OR: 1.32, 95% CI: 1.02–1.71, p<0.05) than non-Hispanic Whites in 2018, consistent with higher odds observed in 2008. Hispanic individuals reported improved colorectal cancer screening over time, with no significant difference compared to non-Hispanics Whites in 2018, despite reporting lower odds in 2008. The uninsured status was associated with significantly lower odds of cancer screening than private insurance for all three cancers in 2008 and 2018. Conclusion Despite an overall increase in breast and colorectal cancer screening rates between 2008 and 2018, persistent racial/ethnic and insurance disparities exist among race/ethnicity and insurance groups. These findings highlight the importance of addressing underlying factors contributing to disparities among underserved populations and developing corresponding interventions.
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Pan, Xianying, Devashish Verma, Jiayin Zhang, Raminder Pathak, Stefano Monda, and Xiaomei Ma. "Abstract 736: Treatment with immune checkpoint inhibitors (ICIs) and the occurrence of colitis among patients with melanoma in the United States." Cancer Research 83, no. 7_Supplement (April 4, 2023): 736. http://dx.doi.org/10.1158/1538-7445.am2023-736.
Повний текст джерелаАнотація:
Abstract Background: Immune checkpoint inhibitors (ICIs) have improved the survival of cancer patients, but their use comes with the risk of immune-related adverse events. We evaluated the association between ICI treatment and the occurrence of colitis in patients with melanoma using a propensity score matched case-control design nested within a retrospective cohort. Methods: Using the United Healthcare (Optum Clinformatics) Closed Claims & Lab Results Database (01/01/2016 - 12/31/2021), we assembled a cohort of adult patients with melanoma who fulfilled the following eligibility criteria: 1) had ≥2 outpatient claims at least 30 days apart or ≥1 inpatient claim with an International Classification of Diseases (ICD) code indicative of melanoma; 2) received cancer treatment (surgery, chemotherapy, radiotherapy, ICI, or targeted therapy); 3) had a claim with a melanoma ICD code within 5 days before first cancer treatment (i.e., baseline); 4) had ≥12 months of continuous insurance coverage before baseline; 5) had no missing data on age, sex, race, and geographic region; and 6) had no claims for colitis in the 12 months before baseline. From the baseline cohort of 14,781 melanoma patients, cases with colitis were identified if they had ≥1 claim with a colitis ICD code during follow-up (i.e., from baseline to end of insurance coverage, or 12/31/2021), followed by claims for colitis medications within 30 days. Controls were melanoma patients without any colitis claims and were matched to cases with a 10:1 ratio using propensity scores, which were developed using a logistic regression model with colitis being the dependent variable and all available sociodemographic factors (age, sex, race, and region) and comorbidities identified from the 12 months before baseline as independent variables. For controls, we identified their ICI treatment through a specific date so that their follow-up time was the same as that of their matched case. We then conducted conditional logistic regression to estimate the association between ICI treatment and occurrence of colitis. Results: A total of 264 colitis cases (64.8% received ICI) and 1,906 controls (10.9% received ICI) were included. Cases and controls were balanced with respect to the variables associated with colitis occurrence (all standardized differences <0.1), indicating adequate matching based on propensity scores. Melanoma patients who underwent ICI treatment were more likely to develop colitis during follow-up, compared with controls (odds ratio = 19.1, 95% confidence interval: 13.4-27.2; p<.001). Conclusions: In a large cohort of patients treated for melanoma during 2016-2021, treatment with ICIs, compared with the other treatments, was associated with a 19-fold increase in the odds of colitis occurrence. Further research is needed to identify melanoma patients at risk for colitis to facilitate early treatment and improve patient outcomes. Citation Format: Xianying Pan, Devashish Verma, Jiayin Zhang, Raminder Pathak, Stefano Monda, Xiaomei Ma. Treatment with immune checkpoint inhibitors (ICIs) and the occurrence of colitis among patients with melanoma in the United States [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 736.
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Dacosta Byfield, Stacey, Diana Chen, Yeun Mi Yim, and Carolina Reyes. "Age distribution of patients with advanced non-melanoma skin cancer in the United States." Archives of Dermatological Research 305, no. 9 (April 21, 2013): 845–50. http://dx.doi.org/10.1007/s00403-013-1357-2.
Повний текст джерелаАнотація:
Abstract The epidemiology of non-melanoma skin cancer (NMSC) is not well understood due to exclusion from most US cancer registries. Patients with at least two claims with a NMSC diagnosis (ICD-9-CM 173.xx) at least 60 days apart, or at least one claim for a NMSC-specific treatment from 1/2010 to 12/2010, were identified from a large US commercial insurance claims database and grouped into one of three cohorts: metastatic (MET), locally advanced (LA), or “all other”. MET patients had at least two claims with a metastasis code at least 30 days apart. LA patients had at least two visits to a medical oncologist, one diagnostic imaging service, two radiation therapy services, or one visit to two or more physician specialties. Remaining patients were “all other”. Incidence and prevalence of NMSC were calculated from among the total number of persons continuously enrolled in the plan during the study period and standardized to the 2010 US population. From among 6,610,256 patients, there were 47,451 incident cases of NMSC (MET n = 16, LA n = 387, all other n = 47,048). The age-adjusted incidence rate of 693 per 100,000 persons (2010 population) approximates to 2,139,535 total NMSC cases in the US (0.7 % of population). 671 prevalent cases had advanced disease (MET n = 43, LA n = 628); an age-adjusted rate of 0.6 and 10 per 100,000 US persons equivalent to 1,993 and 29,841 MET and LA cases, respectively. Although NMSCs rarely progress, the number of patients with advanced disease is significant. Further studies to determine proportions of advanced NMSC by subtype are needed.
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Lieneck, Cristian, Mario Gallegos, Madison Ebner, Hannah Drake, Emma Mole, and Kaitlin Lucio. "Rapid Review of “No Surprise” Medical Billing in the United States: Stakeholder Perceptions and Challenges." Healthcare 11, no. 5 (March 5, 2023): 761. http://dx.doi.org/10.3390/healthcare11050761.
Повний текст джерелаАнотація:
Surprise medical bills received after care delivery in both emergency and non-emergency situations for out-of-network (OON) or other contractual health plan regulations adds additional stress upon the care guarantor, most often the patient. The passing and continued implementation of the federal No Surprises Act (NSA) and related state-level legislation continues to influence the processes of care delivery in the United States. This rapid review evaluated the literature specific to surprise medical billing in the United States since the passing of the No Surprise Act, guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol. A total of 33 articles were reviewed by the research team and the results demonstrate industry stakeholder perceptions related to two primary industry themes (constructs) surrounding surprise billing: healthcare stakeholder perspectives and medical claim dispute (arbitration) processes. Further investigation identified sub-constructs for each: the practice of balance-billing patients for OON care and healthcare provider, and facility equitable reimbursement challenges (primary theme 1), and arbitration observations and challenges surrounding (a) the NSA medical dispute process, (b) state-level arbitration processes and perceptions, and (c) use of the Medicare fee schedule as a benchmark for arbitration decisions (primary theme 2). The results indicate the need for formative policy improvement initiatives to address the generation of surprise billing.
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de Pins, Agathe M., and Chelsea A. DeBolt. "Evaluating the Effect of Intimate Partner Violence on Hypertensive Disorders of Pregnancy [ID 2683517]." Obstetrics & Gynecology 143, no. 5S (May 2024): 62S. http://dx.doi.org/10.1097/01.aog.0001013808.50247.3e.
Повний текст джерелаАнотація:
INTRODUCTION: Approximately 5% of pregnant individuals in the United States will experience intimate partner violence (IPV) during their pregnancy. Studies have linked IPV during pregnancy to adverse pregnancy outcomes, but most were either conducted in small datasets, low/middle-income countries, or are outdated. Hypertensive disorders of pregnancy (HDP) have been linked to maternal stress and adverse pregnancy outcomes, but no study to date has looked at the effect of IPV during pregnancy on HDP. METHODS: Data from the 2016–2021 Pregnancy Risk Assessment Monitoring System were used to conduct univariate and multivariate logistic regression analyses to assess the relationship between IPV (physical, sexual, and emotional) and HDP, adjusting for maternal age, education, insurance, preexisting hypertension or diabetes, smoking, and no previous live births. RESULTS: Of the 41,075 participants, 2,762 (6.7%) reported IPV during pregnancy and were younger with higher rates of public insurance, tobacco use, preexisting hypertension/diabetes, and less likely to have a bachelors degree. Incidence of HDP among individuals reporting IPV was 20.8%. Those who reported IPV had increased odds of HDP compared to those who did not (adjusted odds ratio [OR] 1.13 [1.02–1.26]). This association remained significant in individuals reporting physical abuse (N=863) during pregnancy (adjusted OR, 1.25 [1.05–1.50]) and reporting emotional abuse (N=2,607) during pregnancy (adjusted OR, 1.13 [1.01–1.25]). There was no association between IPV and HDP for individuals reporting sexual (N=490) abuse. CONCLUSION: This study provides a current understanding of the effect of IPV during pregnancy on HDP. Its findings provide ground for greater advocacy against IPV and towards IPV screening and support during pregnancy.
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Labisi, Titilola O., Anthony T. Podany, Nada A. Fadul, Jason D. Coleman, and Keyonna M. King. "Factors associated with viral suppression among cisgender women living with human immunodeficiency virus in the United States: An integrative review." Women's Health 18 (January 2022): 174550572210922. http://dx.doi.org/10.1177/17455057221092267.
Повний текст джерелаАнотація:
Introduction: Women account for 23% of new human immunodeficiency virus diagnoses in the United States, yet remain understudied. Adherence to antiretroviral therapy and consequent viral suppression are keys to preventing human immunodeficiency virus transmission, reducing risk of drug resistance, and improving health outcomes. Objectives: This review identified and synthesized peer-reviewed studies in the United States describing factors associated with viral suppression among cisgender women living with human immunodeficiency virus. Methods: We searched five databases: Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, Embase, Scopus, and PsycINFO, and reported the findings using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eligible studies included: (1) peer-reviewed English-language articles published since 2010; (2) includes only cisgender women; (3) participants were at least 18 years of age; (4) reported metrics on viral loads; and (5) conducted in the United States. Results: Fourteen studies in total were reviewed. Eight studies had adult women living with human immunodeficiency virus, four recruited only pregnant women, and two included only racial minority women. The most commonly reported factors negatively associated with viral suppression were substance use ( n = 4), followed by availability of health insurance, financial constraint, complexity of human immunodeficiency virus treatment regimen ( n = 3), and intimate partner violence ( n = 2). Other factors were depression, race, and age. In addition, all four studies that included only pregnant women reported early human immunodeficiency virus care engagement as a significant predictor of low viral loads pre- and post-partum. Conclusion: Substance use, financial constraint, lack of health insurance, human immunodeficiency virus treatment regimen type, intimate partner violence, and late human immunodeficiency virus care pre–post pregnancy were the most common factors negatively associated with viral suppression. There is a paucity of data on viral suppression factors related to transgender and rural populations. More human immunodeficiency virus research is needed to explore factors associated with human immunodeficiency virus treatment outcomes in transgender women and cisgender women in rural U.S. regions.
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Bosetti, Rita, Laila Tabatabai, Georges Naufal, Terri Menser, and Bita Kash. "Comprehensive cost-effectiveness of diabetes management for the underserved in the United States: A systematic review." PLOS ONE 16, no. 11 (November 18, 2021): e0260139. http://dx.doi.org/10.1371/journal.pone.0260139.
Повний текст джерелаАнотація:
Background Diabetes mellitus affects almost 10% of U.S. adults, leading to human and financial burden. Underserved populations experience a higher risk of diabetes and related complications resulting from a combination of limited disposable income, inadequate diet, and lack of insurance coverage. Without the requisite resources, underserved populations lack the ability to access healthcare and afford prescription drugs to manage their condition. The aim of this systematic review is to synthesize the findings from cost-effectiveness studies of diabetes management in underserved populations. Methods Original, English, peer-reviewed cost-effectiveness studies of diabetes management in U.S. underserved populations were obtained from 8 databases, and PRISMA 2009 reporting guidelines were followed. Evidence was categorized as strong or weak based on a combination of GRADE and American Diabetes Association guidelines. Internal validity was assessed by the Cochrane methodology. Studies were classified by incremental cost-effectiveness ratio as very cost-effective (ICER≤US$25,000), cost-effective (US$25,000<ICER≤US$50,000), marginally cost-effective (US$50,000<ICER≤US$100,000) or cost-ineffective (ICER>US$100,000). Reporting and quality of economic evaluations was assessed using the CHEERS guidelines and Recommendations of Second Panel for Cost-Effectiveness in Health and Medicine, respectively. Findings Fourteen studies were included. All interventions were found to be cost-effective or very cost-effective. None of the studies reported all 24 points of the CHEERS guidelines. Given the considered cost categories vary significantly between studies, assessing cost-effectiveness across studies has many limitations. Program costs were consistently analyzed, and a third of the included studies (n = 5) only examined these costs, without considering other costs of diabetes care. Interpretation Cost-effectiveness studies are not based on a standardized methodology and present incomplete or limited analyses. More accurate assessment of all direct and indirect costs could widen the gap between intervention and usual care. This demonstrates the urgent need for a more standardized and comprehensive cost-effectiveness framework for future studies.