Hasil untuk "Insurance"

Belen Chavez, Yan Huang, Tanya Mallavarapu

D. Mortensen

Jean M. Elwing, Stacey Barta, Tim Smith et al.

ABSTRACT Pulmonary arterial hypertension (PAH) requires lifelong medication, with patients taking an average of 12 tablets/day. Several chronic diseases can be treated with a fixed‐dose combination (FDC) tablet, decreasing patient pill burden and increasing adherence. This exploratory research, conducted via focus groups, asked 13 patients with PAH for their insights about the use of FDC (2 PAH treatments in a single tablet), its potential benefits, and challenges to its use. At the time of the focus groups (July 2023), no FDC medications were available for PAH and the discussions were therefore hypothetical. Focus group transcripts were analyzed by a qualitative research specialist to identify key themes. Most participants were unfamiliar with FDC prior to taking part in the focus groups; however, during the engagement, 12/13 participants expressed interest in taking FDC as single‐tablet therapy for their PAH. In general, participants saw the potential benefits as improved convenience, less time spent navigating insurance coverage, and improved adherence. Participants felt that reducing their tablet count by just one tablet would be meaningful to them. Concerns were raised about the potential difficulty with medication titration and challenges distinguishing between the side effects of two combined medications. This exploratory research provides insight into the perceptions of US patients on the utility of FDC in PAH and highlights an unmet need for patient education on medication adherence in PAH.

Ewunetie Mekashaw Bayked, Abebe Kibret Assfaw, Husien Nurahmed Toleha et al.

BackgroundUniversal health coverage (UHC) is crucial for public health, poverty eradication, and economic growth. However, 97% of low- and middle-income countries (LMICs), particularly Africa and Asia, lack it, relying on out-of-pocket (OOP) expenditure. National Health Insurance (NHI) guarantees equity and priorities aligned with medical needs, for which we aimed to determine the pooled willingness to pay (WTP) and its influencing factors from the available literature in Africa and Asia.MethodsDatabase searches were conducted on Scopus, HINARI, PubMed, Google Scholar, and Semantic Scholar from March 31 to April 4, 2023. The Joanna Briggs Institute’s (JBI’s) tools and the “preferred reporting items for systematic reviews and meta-analyses (PRISMA) 2020 statement” were used to evaluate bias and frame the review, respectively. The data were analyzed using Stata 17. To assess heterogeneity, we conducted sensitivity and subgroup analyses, calculated the Luis Furuya-Kanamori (LFK) index, and used a random model to determine the effect estimates (proportions and odds ratios) with a p value less than 0.05 and a 95% CI.ResultsNineteen studies were included in the review. The pooled WTP on the continents was 66.0% (95% CI, 54.0–77.0%) before outlier studies were not excluded, but increased to 71.0% (95% CI, 68–75%) after excluding them. The factors influencing the WTP were categorized as socio-demographic factors, income and economic issues, information level and sources, illness and illness expenditure, health service factors, factors related to financing schemes, as well as social capital and solidarity. Age has been found to be consistently and negatively related to the WTP for NHI, while income level was an almost consistent positive predictor of it.ConclusionThe WTP for NHI was moderate, while it was slightly higher in Africa than Asia and was found to be affected by various factors, with age being reported to be consistently and negatively related to it, while an increase in income level was almost a positive determinant of it.

J. Goswami, V. Senpakapriya, C. Goswami et al.

Agriculture faces unprecedented challenges due to the increasing frequency and severity of natural disasters and extreme weather events. Agriculture sector needs resilience to support food production and livelihoods because it is susceptible to cyclones, floods, droughts, soil erosion, pests, and disease outbreaks. Geospatial technology plays a significant role in disaster management for agriculture, offering tools for preparedness, response, and recovery. This study explores the role of geospatial technology in early warning systems and risk assessment for different types of natural disasters that impact agriculture activity. Sustainable farming practices that are essential for resilience include crop diversity, climate-resilience varieties, and adaptation strategies. Capacity building and training are vital for effective geospatial technology utilization, especially in developing countries like India, where infrastructure and technology access may be limited. Tailored capacity-building programs are essential, emphasizing climate-smart practices, sustainable land management, and post-disaster recovery strategies. Access to financial services and insurance schemes enhances resilience by helping farmers cope with losses and recover from disasters. In order to improve resilience and sustainability in agriculture, geospatial decision support systems make it possible to evaluate alternative planning, optimise resource allocation, and implement adaptive management.

Xiangju Hu, Xin Fang, Minxia Wu

Abstract Aims/Introduction To estimate the prevalence, awareness, treatment, control rate, and influence factors of type 2 diabetes in Fujian province and provide the scientific basic for prevention. Materials and Methods A population‐based study with the analysis of binary logistic regression was carried out to estimate the odds ratios of the influencing factor on type 2 diabetes. Data of the Patient‐Centered Evaluative Assessment of Cardiac Events (PEACE) in southeast China were used. The study sample originated from 12 counties in Fujian province and included 135,352 permanent residents aged 35–75 years in 2021. Results The prevalence of type 2 diabetes was 18.32% (24,801/135,352). Among them, 13,921 (56.13%) were aware of their condition, 11,894 (47.96%) were receiving treatment, and 4,537 (18.29%) had achieved control of blood glucose. Multivariate logistic regression analysis showed that older age, men, low‐family income, low‐education level, urban locality, no medical insurance, and histories of myocardial infarction, stroke, dyslipidemia, hypertension, alcohol consumption, and obesity were associated with a higher prevalence of type 2 diabetes. Conclusions The prevalence of type 2 diabetes among residents aged 35–75 years in southeast China is high, whereas the status of its low awareness, treatment and control is severe, warranting a broad‐based global strategy, including greater efforts in earlier screening, and more effective and affordable treatment is essential.

Allison R. Loiselle, Raj Chovatiya, Isabelle J. Thibau et al.

Abstract Introduction Despite advances in atopic dermatitis (AD) treatments, many patients face challenges obtaining medications. This study aimed to determine the frequency and causes of insurance coverage delays and denials for AD prescriptions and characterize the associated wait times and extent to which patients understand what to do when faced with a coverage issue. Methods This was a cross-sectional, observational study in which adult U.S. residents (aged 18+ years) with AD or caregivers of pediatric U.S. patients with AD (aged 0–17 years) completed an online survey (3 June–16 July 2021). Results Respondents (N = 978) were primarily adults with AD (81.8%), female (67.7%), and white (70.2%). There were 645 insurance delays or denials for AD prescriptions, with 48.1% (470/978) of respondents experiencing at least one delay/denial in the past year. Most delays/denials were for topical steroids (39.2%, 253/645), the most highly used prescription treatment class (83.9%, 821/978). However, the highest rate of delay/denials was for biologics, of which 43.6% (109/250) of all prescriptions faced a delay or denial. Denials were caused primarily by step therapy (27.6%) and delays by prior authorization (55.1%). Only 56.0% of respondents said they would know what to do if they faced an issue with AD prescription coverage. Conclusions Patients with AD frequently experience insurance-related barriers to obtaining recommended therapies, and many do not know how to respond when these barriers arise. Strategies to improve timely therapeutic access are needed.

Charles Agyemang, Manuela Deidda, Gershim Asiki et al.

Introduction COVID-19 affected healthcare access, utilisation and affordability, especially for patients suffering from chronic diseases, including type 2 diabetes (T2D). This study measured the occurrence and magnitude of changes in healthcare and broader societal costs among patients with T2D before and during COVID-19 in Kenya and Tanzania to understand whether and how COVID-19 affected T2D management in countries implementing different policies during the pandemic.Methods A cross-sectional study was conducted in Kenya and Tanzania in March–April 2022 among 500 patients with T2D in each country. We interviewed patients on direct healthcare costs (eg, inpatient and outpatient costs), societal costs (eg, productivity loss) and patients’ characteristics before and during the COVID-19 pandemic. We estimated changes over time using the Generalised Linear Model in Kenya and a two-part model in Tanzania, adjusting for patient-level covariates.Results The overall costs of management of T2D in most categories increased in both countries during COVID-19, but some of the increase was not significant. Transport and testing costs increased significantly in Tanzania (I$0.33, p<0.01 and I$0.85, p<0.01) but not in Kenya (I$1.69, p=0.659 and I$0.10, p=0.603). Outpatient costs increased significantly in Tanzania (I$8.84, p<0.01) but there was no significant change in Kenya (I$8.09, p=0.432). T2D medication costs did not change in Tanzania (I$0.19, p=0.197), but decreased significantly in Kenya (I$18.48, p<0.01). Productivity losses increased significantly in both countries.Conclusion The COVID-19 pandemic is associated with increased direct costs but with a significant increase in many cost categories (transport, testing and outpatient) in Tanzania than in Kenya. A significant increase in productivity loss was observed in both countries. The minimal cost increases in Kenya may be due to the inaccessibility of services associated with lockdown measures and higher insurance coverage compared with Tanzania. Pandemic preparedness initiatives and interventions are needed to safeguard the welfare of patients with chronic conditions during pandemics.

Kyungdo Han, Mee Kyoung Kim

Background : High body weight variability (BWV) is associated with many metabolic and cardiovascular diseases in adults. The study was designed to explore the baseline characteristics associated with high BWV. Methods : Using a nationally representative database from the Korean National Health Insurance system, 77,424 individuals who underwent five health examinations between 2009 and 2013 were enrolled. BWV was calculated using the body weight recorded at each examination, and the clinical and demographic characteristics associated with high BWV were investigated. High BWV was defined as the highest quartile of coefficient variation in body weight. Results : Subjects with high BWV were younger, more commonly female, less likely to have a high income, and more likely to be a current smoker. Young people under the age of 40 years were more than twice as likely to have high BWV compared with those over 65 years (odds ratio [OR], 2.17; 95% confidence interval [CI], 1.88 to 2.50). The incidence of high BWV was higher in female than in male (OR, 1.67; 95% CI, 1.59 to 1.76). Male with the lowest income had a 1.9-fold higher risk of high BWV compared to male with the highest income (OR, 1.97; 95% CI, 1.81 to 2.13). A high BWV in female was associated with heavy alcohol intake (OR, 1.50; 95% CI, 1.17 to 1.91) and current smoking (OR, 1.97; 95% CI, 1.67 to 2.33). Conclusion : Young people, female, low income, and unhealthy behaviors were independently associated with high BWV. Further research is needed on the mechanisms linking high BWV to detrimental health outcomes.

Vladimir Njegomir, Dragan Stojić, Jelena Demko-Rihter

Research Question: What type of mutual relations exist between business insurance and entrepreneurship, and how do they impact economic growth? Motivation: The primary motive for the research is the identified literature gap in the field of interdependence between business insurance and entrepreneurship and their joint contribution to economic growth. Idea: To test whether the interdependence between business insurance and entrepreneurship exists and their combined contribution to economic growth. The following independent variables were used: premium per entrepreneur, solved claims per entrepreneur, total technical reserves, GDP/p.c., a measure of demographic variables in the form of education level, a measure of the impact of banking, and the measure for institutional factors in terms of establishment costs the number of entrepreneurs by years as the dependent variable was considered. Data: Data were gathered from various sources (Serbian Statistical Office, National Bank of Serbia, World Bank) in the period from 2008 to 2019. Tools: Descriptive statistics, regression analysis, and statistical tests. Findings: The presented results show that there is a significant influence of insurance, both through insurance premiums per entrepreneur, which are paid to ensure the safety of the entrepreneur, and through resolved claims per entrepreneur, which present an indicator of insurance compensation in the case of damage to the entrepreneur, and through the impact of insurance on financial market by the amount of technical reserves. The return influence was not confirmed, considering that the number of entrepreneurs per year is a stationary variable, so the effect of the number of entrepreneurs on the development of insurance, measured by the premium per entrepreneur, could not be confirmed. Contribution: This research conducted in Serbia, a developing and upper middle-income country, confirmed the positive impact of insurance on entrepreneurship, but the return influence of entrepreneurship on insurance was not proven.

Shaun S. Wang, V. Young, H. Panjer

Song A, Johnson NA, Mirzania D et al.

Ailin Song,1 Nicholas A Johnson,1 Delaram Mirzania,1,2 Alexandria M Ayala,1 Kelly W Muir,3,4 Atalie C Thompson3,5 1Duke University School of Medicine, Durham, NC, USA; 2Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, University of Michigan Health, Ann Arbor, MI, USA; 3Department of Ophthalmology, Duke University, Durham, NC, USA; 4Durham Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Health Care System, Durham, NC, USA; 5Wake Forest Baptist Health, Winston Salem, NC, USACorrespondence: Atalie C Thompson, Wake Forest Baptist Health, Janeway Tower, 6 th Floor, 1 Medical Center Blvd, Winston Salem, NC, 27103, USA, Tel +1 650-868-8050, Email ataliethompson@gmail.comBackground: Early detection of ophthalmic conditions such as diabetic retinopathy (DR) and glaucoma is crucial to preventing vision loss. Previous studies have evaluated teleretinal screening programs for DR in well-insured populations. The purpose of this retrospective study was to evaluate a teleretinal screening program in a population of uninsured and underinsured patients seen in a Federally Qualified Health Center (FQHC).Methods: We conducted a retrospective chart review of patients (age ≥ 18) who underwent teleretinal imaging (TRI) at a FQHC between January 2015 and September 2019. TRI gradings and patient demographic and clinical information were abstracted. Factors associated with referral for a dilated eye exam by an ophthalmologist, adherence to recommended follow-up dilated eye exam, and ophthalmology visit attendance were examined.Results: 3130 TRIs were graded in 2216 eyes (1107 patients). 65.2% (N = 722) self-identified as Hispanic and 56.3% (N = 623) required interpreter services. Follow-up dilated fundus examination (DFE) was recommended for 388 TRIs, 49% (N = 190) of which were completed within 1 year. Adherence to the recommended ophthalmology exam was not associated with any baseline clinical or demographic characteristics (p > 0.05). Older age, male sex, hypertension, proteinuria, and higher A1c were significantly associated with greater odds of ophthalmology referral based on TRI (all p < 0.05), after adjusting for covariates. Less severe diabetic retinopathy, no insurance coverage, and Hispanic ethnicity were associated with lower odds of attending an ophthalmology visit, regardless of follow-up recommendations based on TRI (all p < 0.05).Conclusion: In an FQHC serving predominantly uninsured and underinsured patients, only 49% of recommended DFE were completed within one year. Less severe diabetic retinopathy, lack of insurance coverage, and Hispanic ethnicity were associated with a lower likelihood of having a DFE regardless of recommendation. These results suggest that greater system-level efforts are needed to increase adherence to follow-up eye exams after TRI to ensure sight-saving care for underserved populations.Keywords: teleretinal screening, teleophthalmology, uninsured, underinsured, adherence, ophthalmology referral

J. Morduch

L. Ku, Sheetal Matani

Lia D Delaney, Brooke Kenney, May Hu et al.

ABSTRACT IMPACT: This is the first examination of risk factors for prolonged opioid use after an ICU stay and will inform efforts to strengthen prescribing guidelines and care transition models for patients after critical illness. OBJECTIVES/GOALS: The majority of patients in intensive care units (ICU) receive opioids during admission, and up to 25% receive a prescription at discharge. However, transitions of care and prolonged use after discharge remain unknown. We aim to characterize risk factors for prolonged opioid use after an ICU stay. METHODS/STUDY POPULATION: A retrospective study using insurance claims from Optum Clinformatics ®Data Mart was conducted for opioid-naive adult patients (18-64 years) with an ICU admission from 2010 to 2019. The primary outcome was new persistent opioid use, defined as a continued prescription fill 91-180 days after discharge, in addition to a fill in the first 90 days. The primary exposure was an opioid fill at discharge. The ICU admission was characterized using the Clinical Classification System from the Agency of Healthcare Research and Quality, based on patients’primary diagnosis code. Diagnoses were combined into 11 groups highlighting the affected organ system/mechanism of injury. Logistic regression evaluated the associations of patient demographic and clinical characteristics with the probability of persistent opioid use. RESULTS/ANTICIPATED RESULTS: In this cohort of 90,721 patients discharged from the ICU, 3.3% continued to fill opioids at 6 months. An opioid prescription fill (OR 3.1; 95% CI 28 - 3.3) and benzodiazepine prescription fill (OR 1.6; 95% CI 1.4 - 1.8) within 3 days of ICU discharge were each significantly associated with the development of new persistent opioid use. Patient diagnosis groups of Musculoskeletal/Trauma (OR 2.3; 95% CI 2.0 - 2.6), Neoplasms (OR 1.6; 95% CI 1.5 - 1.9), and GI/Hepatobiliary (OR 1.5; 95% CI 1.3 - 1.8) were significantly more likely to develop new persistent use when compared to the Cardiovascular diagnosis group. DISCUSSION/SIGNIFICANCE OF FINDINGS: Opioid prescriptions at discharge after an ICU stay increase the odds of prolonged opioid use. These results will inform efforts to strengthen prescribing guidelines and care models after a critical illness. Further work will characterize the trajectory of prescribing and patient exposure to high-risk prescribing after ICU discharge.

Takahiro Mori, Tomohisa Nagata, Masako Nagata et al.

Abstract Background The number of people with diabetes is increasing and resulting in major economic losses. Presenteeism accounts for the majority of economic losses, so measures against presenteeism are important. This study investigated the relationship between severity of type 2 diabetes and presenteeism. Methods A cross-sectional study was conducted among workers over 40 years of age. Participants were classified as normal group or diabetic treatment group using their medical examination results and health insurance claims data. Diabetic treatment groups were described by degree of treatment control: Good (HbA1c < 7%), Intermediate (7% ≤ HbA1c < 8%), and Poor (8% ≤ HbA1c). Therapy type was also divided into monotherapy and combination therapy. Logistic regression analysis was performed to predict presenteeism loss using the Quantity and Quality method. Results Data on 13,271 workers were analyzed. Presenteeism loss was significantly higher in all treatment control groups compared with the normal group, particularly for the intermediate and poor control groups. The monotherapy group did not differ from the normal group, but presenteeism loss was significantly higher in the combination therapy group than the normal group. Conclusions Presenteeism loss in workers with diabetes may be affected by diabetes severity, and even if treatment control were good, presenteeism loss could occur when the number of anti-diabetic drugs was high. Therefore, it is important to provide early intervention and continuous support as a preventive measure against not only diabetes and diabetes-related complications but also presenteeism.

Mohamed M. Gad, Islam Y. Elgendy, Ahmed N. Mahmoud et al.

Background The incidence of cardiovascular disease among pregnant women is rising in the United States. Data on racial disparities for the major cardiovascular events during pregnancy are limited. Methods and Results Pregnant and post‐partum women hospitalized from January 2007 to December 2017 were identified from the Nationwide Inpatient Sample. The outcomes of interest included: in‐hospital mortality, myocardial infarction, stroke, pulmonary embolism, and peripartum cardiomyopathy. Multivariate regression analysis was used to assess the independent association between race and in‐hospital outcomes. Among 46 700 637 pregnancy‐related hospitalizations, 21 663 575 (46.4%) were White, 6 302 089 (13.5%) were Black, and 8 914 065 (19.1%) were Hispanic. The trends of mortality and stroke declined significantly in Black women, but however, were mostly unchanged among White women. The incidence of mortality and cardiovascular morbidity was highest among Black women followed by White women, then Hispanic women. The majority of Blacks (62.3%) were insured by Medicaid while the majority of White patients had private insurance (61.9%). Most of Black women were below‐median income (71.2%) while over half of the White patients were above the median income (52.7%). Compared with White women, Black women had the highest mortality with adjusted odds ratio (aOR) of 1.45, 95% CI (1.21–1.73); myocardial infarction with aOR of 1.23, 95% CI (1.06–1.42); stroke with aOR of 1.57, 95% CI (1.41–1.74); pulmonary embolism with aOR of 1.42, 95% CI (1.30–1.56); and peripartum cardiomyopathy with aOR of 1.71, 95 % CI (1.66–1.76). Conclusions Significant racial disparities exist in major cardiovascular events among pregnant and post‐partum women. Further efforts are needed to minimize these differences.

A. Wagstaff, M. Lindelow

B. Starfield, Leiyu Shi

OBJECTIVE To review the extent to which the literature supports the position that a medical home is important and to review the extent to which insurance is related to having a medical home. METHODS A review of literature concerning the benefits of a medical home on effectiveness, costs, and equity (reducing disparities) was conducted. RESULTS International and within-nation studies indicate that a relationship with a medical home is associated with better health, on both the individual and population levels, with lower overall costs of care and with reductions in disparities in health between socially disadvantaged subpopulations and more socially advantaged populations. Although important in facilitating use overall, insurance does not guarantee a medical home. CONCLUSIONS A medical home, with its 4 key features, provides better effectiveness as well as more efficient and more equitable care to individuals and populations. A concerted attempt to provide a means of universal financial access as well as a medical home should be of high priority for the United States.

Marcus Miller, Lei Zhang

This paper proposes an integrated framework to analyze jointly two key issues: the emergence of global imbalances and the precautionary motive for accumulating reserves. Standard models of general equilibrium would predict modest current account surpluses in the emerging markets if they face higher risk than the US itself. But, with pronounced Loss Aversion in emerging markets, their precautionary savings can generate substantial global imbalances, especially if there is an inefficient supply of global insurance. In principle, lower real interest rates will ensure that aggregate demand equals supply at a global level (though the required real interest may be negative). While a precautionary savings glut appears to be a temporary phenomenon, a process of correction triggered by a Sudden Stop in capital flows to the United States might lead to a hard landing.