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Insurance reimbursement

Vivek Shetty, John Yamamoto, Kenneth Yale
The convergent forces of rising costs, growing consumerism, expensive new treatments, sociodemographic shifts and increasing health disparities are exerting intense and unsustainable pressures on healthcare systems. As with the other health domains, these disruptive forces demand new approaches and delivery models for oral healthcare. Technological innovations and practices borrowed from the e-commerce and tech sectors could facilitate the move to a sustainable 21st century oral healthcare system, one that delivers high-quality, value-based care to wider groups of patients...
July 2018: Journal of Dentistry
Anna Marie Jilla, Carole E Johnson, Jeffrey L Danhauer
Limited accessibility to and affordability of hearing health care (HHC) and hearing aids (HAs) are two reasons why people do not seek treatment for their hearing losses. This article is the first in a series of two and discusses affordability issues (i.e., billing models, cost-effectiveness, insurance coverage, and reimbursement) related to and provides a historical context for the Over-the-Counter Hearing Aid Act of 2017. This piece of legislation supports development of a new class of over-the-counter HAs that represents a disruptive technology that may transform the HHC industry by reducing costs specific to the device...
May 2018: Seminars in Hearing
Sarah Streeter Hutcheson, Victoria Phillips, Rachel Patzer, Andrew Smith, J David Vega, Alanna A Morris
BACKGROUND: Medicaid insurance in Georgia provides limited reimbursement for heart transplant (HT) and left ventricular assist devices (LVAD). We examined whether insurance type affects eligibility for and survival after receipt of HT or LVAD. METHODS AND RESULTS: We retrospectively identified patients evaluated for HT/LVAD from 2012 to 2016. We used multivariable logistic and Cox proportional hazards regression to examine the association of insurance type on treatment eligibility and one year survival...
June 15, 2018: Clinical Transplantation
Helen H Lee, Nicholas M Dalesio, Anthony T Lo Sasso, William C Van Cleve
BACKGROUND: Pediatric adenotonsillectomies are common and carry known risks of potentially severe complications. Complications that require a revisit, to either the emergency department or hospital readmission, increase costs and may be tied to lower reimbursements by federal programs. In 2011 and 2012, recommendations by pediatric and surgical organizations regarding selection of candidates for ambulatory procedures were issued. We hypothesized that guideline-associated changes in practice patterns would lower the odds of revisits...
June 12, 2018: Anesthesia and Analgesia
Carlos Renato Moreira-Maia, Rafael Massuti, Luca Tessari, Fausto Campani, Glaucia Chiyoko Akutagava-Martins, Samuele Cortese, Luis Augusto Rohde
INTRODUCTION: Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder, characterized by age inappropriate and impairing levels of inattention and/or hyperactivity/impulsivity. Pharmacotherapy is an important part of the ADHD multimodal treatment. The extent to which ADHD is pharmacologically over or under treated worldwide is controversial. We aimed to estimate the pooled worldwide rate of ADHD pharmacological treatment in individuals with and without the disorder...
June 2018: Medicine (Baltimore)
Jennifer Kurowicki, Samuel Rosas, Anton Khlopas, Jared M Newman, Tsun Yee Law, Martin W Roche, Carlos A Higuera, Michael A Mont
BACKGROUND: Patients who have diabetes mellitus (DM) are at an increased risk of postoperative complications following total hip arthroplasty (THA). Therefore, much interest has been paid to perioperative glycemic control. However, no prior studies have evaluated the patient variation of HbA1c levels on costs. Therefore, the purpose of this study was to evaluate the impact of obtaining preoperative HbA1c levels on (1) day of surgery (DOS) cost; (2) subsequent 89-day costs; and (3) global 90-day cost...
July 2018: Journal of Arthroplasty
Kengo Suzuki, Yutaka Hirano, Hirotsugu Yamada, Mitsushige Murata, Masao Daimon, Masaaki Takeuchi, Yoshihiro Seo, Chisato Izumi, Makoto Akaishi
Exercise stress testing has been widely undertaken for the diagnosis of heart diseases. The accurate assessment of clinical conditions can be conducted by comparing the findings obtained from the results of stress echocardiography with the changes in the blood/heart rate and electrocardiograms. Numerous overseas studies have reported the utility of stress echocardiography in diagnosing myocardial ischemia; in Japan, the use of this modality for this purpose was included in the national health insurance reimbursable list in 2012...
June 6, 2018: Journal of Echocardiography
Arpita Mehrotra, Allison Kennedy Fisher, Jennifer Mullen, Leslie Rodriguez, Angela J Jiles, Alison P Albert, Laura A Randall, Paula M Frew
Background: Pertussis, or "whooping cough," is an acute, contagious pulmonary disease that, despite being vaccine-preventable, has become an increasingly widespread problem in the United States. As a result, the Advisory Committee on Immunization Practices and American College of Obstetricians and Gynecologists updated recommendations stating clinicians should give a Tdap dose during every pregnancy, preferably at 27-36 weeks. Despite this recommendation, reported Tdap vaccine receipt rates during pregnancy vary from 16-61%, and previous studies have shown that clinician recommendation and vaccine administration are strongly associated with vaccine uptake among pregnant women...
May 2018: Heliyon
Tzu-Yi Wu, Chia-Hua Chung, Chia-Ni Lin, Jing-Shiang Hwang, Jung-Der Wang
Background: The mortality rates for different cancers are no longer an efficient tool for making national policy. The purpose of this study were to quantify the lifetime risks, life expectancies (LEs) after diagnosis, expected years of life lost (EYLL), and lifetime health care expenditures for 19 major cancers in Taiwan. Methods: A total of 831,314 patients with 19 pathologically proven cancers were abstracted from the Taiwan Cancer Registry from 1998 to 2012. They were linked to the National Mortality Registry (1998-2014) and National Health Insurance reimbursement database (1998-2013) for survival and health care costs...
2018: Clinical Epidemiology
Matthew J Niedzwiecki, Renee Y Hsia, Yu-Chu Shen
BACKGROUND: The Affordable Care Act has provided health insurance to a large portion of the uninsured in the United States. However, different types of health insurance provide varying amounts of reimbursements to providers, which may lead to different types of treatment, potentially worsening health outcomes in patients covered by low-reimbursement insurance plans, such as Medicaid. The objective was to determine differences in access, treatment, and health outcomes by insurance type, using hospital fixed effects...
June 5, 2018: Journal of the American Heart Association
Peivand Bastani, Mahnaz Samadbeik, Rassoul Dinarvand, Sara Kashefian-Naeeini, Soudabeh Vatankhah
BACKGROUND: Iranian health sector encountered many challenges in resource allocation and health service purchasing during the past decades, the aim of this study was to determine the main challenges of the present process of health service purchasing for national policymakers and other developing countries with the same setting. METHODS: It was a qualitative study carried out via the complete content analysis of all relevant national documents from 2007 to 2014...
June 5, 2018: BMC Health Services Research
Kirsi Karvala, Jukka Uitti, Saara Taponen, Ritva Luukkonen, Lauri Lehtimäki
OBJECTIVE: To study the association between perceptions of various triggers of asthma and employment status. METHODS: A questionnaire was administered to all those adults living in the city of Tampere, Finland, who were entitled to special reimbursement for asthma medication by the Social Insurance Institution (n = 2613). The response rate was 79%. The study population (n = 1657) consisted of individuals who worked full-time (n = 967), were unemployed (n = 197), had all-cause work disability (n = 334), or were retired due to old age (n = 159)...
June 2018: Respiratory Medicine
Jillian B Harvey, Shawn Valenta, Kit Simpson, Mark Lyles, James McElligott
Background and Introduction: Telehealth is a promising approach to improving healthcare access and quality. While coverage for telehealthcare has expanded, reimbursement remains one of the biggest barriers to provider adoption. Thirty-four states and the District of Columbia have enacted parity legislation requiring private insurance companies to provide some level of reimbursement coverage for telehealth services. MATERIALS AND METHODS: The purpose of this article is to describe the trends in telehealth utilization from 2010 to 2015 for privately insured patients...
May 30, 2018: Telemedicine Journal and E-health: the Official Journal of the American Telemedicine Association
Marie Simon, Annabel Rigou, Joëlle Le Moal, Abdelkrim Zeghnoun, Alain Le Tertre, Perrine De Crouy-Chanel, Florentia Kaguelidou, Juliane Leger
Context: Hyperthyroidism affects all age groups, but epidemiological data for children are scarce. Objective: To perform a nationwide epidemiological survey of hyperthyroidism in children and adolescents. Design: A cross-sectional descriptive study. Setting: Identification of entries corresponding to reimbursements for antithyroid drugs in the French national insurance database. Participants: All cases of childhood hyperthyroidism (6 months-17 years) in 2015...
May 28, 2018: Journal of Clinical Endocrinology and Metabolism
A Dufay, A Gallo, O Hanon, B Vaïsse, X Girerd
OBJECTIVE: Since January 2017, olmesartan-based treatments are no longer reimbursed by French health insurance. Health authorities have recommended switch to one of the "many effective, better tolerated and reimbursed alternatives". The objective of this study was to evaluate the consequences on the prescription of antihypertensive drugs in France and to evaluate the blood pressure control of treated hypertensive patients after the switch from olmesartan to another Angiotensin receptor blocker (ARB)...
May 25, 2018: Annales de Cardiologie et D'angéiologie
Sheng-Kai Liang, Meng-Rui Lee, Wei-Yu Liao, Chao-Chi Ho, Jen-Chung Ko, Jin-Yuan Shih
Lung cancer remains the primary cause of cancer-related mortality worldwide. Several treatment modalities are available for lung cancer, including surgery, radiation, and chemotherapy. Among the chemotherapeutics available, afatinib has been shown to be effective for those with epidermal growth factor receptor ( EGFR ) mutation-positive lung adenocarcinoma. Herein, we analyzed the factors affecting the prognosis of patients who received afatinib as a first-line therapy for advanced EGFR mutation-positive lung adenocarcinoma in the real-world setting...
May 4, 2018: Oncotarget
C-H Tseng
PURPOSE: This study aimed to investigate whether metformin can affect risk of chronic obstructive pulmonary disease (COPD) in type 2 diabetes (T2D) patients. METHODS: T2D patients newly diagnosed during 1999-2005 were enrolled from the reimbursement database of Taiwan's National Health Insurance system and followed up to 31 December 2011. Analyses were conducted in an unmatched cohort (92,272 ever-users and 10,697 never-users of metformin) and a propensity score (PS) matched pair cohort (10,697 ever-users and 10,697 never-users)...
May 17, 2018: Diabetes & Metabolism
Leslie Wilson, Fatema A Turkistani, Wei Huang, Dang M Tran, Tracy Kuo Lin
INTRODUCTION: California's Workers' Compensation System (CAWCS) Department of Industrial Relations questioned the adequacy of the current Medi-Cal fee-schedule pricing and requested analysis of alternatives that maximize price availability and maintain budget neutrality. OBJECTIVES: To compare CAWCS pharmacy-dispensed (PD) drug prices under alternative fee schedules, and identify combinations of alternative benchmarks that have prices available for the largest percentage of PD drugs and that best reach budget neutrality...
2018: PloS One
Lisa S Rotenstein, Stacie B Dusetzina, Nancy L Keating
BACKGROUND: With total and out-of-pocket spending for oral oncolytics rising, there is increased interest in choosing oncology treatments based on their clinical value relative to cost. OBJECTIVE: To determine if out-of-pocket spending varied for higher versus lower benefit oral oncology drugs reimbursed by commercial insurers. METHODS: This study was a retrospective analysis of commercial insurer prescription drug claims filed between 2007 and 2014 for 13 oral oncolytics approved before 2009...
June 2018: Journal of Managed Care & Specialty Pharmacy
Ulrike Kuchenbecker, Daniela Chase, Anika Reichert, Julia Schiffner-Rohe, Mark Atwood
INTRODUCTION: In Germany, a 23-valent polysaccharide pneumococcal vaccine (PPSV23) is recommended for elderly (60+) and patients 16+ with chronic diseases not associated with immune suppression. For all other patients at risk, sequential immunization with a 13-valent pneumococcal conjugate vaccine (PCV13) first, followed by PPSV23 is recommended. Repeated vaccination with PPSV23 is recommended every 6 years after individual assessment by the physician. This was adopted into the vaccination directive with binding reimbursement and funding...
2018: PloS One
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