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Insurance reimbursement

Denggui Wen, Yutong He, Lizhen Wei, Nan Zhang, Shumei Li, Xiaoduo Wen, Yi Yang, Guiying Wang, Shijie Wang, Cuizhi Geng, Yunjiang Liu, Baoen Shan
BACKGROUND: Breast cancer is diagnosed more frequently among urban than rural women in China; however, the incidence among women in Shijiazhuang is unknown. METHODS: As registered Chinese citizens are entitled to complete public medical insurance coverage, the incidence rate was estimated using reimbursement records of first hospitalization. RESULTS: Breast cancer is the most common cancer among women in Shijiazhuang. The crude rate and age-standardized incidence rates by China (ASRC) and world (ASRW) standards were 59...
September 2016: Thoracic Cancer
Joseph E Tanenbaum, Vincent J Alentado, Jacob A Miller, Daniel Lubelski, Edward C Benzel, Thomas E Mroz
BACKGROUND CONTEXT: Lumbar fusion is a common and costly procedure in the United States. Reimbursement for surgical procedures is increasingly tied to care quality and patient safety as part of value-based reimbursement programs. The incidence of adverse quality events among lumbar fusion patients is unknown using the definition of care quality (patient safety indicators [PSI]) utilized by the Centers for Medicare and Medicaid Services (CMS). The association between insurance status and the incidence of PSI is similarly unknown in lumbar fusion patients...
October 17, 2016: Spine Journal: Official Journal of the North American Spine Society
Helmuth Cremer, Jean-Marie Lozachmeur, Pierre Pestieau
This paper studies the design of long term care (LTC) insurance contracts in the presence of ex post moral hazard. While this problem bears some similarity with the study of health insurance (Blomqvist, 1997) the significance of informal LTC affects the problem in several crucial ways. It introduces the potential crowding out of informal care by market care financed through insurance coverage. Furthermore, the information structure becomes more intricate. Informal care is not publicly observable and, unlike the insurer, caregivers know the true needs of their relatives...
September 27, 2016: Journal of Health Economics
Gunter Laux, Sarah Berger, Joachim Szecsenyi, Petra Kaufmann-Kolle, Rüdiger Leutgeb
BACKGROUND: The objective of this study was to analyze prescription decisions for family practice (FP) patients with Diabetes mellitus type 2 (DM2) using the case of the incretin mimetics Dipeptidyl peptidase-4 (DDP-4) inhibitors and Glucagon-like peptide-1 (GLP-1) agonists dependent on patients' health insurance status (statutory or private) in Germany. This study is important since the scientific debate is still open with regard to DPP-4-inhibitors and GLP-1-agonists, where some critics are raising questions on potential long-term risks for patients...
October 19, 2016: BMC Family Practice
Melinda Wolboldt, Barbara Saltzman, Patrick Tenbrink, Khaled Shahrour, Samay Jain
INTRODUCTION: With healthcare reform, cost and patient satisfaction will directly affect hospital reimbursement. We present data on same day discharge (SDD) for patients who underwent robot assisted laparoscopic radical prostatectomy (RALP). METHODS: Patient data were gathered in an IRB approved database. In April 2015, surgeon (SJ) began SDD. The SDD protocol for RALP includes multimodal anesthesia/analgesia and extended recovery. Interim analysis revealed that government insurance (CMS) refused hospital reimbursement for SDD...
October 19, 2016: Journal of Endourology
Do Young Kim, Ki Tae Yoon, Won Kim, Jung Il Lee, Sung Hwi Hong, Danbi Lee, Jeong Won Jang, Jong Won Choi, Ilsu Kim, Yong Han Paik
BACKGROUND: This study aimed to estimate the direct medical costs of managing chronic hepatitis C (CHC) and its complications based on health-care resources in South Korea. METHODS: The study design was multicenter, retrospective, non-interventional, and observational. Between September 2013 and April 2014, health-care resource data from patients chronically infected with hepatitis C virus, regardless of genotype, were collected from 8 institutions, including data related to outpatient management, emergency care, and hospitalization...
July 2016: Medicine (Baltimore)
Khaled J Saleh, William O Shaffer
In 2015, the US Congress passed legislation entitled the Medicare Access and CHIP [Children's Health Insurance Program] Reauthorization Act (MACRA), which led to the formation of two reimbursement paradigms: the merit-based incentive payment system (MIPS) and alternative payment models (APMs). The MACRA effectively repealed the Centers for Medicare and Medicaid Services (CMS) sustainable growth rate (SGR) formula while combining several CMS quality-reporting programs. As such, MACRA represents an unparalleled acceleration toward reimbursement models that recognize value rather than volume...
November 2016: Journal of the American Academy of Orthopaedic Surgeons
Isabelle Récoché, Vanessa Rousseau, Robert Bourrel, Maryse Lapeyre-Mestre, Leila Chebane, Fabien Despas, Jean-Louis Montastruc, Emmanuelle Bondon-Guitton
Many patients treated with imatinib, used in cancer treatment, are using several other drugs that could interact with imatinib. Our aim was to study all the drug-drug interactions (DDIs) observed in patients treated with imatinib.We performed 2 observational studies, between the 1st January 2012 and the 31st August 2015 in the Midi-Pyrénées area (South Western France), using the French health insurance reimbursement database and then the French Pharmacovigilance Database (FPVD).A total of 544 patients received at least 1 reimbursement for imatinib...
October 2016: Medicine (Baltimore)
Mark A Healy, Jason C Pradarelli, Robert W Krell, Scott E Regenbogen, Pasithorn A Suwanabol
BACKGROUND: Despite substantially improved survival with metastatic site resection in colorectal cancers, uptake of aggressive surgical approaches remains low among certain patients. It is unknown whether financial determinants of care, such as insurance status, play a role in this treatment gap. OBJECTIVE: We sought to evaluate the effect of insurance status on metastasectomy in patients with advanced colorectal cancers. DESIGN: This was a retrospective cohort study...
November 2016: Diseases of the Colon and Rectum
Jonathan Howland, Nicole J Treadway, Alyssa A Taylor, Elizabeth W Peterson
BACKGROUND: The Massachusetts (MA) Department of Public Health engaged the Injury Prevention Center at Boston Medical Center to develop a statewide baseline (2012) inventory of evidence-based (EB) community falls prevention programs for community-dwelling older adults. METHODS: A web-based survey of organizations (n = 825) serving older adults was deployed in two parts. The Directors' survey determined if a falls prevention program had been offered in 2012, the salience (rating of importance) of falls prevention for the organization, and intention to offer future falls prevention programming...
December 2015: Injury Epidemiology
Juan Yang, Katherine E Atkins, Luzhao Feng, Mingfan Pang, Yaming Zheng, Xinxin Liu, Benjamin J Cowling, Hongjie Yu
BACKGROUND: To explore the current landscape of seasonal influenza vaccination across China, and estimate the budget of implementing a national "free-at-the-point-of-care" vaccination program for priority populations recommended by the World Health Organization. METHODS: In 2014 and 2016, we conducted a survey across provincial Centers for Disease Control and Prevention to collect information on regional reimbursement policies for influenza vaccination, estimated the national uptake using distributed doses of influenza vaccines, and evaluated the budget using population size and vaccine cost obtained from official websites and literatures...
October 13, 2016: Vaccine
Diana Karpman, Peter Höglund
Orphan drugs designed to treat rare diseases are often overpriced per patient. Novel treatments are sometimes even more expensive for patients with ultra-rare diseases, in part due to the limited number of patients. Pharmaceutical companies that develop a patented life-saving drug are in a position to charge a very high price, which, at best, may enable these companies to further develop drugs for use in rare disease. However, is there a limit to how much a life-saving drug should cost annually per patient? Government interventions and regulations may opt to withhold a life-saving drug solely due to its high price and cost-effectiveness...
October 13, 2016: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Caryn E Peterson, J Andrew Dykens, Noel T Brewer, Joanna Buscemi, Karriem Watson, DeLawnia Comer-Hagans, Zo Ramamonjiarivelo, Marian Fitzgibbon
Human papillomavirus (HPV) vaccine coverage remains low in the USA. The Society for Behavioral Medicine (SBM) supports the goals outlined by Healthy People 2020, the President's Cancer Panel, and the National Vaccine Advisory Committee to increase vaccination coverage among both males and females. SBM makes the following recommendations in support of efforts to reduce structural and other barriers to HPV vaccination services in order to increase rates of series completion. We encourage legislators and other policymakers to improve administration authority, insurance coverage, and reimbursement rates to healthcare providers who make the HPV vaccine available to adolescents; provide instrumental support to fund the development of school curricula on HPV vaccination; and increase public awareness that HPV vaccination can prevent cancer...
October 7, 2016: Translational Behavioral Medicine
Yasuo Yanagi, Aya Fukuda, Victor Barzey, Kenji Adachi
OBJECTIVE: This analysis estimated the cost-effectiveness of intravitreal aflibercept injection(s) (IAI) for wet age-related macular degeneration (wAMD) compared with other treatments in Japan. METHODS: This was a cost-utility analysis based on published data. A state-transition cohort model was constructed with six health states based on best-corrected visual acuity in the better-seeing eye. The cycle time was 4 weeks, and the time horizon was 12 years. The model compared IAI 2mg every 8 weeks (2q8) for 2 years after three initial monthly injections, ranibizumab as needed, ranibizumab 0...
October 5, 2016: Journal of Medical Economics
Shou-Hsia Cheng, Chi-Chen Chen, Hung-Chih Kuo, Chi-Chuan Wang
OBJECTIVES: To examine the long-term effects of drug reimbursement adjustments on drug-switching decisions and to investigate whether patients with complicated or severe conditions are more affected. METHODS: A population-based, longitudinal study with a before-and-after design. Analysis of 141,703 patients with type 2 diabetes covered by the universal health insurance program in Taiwan. Observation of five 6-month phases before and after a drug reimbursement adjustment implemented in October 2009...
October 3, 2016: Journal of Health Services Research & Policy
Chun-Chieh Yeh, Chien-Chang Liao, Chun-Chuan Shih, Long-Bin Jeng, Ta-Liang Chen
Outcomes after surgeries involving physicians as patients have not been researched. This study compares postoperative adverse events between physicians as surgical patients and nonhealth professional controls.Using reimbursement claims data from Taiwan's National Health Insurance Program, we conducted a matched retrospective cohort study of 7973 physicians as surgical patients and 7973 propensity score-matched nonphysician controls receiving in-hospital major surgeries between 2004 and 2010. We compared postoperative major complications, length of hospital stay, intensive care unit (ICU), medical expenditure, and 30-day mortality...
September 2016: Medicine (Baltimore)
T Griesbacher, R Sauermann
No abstract text is available yet for this article.
October 6, 2016: Clinical Therapeutics
Syed K Mehdi, Joseph E Tanenbaum, Vincent J Alentado, Jacob A Miller, Daniel Lubelski, Edward C Benzel, Thomas E Mroz
STUDY DESIGN: Retrospective cohort study. BACKGROUND CONTEXT: CMS defines "adverse quality events" as the incidence of certain complications such as post-surgical hematoma and/or iatrogenic pneumothorax during an inpatient stay. Patient safety indicators (PSI) are a means to measure the incidence of these adverse events. When these occur, reimbursement to the hospital decreases. The incidence of adverse quality events among patients hospitalized for primary spinal neoplasms is unknown...
September 21, 2016: Spine Journal: Official Journal of the North American Spine Society
Chin-Hsiao Tseng
This retrospective cohort study evaluated the risk of prostate cancer associated with sitagliptin use in Taiwanese male patients with type 2 diabetes mellitus by using the reimbursement databases of the National Health Insurance. Male patients with newly diagnosed type 2 diabetes mellitus at an age ≥25 years between 1999 and 2010 were recruited. A total of 37,924 ever users of sitagliptin and 426,276 never users were followed until December 31, 2011. The treatment effect of sitagliptin (for ever versus never users, and for tertiles of cumulative duration of therapy) was estimated by Cox regression incorporated with the inverse probability of treatment weighting using propensity score...
September 20, 2016: Oncotarget
C Holmberg, R Muckelbauer, G Sarganas, V Braun, C Heintze, L Dini, J Müller-Nordhorn
Aim of the study: According to the German social insurance code §20 Sec. 1, statutory health insurance companies can reimburse up to 80% of costs incurred by primary prevention programs in physical activity, nutrition, stress management and drug consumption. Whether and how many general practitioners (GPs) provide their patients with information on such programs as part of their own practice is unknown. In this study, we investigate to which primary prevention programs primary care physicians refer their patients and whether they take into account reimbursability of programs...
September 16, 2016: Das Gesundheitswesen
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