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Cost sharing in healthcare

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https://www.readbyqxmd.com/read/27902648/incidence-and-burden-of-pertussis-among-infants-less-than-1-year-of-age
#1
Cristina Masseria, Carolyn K Martin, Girishanthy Krishnarajah, Laura K Becker, Ami Buikema, Tina Q Tan
BACKGROUND: Infant-specific pertussis data, especially among neonates, are limited and variable. This study (NCT01890850) provides overall and age-specific pertussis incidence and associated healthcare utilization and costs among commercially insured infants in the United States. METHODS: Nearly 1.2 million infants born from 2005-2010 with commercial health plan coverage were followed during their first 12 months of life. Pertussis cases were identified from medical claims (ICD-9-CM 033...
November 28, 2016: Pediatric Infectious Disease Journal
https://www.readbyqxmd.com/read/27897016/open-data-for-discovery-science
#2
Philip R O Payne, Kun Huang, Nigam H Shah, Jessica Tenenbaum
The modern healthcare and life sciences ecosystem is moving towards an increasingly open and data-centric approach to discovery science. This evolving paradigm is predicated on a complex set of information needs related to our collective ability to share, discover, reuse, integrate, and analyze open biological, clinical, and population level data resources of varying composition, granularity, and syntactic or semantic consistency. Such an evolution is further impacted by a concomitant growth in the size of data sets that can and should be employed for both hypothesis discovery and testing...
2016: Pacific Symposium on Biocomputing
https://www.readbyqxmd.com/read/27896681/financial-impact-of-direct-acting-oral-anticoagulants-in-medicaid-budgetary-assessment-based-on-number-needed-to-treat
#3
Kathleen A Fairman, Lindsay E Davis, Courtney R Kruse, David A Sclar
BACKGROUND: Faced with rising healthcare costs, state Medicaid programs need short-term, easily calculated budgetary estimates for new drugs, accounting for medical cost offsets due to clinical advantages. OBJECTIVE: To estimate the budgetary impact of direct-acting oral anticoagulants (DOACs) compared with warfarin, an older, lower-cost vitamin K antagonist, on 12-month Medicaid expenditures for nonvalvular atrial fibrillation (NVAF) using number needed to treat (NNT)...
November 28, 2016: Applied Health Economics and Health Policy
https://www.readbyqxmd.com/read/27896623/effect-of-the-new-maternity-insurance-scheme-on-medical-expenditures-for-caesarean-delivery-in-wuxi-china-a-retrospective-pre-post-reform-case-study
#4
Chun Chen, Zhihong Cheng, Ping Jiang, Mei Sun, Qi Zhang, Jun Lv
Aiming to control rising medical expenditures and help improve China's healthcare systems, this study examined whether a cap-based medical insurance scheme with shared financial interest between the insurance and healthcare providers is effective in containing hospitals' C-section medical expenditures. We used 6547 caesarean delivery case records from a teaching tertiary-level general public hospital located in Wuxi, China (2004-2013), and used the Chow test to investigate the possibility of significant variation in mean medical expenditures for caesarean deliveries pre- and post-reform...
November 28, 2016: Frontiers of Medicine
https://www.readbyqxmd.com/read/27893144/effectiveness-of-shared-medical-appointments-targeting-the-triple-aim-among-patients-with-overweight-obesity-or-diabetes
#5
Kristi H Trickett, Paul M Matiaco, Kathryn Jones, Bernadette Howlett, Kathaleen Briggs Early
BACKGROUND: Obesity and diabetes are epidemic in the United States, with many treatment options having limited long-term efficacy. A possible effective medical management tool is the shared medical appointment (SMA), which offers an efficient and cost-effective approach to behavior change and aligns with the Triple Aim (reduce costs, improve population health, and improve patient care experience) set forth by the Institute for Healthcare Improvement. OBJECTIVES: To assess the effectiveness of SMAs to achieve the Triple Aim and to improve the management of overweight/obesity or diabetes...
December 1, 2016: Journal of the American Osteopathic Association
https://www.readbyqxmd.com/read/27888437/estimated-budget-impact-of-adopting-the-affordable-care-act-s-required-smoking-cessation-coverage-on-united-states-healthcare-payers
#6
Christine L Baker, Cheryl P Ferrufino, Marianna Bruno, Stacey Kowal
INTRODUCTION: Despite abundant information on the negative impacts of smoking, more than 40 million adult Americans continue to smoke. The Affordable Care Act (ACA) requires tobacco cessation as a preventive service with no patient cost share for all FDA-approved cessation medications. Health plans have a vital role in supporting smoking cessation by managing medication access, but uncertainty remains on the gaps between smoking cessation requirements and what is actually occurring in practice...
November 25, 2016: Advances in Therapy
https://www.readbyqxmd.com/read/27878711/a-framework-for-guiding-efforts-to-reward-value-instead-of-volume
#7
Taylor J Christensen
The U.S. healthcare system is in the midst of a major shift from fee-for-service to value-based reimbursement models. To date, these new reimbursement models have been focused on quality-contingent bonuses and cost-of-care risk sharing for providers, both of which have yielded only modest success.An analysis of health policy and business strategy literature was performed to identify the mechanisms of how value is rewarded in other industries and to understand the barriers to those mechanisms operating in the healthcare industry...
June 2016: Int J Health Econ Manag
https://www.readbyqxmd.com/read/27870546/integrated-care-organizations-medicare-financing-for-care-at-home
#8
Karen Davis, Amber Willink, Cathy Schoen
OBJECTIVES: As the boomer population ages, there is a growing need for integrated care organizations (ICOs) that can integrate both medical care and long-term services and supports in the home. This paper presents a policy proposal to support the creation of ICOs, redesign care, and provide financing for home- and community-based services (HCBS), with the goal of enhancing financial protection for beneficiaries, coordinating care, and preventing costly hospital and nursing home use. METHODS: This study used the 2012 Medicare Current Beneficiary Survey (MCBS) Cost and Use File, inflated to 2016 figures, to describe the characteristics of Medicare beneficiaries and their healthcare utilization and spending...
November 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27844177/a-method-to-simulate-incentives-for-cost-containment-under-various-cost-sharing-designs-an-application-to-a-first-euro-deductible-and-a-doughnut-hole
#9
D Cattel, R C van Kleef, R C J A van Vliet
Many health insurance schemes include deductibles to provide consumers with cost containment incentives (CCI) and to counteract moral hazard. Policymakers are faced with choices on the implementation of a specific cost sharing design. One of the guiding principles in this decision process could be which design leads to the strongest CCI. Despite the vast amount of literature on the effects of cost sharing, the relative effects of specific cost sharing designs-e.g., a traditional deductible versus a doughnut hole-will mostly be absent for a certain context...
November 14, 2016: European Journal of Health Economics: HEPAC: Health Economics in Prevention and Care
https://www.readbyqxmd.com/read/27835983/evaluating-the-implementation-of-a-national-disclosure-policy-for-large-scale-adverse-events-in-an-integrated-health-care-system-identification-of-gaps-and-successes
#10
Elizabeth M Maguire, Barbara G Bokhour, Todd H Wagner, Steven M Asch, Allen L Gifford, Thomas H Gallagher, Janet M Durfee, Richard A Martinello, A Rani Elwy
BACKGROUND: Many healthcare organizations have developed disclosure policies for large-scale adverse events, including the Veterans Health Administration (VA). This study evaluated VA's national large-scale disclosure policy and identifies gaps and successes in its implementation. METHODS: Semi-structured qualitative interviews were conducted with leaders, hospital employees, and patients at nine sites to elicit their perceptions of recent large-scale adverse events notifications and the national disclosure policy...
November 11, 2016: BMC Health Services Research
https://www.readbyqxmd.com/read/27832195/the-clinical-and-economic-impact-of-probiotics-consumption-on-respiratory-tract-infections-projections-for-canada
#11
Irene Lenoir-Wijnkoop, Laetitia Gerlier, Denis Roy, Gregor Reid
INTRODUCTION: There is accumulating evidence supporting the use of probiotics, which are defined as "live micro-organisms which, when administered in adequate amounts, confer a health benefit on the host", as a preventive measure against respiratory tract infections (RTI). Two recent meta-analyses showed probiotic consumption (daily intake of 107 to 1010 CFU in any form for up to 3 months) significantly reduced RTI duration, frequency, antibiotic use and work absenteeism. OBJECTIVES: The aim of this study was to assess the impact of probiotic use in terms of number of RTI episodes and days averted, and the number of antibiotic prescriptions and missed workdays averted, in the general population of Canada...
2016: PloS One
https://www.readbyqxmd.com/read/27822297/community-based-system-dynamic-as-an-approach-for-understanding-and-acting-on-messy-problems-a-case-study-for-global-mental-health-intervention-in-afghanistan
#12
Jean-Francois Trani, Ellis Ballard, Parul Bakhshi, Peter Hovmand
BACKGROUND: Afghanistan lacks suitable specialized mental healthcare services despite high prevalence of severe mental health disorders which are aggravated by the conflict and numerous daily stressors. Recent studies have shown that Afghans with mental illness are not only deprived of care but are vulnerable in many other ways. Innovative participatory approaches to the design of mental healthcare policies and programs are needed in such challenging context. METHODS: We employed community based system dynamics to examine interactions between multiple factors and actors to examine the problem of persistently low service utilization for people with mental illness...
2016: Conflict and Health
https://www.readbyqxmd.com/read/27815745/a-new-perspective-on-the-value-of-minimally-invasive-colorectal-surgery-payer-provider-and-patient-benefits
#13
Deborah S Keller, Anthony J Senagore, Kathryn Fitch, Andrew Bochner, Eric M Haas
BACKGROUND: The clinical benefits of minimally invasive surgery (MIS) are proven, but overall financial benefits are not fully explored. Our goal was to evaluate the financial benefits of MIS from the payer's perspective to demonstrate the value of minimally invasive colorectal surgery. METHODS: A Truven MarketScan(®) claim-based analysis identified all 2013 elective, inpatient colectomies. Cases were stratified into open or MIS approaches based on ICD-9 procedure codes; then costs were assessed using a similar distribution across diagnosis related groups (DRGs)...
November 4, 2016: Surgical Endoscopy
https://www.readbyqxmd.com/read/27813447/fostering-innovative-product-development-for-neglected-tropical-diseases-through-partnerships
#14
Amy Starr, Katy M Graef, Jennifer Dent
Neglected tropical diseases are a group of infectious diseases that threaten and impact a significant portion of individuals living in low- and middle-income countries. Healthcare product R&D, which has been relatively limited for this group of infectious diseases, is timely and requires significant risk and resource investment by companies. Regardless of these costs, the global community has recognized the impact on human health that developing products for these diseases could have. Incentives, including 'push' and 'pull' funding, and platforms that support sharing of intellectual property through partnerships, such as The World Intellectual Property Organization Re:Search, are driving R&D...
September 2016: Pharmaceutical Patent Analyst
https://www.readbyqxmd.com/read/27798039/integration-of-oral-health-into-primary-care-a-scoping-review-protocol
#15
Elham Emami, Hermina Harnagea, Felix Girard, Anne Charbonneau, René Voyer, Christophe Pierre Bedos, Martin Chartier, John Wootton, Yves Couturier
INTRODUCTION: Integrated care has been introduced as a means of improving health outcomes and access to care, and reducing the cost of healthcare. Despite its importance, the integration of oral health into primary care is still an emerging healthcare pathway. This scoping review protocol has been developed and funded by the Canadian Institutes of Health Research to provide an evidence-based synthesis on a primary oral healthcare approach and its effectiveness in improving oral health outcomes...
October 18, 2016: BMJ Open
https://www.readbyqxmd.com/read/27766188/healthcare-commercialization-programs-improving-the-efficiency-of-translating-healthcare-innovations-from-academia-into-practice
#16
John M Collins, Ofer Reizes, Michael K Dempsey
Academic investigators are generating a plethora of insights and technologies that have the potential to significantly improve patient care. However, to address the imperative to improve the quality, cost and access to care with ever more constrained funding, the efficiency and the consistency with which they are translated into cost effective products and/or services need to improve. Healthcare commercialization programs (HCPs) are described and proposed as an option that institutions can add to their portfolio to improve translational research...
2016: IEEE Journal of Translational Engineering in Health and Medicine
https://www.readbyqxmd.com/read/27762517/strategies-for-better-hypertension-control-in-india-and-other-lower-middle-income-countries
#17
Rajeev Gupta, Raghuvir Singh Khedar, Raja Babu Panwar
Hypertension is the most important cause of global burden of disease. It is highly prevalent in India and other low and lower-middle income countries. Prevalence of uncontrolled hypertension varies from 70-90% and is significantly greater in rural vs urban locations. Guidelines based treatment strategy has improved blood pressure (BP) control in high income countries but no context-specific guidelines exist in low and lower-middle income countries such as India. There are numerous barriers to proper BP control in these countries and include political apathy, bureaucratic inertia, weak health systems, overburdened healthcare providers and unempowered patients...
September 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/27753804/ssa-02-3-trend-in-hypertension-epidemiology-in-south-asia
#18
Rajeev Gupta
High BP is the most important cause of mortality and disease burden globally as well as in South Asian region. Global Burden of Diseases Study has reported that in year 2013 high systolic BP globally led to 10.8 million deaths and 208.1 million DALYs and in South Asian countries led to 2.1 million deaths (19.4%) and 49.9 million DALYs (24.0%). Global Burden of Chronic Disease Risk Factors study has reported from years 1980 to 2008 that while mean BP declined in high income countries, it increased in South Asian countries...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27749543/higher-cost-sharing-for-visiting-general-hospitals-and-the-changing-trend-in-the-first-visited-healthcare-organization-among-newly-diagnosed-hypertension-patients
#19
Jaeyong Shin, Young Choi, Sang Gyu Lee, Tae Hyun Kim, Eun-Cheol Park
Unnecessary use of high-quality resources in general hospitals hinders treatment of patients with urgent and complicated conditions. Thus, the Korean Government has sought to reduce general hospital visiting of patients with 52 mild diseases, including hypertension. The higher cost sharing for medical expenses and medications from general hospitals were enacted in 2009 and 2011, respectively.We determined whether these regulations were effective through evaluating changing trends in first-visited healthcare organizations and defined the first visiting healthcare organization level (primary clinics, hospital, and general hospital) as an outcome measure...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27720342/national-and-state-specific-shingles-vaccination-among-adults-aged-%C3%A2-60-years
#20
Peng-Jun Lu, Alissa O'Halloran, Walter W Williams, Rafael Harpaz
INTRODUCTION: Shingles (herpes zoster) causes substantial morbidity, especially among older adults. The shingles vaccine has been recommended for people aged ≥60 years since 2006. This study assessed recent shingles vaccination at national and state levels among adults aged ≥60 years. METHODS: The 2014 Behavioral Risk Factor Surveillance System data were analyzed in 2015 to assess shingles vaccination coverage among adults aged ≥60 years at national and state levels...
October 5, 2016: American Journal of Preventive Medicine
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