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Affordable healthcare and cost sharing

Vivian Y Wu, Kathryn R Fingar, H Joanna Jiang, Raynard Washington, Andrew W Mulcahy, Eli Cutler, Gary Pickens
OBJECTIVE: To examine the impact of the Affordable Care Act's coverage expansion on safety-net hospitals (SNHs). STUDY SETTING: Nine Medicaid expansion states. STUDY DESIGN: Differences-in-differences (DID) models compare payer-specific pre-post changes in inpatient stays of adults aged 19-64 years at SNHs and non-SNHs. DATA COLLECTION METHODS: 2013-2014 Healthcare Cost and Utilization Project State Inpatient Databases...
January 21, 2018: Health Services Research
John Wise, Angeli Möller, David Christie, Dipak Kalra, Elia Brodsky, Evelina Georgieva, Greg Jones, Ian Smith, Lars Greiffenberg, Marie McCarthy, Michael Arend, Olivier Luttringer, Sebastian Kloss, Steve Arlington
Demand for healthcare services is unprecedented. Society is struggling to afford the cost. Pricing of biopharmaceutical products is under scrutiny, especially by payers and Health Technology Assessment agencies. As we discuss here, rapidly advancing technologies, such Real-World Data (RWD), are being utilized to increase understanding of disease. RWD, when captured and analyzed, produces the Real-World Evidence (RWE) that underpins the economic case for innovative medicines. Furthermore, RWD can inform the understanding of disease, help identify new therapeutic intervention points, and improve the efficiency of research and development (R&D), especially clinical trials...
January 11, 2018: Drug Discovery Today
Katherine Hempstead, Josh Gray, Anna Zink
OBJECTIVES: Public discussion suggests that rising out-of-pocket costs have dramatically reduced the value of insurance and led to patients doing without needed care. Our aim was to ascertain trends in patient responsibility for cost sharing. STUDY DESIGN: We used data from an organization that serves over 78,000 healthcare providers and has access to visit-level data, including the amounts paid by patients. These practices are broadly representative of physicians and patients nationally...
November 2017: American Journal of Managed Care
Marianne M Casilla-Lennon, Seul Ki Choi, Allison M Deal, Jeannette T Bensen, Gopal Narang, Pauline Filippou, Benjamin McCormick, Raj Pruthi, Eric Wallen, Hung-Jui Tan, Michael Woods, Matthew Nielsen, Angela Smith
PURPOSE: Costly surveillance and treatment of bladder cancer can lead to financial toxicity (FT), a treatment-related financial burden. Our objective was to define the prevalence of FT among bladder cancer patients and identify delays in care and its effect on health-related quality of life (HRQOL). METHODS: We identified bladder cancer patients in the UNC Health Registry/Cancer Survivorship Cohort. FT was defined as agreement with having "to pay more for medical care than you can afford...
November 16, 2017: Journal of Urology
Joshua Chodosh, Michael Weiner
Innovative geriatric clinical programs have proliferated in the 21st century, and many have been highlighted in the Journal of the American Geriatrics Society (JAGS). The Affordable Care Act has supported the accelerated innovation of publicized and unpublicized program development, adaptation, and implementation. Many JAGS articles report work conducted in programs with significant improvements in quality; high satisfaction for patients and providers; and for some, reductions in costs. Despite considerable detail, enabling implementers to attempt to adopt reported programs or adapt them to local environments, much less is typically conveyed about the subtleties of the implementation process that led to a successful outcome...
November 11, 2017: Journal of the American Geriatrics Society
Alexander Kutz, Fahim Ebrahimi, Tristan Struja, Jeffrey Greenwald, Philipp Schuetz, Beat Mueller
Understanding how best to manage the complex healthcare needs of hospitalised, mostly multimorbid medical patients is an international priority. Healthcare should be effective, safe and provide high quality at a reasonable cost. However, basic logistic and organisational issues of medical ward-based care have received less attention than the medical treatment of specific pathologies. Consequently, we still use old-fashioned care and transition procedures for medical inpatients. This contrasts with dynamic developments in other, non-healthcare industries, where process optimisation is a major part of innovation...
November 9, 2017: Swiss Medical Weekly
Brian K Chen, Y Tony Yang, Karen Eggleston
Expanding access through insurance expansion can increase healthcare utilization through moral hazard. Reforming provider incentives to introduce more supply-side cost sharing is increasingly viewed as crucial for affordable, sustainable access. Using both difference-in-differences and segmented regression analyses on a panel of 1,466 hypertensive and diabetic patients, we empirically examine Shandong province's initial implementation of China's 2009 Essential Medications List policy. The policy reduced drug sale markups to providers but also increased drug coverage benefits for patients...
March 2017: World Medical & Health Policy
Seth Freedman, Sayeh Nikpay, Aaron Carroll, Kosali Simon
CONTEXT: The Affordable Care Act resulted in unprecedented reductions in the uninsured population through subsidized private insurance and an expansion of Medicaid. Early estimates from the beginning of 2014 showed that the Medicaid expansion decreased uninsured discharges and increased Medicaid discharges with no change in total discharges. OBJECTIVE: To provide new estimates of the effect of the ACA on discharges for specific conditions. DESIGN, SETTING, AND PARTICIPANTS: We compared outcomes between states that did and did not expand Medicaid using state-level all-capture discharge data from 2009-2014 for 42 states from the Healthcare Costs and Utilization Project's FastStats database; for a subset of states we used data through 2015...
2017: PloS One
Dwight W Burney Iii
The surgeon-patient relationship is rapidly evolving from surgeon-centric to patient-centric. External forces, such as the Affordable Care Act and the unsustainable growth of healthcare costs in the United States, have disrupted the old model of medical care. Effective communication between surgeons and patients as well as patient satisfaction, treatment adherence, and shared decision making are essential components of the patient-centered care paradigm. Effective communication carries high stakes for surgeons, including increased surgeon satisfaction and a reduced risk of surgeon burnout and malpractice litigation...
February 15, 2017: Instructional Course Lectures
Warren A Kaplan, Paul G Ashigbie, Mohamad I Brooks, Veronika J Wirtz
BACKGROUND: Many middle-income countries are scaling up health insurance schemes to provide financial protection and access to affordable medicines to poor and uninsured populations. Although there is a wealth of evidence on how high income countries with mature insurance schemes manage cost-effective use of medicines, there is limited evidence on the strategies used in middle-income countries. This paper compares the medicines management strategies that four insurance schemes in middle-income countries use to improve access and cost-effective use of medicines among beneficiaries...
2017: Journal of Pharmaceutical Policy and Practice
Roger Lee Mendoza
AIM: Now considered a subspecialty of medicine and nursing, palliative care is a critical aspect of healthcare at the end of life. National and international healthcare agencies typically attribute its slow or haphazard growth in developing countries to various resource constraints. However, this study provides evidence of the substantial and widening gap between policy advocacy and patient choices in end-of-life care. It does so by establishing the incentives and risks that underlie decision-making by patients and providers against the relative scarcity of palliative care and hospices in these countries...
September 2017: International Journal of Evidence-based Healthcare
Jonathan R Slotkin, Olivia A Ross, Eric D Newman, Janet L Comrey, Victoria Watson, Rachel V Lee, Megan M Brosious, Gloria Gerrity, Scott M Davis, Jacquelyn Paul, E Lynn Miller, David T Feinberg, Steven A Toms
One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms...
April 1, 2017: Neurosurgery
Jeffrey W Dwyer, Dawn Contreras, Cheryl L Eschbach, Holly Tiret, Cathy Newkirk, Erin Carter, Linda Cronk
PROBLEM: The Affordable Care Act charged the Agency for Healthcare Research and Quality to create the Primary Care Extension Program, but did not fund this effort. The idea to work through health extension agents to support health care delivery systems was based on the nationally known Cooperative Extension System (CES). Instead of creating new infrastructure in health care, the CES is an ideal vehicle for increasing health-related research and primary care delivery. APPROACH: The CES, a long-standing component of the land-grant university system, features a sustained infrastructure for providing education to communities...
October 2017: Academic Medicine: Journal of the Association of American Medical Colleges
Alan Lyles
Pharmacy benefit management companies (PBMs) perform functions in the US market-based healthcare system that may be performed by public agencies or quasi-public institutions in other nations. By aggregating lives covered under their many individual contracts with payers, PBMs have formidable negotiating power. They influence pharmaceutical insurance coverage, design the terms of coverage in a plan's drug benefit, and create competition among providers for inclusion in a plan's network. PBMs have, through intermediation, the potential to secure lower drug prices and to improve rational prescribing...
May 2017: PharmacoEconomics
Xin Hu, Helen M Parsons, Zhiyuan Zheng
44 Background: We examined changes in financial worry for working-aged cancer survivors compared to individuals without a cancer history (controls) after ACA-mandated health insurance enrollment and caps on cost-sharing were implemented in 2014. We hypothesized that cancer survivors would be more likely to report financial worry, and that ACA implementation would reduce financial worry. METHODS: We pooled data from the 2013-2014 National Health Interview Survey for adults aged 21-64 years...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
Elin H Davies, Emma Fulton, Daniel Brook, Dyfrig A Hughes
AIMS: The success of the Regulation on Orphan Medicinal Products in the European Union is evidenced by the 127 orphan drugs that have had market authorization since 2000. However, the incentives aimed at stimulating research and development have had the unintended consequence of increasing drug cost, resulting in many orphan drugs not being cost-effective. Orphan drugs command an increasing share of the pharmaceutical market and account for a disproportionate amount of healthcare expenditure...
July 2017: British Journal of Clinical Pharmacology
Surachat Ngorsuraches, Jane R Mort
BACKGROUND: The Affordable Care Act (ACA) initiated federally and state-run health insurance exchanges, or marketplaces, with health plans offering subsidies for plan members as well as coverage for essential health benefits, to help individuals, families, and small businesses find health plans that fit their specific needs. A recent study found that the value of these healthcare subsidies varied with the number of health plans in the different geographic rating areas, but that study only examined the premiums and the deductibles of those health plans...
October 2016: American Health & Drug Benefits
Kristyn Rohrer, Lauren Dundes
When settling healthcare bills, the Old Order Amish of Lancaster County, Pennsylvania rely on an ethos of mutual aid, independent of the government. Consonant with this philosophy, many Amish do not participate in or receive benefits from Social Security or Medicare. They are also exempted from the Affordable Care Act of 2010. This study expands the limited documentation of Amish Hospital Aid, an Amish health insurance program that covers major medical costs. Interview data from 11 Amish adults in Lancaster County depict how this aid program supplements traditional congregational alms coverage of medical expenses...
December 14, 2016: Healthcare (Basel, Switzerland)
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...
January 2017: Advances in Therapy
Bethany Lanese
Purpose The purpose of this paper is to test and measure the outcome of a community hospital in implementing the Affordable Care Act (ACA) through a co-management arrangement. RQ1: do the benefits of a co-management arrangement outweigh the costs? RQ2: does physician alignment aid in the effective implementation of the ACA directives set for hospitals? Design/methodology/approach A case study of a 350-bed non-profit community hospital co-management company. The quantitative data are eight quarters of quality metrics prior and eight quarters post establishment of the co-management company...
September 19, 2016: Journal of Health Organization and Management
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