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Us health insurance

Gregory S Sawicki, Joshua Ostrenga, Kristofer Petren, Aliza K Fink, Emma D'Agostino, Camila Strassle, Michael S Schechter, Margaret Rosenfeld
RATIONALE: With improved survival into adulthood, the number of dedicated adult cystic fibrosis (CF) care programs has expanded in the US over the past decade. Transfer from pediatric to adult CF programs represents a potential time for lapses in recommended healthcare. OBJECTIVES: To describe variability in transfer between pediatric and adult CF care programs and to identify factors associated with prolonged gaps in care. METHODS: Using the US CF Foundation Patient Registry (CFFPR), we identified individuals with CF who transferred care from a pediatric to adult CF care program during 2007-2013...
December 8, 2017: Annals of the American Thoracic Society
Micah Hartman, Anne B Martin, Nathan Espinosa, Aaron Catlin, The National Health Expenditure Accounts Team
Total nominal US health care spending increased 4.3 percent and reached $3.3 trillion in 2016. Per capita spending on health care increased by $354, reaching $10,348. The share of gross domestic product devoted to health care spending was 17.9 percent in 2016, up from 17.7 percent in 2015. Health spending growth decelerated in 2016 following faster growth in 2014 and 2015 associated with coverage expansions under the Affordable Care Act (ACA) and strong retail prescription drug spending growth. In 2016 the slowdown was broadly based, as spending for the largest categories by payer and by service decelerated...
December 6, 2017: Health Affairs
E Patorno, C Gopalakrishnan, J M Franklin, K G Brodovicz, E Masso-Gonzalez, D B Bartels, J Liu, S Schneeweiss
BACKGROUND: Healthcare claims databases can provide information on the effects of type 2 diabetes (T2DM) medications as used in routine care, but often do not contain data on important clinical characteristics, which may be captured in electronic health records (EHR). OBJECTIVES: To evaluate the extent to which balance in unmeasured patient characteristics was achieved in claims data, by comparing against more detailed information from linked EHR data. METHODS: Within a large US commercial insurance database and using a cohort design, we identified T2DM patients initiating linagliptin or a comparator agent within class (i...
December 5, 2017: Diabetes, Obesity & Metabolism
C Brooke Steele, Jun Li, Bin Huang, Hannah K Weir
BACKGROUND: The 5-year relative survival for prostate cancers diagnosed between 1990 and 1994 in the United States was very high (92%); however, survival in black males was 7% lower compared with white males. The authors updated these findings and examined survival by stage and race. METHODS: The authors used data from the CONCORD-2 study for males (ages 15-99 years) who were diagnosed with prostate cancer in 37 states, covering 80% of the US population. Survival was adjusted for background mortality (net survival) using state-specific and race-specific life tables and was age-standardized...
December 15, 2017: Cancer
Lakshmi Goparaju, Nathan C Praschan, Lari Warren-Jeanpiere, Laure S Experton, Mary A Young, Seble Kassaye
Background: Pre-Exposure Prophylaxis (PrEP) use has remained low among US women while significantly increasing among men who have sex with men. Besides lack of awareness, women face several social and structural barriers in gaining access to and using PrEP. Methods: Four focus group discussions with 20 HIV-negative women who live in the Washington DC metropolitan area. Results: The women expressed concerns about social and structural barriers to PrEP use...
September 2017: Journal of AIDS & Clinical Research
Beth Han, Mark Olfson, Larke Huang, Ramin Mojtabai
We examined national trends in the receipt of specialty outpatient mental health care, using data for 2008-15 from the National Survey on Drug Use and Health. Between 2008-09 and 2014-15 the number of US adults who received outpatient mental health care in the specialty sector rose from 11.3 million to 13.7 million per year, representing an increase from 5.0 percent to 5.7 percent of the adult population. Among those recipients, however, the annual weighted mean number of visits to the specialty sector remained unchanged...
December 2017: Health Affairs
Cathy Schoen, Sara R Collins
The five largest US commercial health insurance companies together enroll 125 million members, or 43 percent of the country's insured population. Over the past decade these insurers have become increasingly dependent for growth and profitability on public programs, according to an analysis of corporate reports. In 2016 Medicare and Medicaid accounted for nearly 60 percent of the companies' health care revenues and 20 percent of their comprehensive plan membership. Although headlines have focused on losses in the state Marketplaces created by the Affordable Care Act (ACA), the Marketplaces represent only a small fraction of insurers' members...
December 2017: Health Affairs
Rajeev Raghavan
The care of dialysis-dependent undocumented immigrants exemplifies a problem at the crux of 2 US national agendas: immigration and health care reform. Undocumented immigrants represent 3% of the US population and 27% of the uninsured, and an estimated 6,500 individuals are dialysis dependent. With no uniform national policy, an estimated 30% to 50% of these individuals receive treatment only in life-threatening situations (emergent dialysis). Since 2005, about 400 undocumented immigrants have received a kidney transplant (>70% living)...
November 30, 2017: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Ning Cheng, Md Motiur Rahman, Yasser Alatawi, Jingjing Qian, Peggy L Peissig, Richard L Berg, C David Page, Richard A Hansen
INTRODUCTION: Several different types of drugs acting on the central nervous system (CNS) have previously been associated with an increased risk of suicide and suicidal ideation (broadly referred to as suicide). However, a differential association between brand and generic CNS drugs and suicide has not been reported. OBJECTIVES: This study compares suicide adverse event rates for brand versus generic CNS drugs using multiple sources of data. METHODS: Selected examples of CNS drugs (sertraline, gabapentin, zolpidem, and methylphenidate) were evaluated via the US FDA Adverse Event Reporting System (FAERS) for a hypothesis-generating study, and then via administrative claims and electronic health record (EHR) data for a more rigorous retrospective cohort study...
December 2, 2017: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
Ricky W McCullough
Approximate oncology-wide incidence, duration, costs and deaths associated with mucositis and identify health economic benefits of antimucositis therapies. Review the literature relevant to the clinical experience of mucositis by pathophysiology, incidence, duration, costs and deaths. Use US insurance actuarial and epidemiology on cancer to generalize an oncology-wide impact of toxic mucositis. Toxic mucositis causes oropharyngoesophageal ulcerations, chemo-induced nausea, vomiting and diarrhea. Acutely, it lasts 102 days/six cycles of chemotherapy, 60 days in human stem-cell transplantation patients and 70-84 days in head and neck cancer patients at annual costs of US$13...
December 1, 2017: Future Oncology
Darren R Raphael, Paulina T Tran, Zeev N Kain, Joseph B Rinehart
Anesthesiologists' perspectives on US health care finance reform are increasingly germane to recent policy reforms. The aim of this follow-up survey was to examine how anesthesiologists' views of health care costs and future practice roles have changed since 2014. Six thousand randomly chosen active members of the American Society of Anesthesiologists were again surveyed and were also asked several new questions regarding specialties and perioperative management. Results showed an increase in self-reported understanding of the perioperative surgical home...
November 17, 2017: Anesthesia and Analgesia
Frank Diamond
The insurer's general manager of behavioral and EAP services wants to make mental health care more mainstream. Only 17% of American adults function with optimal mental health. "We talk about it as if it's them over there, but 83% of us have a need."
November 2017: Managed Care
Kenneth H Mayer, Kevin M Maloney, Kenneth Levine, Dana King, Chris Grasso, Douglas S Krakower, Eli S Rosenberg, Stephen L Boswell
Background: The reasons why bacterial sexually transmitted infections (BSTIs) are increasing in US men who have sex with men (MSM) have not been fully characterized. Methods: An open cohort of MSM accessing medical care at a Boston community health center was used to assess secular trends in BSTI diagnoses. Frequency of infection and the estimated population size were used to calculate diagnosis rates. Poisson models were fit for multivariable analyses. Results: Between 2005 and 2015, 19 232 men had at least 1 clinic visit...
2017: Open Forum Infectious Diseases
Marina Serper, Peter Reese, Rachel Patzer, Josh Levitsky, Michael S Wolf
High out-of-pocket medication costs negatively impact adherence in transplantation. We evaluated the association of "medication tradeoffs" - defined as choosing to spend money on other expenses over medications -with medication non-adherence and transplant outcomes. From 2011-2012, we performed a prospective study of 201 transplant recipients (n=103 liver, n=98 kidney and) at two large US transplant centers. Structured interviews assessed socio-demographics, medication adherence, and medication tradeoffs. Multivariable models assessing risk factors for medications tradeoffs and the association between medications tradeoffs and post-transplant hospital admissions were performed...
November 25, 2017: Transplant International: Official Journal of the European Society for Organ Transplantation
Faheem Sandhu, Scott Blumenthal, Betsy Grunch, Bent Kimball, Nicole Ferko, Sarah Hollmann
: Evidence on the favorable efficacy, safety, and cost effectiveness of lumbar total disc replacement (TDR) compared with fusion for lumbar degenerative disc disease is mounting; however, a key barrier identified for TDR utilization is lack of coverage by US health insurers. Although economic considerations in a fee-for-service model should not be a determining factor in patient access, concerns regarding the budget impact of lumbar TDR surgery may unfortunately underlie coverage decisions. On the basis of the data available and economic modeling, the panel agreed that there is no indication that there would be a dramatic increase in patients seeking lumbar TDR...
December 15, 2017: Spine
Shota Saito, Yusuke Muneoka, Takashi Ishikawa, Kouhei Akazawa
PURPOSE: The combination of paclitaxel + ramucirumab is a standard second-line treatment in patients with advanced gastric cancer. This therapy has been associated with increased median overall survival and progression-free survival compared with those with paclitaxel monotherapy. We evaluated the cost-effectiveness of paclitaxel + ramucirumab combination therapy in patients with advanced gastric cancer, from the perspective of health care payers in Japan. METHODS: We constructed a Markov model to compare, over a time horizon of 3 years, the costs and effectiveness of the combination of paclitaxel + ramucirumab and paclitaxel alone as second-line therapies for advanced gastric cancer in Japan...
November 23, 2017: Clinical Therapeutics
John W Jackson, Lisa Fulchino, James Rogers, Helen Mogun, Jennifer Polinski, David C Henderson, Sebastian Schneeweiss, Michael A Fischer
OBJECTIVE: To quantify and explain variation in use of long-acting injectable antipsychotics (LAIs) in the United States, and understand the relationship between patient characteristics, drug reimbursement policies, and LAI prescribing after relapse. METHODS: A cohort of recently relapsed patients with schizophrenia ages 18 to 64, identified immediately after discharge from a related inpatient hospitalization, partial hospitalization, or emergency room visit, drawn from 2004 to 2006 Medicaid claims, and followed for 90 days until LAI initiation...
November 23, 2017: Pharmacoepidemiology and Drug Safety
Philip Ayizem Dalinjong, Alex Y Wang, Caroline S E Homer
BACKGROUND: To promote skilled attendance at births and reduce maternal deaths, the government of Ghana introduced the free maternal care policy under the National Health Insurance Scheme (NHIS) in 2008. The objective is to eliminate financial barriers associated with the use of services. But studies elsewhere showed that out of pocket (OOP) payments still exist in the midst of fee exemptions. The aim of this study was to estimate OOP payments and the financial impact on women during childbirth in one rural and poor area of Northern Ghana; the Kassena-Nankana municipality...
November 22, 2017: Health Economics Review
Jae Kennedy, Elizabeth Geneva Wood, Lex Frieden
The objective of this study was to assess trends in health insurance coverage, health service utilization, and health care access among working-age adults with and without disabilities before and after full implementation of the Affordable Care Act (ACA), and to identify current disability-based disparities following full implementation of the ACA. The ACA was expected to have a disproportionate impact on working-age adults with disabilities, because of their high health care usage as well as their previously limited insurance options...
January 2017: Inquiry: a Journal of Medical Care Organization, Provision and Financing
Elaine W Flagg, Elizabeth A Torrone
OBJECTIVES: To detect decreases in anogenital warts (AGW) among sex and age groups likely to be affected by human papillomavirus vaccination. METHODS: We estimated annual AGW prevalence during 2006 to 2014 using health care claims among US private health insurance enrollees aged 15 to 39 years. We derived AGW diagnoses using 1 of the following: (1) condylomata acuminata diagnosis, (2) viral wart diagnosis combined with a benign anogenital neoplasm diagnosis or destruction or excision of an anogenital lesion, or (3) AGW medication combined with a benign anogenital neoplasm diagnosis or destruction or excision of an anogenital lesion...
November 21, 2017: American Journal of Public Health
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