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Machta RM, D. Reschovsky J, Jones DJ, Kimmey L, Furukawa MF, Rich EC. Health system integration with physician specialties varies across markets and system types. Health Serv Res 2020; 55 Suppl 3:1062-1072. [PMID: 33284522 PMCID: PMC7720709 DOI: 10.1111/1475-6773.13584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine system integration with physician specialties across markets and the association between local system characteristics and their patterns of physician integration. DATA SOURCES Data come from the AHRQ Compendium of US Health Systems and IQVIA OneKey database. STUDY DESIGN We examined the change from 2016 to 2018 in the percentage of physicians in systems, focusing on primary care and the 10 most numerous nonhospital-based specialties across the 382 metropolitan statistical areas (MSAs) in the US. We also categorized systems by ownership, mission, and payment program participation and examined how those characteristics were related to their patterns of physician integration in 2018. DATA COLLECTION/EXTRACTION METHODS We examined local healthcare markets (MSAs) and the hospitals and physicians that are part of integrated systems that operate in these markets. We characterized markets by hospital and insurer concentration and systems by type of ownership and by whether they have an academic medical center (AMC), a 340B hospital, or accountable care organization. PRINCIPAL FINDINGS Between 2016 and 2018, system participation increased for primary care and the 10 other physician specialties we examined. In 2018, physicians in specialties associated with lucrative hospital services were the most commonly integrated with systems including hematology-oncology (57%), cardiology (55%), and general surgery (44%); however, rates varied substantially across markets. For most specialties, high market concentration by insurers and hospital-systems was associated with lower rates of physician integration. In addition, systems with AMCs and publicly owned systems more commonly affiliated with specialties unrelated to the physicians' potential contribution to hospital revenue, and investor-owned systems demonstrated more limited physician integration. CONCLUSIONS Variation in physician integration across markets and system characteristics reflects physician and systems' motivations. These integration strategies are associated with the financial interests of systems and other strategic goals (eg, medical education, and serving low-income populations).
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Abstract
IMPORTANCE High out-of-pocket drug costs can cause patients to skip treatment and worsen outcomes, and high insurer drug payments could increase premiums. Drug wholesale list prices have doubled in recent years. However, because of manufacturer discounts and rebates, the extent to which increases in wholesale list prices are associated with amounts paid by patients and insurers is poorly characterized. OBJECTIVE To determine whether increases in wholesale list prices are associated with increases in amounts paid by patients and insurers for branded medications. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional retrospective study analyzing pharmacy claims for patients younger than 65 years in the IBM MarketScan Commercial Database and pricing data from SSR Health, LLC, between January 1, 2010, and December 31, 2016. Pharmacy claims analyzed represent claims of employees and dependents participating in employer health benefit programs belonging to large employers. Rebate data were estimated from sales data from publicly traded companies. Analysis focused on the top 5 patent-protected specialty and 9 traditional brand-name medications with the highest total drug expenditures by commercial insurers nationwide in 2014. Data were analyzed from July 2017 to July 2020. EXPOSURES Calendar year. MAIN OUTCOMES AND MEASURES Changes in inflation-adjusted amounts paid by patients and insurers for branded medications. RESULTS In this analysis of 14.4 million pharmacy claims made by 1.8 million patients from 2010-2016, median drug wholesale list price increased by 129% (interquartile range [IQR], 78%-133%), while median insurance payments increased by 64% (IQR, 28%-120%) and out-of-pocket costs increased by 53% (IQR, 42%-82%). The mean percentage of wholesale list price accounted for by discounts increased from 17% in 2010 to 21% in 2016, and the mean percentage of wholesale list price accounted for by rebates increased from 22% in 2010 to 24% in 2016. For specialty medications, median patient out-of-pocket costs increased by 85% (IQR, 73%-88%) from 2010 to 2016 after adjustment for inflation and 42% (IQR, 25%-53%) for nonspecialty medications. During that same period, insurer payments increased by 116% for specialty medications (IQR, 100%-127%) and 28% for nonspecialty medications (IQR, 5%-34%). CONCLUSIONS AND RELEVANCE This study's findings suggest that drug list prices more than doubled over a 7-year study period. Despite rising manufacturer discounts and rebates, these price increases were associated with large increases in patient out-of-pocket costs and insurer payments.
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Affiliation(s)
- Eric J. Yang
- Department of Dermatology, Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Emilio Galan
- Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Robert Thombley
- Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Andrew Lin
- Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Jaeyun Seo
- Center for Healthcare Value, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Chien-Wen Tseng
- Department of Family Medicine and Community Health, University of Hawaii John A. Burns School of Medicine, Honolulu
| | - Jack S. Resneck
- Department of Dermatology, University of California, San Francisco
| | - Peter B. Bach
- Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, New York
| | - R. Adams Dudley
- School of Medicine, School of Public Health, Institute for Health Informatics, University of Minnesota, Minneapolis
- Minneapolis VA Medical Center, Minneapolis, Minnesota
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Park SH, Han X, Lobo F, Kratochvil D, Patel D. A budget impact analysis for making treatment decisions based on anti-cyclic citrullinated peptide (anti-CCP) testing in rheumatoid arthritis. J Med Econ 2020; 23:624-630. [PMID: 32075453 DOI: 10.1080/13696998.2020.1732991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Aim: Given that rheumatoid arthritis (RA) patients with high anti-citrullinated protein antibodies (ACPA) titer values respond well to abatacept, the aim of this study was to estimate the annual budget impact of anti-cyclic citrullinated peptide (anti-CCP) testing and treatment selection based on anti-CCP test results.Materials and methods: Budget impact analysis was conducted for patients with moderate-to-severe RA on biologic or Janus kinase inhibitor (JAKi) treatment from a hypothetical US commercial payer perspective. The following market scenarios were compared: (1) 90% of target patients receive anti-CCP testing and the results of anti-CCP testing do not impact the treatment selection; (2) 100% of target patients receive anti-CCP testing and the results of anti-CCP testing have an impact on treatment selection such that an increased proportion of patients with high titer of ACPA receive abatacept. A hypothetical assumption was made that the use of abatacept would be increased by 2% in Scenario 2 versus 1. Scenario analyses were conducted by varying the target population and rebate rates.Results: In a hypothetical health plan with one million insured adults, 2,181 patients would be on a biologic or JAKi treatment for moderate-to-severe RA. In Scenario 1, the anti-CCP test cost was $186,155 and annual treatment cost was $101,854,295, totaling to $102,040,450. In Scenario 2, the anti-CCP test cost increased by $20,684 and treatment cost increased by $160,467, totaling an overall budget increase of $181,151. This was equivalent to a per member per month (PMPM) increase of $0.015. The budget impact results were consistently negligible across the scenario analyses.Limitations: The analysis only considered testing and medication costs. Some parameters used in the analysis, such as the rebate rates, are not generalizable and health plan-specific.Conclusions: Testing RA patients to learn their ACPA status and increasing use of abatacept among high-titer ACPA patients result in a small increase in the total budget (<2 cents PMPM).
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Affiliation(s)
- Sang Hee Park
- Pharmerit North America LLC - Modeling and Meta-Analysis, Bethesda, MD, USA
| | - Xue Han
- Bristol-Myers Squibb Co - US Health Economics and Outcomes Research, Lawrence Township, NJ, USA
| | - Francis Lobo
- Bristol-Myers Squibb Co - US Health Economics and Outcomes Research, Lawrence Township, NJ, USA
| | - David Kratochvil
- Pharmerit North America LLC - Modeling and Meta-Analysis, Bethesda, MD, USA
| | - Dipen Patel
- Pharmerit North America LLC - Modeling and Meta-Analysis, Bethesda, MD, USA
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Holloway J, Neely C, Yuan X, Zhang Y, Ouyang J, Cantrell D, Chaisson J, Bergeron T, Washington V, Nigam S. Evaluating the performance of a predictive modeling approach to identifying members at high-risk of hospitalization. J Med Econ 2020; 23:228-234. [PMID: 31505982 DOI: 10.1080/13696998.2019.1666854] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: To evaluate the risk-of-hospitalization (ROH) models developed at Blue Cross Blue Shield of Louisiana (BCBSLA) and compare this approach to the DxCG risk-score algorithms utilized by many health plans.Materials and Methods: Time zero for this study was December 31, 2016. BCBSLA members were eligible for study inclusion if they were fully insured; aged 80 years or younger; and had continuous enrollment starting on or before June 1, 2016, through time zero. Up to 2 years of historical claims data from time zero per patient was included for model development. Members were excluded if they had cancer, renal failure, or were admitted for hospice. The Blue Cross ROH models were developed using (1) regularized logistic regression and (2) random decision forests (a tree ensemble learning classification method). All models were generated using Scikit-learn: Machine Learning in Python. Prognostic capabilities of DxCG risk-score algorithms were compared to those of the Blue Cross models.Results: When stratifying by the top 0.1% of members with the highest ROH, the Blue Cross logistic regression model had the highest area under the receiving operator characteristics curve (0.862) based on the result of 10-fold cross-validation. The Blue Cross random decision forests model had the highest positive predictive value (49.0%) and positive likelihood ratio (61.4), but sensitivity, specificity, negative predictive values, and negative likelihood ratios were similar across all four models.Limitations: The Blue Cross ROH models were developed and evaluated using BCBSLA data, and predictive power may fluctuate if applied to other databases.Conclusions: The predictability of the Blue Cross models show how member-specific, regional data can be used to accurately identify patients with a high ROH, which may allow healthcare workers to intervene earlier and subsequently reduce the healthcare burden for patients and providers.
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Affiliation(s)
- Jack Holloway
- Healthcare Informatics, Blue Cross Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Chris Neely
- Healthcare Informatics, Blue Cross Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Xiaojing Yuan
- Healthcare Informatics, Blue Cross Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Yuan Zhang
- Healthcare Informatics, Blue Cross Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Jason Ouyang
- Healthcare Informatics, Blue Cross Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Dawn Cantrell
- Healthcare Informatics, Blue Cross Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Janet Chaisson
- Healthcare Informatics, Blue Cross Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Tasha Bergeron
- Healthcare Informatics, Blue Cross Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Vindell Washington
- Healthcare Informatics, Blue Cross Blue Shield of Louisiana, Baton Rouge, LA, USA
| | - Somesh Nigam
- Healthcare Informatics, Blue Cross Blue Shield of Louisiana, Baton Rouge, LA, USA
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Khodyakov D, Buttorff C, Bouskill K, Armstrong C, Ma S, Taylor EA, Eibner C. Insurers' perspectives on MA value-based insurance design model. Am J Manag Care 2019; 25:e198-e203. [PMID: 31318510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Value-based insurance design (VBID) lowers cost sharing for high-value healthcare services that are clinically beneficial to patients with certain conditions. In 2017, the Center for Medicare and Medicaid Innovation began a voluntary VBID model test in Medicare Advantage (MA). This article describes insurers' perspectives on the MA VBID model, explores perceived barriers to joining this model, and describes ways to address participation barriers. STUDY DESIGN A descriptive, qualitative study. METHODS In spring/summer 2017, we conducted semistructured interviews with 24 representatives of 10 nonparticipating MA insurers to learn why they did not join the model test. We interviewed 73 representatives of 8 VBID-participating insurers about their participation decisions and implementation experiences. All interview data were analyzed thematically. RESULTS Fewer than 30% of eligible insurers participated in the first 2 years of the model test. The main barriers to entry were a perceived lack of information on VBID in MA, an expectation of low return on investment, concerns over administrative and information technology (IT) hurdles, and model design parameters. Most VBID participants encountered administrative and IT hurdles but overcame them. CMS made changes to the model parameters to increase the uptake. CONCLUSIONS The model uptake was low, and implementation challenges and concerns over VBID effectiveness in the Medicare population were important factors in participation decisions. To increase uptake, CMS could consider providing in-kind implementation assistance to model participants. Nonparticipants may want to incorporate lessons learned from current participants, and insurers should engage their IT departments/vendors early on.
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Block AE. A Financial Analysis of New York City Start-up Health Plans and Reasons for Their Losses. Manag Care 2018; 27:34-36. [PMID: 30620327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
PURPOSE Using New York City as an example, this research explores reasons for the consistently poor financial performance of three start-up health plans (Health Republic, CareConnect, and Oscar) while other health plans have performed relatively well in the same market. DESIGN AND METHODS This study compiles insurer data from financial years 2014 through 2016, submitted to the New York State Department of Financial Services as part of the rate-review process, including premium revenue, claims cost, risk adjustment, administrative costs, net income, and premium. The financial data were used to create a novel metric, adjusted net income, that evaluates the financial performance of an insurer excluding risk adjustment and assuming a market average administrative cost. Descriptive statistics were used to compare the performance of start-up plans, commercial plans, and Medicaid plans in the ACA exchange market. RESULTS Premiums for start-up plans were within 9% of median silver premiums yet adjusted net income was negative (-$190 PMPM) for all three start-ups while it is positive (+$27 PMPM) for the non-start-ups. The difference in adjusted net incomes shows that poor financial performance of start-ups was due to claims costs, not high administrative costs and poor performance in risk adjustment. CONCLUSION The consistent financial losses by New York City start-ups is driven by higher-cost provider contracts for the start-ups relative to competitors.
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Howard DH, Herring B, Graves J, Trish E. Provider-owned insurers in the individual market. Am J Manag Care 2018; 24:e393-e398. [PMID: 30586488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To describe the number and availability of individual market plans sold by provider-owned insurers and compare differences in premiums between traditional and provider-owned insurers. STUDY DESIGN Cross-sectional analysis. METHODS Using the Robert Wood Johnson Foundation's HIX Compare data, we identified insurers selling Affordable Care Act (ACA)-compliant policies in the individual market and identified those insurers owned by health systems by using information on their websites. We determined the number of insurers selling policies in each market and the size of the population living in areas where provider-owned insurers sold plans in 2016 and 2017. We used least squares regression to compare premiums between traditional and provider-owned insurers within markets, and we adjusted standard errors for clustering at the market and insurer level. RESULTS There were 149 insurers that sold ACA-compliant plans in 2017, of which 51 were provider owned. Provider-owned insurers operated in 208 of the 503 exchange markets. We estimate that about 62% of US residents (more than 170 million people) live in a market in which a provider-owned insurer sells plans. Premiums did not differ significantly between traditional and provider-owned plans in 2017. CONCLUSIONS Provider-owned insurers play a prominent role in the individual insurance market. Although health systems that sell insurance have incentives to reduce costs, provider-owned insurers and traditional insurers have similar premiums.
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Affiliation(s)
- David H Howard
- Department of Health Policy and Management, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322.
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Salampessy BH, Alblas MM, Portrait FRM, Koolman X, van der Hijden EJE. The effect of cost-sharing design characteristics on use of health care recommended by the treating physician; a discrete choice experiment. BMC Health Serv Res 2018; 18:797. [PMID: 30342542 PMCID: PMC6195970 DOI: 10.1186/s12913-018-3598-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 10/02/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cost-sharing programs are often too complex to be easily understood by the average insured individual. Consequently, it is often difficult to determine the amount of expenses in advance. This may preclude well-informed decisions of insured individuals to adhere to medical treatment advised by the treating physician. Preliminary research has showed that the uncertainty in these cost-sharing payments are affected by four design characteristics, i.e. 1) type of payments (copayments, coinsurances or deductibles), 2) rate of payments, 3) annual caps on cost-sharing and 4) moment that these payments must be made (directly at point of care or billed afterwards by the insurer). METHODS An online discrete choice experiment was used to assess the extent to which design characteristics of cost-sharing programs affect the decision of individuals to adhere to recommended care (prescribed medications, ordered diagnostic tests and referrals to medical specialist care). Analyses were performed using mixed multinomial logits. RESULTS The questionnaire was completed by 7921 members of a patient organization. Analyses showed that 1) cost-sharing programs that offer clear information in advance on actual expenses that are billed afterwards, stimulate adherence to care recommended by the treating physician; 2) the relative importance of the design characteristics differed between respondents who reported to have forgone health care due to cost-sharing and those who did not; 3) price-awareness among respondents was limited; 4) the utility derived from attributes and respondents' characteristics were positively correlated; 5) an optimized cost-sharing program revealed an adherence of more than 72.9% among those who reported to have forgone health care. CONCLUSIONS The analyses revealed that less complex cost-sharing programs stimulate adherence to recommended care. If these programs are redesigned accordingly, individuals who had reported to have forgone a health service recommended by their treating physician due to cost-sharing, would be more likely to use this service. Such redesigned programs provide a policy option to reduce adverse health effects of cost-sharing in these groups. Considering the upcoming shift from volume-based to value-based health care provision, insights into the characteristics of a cost-sharing program that stimulates the use of recommended care may help to design value-based insurance plans.
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Affiliation(s)
- Benjamin H. Salampessy
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Maaike M. Alblas
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
- Department of Public Health, Erasmus Medical Centre - University Medical Center Rotterdam, P.O. 2040, 3000 CA Rotterdam, The Netherlands
| | - France R. M. Portrait
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Xander Koolman
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Eric J. E. van der Hijden
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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Moore LL, Wurzelbacher SJ, Shockey TM. Workers' compensation insurer risk control systems: Opportunities for public health collaborations. J Safety Res 2018; 66:141-150. [PMID: 30121100 PMCID: PMC8609819 DOI: 10.1016/j.jsr.2018.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 04/20/2018] [Accepted: 07/10/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Workers' compensation (WC) insurers offer services and programs for prospective client selection and insured client risk control (RC) purposes. Toward these aims, insurers collect employer data that may include information on types of hazards present in the workplace, safety and health programs and controls in place to prevent injury/illness, and return-to-work programs to reduce injury/illness severity. Despite the potential impact of RC systems on workplace safety and health and the use of RC data in guiding prevention efforts, few research studies on the types of RC services provided to employers or the RC data collected have been published in the peer-reviewed literature. METHODS Researchers conducted voluntary interviews with nine private and state-fund WC insurers to collect qualitative information on RC data and systems. RESULTS Insurers provided information describing their RC data, tools, and practices. Unique practices as well as similarities including those related to RC services, policyholder goals, and databases were identified. CONCLUSIONS Insurers collect and store extensive RC data, which have utility for public health research for improving workplace safety and health. PRACTICAL APPLICATIONS Increased public health understanding of RC data and systems and an identification of key collaboration opportunities between insurers and researchers will facilitate increased use of RC data for public health purposes.
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Affiliation(s)
- Libby L Moore
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 1090 Tusculum Ave., Cincinnati, OH 45226, USA.
| | - Steven J Wurzelbacher
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 1090 Tusculum Ave., Cincinnati, OH 45226, USA.
| | - Taylor M Shockey
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, 1090 Tusculum Ave., Cincinnati, OH 45226, USA.
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Barker AR, Nienstedt L, Kemper LM, McBride TD, Mueller KJ. Health Insurance Marketplaces: Issuer Participation and Premium Trends in Rural Places, 2018. Rural Policy Brief 2018; 2018:1-4. [PMID: 30211515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Since 2014, when the Health Insurance Marketplaces (HIMs) authorized by the Patient Protection and Affordable Care Act (PPACA) were implemented, considerable premium changes have been observed in the marketplaces across the 50 states and the District of Columbia. This policy brief assesses the changes in average HIM plan premiums from 2014 to 2018, before accounting for subsidies, with an emphasis on the widening variation across rural and urban places, providing information during Congressional debates on the future of the program. KEY FINDINGS (1) Insurance issuers reduced HIM participation across both rural and urban places (with 1.7 and 2.2 issuers, respectively), both in states that expanded Medicaid under the PPACA and in non-expansion states. (2) The average adjusted premium (before premium subsidy) continues to rise across all of the above categories, and the gap has widened between the 32 Medicaid expansion and 19 non-expansion states. Average premiums in rural counties are higher than average premiums in urban counties in both expansion and non-expansion states (by $43 per month and $27 per month, respectively). (3) Prior trends of lower premium changes at greater population densities are no longer observed in the 2018 data. (4) In 2018, 1,581 counties (52 perent) have one participating insurance issuer. Nationwide, 42 percent of all urban counties and 55 percent of all rural counties only have one issuer.
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CABRAL MARIKA, GERUSO MICHAEL, MAHONEY NEALE. Do Larger Health Insurance Subsidies Benefit Patients or Producers? Evidence from Medicare Advantage. Am Econ Rev 2018; 108:2048-87. [PMID: 30091862 PMCID: PMC10782851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A central question in the debate over privatized Medicare is whether increased government payments to private Medicare Advantage (MA) plans generate lower premiums for consumers or higher profits for producers. Using difference‑in‑differences variation brought about by a sharp legislative change, we find that MA insurers pass through 45 percent of increased payments in lower premiums and an additional 9 percent in more generous benefits. We show that advantageous selection into MA cannot explain this incomplete pass‑through. Instead, our evidence suggests that market power is important, with premium pass‑through rates of 13 percent in the least competitive markets and 74 percent in the most competitive.
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Affiliation(s)
- MARIKA CABRAL
- Department of Economics, The University of Texas at Austin, 1 University Station, Austin, TX 78712
| | - MICHAEL GERUSO
- Department of Economics, The University of Texas at Austin, 1 University Station, Austin, TX 78712
| | - NEALE MAHONEY
- University of Chicago Booth School of Business, 5807 South Woodlawn Avenue, Chicago, IL 60637
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Stevenson P. An Analysis of Medico-legal Claims against Dermatologists in Australia from a Single Medical Indemnity Insurer. J Law Med 2018; 25:1100-1105. [PMID: 29978687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Risk mitigation practices are essential to protecting patients from harm and reducing medical practitioner exposure to unnecessary reputational damage and economic loss. Despite traditionally being perceived as a low-risk specialty, published data on medico-legal claims against dermatologists in Australia are currently lacking. This article reviews the sources of medico-legal claims against dermatologists in Australia from a single medical indemnity insurer over the most recent three years. The failure to meet patient expectations was the largest source of claims against dermatologists, followed by adverse outcomes. Improved communication from practitioner to patient remains the most effective step to preventing medico-legal claims. Medico-legal claims, when they occur, are more successfully defended when thorough documentation processes are in place.
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Affiliation(s)
- Paul Stevenson
- Princess Alexandra Hospital; School of Medicine, Griffith University
- Faculty of Medicine, University of Queensland
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Shockey TM, Babik KR, Wurzelbacher SJ, Moore LL, Bisesi MS. Occupational exposure monitoring data collection, storage, and use among state-based and private workers' compensation insurers. J Occup Environ Hyg 2018; 15:502-509. [PMID: 29580189 PMCID: PMC8672207 DOI: 10.1080/15459624.2018.1453140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite substantial financial and personnel resources being devoted to occupational exposure monitoring (OEM) by employers, workers' compensation insurers, and other organizations, the United States (U.S.) lacks comprehensive occupational exposure databases to use for research and surveillance activities. OEM data are necessary for determining the levels of workers' exposures; compliance with regulations; developing control measures; establishing worker exposure profiles; and improving preventive and responsive exposure surveillance and policy efforts. Workers' compensation insurers as a group may have particular potential for understanding exposures in various industries, especially among small employers. This is the first study to determine how selected state-based and private workers' compensation insurers collect, store, and use OEM data related specifically to air and noise sampling. Of 50 insurers contacted to participate in this study, 28 completed an online survey. All of the responding private and the majority of state-based insurers offered industrial hygiene (IH) services to policyholders and employed 1 to 3 certified industrial hygienists on average. Many, but not all, insurers used standardized forms for data collection, but the data were not commonly stored in centralized databases. Data were most often used to provide recommendations for improvement to policyholders. Although not representative of all insurers, the survey was completed by insurers that cover a substantial number of employers and workers. The 20 participating state-based insurers on average provided 48% of the workers' compensation insurance benefits in their respective states or provinces. These results provide insight into potential next steps for improving the access to and usability of existing data as well as ways researchers can help organizations improve data collection strategies. This effort represents an opportunity for collaboration among insurers, researchers, and others that can help insurers and employers while advancing the exposure assessment field in the U.S.
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Affiliation(s)
- Taylor M Shockey
- a Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Health and Safety (NIOSH), Centers for Disease Control and Prevention , Cincinnati , Ohio
- b Division of Environmental Health Sciences, College of Public Health, The Ohio State University , Columbus , Ohio
| | - Kelsey R Babik
- a Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Health and Safety (NIOSH), Centers for Disease Control and Prevention , Cincinnati , Ohio
| | - Steven J Wurzelbacher
- a Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Health and Safety (NIOSH), Centers for Disease Control and Prevention , Cincinnati , Ohio
| | - Libby L Moore
- a Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Health and Safety (NIOSH), Centers for Disease Control and Prevention , Cincinnati , Ohio
| | - Michael S Bisesi
- b Division of Environmental Health Sciences, College of Public Health, The Ohio State University , Columbus , Ohio
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Alberts A, Blanck Olerup A, Gustafson P. [Not Available]. Lakartidningen 2018; 115:EUU9. [PMID: 29381182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Puerpural fever still exist. A rare condition that must be kept in mind All 33 claims to the Swedish National Patient Insurance (LÖF) in 2010-2014 related to obstetric infections, of which 14 were due to endometritis, were examined. Nine women suffered from fulminant infections consistent with classical puerperal fever (childbed fever), 2 of which were life-threatening. They occurred unexpectedly, mainly after uncomplicated deliveries, and were usually caused by Group A streptococci. Five women suffered from endometritis with a mild or moderate clinical course. All occurred after early birth-related complications and were caused by low-virulent bacteria. In order for an infection to occur in a healthy woman who undergoes normal delivery, more virulent bacteria appear to be required. Since these bacteria may exist in the hospital environment, improved hygiene routines are a prerequisite for reducing the number of nosocomial infections.
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Affiliation(s)
- Akke Alberts
- Capio Ortopediska huset - Johanneshov, Sweden Capio Ortopediska huset - Johanneshov, Sweden
| | - Agneta Blanck Olerup
- Karolinska universitetssjukhuset - Obstetrik/Gynekologi Huddinge, Sweden Karolinska universitetssjukhuset - Obstetrik/Gynekologi Huddinge, Sweden
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Abraham JM, Drake C, McCullough JS, Simon K. What drives insurer participation and premiums in the Federally-Facilitated Marketplace? Int J Health Econ Manag 2017; 17:395-412. [PMID: 28447230 DOI: 10.1007/s10754-017-9215-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 04/11/2017] [Indexed: 06/07/2023]
Abstract
We investigate determinants of market entry and premiums within the context of the Affordable Care Act's Marketplaces for individual insurance. Using Bresnahan and Reiss (1991) as the conceptual framework, we study how competition and firm heterogeneity relate to premiums in 36 states using Federally Facilitated or Supported Marketplaces in 2016. Our primary data source is the Qualified Health Plan Landscape File, augmented with market characteristics from the American Community Survey and Area Health Resource File as well as insurer-level information from federal Medical Loss Ratio annual reports. We first estimate a model of insurer entry and then investigate the relationship between a market's predicted number of entrants and insurer-level premiums. Our entry model results suggest that competition is increasing with the number of insurers, most notably as the market size increases from 3 to 4 entrants. Results from the premium regression suggest that each additional entrant is associated with approximately 4% lower premiums, controlling for other factors. An alternative explanation for the relationship between entrants and premiums is that more efficient insurers (who can price lower) are the ones that enter markets with many entrants, and this is reflected in lower premiums. An exploratory analysis of insurers' non-claims costs (a proxy for insurer efficiency) reveals that average costs among entrants are rising slightly with the number of insurers in the market. This pattern does not support the hypothesis that premiums decrease with more entrants because those entrants are more efficient, suggesting instead that the results are being driven mostly by price competition.
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Affiliation(s)
- Jean Marie Abraham
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
| | - Coleman Drake
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | | | - Kosali Simon
- School of Public and Environmental Affairs, Indiana University, Bloomington, IN, USA
- NBER, Cambridge, MA, USA
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Peters SE, Coppieters MW, Ross M, Johnston V. Perspectives from Employers, Insurers, Lawyers and Healthcare Providers on Factors that Influence Workers' Return-to-Work Following Surgery for Non-Traumatic Upper Extremity Conditions. J Occup Rehabil 2017; 27:343-358. [PMID: 27586696 DOI: 10.1007/s10926-016-9662-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE Return-to-work (RTW) stakeholders have varied roles and may therefore hold their own perspectives regarding factors that may influence outcomes. This study aimed to determine stakeholders' perspectives on factors influencing RTW following surgery for non-traumatic upper extremity conditions. METHODS A questionnaire was distributed to RTW stakeholders via gatekeeper organizations. Stakeholders rated 50 potential prognostic factors from 'not' to 'extremely' influential. Data were dichotomized to establish stakeholders' level of agreement. Disagreements between stakeholder groups were analyzed using χ 2. The relationship between stakeholder demographic variables and rating of a factor was determined via regression analysis. RESULTS One thousand and eleven stakeholders completed the survey: healthcare providers (77.8 %); employer representatives (12.2 %); insurer representatives (6.8 %); and lawyers (3.2 %). Factors with the highest stakeholder agreement for influencing RTW were: self-efficacy (92.2 %); post-operative psychological status (91.8 %); supportive employer/supervisor (91.4 %); employer's willingness to accommodate job modifications (90.7 %); worker's recovery expectations (88.3 %); mood disorder diagnosis (86.6 %); post-operative pain level (86.4 %); and whether the job can be modified (86.3 %). Disagreements between stakeholder groups were found for 19 (36 %) factors. The strongest disagreements were for: age; gender; obesity; doctor's RTW recommendation; and presence of a RTW coordinator. Respondents' characteristics (e.g., age, workers' compensation jurisdiction, work experience, stakeholder group) were associated with factor rating. CONCLUSION The factors stakeholders rated as having the greatest influence on RTW were predominately psychosocial and modifiable. These variables should be the focus of future research to determine prognostic factors for RTW for workers with upper extremity conditions, and to develop effective RTW interventions.
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Affiliation(s)
- Susan E Peters
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia.
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia.
| | - Michel W Coppieters
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
| | - Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane Private Hospital, Brisbane, Australia
- Department of Orthopaedics, Princess Alexandra Hospital, Woolloongabba, Australia
- Orthopaedic Surgery, School of Medicine, The University of Queensland, St Lucia, Australia
| | - Venerina Johnston
- MOVE Research Institute Amsterdam, Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Ndumele CD, Schpero WL, Schlesinger MJ, Trivedi AN. Association Between Health Plan Exit From Medicaid Managed Care and Quality of Care, 2006-2014. JAMA 2017; 317:2524-2531. [PMID: 28655014 PMCID: PMC5815071 DOI: 10.1001/jama.2017.7118] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 05/29/2017] [Indexed: 11/14/2022]
Abstract
Importance State Medicaid programs have increasingly contracted with insurers to provide medical care services for enrollees (Medicaid managed care plans). Insurers that provide these plans can exit Medicaid programs each year, with unclear effects on quality of care and health care experiences. Objective To determine the frequency and interstate variation of health plan exit from Medicaid managed care and evaluate the relationship between health plan exit and market-level quality. Design, Setting, and Participants Retrospective cohort of all comprehensive Medicaid managed care plans (N = 390) during the interval 2006-2014. Exposures Plan exit, defined as the withdrawal of a managed care plan from a state's Medicaid program. Main Outcomes and Measures Eight measures from the Healthcare Effectiveness Data and Information Set were used to construct 3 composite indicators of quality (preventive care, chronic disease care management, and maternity care). Four measures from the Consumer Assessment of Healthcare Providers and Systems were combined into a composite indicator of patient experience, reflecting the proportion of beneficiaries rating experiences as 8 or above on a 0-to-10-point scale. Outcome data were available for 248 plans (68% of plans operating prior to 2014, representing 78% of beneficiaries). Results Of the 366 comprehensive Medicaid managed care plans operating prior to 2014, 106 exited Medicaid. These exiting plans enrolled 4 848 310 Medicaid beneficiaries, with a mean of 606 039 beneficiaries affected by plan exits annually. Six states had a mean of greater than 10% of Medicaid managed care recipients enrolled in plans that exited, whereas 10 states experienced no plan exits. Plans that exited from a state's Medicaid market performed significantly worse prior to exiting than those that remained in terms of preventive care (57.5% vs 60.4%; difference, 2.9% [95% CI, 0.3% to 5.5%]), maternity care (69.7% vs 73.6%; difference, 3.8% [95% CI, 1.7% to 6.0%]), and patient experience (73.5% vs 74.8%; difference, 1.3% [95% CI, 0.6% to 1.9%]). There was no significant difference between exiting and nonexiting plans for the quality of chronic disease care management (76.2% vs 77.1%; difference, 1.0% [95% CI, -2.1% to 4.0%]). There was also no significant change in overall market performance before and after the exit of a plan: 0.7-percentage point improvement in preventive care quality (95% CI, -4.9 to 6.3); 0.2-percentage point improvement in chronic disease care management quality (95% CI, -5.8 to 6.2); 0.7-percentage point decrease in maternity care quality (95% CI, -6.4 to 5.0]); and a 0.6-percentage point improvement in patient experience ratings (95% CI, -3.9 to 5.1). Medicaid beneficiaries enrolled in exiting plans had access to coverage for a higher-quality plan, with 78% of plans in the same county having higher quality for preventive care, 71.1% for chronic disease management, 65.5% for maternity care, and 80.8% for patient experience. Conclusions and Relevance Between 2006 and 2014, health plan exit from the US Medicaid program was frequent. Plans that exited generally had lower quality ratings than those that remained, and the exits were not associated with significant overall changes in quality or patient experience in the plans in the Medicaid market.
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Affiliation(s)
- Chima D. Ndumele
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - William L. Schpero
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Mark J. Schlesinger
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Amal N. Trivedi
- Department of Health Services Policy and Practice, Brown School of Public Health, Providence, Rhode Island
- Providence VA Medical Center, Providence, Rhode Island
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Affiliation(s)
- Uwe Reinhardt
- Uwe E. Reinhardt, PhD, is the James Madison professor of political economy and of economics at Princeton University, where he teaches health economics, comparative health systems, general microeconomics, and financial management. Dr Reinhardt is also the codirector of the Griswold Center for Economic Policy Studies at Princeton University. The bulk of his research has been focused on health economics and policy, both in the United States and abroad. He is a member of the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine)
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Feria-Domínguez JM, Paneque P, Gil-Hurtado M. Risk Perceptions on Hurricanes: Evidence from the U.S. Stock Market. Int J Environ Res Public Health 2017; 14:ijerph14060600. [PMID: 28587237 PMCID: PMC5486286 DOI: 10.3390/ijerph14060600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 11/16/2022]
Abstract
This article examines the market reaction of the main Property and Casualty (P & C) insurance companies listed in the New York Stock Exchange (NYSE) to seven most recent hurricanes that hit the East Coast of the United States from 2005 to 2012. For this purpose, we run a standard short horizon event study in order to test the existence of abnormal returns around the landfalls. P & C companies are one of the most affected sectors by such events because of the huge losses to rebuild, help and compensate the inhabitants of the affected areas. From the financial investors' perception, this kind of events implies severe losses, which could influence the expected returns. Our research highlights the existence of significant cumulative abnormal returns around the landfall event window in most of the hurricanes analyzed, except for the Katrina and Sandy Hurricanes.
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Affiliation(s)
| | - Pilar Paneque
- Department of Geography, Pablo de Olavide University, 41013 Seville, Spain.
| | - María Gil-Hurtado
- EY Climate Change and Sustainability Assurance, 41013 Seville, Spain.
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Young AE, Besen E, Willetts J. The Relationship Between Work-Disability Duration and Claimant's Expected Time to Return to Work as Recorded by Workers' Compensation Claims Managers. J Occup Rehabil 2017; 27:284-295. [PMID: 27460477 PMCID: PMC5405108 DOI: 10.1007/s10926-016-9656-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Purpose This research sought to determine whether there is a relationship between claimants' expected time to return to work (RTW) as recorded by claims managers and compensated days of work disability. Methods We utilized workers' compensation data from a large, United States-based insurance company. RTW expectations were collected within 30 days of the claim being reported and these were compared with the termination of total temporary indemnity payments. Bivariate and hierarchical regression analyses were conducted. Results A significant relationship between expected time to RTW and compensated disability duration was observed. The unadjusted correlation between work-disability duration and expected time to RTW was .25 (p < .001). Our multivariate model explained 29.8 % of the variance, with expected time to RTW explaining an additional 9.5 % of the variance in work-disability duration beyond what was explained by the covariates. Conclusion The current study's findings support the hypothesis that claimant RTW estimates as recorded by claims managers are significantly related to compensated-disability duration, and the relationship is maintained after controlling for variance that can be explained by other variables available within workers' compensation databases.
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Affiliation(s)
- Amanda E Young
- Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA.
| | - Elyssa Besen
- Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA
| | - Joanna Willetts
- Center for Disability Research, Liberty Mutual Research Institute for Safety, 71 Frankland Road, Hopkinton, MA, 01748, USA
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Largest professional liability carriers. Mod Healthc 2017; 47:34. [PMID: 30707797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Fronstin P, Roebuck MC. Health Plan Switching: A Case Study--Implications for Private- and Public-Health-Insurance Exchanges and Increased Health Plan Choice. EBRI Issue Brief 2017:1-20. [PMID: 29215239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Reinke T. CMS Wants to Remodel Cancer Payment, Care. Manag Care 2016; 25:12-15. [PMID: 28121537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
CMS' Oncology Care Model program is bringing bundled payments to cancer care. With drug costs so high and hard to control, the 195 participating practices will have to figure out other ways to control costs if they want to beat financial benchmarks and earn bonuses.
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Herman B. Aiming for happier customers. Mod Healthc 2016; 46:20-22. [PMID: 30399297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In an industry saddled with a reputation for poor service, some health insurers are putting a priority on reaching out to solve subscribers problems.
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van Kleef RC, van Vliet RCJA, van de Ven WPMM. Overpaying morbidity adjusters in risk equalization models. Eur J Health Econ 2016; 17:885-895. [PMID: 26420555 DOI: 10.1007/s10198-015-0729-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 09/15/2015] [Indexed: 06/05/2023]
Abstract
Most competitive social health insurance markets include risk equalization to compensate insurers for predictable variation in healthcare expenses. Empirical literature shows that even the most sophisticated risk equalization models-with advanced morbidity adjusters-substantially undercompensate insurers for selected groups of high-risk individuals. In the presence of premium regulation, these undercompensations confront consumers and insurers with incentives for risk selection. An important reason for the undercompensations is that not all information with predictive value regarding healthcare expenses is appropriate for use as a morbidity adjuster. To reduce incentives for selection regarding specific groups we propose overpaying morbidity adjusters that are already included in the risk equalization model. This paper illustrates the idea of overpaying by merging data on morbidity adjusters and healthcare expenses with health survey information, and derives three preconditions for meaningful application. Given these preconditions, we think overpaying may be particularly useful for pharmacy-based cost groups.
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Affiliation(s)
- R C van Kleef
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - R C J A van Vliet
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - W P M M van de Ven
- Institute of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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Keegan C, Teljeur C, Turner B, Thomas S. Switching insurer in the Irish voluntary health insurance market: determinants, incentives, and risk equalization. Eur J Health Econ 2016; 17:823-831. [PMID: 26359243 DOI: 10.1007/s10198-015-0724-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 08/19/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND The determinants of consumer mobility in voluntary health insurance markets providing duplicate cover are not well understood. Consumer mobility can have important implications for competition. Consumers should be price-responsive and be willing to switch insurer in search of the best-value products. Moreover, although theory suggests low-risk consumers are more likely to switch insurer, this process should not be driven by insurers looking to attract low risks. METHODS This study utilizes data on 320,830 VHI healthcare policies due for renewal between August 2013 and June 2014. At the time of renewal, policyholders were categorized as either 'switchers' or 'stayers', and policy information was collected for the prior 12 months. Differences between these groups were assessed by means of logistic regression. The ability of Ireland's risk equalization scheme to account for the relative attractiveness of switchers was also examined. RESULTS Policyholders were price sensitive (OR 1.052, p < 0.01), however, price-sensitivity declined with age. Age (OR 0.971; p < 0.01) and hospital utilization (OR 0.977; p < 0.01) were both negatively associated with switching. In line with these findings, switchers were less costly than stayers for the 12 months prior to the switch/renew decision for single person (difference in average cost = €540.64) and multiple-person policies (difference in average cost = €450.74). Some cost differences remain for single-person policies following risk equalization (difference in average cost = €88.12). CONCLUSIONS Consumers appear price-responsive, which is important for competition provided it is based on correct incentives. Risk equalization payments largely eliminated the profitable status of switchers, although further refinements may be required.
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Affiliation(s)
- Conor Keegan
- Centre of Health Policy and Management, Trinity College Dublin (TCD), Dublin 2, Ireland.
| | - Conor Teljeur
- Health Information and Quality Authority (HIQA), Dublin 7, Ireland
| | - Brian Turner
- School of Economics, University College Cork (UCC), Cork, Ireland
| | - Steve Thomas
- Centre of Health Policy and Management, Trinity College Dublin (TCD), Dublin 2, Ireland
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Abstract
OBJECTIVE To identify predictors potentially contributing to patients' nonattendance or to same-day cancellation of scheduled appointments at an adult endocrinology office practice. METHODS A retrospective, records-based, cross-sectional study was conducted using data from 9,305 electronic medical records of patients presenting at a U.S. metropolitan adult endocrinology clinic in 2013. Statistical analyses included multivariate regression, calculated odds ratios, and posttest probabilities. RESULTS Of 29,178 total patient visits analyzed, 68% were attended by patients. Of total scheduled appointments, 7% resulted in nonattendance and 5% in same-day cancellation. The most significant predictors of nonatten-dance were a previous history of nonattendance (P<.001), uncontrolled diabetes (P<.001), and new patients to the practice (P<.001). Long lead-time to appointment (P = .001), younger age (P<.001), and certain insurance carriers (P<.001) also were significant predictors. CONCLUSION Specific predictors of nonattendance at scheduled appointments were identified using statistical analysis of electronic medical record data. Previous history of nonattendance and having uncontrolled diabetes (especially in patients newly referred to the practice) are among these significant predictors. Identifying specific predictors for nonattendance enables targeted strategies to be developed. ABBREVIATIONS APRN = Advanced Practice Registered Nurse CI = confidence interval DM = diabetes mellitus EMR = electronic medical record HbA1c = glycated hemoglobin NS = no-show OR = odds ratio SDC = same-day cancellation.
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Boonen LHHM, Laske-Aldershof T, Schut FT. Switching health insurers: the role of price, quality and consumer information search. Eur J Health Econ 2016; 17:339-353. [PMID: 25820635 PMCID: PMC4805725 DOI: 10.1007/s10198-015-0681-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 02/27/2015] [Indexed: 06/04/2023]
Abstract
We examine the impact of price, service quality and information search on people's propensity to switch health insurers in the competitive Dutch health insurance market. Using panel data from annual household surveys and data on health insurers' premiums and quality ratings over the period 2006-2012, we estimate a random effects logit model of people's switching decisions. We find that switching propensities depend on health plan price and quality, and on people's age, health, education and having supplementary or group insurance. Young people (18-35 years) are more sensitive to price, whereas older people are more sensitive to quality. Searching for health plan information has a much stronger impact on peoples' sensitivity to price than to service quality. In addition, searching for health plan information has a stronger impact on the switching propensity of higher than lower educated people, suggesting that higher educated people make better use of available health plan information. Finally, having supplementary insurance significantly reduces older people's switching propensity.
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Affiliation(s)
- Lieke H H M Boonen
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Trea Laske-Aldershof
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Frederik T Schut
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
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Senn A, Filzmaier K. [Rare diseases from a life insurance perspective]. Versicherungsmedizin 2015; 67:180-183. [PMID: 26775306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A rare disease is defined as a disease that affects a maximum of 5 in 10,000 people. As of today there are roughly 7000 different rare diseases known. On account of this one can say that "rare diseases are rare, but people affected by them are common". For Germany this amounts to: 4 million people that are affected by a rare disease. Diagnosis, therapeutic options and prognosis have substantially improved for some of the rare diseases. Besides the general medical advances--especially in the area of genetics--this is also due to networking and sharing information by so-called Centres of Competence on a national and international scale. This results in a better medical care for the corresponding group of patients. Against this backdrop, the number of people applying for life assurance who are suffering from a complex or rare disease has risen steadily in the last years. Due to the scarce availability of data regarding long-term prognosis of many rare diseases, a biomathematical, medical and actuarial expertise on the part of the insurer is necessary in order to adequately assess the risk of mortality and morbidity. Furthermore there is quite a focus on the issue of rare diseases from not only politics but society as well. Therefore evidence based medical assessment by insurers is especially important in this group of applicants--thinking of legal compliance and reputational risk.
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Sinnott M, Kinsley BT, Jackson AD, Walsh C, O’Grady T, Nolan JJ, Gaffney P, Boran G, Kelleher C, Carr B. Fasting plasma glucose as initial screening for diabetes and prediabetes in irish adults: The Diabetes Mellitus and Vascular health initiative (DMVhi). PLoS One 2015; 10:e0122704. [PMID: 25874867 PMCID: PMC4398404 DOI: 10.1371/journal.pone.0122704] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/18/2015] [Indexed: 12/14/2022] Open
Abstract
Objective Type 2 diabetes has a long pre clinical asymptomatic phase. Early detection may delay or arrest disease progression. The Diabetes Mellitus and Vascular health initiative (DMVhi) was initiated as a prospective longitudinal cohort study on the prevalence of undiagnosed Type 2 diabetes and prediabetes, diabetes risk and cardiovascular risk in a cohort of Irish adults aged 45-75 years. Research Design and Methods Members of the largest Irish private health insurance provider aged 45 to 75 years were invited to participate in the study. Exclusion criteria: already diagnosed with diabetes or taking oral hypoglycaemic agents. Participants completed a detailed medical questionnaire, had weight, height, waist and hip circumference and blood pressure measured. Fasting blood samples were taken for fasting plasma glucose (FPG). Those with FPG in the impaired fasting glucose (IFG) range had a 75gm oral glucose tolerance test performed. Results 122,531 subjects were invited to participate. 29,144 (24%) completed the study. The prevalence of undiagnosed diabetes was 1.8%, of impaired fasting glucose (IFG) was 7.1% and of impaired glucose tolerance (IGT) was 2.9%. Dysglycaemia increased among those aged 45-54, 55-64 and 65-75 years in both males (10.6%, 18.5%, 21.7% respectively) and females (4.3%, 8.6%, 10.9% respectively). Undiagnosed T2D, IFG and IGT were all associated with gender, age, blood pressure, BMI, abdominal obesity, family history of diabetes and triglyceride levels. Using FPG as initial screening may underestimate the prevalence of T2D in the study population. Conclusions This study is the largest screening study for diabetes and prediabetes in the Irish population. Follow up of this cohort will provide data on progression to diabetes and on cardiovascular outcomes.
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Affiliation(s)
| | | | | | - Cathal Walsh
- Department of Statistics, Trinity College Dublin, Dublin, Republic of Ireland
| | | | | | - Peter Gaffney
- The Adelaide and Meath Hospital incorporating the National Children’s Hospital, Dublin, Republic of Ireland
| | - Gerard Boran
- The Adelaide and Meath Hospital incorporating the National Children’s Hospital, Dublin, Republic of Ireland
| | - Cecily Kelleher
- University College Dublin School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Republic of Ireland
| | - Bernadette Carr
- Vhi Healthcare Ltd, Dublin, Republic of Ireland
- University College Dublin School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Republic of Ireland
- * E-mail:
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Gruber J. Growth and variability in health plan premiums in the individual insurance market before the Affordable Care Act. Issue Brief (Commonw Fund) 2014; 11:1-12. [PMID: 24922979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Before we can evaluate the impact of the Affordable Care Act on health insurance premiums in the individual market, it is critical to understand the pricing trends of these premiums before the implementation of the law. Using rates of increase in the individual insurance market collected from state regulators, this issue brief documents trends in premium growth in the pre-ACA period. From 2008 to 2010, premiums grew by 10 percent or more per year. This growth was also highly variable across states, and even more variable across insurance plans within states. The study suggests that evaluating trends in premiums requires looking across a broad array of states and plans, and that policymakers must examine how present and future changes in premium rates compare with the more than 10 percent per year premium increases in the years preceding health reform.
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Downey L, Zun LS, Burke T, Jefferson T. Who pays? How reimbursement impacts the emergency department. J Health Hum Serv Adm 2014; 36:400-416. [PMID: 24772689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Nationwide from 1996 to 2004, the overall proportion of Emergency Department (ED) reimbursement ratios for outpatient ED visits decreased from 57% to 42%. The continued falling of ED reimbursement ratios, which is the share of ED charges that are ultimately paid, is an indicator of the financial pressures facing the ED. Once the healthcare reforms are put in place what will the impact be on reimbursement rates of overburdened and underfunded emergency departments. PURPOSE The purpose of this study is to examine if there is a declining disparity in payment rates for ED care based on payment sources in a safety net ED provider. Findings of this study could indicate how the healthcare reforms might impact these types of ED reimbursement ratios in the upcoming years. METHODS This was a retrospective study that examined randomly selected charts of all ED visits charts from May 2002 to May 2008 at a level one adult and pediatric emergency trauma center with 45,000 annual visits. This study was IRB approved. RESULTS A regression model was used to predict if there was a relationship between amount received and types of insurance payers within the ED. A significant relationship was found between types of insurance (payers) as the independent variable, and the dependent variables of charges (p = .00), payments (p = .00), amount of adjustments (p= .00), and balance remaining after 90 days (p = .00). CONCLUSIONS Who pays for the ED services does impact the ED's bottom line. The privately funded patients will provide an ED with a higher reimbursement ratio per year as compared to those patients who are publicly or self pay. This explains why EDs that provide care for 40% or more publicly or self pay patients have seen a decline in reimbursement ratios. Healthcare reform has the potential to change and possibly improve safety net ED rate of reimbursement depending on how private, public and self pay patients pay for ED services.
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Schlingensiepen I. [Statistical report: insured patients are leaving PKV]. MMW Fortschr Med 2012; 154:14. [PMID: 23270049 DOI: 10.1007/s15006-012-1567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Ramsey SD, McDermott CL, Clarke L, Blough DK. Health insurer policies toward risk-stratified colorectal cancer screening: a survey of health plan medical directors. J Insur Med 2012; 43:92-101. [PMID: 22876413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES We sought to determine whether health insurance coverage of colorectal cancer (CRC) screening varied based on risk. BACKGROUND Population-wide screening guidelines for cancer often incorporate risk information, with modified screening recommendations for those at higher risk due to family history or other factors. METHODS In a nationwide Internet- and mail-based survey of health insurance plan medical directors, respondents were asked about their organization's policies towards coverage of CRC screening for persons at average and higher risk of CRC. Additional questions asked about whether the insurer had a definition of increased risk, and coverage of genetic testing for familial CRC syndromes. RESULTS Survey invitations were sent to 1158 medical directors; 133 (11%) completed the survey. All plans covered screening for average and high-risk persons. The onset of screening was earlier and intervals were more frequent for higher risk compared to average risk persons, with most respondents stating coverage was determined by "physician discretion." While 75% had a definition of high risk, only 55% covered genetic testing. CONCLUSIONS Most insurers offer enhanced coverage of CRC screening, most commonly following the discretion of the physician. Whether this coverage results in earlier, more frequent, or more complete screening of higher risk persons remains uncertain.
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Affiliation(s)
- Scott D Ramsey
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North M3-B232, Seattle, WA 98109, USA.
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36
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Kessler DP. How should risk adjustment data be collected? Inquiry 2012; 49:127-140. [PMID: 22931020 DOI: 10.5034/inquiryjrnl_49.02.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Risk adjustment has broad general application and is a key part of the Patient Protection and Affordable Care Act (ACA). Yet, little has been written on how data required to support risk adjustment should be collected. This paper offers analytical support for a distributed approach, in which insurers retain possession of claims but pass on summary statistics to the risk adjustment authority as needed. It shows that distributed approaches function as well as or better than centralized ones-where insurers submit raw claims data to the risk adjustment authority-in terms of the goals of risk adjustment. In particular, it shows how distributed data analysis can be used to calibrate risk adjustment models and calculate payments, both in theory and in practice--drawing on the experience of distributed models in other contexts. In addition, it explains how distributed methods support other goals of the ACA, and can support projects requiring data aggregation more generally. It concludes that states should seriously consider distributed methods to implement their risk adjustment programs.
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Affiliation(s)
- Daniel P Kessler
- Law School and Graduate School of Business, Stanford University, Stanford, CA 94305, USA.
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Abstract
OBJECTIVE To quantify the health economic impact of managing cow milk allergy (CMA) in South Africa, from the perspective of healthcare insurers in both the private and public sectors and parents/carers of CMA sufferers. METHODS A decision model depicting the management of CMA in South Africa was constructed, using information obtained from interviews with paediatric specialists in the private and public sectors with relevant clinical experience. The model was used to estimate the expected 12-monthly levels of healthcare resource use and corresponding costs (at 2007/08 prices) attributable to managing CMA sufferers following an initial consultation with a paediatrician. RESULTS The expected 12-monthly cost incurred by an insurer attributable to managing a CMA sufferer following an initial consultation with a paediatrician was estimated to be R2,430.4 (€202.0) and R1,073.7 (€89.0) in the private and public sector, respectively. The expected 12-monthly cost incurred by parents/carers following an initial consultation with a paediatrician was estimated to be R43,563.1 (€3,634.0) and R24,899.9 (€2,076.9) in the private and public sector, respectively. The time taken for a CMA sufferer to be put on an appropriate diet and achieve symptom resolution was estimated to be 24 days in the private sector and 18 days in the public sector. The total cost to manage an annual cohort of 18,270 newly diagnosed infants with CMA in South Africa in the first year following presentation to a paediatrician was estimated to be R22.1 (€1.8) million for healthcare insurers and R489.1 (€40.8) million for parents/carers. The expected costs to insurers were driven by visits to general paediatricians and prescriptions for dermatological drugs in both the private and public sectors. The expected costs to parents/carers were driven by over-the-counter (OTC) purchases of clinical nutrition preparations. LIMITATIONS The intolerance rates were derived from a study among 1,000 infants with CMA in the UK, healthcare resource use was not collected prospectively and the study period was limited to 1 year following presentation to a paediatrician and does not consider the impact of CMA in subsequent years. However, most children outgrow this form of allergy by the time they reach 2 years of age. CONCLUSION CMA imposes a substantial socio-economic burden in South Africa, especially on parents/carers of CMA sufferers. Any strategy that reduces this burden should potentially lead to higher compliance with clinicians' recommendations, thereby improving health outcomes associated with treatment and should also release healthcare resource use for alternative use.
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Abstract
Polycythemia vera (PV) and essential thrombocythemia (ET) are common types of myeloproliferative disorders (MPD), the prevalence of which has not been well documented in the United States. Recent breakthroughs in the molecular etiology of these disorders and the accelerated development of targeted pharmacotherapeutics to treat them underscore the need to define the affected population. In this study, we obtained health claims data from major commercial insurance payers in Connecticut and the Center for Medicare and Medicaid Services to estimate the prevalence of PV and ET. Specifically, logistic regression was utilized to develop algorithms to predict the probability that an individual with claims suggestive of MPD truly has PV or ET, and the algorithms were then applied to health claims to estimate the number of PV and ET patients in Connecticut. As of 2003, the age-standardized prevalence was 22 per 100,000 and 24 per 100,000 for PV and ET, respectively, in Connecticut. Applying the age-specific prevalence of PV and ET to the entire US population resulted in an estimated total of 65,243 patients with PV and 71,078 patients with ET in the United States in 2003. This study is the first to assess the prevalence of PV and ET in a large US population. Given the large number of individuals afflicted with these diseases and the fact that demographic changes alone will further increase the burden of
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Affiliation(s)
- Xiaomei Ma
- Yale University School of Medicine, New Haven, Connecticut, USA.
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By the numbers. Et cetera--10 largest healthcare associations. Mod Healthc 2007; Suppl:93. [PMID: 18220143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Galloro V, Vesely R, Zigmond J. Trying to compensate. Latest ranking of CEO compensation finds stock options still key to pay as experts monitor for effects of SEC rule changes. Mod Healthc 2007; 37:6, 14, 16 passim. [PMID: 17824144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Despite past outcries from critics, stock options continue to play a starring, albeit smaller, role in compensation for CEOs at top companies, based on research by accounting professor Steven Balsam, left. Read about the 30 healthcare executives who brought home the biggest pay packages in our annual ranking of CEOs' compensation.
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By the numbers. 20 largest health insurers, by revenue. Based on 2006 healthcare-related revenue from health, life and health statutory filings. Mod Healthc 2007; 37:32. [PMID: 17847172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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20 largest health insurers, by revenue based on 2005 healthcare-related revenue from health, life and health statutory filings. Mod Healthc 2006; 36:32. [PMID: 16910095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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Abstract
OBJECTIVE Although Medicaid is the primary payer for public mental health systems, relatively little is known about managed care arrangements at the health plan level. METHODS A brief cross-sectional survey was customized for each of the 51 Medicaid agencies. Survey data were collected and combined with Centers for Medicare and Medicaid Services data elements. Where possible, analyses were conducted at the state, waiver program, and health plan levels. RESULTS Findings confirmed that most states were contracting to serve a broad range of Medicaid enrollees. The array of covered benefits was extensive. Health maintenance organization (HMO)-type arrangements accounted for most plans nationally, but 40 percent of plans were specialty carve-outs. Most states used capitation contracts, but a third shared risk with their vendors. A surprising number of states (41 percent) reported using governmental entities as vendors. CONCLUSIONS By the year 2000, large numbers of public sector clients were being served by HMO-type arrangements. Benefit designs under managed care were perhaps more inclusive than some advocates had feared. The flexibility of capitation financing may have enhanced the ability of health plans to ration care in a clinically informed manner. However, large numbers of vulnerable individuals were receiving care through fully capitated health plans. This finding suggests the need for vigilance by public-sector mental health and substance abuse authorities. Authorities should aggressively pursue opportunities to influence Medicaid policy.
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Affiliation(s)
- M Susan Ridgely
- RAND Corporation, 1776 Main Street, Santa Monica, California 90407, USA.
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Brown LJ, Guay AH, House DR. The impact of concentration in dental insurance markets on dental reimbursement in Minnesota. Northwest Dent 2005; 84:12-20. [PMID: 16224886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
The following article has been prepared by the American Dental Association (ADA) at the request of the Minnesota Dental Association (MDA). The article is the culmination of a rigorous national study by the ADA to measure the concentration of dental insurance in major dental marketplaces around the country. Five Metropolitan Statistical Areas (MSA's)from Minnesota were compared to other MSA's around the country. The results of this study are very significant for dentists and dental patients in Minnesota. Minnesota' practicing dental community may find the results of the study to be somewhat disturbing. Nevertheless, the MDA believes that it is important to share the results of this study with MDA members and others in the Minnesota dental community. It is important to consider both the study's short-term ramifications, as well as its long-term implications, as we attempt to better understand Minnesota's dental marketplace. It is also important for MDA members to know that the ADA brought the results of this study as they relate to the Minnesota Dental Marketplace to the appropriate federal agencies. The ADA believed that these agencies might choose to develop it into an anti-trust case. After reviewing the matter and working with the ADA over a long period of time, these agencies decided that they would not proceed with a Minnesota-based anti-trust case; additional information beyond what the ADA was legally able to provide was needed by the federal agencies in order for them to proceed. The MDA will continue to analyze and respond to these dental marketplace developments.
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Kline LA. Alternative insurance requires close scrutiny. Mich Med 2005; 104:15-6. [PMID: 16053233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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Olzowy B, Osterkorn D, Suckfüll M. [The incidence of sudden hearing loss is greater than previously assumed]. MMW Fortschr Med 2005; 147:37-8. [PMID: 15887682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The global incidence of sudden hearing loss is quoted to be 5-20 new cases/100,000 inhabitants/year. In the opinion of the present authors, the data on which these figures are based, are too old, methodologically questionable and non-transferable. An analysis of data from the compulsory health insurance carriers in Baden-Württemberg and the Nordrhein district suggests that an appreciably higher incidence must be assumed for Germany. Statistical processing of the numerical data of all cost carriers is necessary if we are to obtain an accurate incidence for Germany.
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Affiliation(s)
- B Olzowy
- Klinik und Poliklinik für Hals-Nasen-Ohren-Krankheiten der LMU München
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Galloro V, Benko LB. Rolling in dough. Despite the controversy surrounding CEO pay, healthcare leaders continue to enjoy generous compensation, with insurers leading the pack. Mod Healthc 2004; 34:6-7, 16, 1. [PMID: 15332515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Despite the controversy about pay for CEOs, leaders continue to enjoy highly lucrative compensation. Modem Healthcares second annual report on CEO pay shows healthcare chieftains fared nicely. Acute-care hospital CEOs, such as HCA's Jack Bovender Jr., left, saw their median compensation rise 12.50%
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Dutta-Bergman M. Trusted online sources of health information: differences in demographics, health beliefs, and health-information orientation. J Med Internet Res 2003; 5:e21. [PMID: 14517112 PMCID: PMC1550562 DOI: 10.2196/jmir.5.3.e21] [Citation(s) in RCA: 146] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2002] [Accepted: 09/12/2003] [Indexed: 11/15/2022] Open
Abstract
Background The recent surge in online health information and consumer use of such information has led to expert speculations and prescriptions about the credibility of health information on the World Wide Web. In spite of the growing concern over online health information sources, existing research reveals a lacuna in the realm of consumer evaluations of trustworthiness of different health information sources on the Internet. Objective This study examines consumer evaluation of sources of health information on the World Wide Web, comparing the demographic, attitudinal, and cognitive differences between individuals that most trust a particular source of information and individuals that do not trust the specific source of health information. Comparisons are made across a variety of sources. Methods The Porter Novelli HealthStyles database, collected annually since 1995, is based on the results of nationally-representative postal-mail surveys. In 1999, 2636 respondents provided usable data for the HealthStyles database. Independent sample t tests were conducted to compare the respondents in the realm of demographic, attitudinal, and cognitive variables. Results The most trusted sources of online health information included the personal doctor, medical university, and federal government. The results demonstrated significant differences in demographic and health-oriented variables when respondents who trusted a particular online source were compared with respondents that did not trust the source, suggesting the need for a segmented approach to research and application. Individuals trusting the local doctor were younger ( t2634= 4.02, P< .001) and held stronger health beliefs (F 1= 5.65, P= .018); individuals trusting the local hospital were less educated ( t2634= 3.83, P< .001), low health information oriented (F 1= 6.41, P= .011), and held weaker health beliefs (F 1= 5.56, P= .018). Respondents with greater trust in health insurance companies as online health information sources were less educated ( t2634= 1.90, P= .05) and less health information oriented (F 1= 4.30, P= .04). Trust in medical universities was positively associated with education ( t2634= 11.83, P< .001), income ( t2634= 10.19, P< .001), and health information orientation (F 1= 10.32, P<.001). Similar results were observed in the realm of federal information credibility, with individuals with greater trust in federal sources being more educated ( t2634= 7.45, P< .001) and health information oriented (F 1= 4.45, P= .04) than their counterparts. Conclusions The results suggest systematic differences in the consumer segment based on the different sources of health information trusted by the consumer. While certain sources such as the local hospital and the health insurance company might serve as credible sources of health information for the lower socioeconomic and less health-oriented consumer segment, sources such as medical universities and federal Web sites might serve as trustworthy sources for the higher socioeconomic and more health-oriented groups.
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Affiliation(s)
- Mohan Dutta-Bergman
- Department of Communication, Purdue University, West Lafayette, IN 47906, USA.
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Torres EA, De Jesús R, Pérez CM, Iñesta M, Torres D, Morell C, Just E. Prevalence of inflammatory bowel disease in an insured population in Puerto Rico during 1996. P R Health Sci J 2003; 22:253-8. [PMID: 14619451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVES Limited data exists about Inflammatory Bowel Disease (IBD) in Hispanic populations. The aims of the present study were to estimate overall and specific prevalence of IBD (Crohn's disease and ulcerative colitis) and to describe the characteristics of a group of patients from the University of Puerto Rico's IBD Registry. METHODS To estimate the prevalence of IBD, computerized records of all physician billing and hospital discharges from a major health insurer in Puerto Rico and classified with ICD-9-CM codes 555.0-555.9 (Crohn's disease) and 556.0-556.9 (ulcerative colitis) during 1996 were searched. Prevalence was estimated by age group, sex, and type of insurance. To describe demographic and selected clinical information from patients with IBD, data gathered in the University of Puerto Rico's IBD Registry from 1995 through 2000 was analyzed. RESULTS Out of 802,726 insured individuals, 332 had a diagnosis of Crohn's disease, 499 of ulcerative colitis and 21 had both diagnoses. The estimated prevalence per 100,000 was 41.4 for Crohn's disease, 62.2 for ulcerative colitis, and 106.1 cases per 100,000 for IBD. Peak prevalence of Crohn's disease occurred among the age groups 50-59 years and > or = 60 years, and the overall female:male prevalence ratio of Crohn's disease was 1.13 (95% CI: 0.91-1.42). Ulcerative colitis was most prevalent among insured individuals aged 50-59 years and 40-49 years. The prevalence of ulcerative colitis was significantly higher among females than among males, with an overall prevalence ratio of 1.42 (95% CI: 1.18-1.71). Of 342 patients participating in the IBD Registry, 155 (45.3%) had Crohn's disease and 187 (54.7%) had ulcerative colitis. Among patients diagnosed with Crohn's disease, 51.6% were females, the mean age was 35.2 +/- 18.3 years, and 18.1% had a family history of IBD. More than half (57.8%) of patients with ulcerative colitis were females, the mean age was 42.6 +/- 17 years, and 17.1% had a family history of IBD. CONCLUSIONS The estimated prevalence of IBD in this insured population in Puerto Rico places it among the middle-range of that reported for other countries. Additional studies must be conducted in Puerto Rico in order to confirm the observed findings. Population-based epidemiologic studies aimed at estimating the burden of IBD in Hispanic populations in the United States and Latin America are essential for health care planning.
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Affiliation(s)
- Esther A Torres
- Department of Medicine, Medical Sciences Campus, University of Puerto Rico.
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Benjamin DM, Pendrak RF. Medication errors: an analysis comparing PHICO's closed claims data and PHICO's Event Reporting Trending System (PERTS). J Clin Pharmacol 2003; 43:754-9. [PMID: 12856390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Clinical pharmacologists are all dedicated to improving the use of medications and decreasing medication errors and adverse drug reactions. However, quality improvement requires that some significant parameters of quality be categorized, measured, and tracked to provide benchmarks to which future data (performance) can be compared. One of the best ways to accumulate data on medication errors and adverse drug reactions is to look at medical malpractice data compiled by the insurance industry. Using data from PHICO insurance company, PHICO's Closed Claims Data, and PHICO's Event Reporting Trending System (PERTS), this article examines the significance and trends of the claims and events reported between 1996 and 1998. Those who misread history are doomed to repeat the mistakes of the past. From a quality improvement perspective, the categorization of the claims and events is useful for reengineering integrated medication delivery, particularly in a hospital setting, and for redesigning drug administration protocols on low therapeutic index medications and "high-risk" drugs. Demonstrable evidence of quality improvement is being required by state laws and by accreditation agencies. The state of Florida requires that quality improvement data be posted quarterly on the Web sites of the health care facilities. Other states have followed suit. The insurance industry is concerned with costs, and medication errors cost money. Even excluding costs of litigation, an adverse drug reaction may cost up to $2500 in hospital resources, and a preventable medication error may cost almost $4700. To monitor costs and assess risk, insurance companies want to know what errors are made and where the system has broken down, permitting the error to occur. Recording and evaluating reliable data on adverse drug events is the first step in improving the quality of pharmacotherapy and increasing patient safety. Cost savings and quality improvement evolve on parallel paths. The PHICO data provide an excellent opportunity to review information that typically would not be in the public domain. The events captured by PHICO are similar to the errors and "high-risk" drugs described in the literature, the U.S. Pharmacopeia's MedMARx Reporting System, and the Sentinel Event reporting system maintained by the Joint Commission for the Accreditation of Healthcare Organizations. The information in this report serves to alert clinicians to the possibility of adverse events when treating patients with the reported drugs, thus allowing for greater care in their use and closer monitoring. Moreover, when using high-risk drugs, patients should be well informed of known risks, dosage should be titrated slowly, and therapeutic drug monitoring and laboratory monitoring should be employed to optimize therapy and minimize adverse effects.
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Affiliation(s)
- David M Benjamin
- Department of Pharmacology & Experimental Therapeutics, Tufts University School of Medicine, Boston, Massachusetts, USA
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