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Payne, Charlotte A., Timothy Chrusciel, and David A. S. Kaufman. "5 Hospitalization Outcomes Following Neuropsychological Evaluation in a Traumatic Brain Injury Sample." Journal of the International Neuropsychological Society 29, s1 (November 2023): 117–18. http://dx.doi.org/10.1017/s1355617723002096.
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Objective:Previous research has shown that positive outcomes are associated with receiving a neuropsychological evaluation (NPE). The current project examined hospitalization outcomes following an NPE in a sample of patients who had sustained a traumatic brain injury (TBI). Hospitalization rates were compared between the two years pre- and two years post-evaluation. The role that insurance status plays on these health outcomes was also examined. This project is part of a growing effort to evaluate outcomes of clinical neuropsychological services in order to better characterize the broad health impacts of NPEs.Participants and Methods:Participants for the current study come from the Optum® de-identified Electronic Health Record dataset. The final sample included 245 patients who completed at least one NPE and were diagnosed with a TBI, according to ICD codes associated with their healthcare records. Patients were aged 21-87 (M = 51.55, SD = 16.74) with an average Charleston Comorbidity Index of 1.77 (SD = 2.41). The sample consisted of 124 females (50.6%), 121 males (49.4%). The majority of the sample identified as non-Hispanic white (N = 213; 86.9%), while 8.6% identified as another race or ethnicity. Regarding insurance, the most common insurance type was commercial (61.6%), followed by Medicare (13.5%), Medicaid (9.4%), and uninsured (6.5%). Those with unknown insurance status, race, or ethnicity were excluded from analyses of those variables.Results:Hospitalization incidence for the sample was significantly lower in the two years following a NPE, X2(1, N = 245) = 26.98, p < .001, compared to the two years prior. The mean number of hospitalizations were also lower following a NPE (t(244) = 4.83, p < .001). Insurance status did not show a significant main effect or interaction on mean number of hospitalizations over time. Regarding demographic variables, there was no significant main effects of race/ethnicity group or interaction between race/ethnicity and hospitalization rate change over time. However, there was a significant interaction between hospitalization rate change over time and gender (F(242) = 4.74, p = 0.030). A significant decrease in hospitalizations over time was seen for males (p < .001), while females showed a trend-level decrease that approached significance (p = .06).Conclusions:Consistent with previous research, significant reductions in hospitalization incidence and mean number of hospitalizations were seen following a NPE. This finding did not vary based on insurance status. However, hospitalization outcomes varied as a function of gender. These findings suggest that completing a NPE following a traumatic brain injury may contribute to improved hospitalization outcomes, but it does not appear that this benefit is seen equally for all patients. Insurance status may play a role in accessibility to care and hospitalization outcomes in this population, but that relationship is likely influenced by other factors, including racial identity, gender, and income. Future research is needed to investigate the extent that NPEs impact hospitalization rates in the broader context of insurance, demographic factors, and socioeconomic status.
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Xu, Junjie, Minyue Tang, and Jun Shen. "Trends and Factors Affecting Hospitalization Costs in Patients with Inflammatory Bowel Disease: A Two-Center Study over the Past Decade." Gastroenterology Research and Practice 2013 (2013): 1–12. http://dx.doi.org/10.1155/2013/267630.
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With the growing number of patients with inflammatory bowel disease (IBD) and hospitalization cases, the overall medical care cost elevates significantly in consequence. A total of 2458 hospitalizations, involving 1401 patients with IBD, were included from two large medical centers. Hospitalization costs and factors impacting cost changes were determined. Patients with IBD and frequency of hospitalizations increased significantly from 2003 to 2011 (P<0.001). The annual hospitalization cost per patient, cost per hospitalization, and daily cost during hospitalization increased significantly in the past decade (allP<0.001). However, length of stay decreased significantly (P<0.001). Infliximab was the most significant factor associated with higher hospitalization cost (OR = 44380.09,P<0.001). Length of stay (OR = 1.29,P<0.001), no medical insurance (OR = 1.31,P=0.017), CD (OR = 3.55,P<0.001), inflammatory bowel disease unclassified (IBDU) (OR = 4.30,P<0.0001), poor prognosis (OR = 6.78,P<0.001), surgery (OR = 3.16,P<0.001), and endoscopy (OR = 2.44,P<0.001) were found to be predictors of higher hospitalization costs. Patients with IBD and frequency of hospitalizations increased over the past decade. CD patients displayed a special one peak for age at diagnosis, which was different from UC patients. The increased hospitalization costs of IBD patients may be associated with infliximab, length of stay, medical insurance, subtypes of IBD, prognosis, surgery, and endoscopy.
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Zhang, Hui, Chao Zhang, Sufen Zhu, Feng Zhu, and Yan Wen. "Costs of hospitalization for chronic kidney disease in Guangzhou, China." Public Administration and Policy 22, no. 2 (December 2, 2019): 138–51. http://dx.doi.org/10.1108/pap-09-2019-0018.
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Purpose Chronic kidney disease (CKD) is a worldwide public health problem which imposes a significant financial burden not only on patients but also on the healthcare systems, especially under the pressure of the rapid growth of the elderly population in China. The purpose of this paper is to examine the hospitalization costs of patients with CKD between two urban health insurance schemes and investigate the factors that were associated with their inpatient costs in Guangzhou, China. Design/methodology/approach This was a prevalence-based, observational study using data derived from two insurance claims databases during the period from January 2010 to December 2012 in the largest city, Guangzhou in Southern China. The authors identified 5,803 hospitalizations under two urban health insurance schemes. An extension of generalized linear model – the extended estimating equations approach – was performed to identify the main drivers of total inpatient costs. Findings Among 5,803 inpatients with CKD, the mean age was 60.6. The average length of stay (LOS) was 14.4 days. The average hospitalization costs per inpatient were CNY15,517.7. The mean inpatient costs for patients with Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY15,582.0) were higher than those under Urban Resident-based Basic Medical Insurance (URBMI) scheme (CNY14,917.0). However, the percentage of out-of-pocket expenses for the UEBMI patients (19.8 percent) was only half of that for the URBMI patients (44.5 percent). Insurance type, age, comorbidities, dialysis therapies, severity of disease, LOS and hospital levels were significantly associated with hospitalization costs. Originality/value The costs of hospitalization for CKD were high and differed by types of insurance schemes. This was the first study to compare the differences in hospitalization costs of patients with CKD under two different urban insurance schemes in China. The findings of this study could provide economic evidence for understanding the burden of CKD and evaluating different treatment of CKD (dialysis therapy) in China. Such useful information could also be used by policy makers in health insurance program evaluation and health resources allocation.
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Yamada, Tadashi, Tetsuji Yamada, Chia-Ching Chen, and Weihong Zeng. "Determinants of health insurance and hospitalization." Cogent Economics & Finance 2, no. 1 (July 8, 2014): 920271. http://dx.doi.org/10.1080/23322039.2014.920271.
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Yamada, Tetsuji, Chia-Ching Chen, Tadashi Yamada, Haruko Noguchi, and Matthew Miller. "Private Health Insurance and Hospitalization Under Japanese National Health Insurance." Open Economics Journal 2, no. 1 (September 8, 2009): 61–70. http://dx.doi.org/10.2174/1874919400902010061.
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Wadhwa, Aman, Kathryn Six, Smita Bhatia, and Kelly Kenzik. "Hospitalization for Chemotherapy Toxicities (Chemotoxicities) during Treatment of Pediatric Hematologic Malignancies." Blood 138, Supplement 1 (November 5, 2021): 3005. http://dx.doi.org/10.1182/blood-2021-151015.
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Abstract Background: The projected 5y survival rates for pediatric hematologic malignancies exceed 85% (SEER statistics, 2017), in large part due to risk-stratified intensive multi-agent therapeutic approaches. However, these regimens result in chemotoxicity, often requiring hospitalization. However, the burden of chemotoxicity-related hospitalizations in children with hematologic malignancies remains understudied. Methods: Using an administrative claims database (Truven Marketscan ®), we describe chemotoxicity-related hospitalizations within the first 12 mo from first claim of chemotherapy in children with hematologic malignancies who were <21y at diagnosis. Eligibility included (i) incident acute lymphoblastic leukemia (ALL; ICD-10-CM code: C91), acute myeloid leukemia (AML; C92), Hodgkin lymphoma (HL; C81) or non-Hodgkin lymphoma (NHL; C83.0, C83.3, C83.5, C83.7, C84.4, C85) diagnosed between 2011 and 2018; and (ii) continued insurance coverage 30d prior to and 365d after cancer diagnosis. Chemotoxicities (identified using ICD-9 and -10 codes) were grouped into organ systems (hematologic, infectious, gastrointestinal, renal, allergic, pulmonary, central nervous system, cardiovascular and miscellaneous). A hospitalization was considered chemotoxicity-related if a toxicity diagnosis was the primary reason for admission (i.e., first billing code) or occurred in the second billing position only if the cancer diagnosis was in the primary billing position. Hospitalizations for chemotherapy administration for primary or relapsed cancer were excluded. Logistic regression was used to examine the following factors for their association with chemotoxicity-related hospitalization: age at cancer diagnosis, sex, year of diagnosis (2011-2014; 2015-2018), insurance (commercial, Medicaid) and primary cancer diagnosis. Results: We identified 897 eligible patients (ALL: n=461, AML: n=79, HL: n=202, NHL: n=155). Median age at diagnosis was 15y (range, 0-21), 52.7% were male, 54.2% were diagnosed between 2011 and 2014, and 70.2% had commercial insurance. Medicaid patients were younger than those with commercial insurance (median age at diagnosis: 12y [range, 0.9-21] vs. 17y [0-21y]), and were less likely to carry a diagnosis of ALL (46% vs. 54%, P<0.001) but more likely to have AML (15% vs. 6%, P<0.001). Over the 4,736 person-months of follow-up, 360 patients (40.1%) had 636 chemotoxicity-related hospitalizations (ALL: 56.9%, AML: 8.9%, HL: 20.9%, NHL: 13.2%); 164 (18.3%) patients had ≥1 chemotoxicity-related hospitalization. Median time to first chemotoxicity-related hospitalization from start of therapy was 37d (interquartile range, 12-78). Chemotoxicity claims included hematologic toxicities (63.6%), infections (22.7%) and gastrointestinal toxicities (6.1%); the figure shows the distribution of claims during these hospitalizations by hematologic malignancy. The average length of stay (LOS) for chemotoxicity-related hospitalization was 6.8±8.7d [5.8±7.8d (HL) to 8.6±12.6d (AML)]. Multivariable logistic regression analysis identified Medicaid insurance (vs. commercial) to be associated with lower odds of chemotoxicity-related hospitalization (odds ratio=0.68, 95% confidence interval 0.56-0.84, P<0.001). Conclusions: Over 40% of children with hematologic malignancies require chemotoxicity-related hospitalizations during the first year of treatment. These data could be used to provide guidance to patients and their families and inform healthcare policy decisions. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.
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Kauhl, Boris, Jörg König, and Sandra Wolf. "Spatial Distribution of COVID-19 Hospitalizations and Associated Risk Factors in Health Insurance Data Using Bayesian Spatial Modelling." International Journal of Environmental Research and Public Health 20, no. 5 (February 28, 2023): 4375. http://dx.doi.org/10.3390/ijerph20054375.
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The onset of COVID-19 across the world has elevated interest in geographic information systems (GIS) for pandemic management. In Germany, however, most spatial analyses remain at the relatively coarse level of counties. In this study, we explored the spatial distribution of COVID-19 hospitalizations in health insurance data of the AOK Nordost health insurance. Additionally, we explored sociodemographic and pre-existing medical conditions associated with hospitalizations for COVID-19. Our results clearly show strong spatial dynamics of COVID-19 hospitalizations. The main risk factors for hospitalization were male sex, being unemployed, foreign citizenship, and living in a nursing home. The main pre-existing diseases associated with hospitalization were certain infectious and parasitic diseases, diseases of the blood and blood-forming organs, endocrine, nutritional and metabolic diseases, diseases of the nervous system, diseases of the circulatory system, diseases of the respiratory system, diseases of the genitourinary and symptoms, and signs and findings not classified elsewhere.
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Murray, Drew Carl Drennan, Rohit Kumar, Shruti Bhandari, and Mohamed M. Hegazi. "Incidence of graft versus host disease in peri transplant hospitalization after clostridium difficile infection." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 7542. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.7542.
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7542 Background: Hyperacute graft versus host disease (GVHD) after allogenic stem cell transplantation (SCT) has adverse outcomes with increased rates of chronic GVHD and relapse. GVHD risks include mismatched related or matched unrelated donors, myeloablative conditioning, heavy pretreatment, and donor-recipient sex mismatch. Clostridium difficile infection (CDI) is a leading cause of diarrhea in immunocompromised patients. Proposed microbiome effect on immunity and GVHD in allogenic SCT recipients prompts concern of microbiome modulation from CDI and antibiotics inciting GVDH. Methods: National Inpatient Sample database 2014 for hospitalizations with allogeneic SCT in patients ≥18yo. Characteristics (age, sex, race, insurance, graft source, hospital type, region, comorbidities) were compared for hospitalizations with and without CDI. Primary outcome was the difference in the incidence of GVHD during the transplant hospitalization between the 2 groups. Other outcomes were mortality, length of stay and hospital charges. Chi-square, t-test, and multivariate logistic regression utilized. Results: Of 6210 patients with allogenic SCT, 745 (12%) had CDI during the transplant hospitalization. In transplanted patients without CDI the average age was 55yo, 43.9% female, 69.5% Caucasian (C), 7.1% African American (AA), 8.6% Hispanic (H), 32.1% had Medicare/Medicaid, 61.8% private insurance, 5.7% uninsured, 44.7% had hypertension, 13.7% had diabetes, graft source was 84.3% PBSC (peripheral blood stem cells), 11.3% bone marrow, and 4.4% cord blood. CDI group the average age was 52.5yo, 45.3% female, 73% C, 4.7% AA, 8.1% H, 25.7% had Medicare/Medicaid, 66.2% private insurance, 8.1% uninsured, 41.9% had hypertension, 10.1% had diabetes, graft source was 83.8% PBSC, 10.8% bone marrow, and 5.4% cord blood. 25.7% of patients with CDI developed GVHD during that hospitalization while 14.2% of patients without CDI developed GVHD during the hospital stay (OR 2.1, p < 0.001 multivariate analysis). GVHD during the hospitalization had no difference in length of stay (p = 0.32), total cost of stay (p = 0.50) or same hospitalization mortality (p = 0.94). Conclusions: Allogeneic SCT patients with CDI develop GVHD on the same hospitalization at significantly higher rates than patients without CDI. This is true after controlling for age, sex, race, insurance, comorbidities, graft source, hospital location, and type of institution. Despite known associations of early evidence of GVHD on relapse, overall mortality was not different between the two groups.
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Tian, Haitao, Tianjun Li, and Shiqi Lu. "Robust Analysis of the Influencing Factors for Hospitalization Costs of Senile Cataracts Patients in Chengdu Considering Different Types of Insurance." American Journal of Life Sciences 12, no. 2 (April 12, 2024): 33–43. http://dx.doi.org/10.11648/j.ajls.20241202.12.
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Chengdu is one of the earliest pilot cities for urban-rural basic medical insurance integration in China. This study aimed to analyze the influencing factors of hospitalization costs of senile cataract in a tertiary hospital in Chengdu by robust method, especially considering the influence of medical insurance type. A total of 1310 discharged patients from a tertiary hospital from January 2020 to June 2021 who were mainly diagnosed with senile cataracts were selected as the research subjects. Kruskal-Wallis H test and Spearman correlation analysis are used to conduct univariate statistical analysis. The robust multivariate linear regression model and a semi-parametric multivariate regression model are established to obtain the influencing factors for their hospitalization costs. The robust multivariate regression model results show that reimbursement ratio, number of surgeries, type of medical insurance, hospitalization days, number of additional diagnoses and material proportion have significant correlations with the response variable, i.e. total hospitalization costs of the senile cataract patients. In the robust multivariate regression analysis, the type of insurance is significantly associated with the hospitalization costs. Fixing other variables, the hospitalization costs of patients with UEBMI insurance were 7.6% higher than those with URRBMI insurance. Generalized additive model (GAM) can express the nonlinear relationship between explanatory variables and response variable. Because of the nonlinear part of the GAM, the interpretation and description of the model can provide more knowledge than the linear models. In the GAM model, the type of insurance is also significantly related to the total costs. According to the regression effects of reimbursement ratio, number of surgeries, type of medical insurance, hospitalization days, number of additional diagnoses and material proportion on total costs, the paper aims to provide some references for promoting the reform of the local medical system and improving the eye health status and quality of life of middle-aged and elderly groups.
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Feinberg, Bruce, Brad Schenkel, Ali McBride, Lorie Ellis, Menaka Bhor, Janna Radtchenko, and Lincy S. Lal. "Predictors of Emergency Room (ER) Visits and Hospitalizations in Patients with Mantle Cell Lymphoma (MCL) Treated with Chemotherapy." Blood 126, no. 23 (December 3, 2015): 4526. http://dx.doi.org/10.1182/blood.v126.23.4526.4526.
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Abstract Background: Understanding the predictors of increased healthcare resource utilization is essential for better management of patients with MCL, especially as new agents enter the market. This study evaluated predictors for ER visits and hospitalizations in patients with newly diagnosed and relapsed MCL treated with chemotherapy. Methods: Using claims data (MORE2 Registry®), patients treated with antineoplastics from August 2009-2013 for MCL were retrospectively identified by ICD-9 codes (200.4, 200.40 - 200.48). Patients with secondary malignancies, pregnancy, and age <18 were excluded. Univariate logistic regression analysis was conducted to determine covariates associated with ER visits and hospitalizations. Results for significant variables were reported as odds ratio/p-value. Odds ratio >1 indicates increase in chance of events. Results: A total of 449 patients with MCL were identified. Median age at diagnosis was 71 years, 70% were male, 61% had Medicare primary insurance, 32% were treated in the relapsed setting, 50% had ER visits, and 53% had hospitalizations throughout their treatment history. Significant increases in ER visits and hospitalizations were associated with the following factors (OR/p-value): chemotherapy duration (ER: 1.001/.046, hospitalization: 1.001/.01), supportive care (ER: 2.249/.014, hospitalization: 2.56/.004), number of MCL related adverse events (ER: 10.571/<.000, hospitalization: 39.282/<.000), and treatment following relapse (ER: 1.771/.005, hospitalization: 2.012/.001). Significant variables associated with a decrease in ER visits were male gender (0.576/.008) and having commercial insurance (0.548/.009). Age was associated with ER increase (1.024/.024). Patients treated in the Northeast region of the US were more likely to be hospitalized (1.897/.005). Conclusions: This retrospective study shows that older patients with MCL had a higher likelihood of ER visits, while male patients and patients with commercial insurance had a lower likelihood of ER visits. Regional differences impacted hospitalizations. Adverse events, supportive care, and duration of treatment were associated with increases in hospitalizations and ER visits. These data warrant consideration of age and comorbidity-adjusted treatment in MCL patients eligible for treatment with antineoplastics. Disclosures Feinberg: Janssen Scientific Affairs, LLC: Consultancy. Schenkel:Janssen Scientific Affairs, LLC: Employment. McBride:Janssen Scientific Affairs, LLC: Consultancy. Ellis:Janssen Scientific Affairs, LLC: Employment. Bhor:Janssen Scientific Affairs, LLC: Consultancy. Radtchenko:Janssen Scientific Affairs, LLC: Consultancy. Lal:Janssen Scientific Affairs, LLC: Consultancy.
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Sabado, Melanie D., Can-Lan Sun, Liton Francisco, K. Scott Baker, Daniel Weisdorf, Stephen J. Forman, and Smita Bhatia. "Late Hospitalizations in Long-Term Survivors of Hematopoietic Cell Transplantation (HCT): Report From the Bone Marrow Transplant Study (BMTSS)." Blood 114, no. 22 (November 20, 2009): 807. http://dx.doi.org/10.1182/blood.v114.22.807.807.
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Abstract Abstract 807 Long-term survival is now an expected outcome after HCT. However, high intensity chemo-radiotherapy for conditioning, coupled with prolonged immune suppression after HCT are associated with the risk of developing endocrinopathies (diabetes), musculoskeletal disorders (osteonecrosis, osteoporotic fractures), and cardiopulmonary complications (congestive heart failure, pulmonary fibrosis), which could necessitate hospitalization for their management. Although hospitalization needs in the immediate post-HCT period are well-described, details for long-term survivors are lacking. An in-depth study of hospitalization patterns among long-term HCT survivors would help healthcare providers and patients/caregivers in developing resources for the long-term care of survivors. This study describes the prevalence and patterns of late hospitalization among long-term HCT survivors; compares this outcome with siblings; and identifies subpopulations at increased risk. Data are derived from the BMTSS, and include 1022 individuals, who had undergone HCT between 1974 and 1998, and survived at least two years, and 309 unaffected siblings. Primary diagnoses included AML, CML, ALL, HL, NHL, and SAA. Median age at HCT was 35 years (range 0.4-69); median time since HCT 7.3 years (2-28); 55% had received an allogeneic HCT. A total of 436 (43%) survivors required one or more hospitalizations in the two years prior to study participation, compared with 29% of the siblings (p<0.001). Age-, sex-, race/ethnicity-, SES-, education-, and insurance-adjusted analysis revealed that HCT survivors were at a 1.7-fold (95%CI=1.3-2.3) increased risk of hospitalizations compared with their siblings. Among HCT survivors, the prevalence of hospitalizations declined with time since HCT (2-5 years: 49%; 6-10 years 39%; and 11+ years 37%, p for trend<0.001). Multivariate analysis adjusted for sociodemographic factors including health insurance showed that compared with autologous HCT survivors, allogeneic HCT survivors were more likely to report late hospitalizations (related donor: odds ratio [OR]=3.2, 95%CI, 1.1-9.4; unrelated donor: OR=4.1, 95%CI=1.3-13.5); age at HCT >45 years was associated with a higher risk of late hospitalizations (OR=2.3, 95% CI=1.3-4.0); and, patients with chronic graft vs. host disease (cGvHD) were more likely to report late hospitalizations (OR=1.5, 95%CI=1.0-2.1). The major reasons for hospitalization included gastrointestinal (GI) problems (n=93), ocular complications (n=58), infection (n=51), endocrine dysfunction (n=41), musculoskeletal complications (n=40), cardiac (n=37), and pulmonary (n=33) events. After adjusting for SES and insurance status, older age at HCT was associated with hospitalization for musculoskeletal (OR=9.9, 95%CI, 1.1-88.2) and GI problems (OR=3.9, 95%CI, 1.5-10.1); survivors of allogeneic HCT were more likely to be hospitalized for endocrinopathies (related HCT: OR=7.4, 95%CI, 1.4-38.9; unrelated HCT: OR=3.8, 95% CI, 0.4-37.6) and GI problems (related HCT: OR=7.57, 95%CI, 1.8-31.5; unrelated HCT: OR=9.67, 95% CI=1.9-49.6); and patients with cGvHD were more likely to be hospitalized for infection (OR=2.7, 95%CI, 1.2-6.0), ocular (OR=2.8, 95%CI, 1.2-6.4) and pulmonary problems (OR=2.7, 95%CI, 1.0-7.4). This study demonstrates that over 40% of long-term HCT survivors require late hospitalizations; that older individuals, those who underwent allogeneic HCT and those who developed cGvHD continue to be at an increased risk for late hospitalizations; and that attention needs to focus on instituting targeted follow-up to proactively minimize the need for these hospitalizations. Furthermore, ongoing healthcare issues emphasize the requirement for comprehensive health insurance coverage, even many years after HCT. Disclosures: No relevant conflicts of interest to declare.
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Sangamithra, A., and P. Dhavamani. "Benefits of Having Covid-19 Insurance Policies." Shanlax International Journal of Arts, Science and Humanities 9, no. 3 (January 1, 2022): 85–89. http://dx.doi.org/10.34293/sijash.v9i3.4493.
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COVID-19 is a highly infectious virus that shows symptoms comparable to those of ordinary flu. In this connection, Covid-19 Health Insurance Policy is a personalized insurance policy aimed at covering hospitalization, pre-hospitalisation and post-hospitalization expenditures, and other medical expenses arising due to the treatment of COVID-19. Insurance Regulatory Development Authority (IRDA) introduced the new Corona health insurance policies namely Corona Rakshak and Corona Kavach policy and comprehensive Health Insurance policies that also covers the Coronavirus among other illnesses, diseases and healthcare benefits. Corona Rakshak Policy is an affordable Health Insurance policy that offers lump sum uses to the insured if diagnosed with COVID-19. The coverage starts from the day people get diagnosed with COVID-19 infection. Corona Kavach Policy is an affordable Health Insurance policy that protects you and your family against hospitalization expenses due to COVID-19. The coverage starts from the day the patient gets diagnosed with COVID-19 infection. It is always good to have insurance to keep ourselves and family to keep our family safe.
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Guo, Yawei, Jingjie Sun, Simeng Hu, Stephen Nicholas, and Jian Wang. "Hospitalization Costs and Financial Burden on Families with Children with Depression: A Cross-Section Study in Shandong Province, China." International Journal of Environmental Research and Public Health 16, no. 19 (September 20, 2019): 3526. http://dx.doi.org/10.3390/ijerph16193526.
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Background: Depression, one of the most frequent mental disorders, affects more than 350 million people of all ages worldwide, with China facing an increased prevalence of depression. Childhood depression is on the rise; globally, and in China. This study estimates the hospitalization costs and the financial burden on families with children suffering from depression and recommends strategies both to improve the health care of children with depression and to reduce their families’ financial burden. Methods: The data were obtained from the hospitalization information system of 297 general hospitals in six regions of Shandong Province, China. We identified 488 children with depression. The information on demographics, comorbidities, medical insurance, hospitalization costs and insurance reimbursements were extracted from the hospital’s information systems. Descriptive statistics were presented, and regression analyses were conducted to explore the factors associated with hospitalization costs. STATA14 software was used for analysis. Results: The mean age of children with depression was 13.46 ± 0.13 years old. The availability of medical insurance directly affected the hospitalization costs of children with depression. The children with medical insurance had average total hospitalization expenses of RMB14528.05RMB (US$2111.91) and length of stay in hospital of 38.87 days compared with the children without medical insurance of hospital with expenses of RMB10825.55 (US$1573.69) and hospital stays of 26.54 days. Insured children’s mean out-of-pocket expenses (6517.38RMB) was lower than the those of uninsured children (RMB10825.55 or US$1573.69), significant at 0.01 level. Insured children incurred higher treatment costs, drug costs, bed fees, check-up fees, test costs and nursing fees than uninsured patients (p < 0.01). Conclusions: Children suffering from depression with medical insurance had higher hospitalization costs and longer hospitalization stays than children without medical insurance. While uninsured inpatients experienced larger out-of-pocket costs than insured patients, out-of-pocket hospital expenses strained all family budgets, pushing many, especially low-income, families into poverty—insured or uninsured. The different hospital cost structures for drugs, treatment, bed fees, nursing and other costs, between insured and uninsured children with depression, suggest the need for further investigations of treatment regimes, including over-demand by parents for treatment of their children, over-supply of treatment by medical staff and under-treatment of uninsured patients. We recommend more careful attention paid to diagnosing depression in girls and further reform to China’s health insurance schemes—especially to allow migrant families to gain basic medical insurance.
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Kalla Vyas, Arpita, and Lavi Oud. "Temporal patterns of hospitalizations for diabetic ketoacidosis in children and adolescents." PLOS ONE 16, no. 1 (January 7, 2021): e0245012. http://dx.doi.org/10.1371/journal.pone.0245012.
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Objectives To examine the temporal patterns of hospitalizations with diabetic ketoacidosis (DKA) in the pediatric population and their associated fiscal impact. Methods The Texas Inpatient Public Use Data File was used to identify hospitalizations of state residents aged 1month-19 years with a primary diagnosis of DKA during 2005–2014. Temporal changes of population-adjusted hospitalization rates and hospitalization volumes were examined for the whole cohort and on stratified analyses of sociodemographic attributes. Changes in the aggregate and per-hospitalization charges were assessed overall and on stratified analyses. Results There were 24,072 DKA hospitalizations during the study period. The population-adjusted hospitalization rate for the whole cohort increased from 31.3 to 35.9 per 100,000 between 2005–2006 and 2013–2014. Hospitalization volume increased by 30.2% over the same period, driven mainly by males, ethnic minorities, those with Medicaid insurance and uninsured patients. The aggregate hospital charges increased from approximately $69 million to $130 million between 2005–2006 and 2013–2014, with 66% of the rise being due to increased per-hospitalization charges. Conclusions There was progressive rise in pediatric DKA hospitalizations over the last decade, with concurrent near-doubling of the associated fiscal footprint. Marked disparities were noted in the increasing hospitalization burden of DKA, born predominantly by racial and ethnic minorities, as well as by the underinsured and the uninsured. Further studies are needed to identify scalable preventive measures to achieve an equitable reduction of pediatric DKA events.
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Lindauer, Stephanie Purkat, Barbara Hinojosa, Jessica Trevino Jones, Marcela Mazo- Canola, Jonathan Gelfond, and Kate Ida Lathrop. "Cancer costs and trends for newly diagnosed malignancies at an academic institution." Journal of Clinical Oncology 35, no. 5_suppl (February 10, 2017): 8. http://dx.doi.org/10.1200/jco.2017.35.5_suppl.8.
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8 Background: The financial cost of cancer is a large burden and continues to rise substantially. Expenditures can be divided into the initial phase after diagnosis, the continuing phase, and the last year of life. Typically costs are greatest in the initial phase and last year of life. The major determinant of cost during the initial phase is hospitalizations. We sought to examine cancer costs of patients with newly diagnosed malignancies at an academic institution during the initial phase and compare outcomes based on insurance status. Our institution serves a significant portion of South Texas, a population facing serious cancer health disparities. Methods: This was a prospective, non-randomized study evaluating patients with new cancer diagnoses from 2014-2016 at an academic hospital. Patients meeting eligibility criteria were screened and consented for participation. A total of 74 patients were included in analysis. Results: The average age was similar in both the self-pay group and the insurance group (including government-sponsored, private, and county funding); 51.1 vs 54.8 years respectively (p = 0.09). Ethnicity between the two groups was not significantly different, 46.2% were Hispanic in the self-pay group vs 45.8% in the insurance group (p = 0.94). The majority of patients in both groups presented with advanced disease, 61.5% in the self-pay group vs 70.8% in the insurance group (p = 0.44). The average number of days of hospitalization was significantly higher in the insurance group compared to the self-pay group, 15.4 days vs 10.6 (p = 0.04). Congruently, average total cost of hospitalization was higher in the insurance group, $96,200 vs $64,200 (p = 0.05). 26.9% of patients in the self-pay group enrolled in hospice within 6 months of their diagnosis vs 20.8% in the insurance group (p = 0.26). Conclusions: With the limitation of a small sample size, our study demonstrates a statistically significant difference in hospitalization days and cost in insured vs uninsured patients with new cancer diagnoses at an academic hospital.
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Kuo, Tzy-Mey, Anna Schenck, and Anne-Marie Meyer. "Aggregating administrative and claims data from multiple payers to estimate population-based health outcomes: A validation study." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 285. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.285.
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285 Background: Health insurance claims data are increasingly used for estimating individual health outcomes. However, it is challenging to obtain population-based estimates because of difficulties obtaining and reconciling data from all insurance providers. With incomplete insurance data, methods are needed to estimate the entire insured population. Using multi-payer claims we demonstrate and validate a synthetic method to obtain county level morbidity estimates. Methods: We used data from the Integrated Cancer Information and Surveillance System (ICISS) data resource at the University of North Carolina (NC) at Chapel Hill. ICISS data represent a linked data resource comprised of beneficiaries enrolled in federal as well as private insurance plans and rich ecologic data; and represent 5.5 million unique individuals, about 55% of the NC population. Using specific ICD-9 diagnosis codes, claims data from 2008 were compared to state department of public health data. We computed county level hospitalization rates by summing data from three sub-groups: age 65 and older in the 100% Medicare sample, age younger than 65 in the 100% Medicaid sample, and age younger than 65 represented in the private payer data. For the privately insured population, we used census data to obtain estimates of the entire privately insured population and used the hospitalization rate from beneficiaries in ICISS data to estimate a numerator for the synthetic sample of privately insured beneficiaries. We used State Inpatient Data (SID) from NC County Data Book to validate our method. Results: Overall, our synthetic approach showed moderate to high validity with a Pearson correlation coefficient 0.77 for heart disease and 0.93 for flu or pneumonia. Our hospitalization estimates were slightly lower than the data from SID, because SID data include uninsured individuals and multiple hospitalizations for individuals. Conclusions: Our synthetic method can be useful in estimating population-based health outcomes using linked insurance claims data.
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Zhang, Hui, Donglan Zhang, Yujie Yin, Chao Zhang, and Yixiang Huang. "Costs of Hospitalization for Dementia in Urban China: Estimates from Two Urban Health Insurance Scheme Claims Data in Guangzhou City." International Journal of Environmental Research and Public Health 16, no. 15 (August 3, 2019): 2781. http://dx.doi.org/10.3390/ijerph16152781.
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Background: Dementia is one of the public health priorities in China. This study aimed to examine the hospitalization costs of patients with dementia and analyzed the factors associated with their inpatient costs. Methods: This was a prevalence-based, observational study using claims data derived from two urban insurance schemes during the period from 2008 through 2013 in Guangzhou. The extended estimating equations model was performed to identify the main drivers of total inpatient costs. Results: We identified 5747 dementia patients with an average age of 77.4. The average length of stay (LOS) was 24.2 days. The average hospitalization costs per inpatient was Chinese Yuan (CNY) 9169.0 (CNY 9169.0 = US$1479.8 in 2013). The mean inpatient costs for dementia patients with the Urban Employee-based Basic Medical Insurance (UEBMI) scheme (CNY 9425.0 = US$1521.1) were higher than those for patients with the Urban Resident-based Basic Medical Insurance scheme (CNY 7420.5 = US$1197.6) (p < 0.001). Having UEBMI coverage, dementia subtypes, having hypertension, being admitted in larger hospitals, and longer LOS were significantly associated with hospitalization costs of dementia. Conclusions: The costs of hospitalization for dementia were high and differed by types of insurance schemes. Dementia was associated with substantial hospitalization costs, mainly driven by insurance type and long LOS. These findings provided economic evidence for evaluating the burden of dementia in China.
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Et. al., G. Srimannarayana. "A Study on Days of hospitalization of insured with the claims data." Turkish Journal of Computer and Mathematics Education (TURCOMAT) 12, no. 3 (April 11, 2021): 5230–38. http://dx.doi.org/10.17762/turcomat.v12i3.2152.
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: The health insurance sector has grown at a double digit growth rate in India in the past decade. The Government schemes for the individuals' insurance coverage from the low-income group have resulted in higher penetration. Raise in the disposable income of the middle income and awareness of health insurance has led to self-subscription by private individuals. An increase in insurance penetration has also led to an increment in the claims for the insurer. However, the insurance coverage has been actively subscribed by the population in the age group of 19-64 years. The average claim amount processed is higher in infants and aged people. Days of hospitalization for the insured treatment help the insurers derive the claims' amounts and hence can budget the reserves accordingly. Days of hospitalization is found to have a strong positive relationship with age. Logistic regression of Half-yearly bins data has the predictability of Days of hospitalization of claimants at 69%.
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Changwoo Lee. "The Effect of Private Health Insurance on Hospitalization." Health and Social Welfare Review 30, no. 2 (December 2010): 463–83. http://dx.doi.org/10.15709/hswr.2010.30.2.463.
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Huang, Kaisen, Dejia Huang, Dingxiu He, Joris van Loenhout, Wei Liu, Baotao Huang, Xiaojian Deng, Qi Wu, Mao Chen, and Debarati Guha-Sapir. "Changes in Hospitalization for Ischemic Heart Disease After the 2008 Sichuan Earthquake: 10 Years of Data in a Population of 300,000." Disaster Medicine and Public Health Preparedness 10, no. 2 (November 16, 2015): 203–10. http://dx.doi.org/10.1017/dmp.2015.128.
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AbstractObjectiveThe effects of earthquakes on ischemic heart disease (IHD) have often been reported. At a population level, this study examined short-term (60-day) and long-term (5-year) hospitalization events for IHD after the 2008 Sichuan earthquake.MethodsWe examined the 10-year medical hospitalization records on IHD in the city of Deyang provided by the Urban Employee Basic Health Insurance program.ResultsEvaluation of 19,083 hospitalizations showed a significantly lower proportional number and cost of hospitalizations in the 60 days after the earthquake (P<0.001). Hospitalizations were 27.81% lower than would have been expected in a normal year; costs were 32.53% lower. However, in the 5 years after the earthquake, the age-adjusted annual incidence of hospitalization increased significantly (P<0.001). In the fifth year after the earthquake, it was significantly higher in the extremely hard-hit area than in the hard-hit area (P<0.01).ConclusionAfter the 2008 earthquake, short- and long-term patterns of hospitalization for IHD changed greatly, but in different ways. Our findings suggest that medical resources for IHD should be distributed dynamically over time after an earthquake. (Disaster Med Public Health Preparedness. 2016;10:203–210)
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Kim, Hyung Jin. "Judgment Review on Liability for Cataract Surgery Costs in Medical Indemnity Insurance." Korean Insurance Law Association 16, no. 2 (June 30, 2022): 141–87. http://dx.doi.org/10.36248/kdps.2022.16.2.141.
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Cataract is a disease in which the lens becomes cloudy due to aging and causes loss of vision. It is treated with surgery to remove the cloudy lens and insert an artificial lens. There are single vision lenses and multifocal lenses as types of intraocular lenses, which are the treatment materials used at this time. Monofocal lenses have the disadvantage of requiring separate corrective glasses for near vision even after insertion, but they are inexpensive and require medical treatment under the National Health Insurance Act. On the other hand, multifocal lenses have the advantage of correcting both near and far vision, but they are expensive and do not qualify for medical care benefits under the National Health Insurance Act.
In this case, while the state determines the price of the salary, the non-insurance price is set by the medical institution, so the medical institution has an incentive to make a profit by arbitrarily setting the cost of treatment for non-insured items. In particular, in the case of non-insured items covered by medical insurance for indemnity insurance, the patient can claim most of the medical expenses from the insurance company as insurance money. There may be cases in which overpayment or overtreatment may occur.
In relation to cataract surgery, some eye clinics, mainly in the Gangnam area of Seoul, arbitrarily adjust the cost of examination or multifocal lenses, which are representative non-covered items, according to changes in the health insurance benefit system or medical insurance policy, without reasonable standards. It is confirmed that they are taking advantage of the business by misusing them. For example, in September 2020, when health insurance was applied to the examination fee, it was no longer possible to claim high medical expenses for the examination fee. Excessive indemnity payments are being made in the medical insurance for loss by processing hospitalization and issuing a confirmation of hospitalization, and the damage is being passed on to good medical consumers and insurance organizations.
However, in the recent judgment of 2021 na 2013354 of the Seoul High Court on January 20, 2022, the scope of claims for medical insurance for medical loss for insured persons who underwent cataract surgery was limited to the amount of out-of-patient insurance, not hospitalization. Based on the Supreme Court’s general definition, it was emphasized that ‘the substance of hospitalization’ should be provided in addition to the standards of the Ministry of Health and Welfare notification. He also pointed out that the fact that the comprehensive fee-for-service system is applied in cataract surgery is completely different from judging whether or not the patients were actually ‘hospitalized’.
As such, it can be said that the above judgment on the criteria for ‘hospitalization’ for cataract surgery is not limited to the clinic in this case, but is also applied to general ophthalmology clinics performing cataract surgery. Although there is regret in the interpretation of the terms and conditions related to the exemption, I hope that the judgment of the subject judgment regarding hospitalization will be an opportunity to suppress unnecessary and reckless cataract surgery.
It seems to be a very desirable direction for government ministries, financial supervisory authorities, and the industry to take an interest in the recent cataract surgery and other problems of the surge in medical expenses and to make various efforts and attempts. As a member of society, the court also expects effective and rational judgments that can effectively suppress turmoil in the medical market and protect the rights and interests of good medical care and insurance consumers.
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Xu, Xin, and Dongxiao Chu. "Modeling Hospitalization Decision and Utilization for the Elderly in China." Discrete Dynamics in Nature and Society 2021 (July 1, 2021): 1–13. http://dx.doi.org/10.1155/2021/4878442.
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Getting medical services has become more difficult and expensive in China, which led to a problem of illness not being treated and a large number of zeros in the statistics of being hospitalized for the elderly. Traditional classic models such as the Poisson model and the negative binomial model cannot fit this kind of data well. One aim of this study was to use zero-inflated and hurdle models to better solve the problem of excess zeros. Another aim was to discover the factors affecting the decision-making behavior of the elderly being hospitalized and hospitalization service utilization. Therefore, the XGBoost model was firstly introduced to rank the importance of influencing factors in this paper. It was found that the zero-inflated negative binomial model performed best. The results showed that the elderly who had enjoyed NRCM or ERBMI/URBMI were more likely to have a higher number of hospitalizations. This indicated that the high cost of hospitalization had prevented the willingness of the elderly being hospitalized, but the basic medical insurance had increased the times of their repeated hospital readmissions. Policy efforts should be made to improve the level of basic medical insurance.
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Peterson, Thomas H., Tom Peterson, Carl Armon, and James Todd. "Insurance-Associated Disparities in Hospitalization Outcomes of Michigan Children." Journal of Pediatrics 158, no. 2 (February 2011): 313–18. http://dx.doi.org/10.1016/j.jpeds.2010.08.002.
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Lee, Brason. "Insurance Parity and Outpatient Care Following a Psychiatric Hospitalization." JAMA 301, no. 18 (May 13, 2009): 1880. http://dx.doi.org/10.1001/jama.2009.633.
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Whitney, Robin L., Janice F. Bell, Daniel J. Tancredi, Patrick S. Romano, Richard J. Bold, and Jill G. Joseph. "Hospitalization Rates and Predictors of Rehospitalization Among Individuals With Advanced Cancer in the Year After Diagnosis." Journal of Clinical Oncology 35, no. 31 (November 1, 2017): 3610–17. http://dx.doi.org/10.1200/jco.2017.72.4963.
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Purpose Among individuals with advanced cancer, frequent hospitalization increasingly is viewed as a hallmark of poor-quality care. We examined hospitalization rates and individual- and hospital-level predictors of rehospitalization among individuals with advanced cancer in the year after diagnosis. Methods Individuals diagnosed with advanced breast, colorectal, non–small-cell lung, or pancreatic cancer from 2009 to 2012 (N = 25,032) were identified with data from the California Cancer Registry (CCR). After linkage with inpatient discharge data, multistate and log-linear Poisson regression models were used to calculate hospitalization rates and to model rehospitalization in the year after diagnosis, accounting for survival. Results In the year after diagnosis, 71% of individuals with advanced cancer were hospitalized, 16% had three or more hospitalizations, and 64% of hospitalizations originated in the emergency department. Rehospitalization rates were significantly associated with black non-Hispanic (incidence rate ratio [IRR], 1.29; 95% CI, 1.17 to 1.42) and Hispanic (IRR, 1.11; 95% CI, 1.03 to 1.20) race/ethnicity; public insurance (IRR, 1.37; 95% CI, 1.23 to 1.47) and no insurance (IRR, 1.17; 95% CI, 1.02 to 1.35); lower socioeconomic status quintiles (IRRs, 1.09 to 1.29); comorbidities (IRRs, 1.13 to 1.59); and pancreatic (IRR, 2.07; 95% CI, 1.95 to 2.20) and non–small-cell lung (IRR, 1.69; 95% CI, 1.54 to 1.86) cancers versus colorectal cancer. Rehospitalization rates were significantly lower after discharge from a hospital that had an outpatient palliative care program (IRR, 0.90; 95% CI, 0.83 to 0.97) and were higher after discharge from a for-profit hospital (IRR, 1.33; 95% CI, 1.14 to 1.56). Conclusion Individuals with advanced cancer experience a heavy burden of hospitalization in the year after diagnosis. Efforts to reduce hospitalization and provide care congruent with patient preferences might target individuals at higher risk. Future work might explore access to palliative care in the community and related health care use among individuals with advanced cancer.
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Leblanc, Soline, Cécile Blein, Antoine Andremont, Pierre-Alain Bandinelli, and Thibaut Galvain. "Burden of Clostridium difficile Infections in French Hospitals in 2014 From the National Health Insurance Perspective." Infection Control & Hospital Epidemiology 38, no. 8 (June 15, 2017): 906–11. http://dx.doi.org/10.1017/ice.2017.114.
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OBJECTIVETo describe the hospital stays of patients with Clostridium difficile infection (CDI) and to measure the hospitalization costs of CDI (as primary and secondary diagnoses) from the French national health insurance perspectiveDESIGNBurden of illness studySETTINGAll acute-care hospitals in FranceMETHODSData were extracted from the French national hospitalization database (PMSI) for patients covered by the national health insurance scheme in 2014. Hospitalizations were selected using the International Classification of Diseases, 10threvision (ICD-10) code for CDI. Hospital stays with CDI as the primary diagnosis or the secondary diagnosis (comorbidity) were studied for the following parameters: patient sociodemographic characteristics, mortality, length of stay (LOS), and related costs. A retrospective case-control analysis was performed on stays with CDI as the secondary diagnosis to assess the impact of CDI on the LOS and costs.RESULTSOverall, 5,834 hospital stays with CDI as the primary diagnosis were included in this study. The total national insurance costs were €30.7 million (US $33,677,439), and the mean cost per hospital stay was €5,267±€3,645 (US $5,777±$3,998). In total, 10,265 stays were reported with CDI as the secondary diagnosis. The total national insurance additional costs attributable to CDI were estimated to be €85 million (US $93,243,725), and the mean additional cost attributable to CDI per hospital stay was €8,295±€17,163, median, €4,797 (US $9,099±$8,827; median, $5,262).CONCLUSIONCDI has a high clinical and economic burden in the hospital, and it represents a major cost for national health insurance. When detected as a comorbidity, CDI was significantly associated with increased LOS and economic burden. Preventive approaches should be implemented to avoid CDIs.Infect Control Hosp Epidemiol 2017;38:906–911
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Gowda, Sachit, Amelia Langston, Jonathan L. Kaufman, Nishi N. Shah, Mary Jo Lechowicz, Lawrence H. Boise, Sagar Lonial, and Ajay K. Nooka. "Hospitalization Outcome Metrics Based On Payer Status In Myeloma Patients That Receive Autologous Stem Cell Transplant (ASCT)." Blood 122, no. 21 (November 15, 2013): 5606. http://dx.doi.org/10.1182/blood.v122.21.5606.5606.
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Abstract Background Myeloma patients have experienced great survival benefits in the last decade due to the use of novel agents and autologous stem cell transplant (ASCT). Prior studies report a complex interplay between payer status and the receipt of ASCT. We have evaluated if the payer status affects outcome metrics of length of stay (LOS), in-hospital mortality rate (IHM), and total hospitalization charges in the context of survival benefit of myeloma with this procedure. Methods We used the NIS (Nationwide Inpatient Sample) 2001-2010 database (part of the HCUP database) to obtain the patient data. Using private insurance as the reference group, we performed multivariate logistic regression to understand the association of payer status with LOS, IHM, hospitalization charges. We adjusted our model for age, race and the presence or absence of co-morbidities. Comorbidites were identified using comorbidity software that created measures reported by Elixhauser et al. Results From 01/2001 until 12/2010, 25656 admissions for ASCT as principal procedure for the principal diagnosis of multiple myeloma were included in our analysis. The IHM rate during this period based on payer status was 3.04%, 1.56%, 1.20% and 0.4% for medicare, medicaid, private insurance and others, respectively. Median LOS for medicaid and medicare were 17 days while private insurance and other insurances had a median LOS of 16 days. Medicare patients undergoing ASCT had higher likelihood of IHM compared to private insurance [Odds ratio: 2.62 ( 95%CI 1.46 – 4.72)]; while medicaid patients had non-significant increase. LOS in medicaid patients was longer compared to private insurance [(Odds ratio: 1.53 ( 95%CI 1.16-2.02)]. Conclusion Myeloma patients with medicare undergoing ASCT had higher likelihood of in-hospital death compared to patients with private insurance. Medicaid patients had a lengthier in-hospital stay but there seems to be no significant difference in hospitalization charges in the different payer groups. However, the acceptable overall cumulative mortality rate suggests that myeloma patients can continue to enjoy the survival benefits associated with ASCT despite payer status. Further studies evaluating long-term outcomes outside the hospital admission would be required to better understand the association of payer status with overall survival benefits of ASCT. Disclosures: Kaufman: Onyx: Consultancy; Celgene: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Janssen: Consultancy; Millenium: Consultancy; Merck: Research Funding. Boise:Onyx: Consultancy. Lonial:Millennium: Consultancy; Celgene: Consultancy; Novartis: Consultancy; BMS: Consultancy; Sanofi: Consultancy; Onyx: Consultancy.
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Hähner-Rombach, Sylvelyn. "Hospitalization: A Contentious Issue for Patients and Health Funds in Baden, 1893–1914." Medical History 48, no. 3 (July 1, 2004): 329–50. http://dx.doi.org/10.1017/s0025727300007663.
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Hospitals in Germany had traditionally provided care on a voluntary basis. Before the end of the nineteenth century, hospitalization was compulsory only during epidemics or in the case of infectious diseases such as syphilis or leprosy. Voluntary hospitalization normally occurred only when hospital beds were available, when payment was guaranteed, or during emergencies. Towards the end of the nineteenth century, however, there was a definite increase in hospitalization levels, primarily due to two important developments: the introduction of health insurance in 1883, and the growing number and size of hospitals. Health insurance covered its members' hospital expenses, and the hospitals provided facilities for more and more patients.
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Souliotis, Kyriakos, Christina Golna, Vasiliki Mantzana, Sotirios Papaspyropoulos, Anastasios Koutsovasilis, and Alexios Sotiropoulos. "Clinical audit as a tool to optimize contracted private healthcare provision: Testing the waters in resource-deprived Greece." SAGE Open Medicine 7 (January 2019): 205031211983873. http://dx.doi.org/10.1177/2050312119838736.
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Background and Aims: Clinical audit is applied to optimize clinical practice and quality of healthcare services while controlling for money spent, critically in resource-deprived settings. This case study reports on the outcomes of a retrospective clinical audit on private hospitalizations, for which reimbursement had been pending by the Health Care Organization for Public Servants (OPAD) in Greece. This case study is the first effort by a social insurance organization in Greece to employ external clinical audit before settling contracted private healthcare charges. Methods: One thousand two hundred hospitalization records were reviewed retrospectively and a fully anonymized clinical audit summary report created for each one of them by a team of clinical audit experts, proposing evidence-based cuts in pending charges where medical services were deemed clinically unnecessary. These audit reports were then collated and analysed to test trends in overcharges among hospitalized insureds per reason for hospitalization. Results: The clinical audit report concluded that 17.4% of a total reimbursement claim of €12,387,702.18 should not be reimbursed, as it corresponded to unnecessary or not fully justifiable according to evidence-based, best practice, medical service provision. The majority of proposed cuts were related to charges for medical devices, which are borne directly by social insurance with no patient or private insurance co-payment. Conclusion: Clinical audit of hospital practice may be a key tool to optimize care provision, address supplier-induced demand and effectively manage costs for national health insurance, especially in circumstances of budgetary constraints, such as in austerity-stricken settings or developing national healthcare systems.
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Pinto, Jamie M., Sarita Wagle, Lauren J. Navallo, and Anna Petrova. "Combined Effect of Race/Ethnicity and Type of Insurance on Reuse of Urgent Hospital-Based Services in Children Discharged with Asthma." Children 7, no. 9 (August 20, 2020): 107. http://dx.doi.org/10.3390/children7090107.
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Asthma is a leading cause of health disparity in children. This study explores the joint effect of race/ethnicity and insurance type on risk for reuse of urgent services within a year of hospitalization. Data were collected from 604 children hospitalized with asthma between 2012 and 2015 and stratified with respect to combination of patients’ insurance status (public vs. private) and race/ethnicity (white vs. nonwhite). Highest rates for at least one emergency department (ED) revisit (49.5%, 95% CI 42.5, 56.5) and for average revisits (1.03, 95% CI 0.83, 1.22) were recorded in nonwhite children with public insurance. Adjusted models revealed higher chance for ED reuse in white as well as nonwhite children covered by public insurance. Hospitalization rate was not dependent on the combination of social determinants, but on the number of post-discharge ED revisits. The combined effect of race/ethnicity and health insurance are associated with post-discharge utilization of ED services, but not with hospital readmission.
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Attilus, Jonas, Mengting Li, Qun Le, and XinQi Dong. "Physical Impairment, Insurance Coverage, and Healthcare Utilization Among U.S. Chinese Older Adults." Innovation in Aging 4, Supplement_1 (December 1, 2020): 80. http://dx.doi.org/10.1093/geroni/igaa057.264.
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Abstract The relationship between physical impairment and healthcare utilization is well studied. However, few studies examined this relationship among immigrant older adults whose health insurance status may represent a barrier to healthcare use. This study aims to examine the relationship between physical impairment, health insurance, and types of healthcare utilization. The PINE Study provided data of 3,157 Chinese older adults age 60 and over. Most (70.67%) of them had insurance. Physical function was assessed by Activities of Daily Living and Instrumental Activities of Daily Living. Healthcare utilization was evaluated by the times of physician visit (PV), ER, and hospitalization, separately, in the past two years. Logistic regression was used. After adjusting for covariates, among the insured patients, every one unit increase in ADL impairment was associated with higher odds of ER visit (OR:1.32 [95%CI 1.21-1.45]) and hospitalization (OR: 1.37, [95%CI 1.25-1.50]). Every one greater IADL impairment was associated with higher odds of PV (OR: 1.26, [95%CI 1.12-1.43]), ER visit (OR: 1.21, [95%CI 1.16-1.26]), and hospitalization (OR: 1.23, [95%CI 1.18-1.28]). Among the non-insured, every one unit increase in ADL impairment was associated with higher odds of ER visit (OR: 1.82, [95%CI 1.19-2.78]) and hospitalization (OR: 3.05, [95%CI 1.51-6.16]). Every one unit increase in IADL impairment was associated with higher odds of PV (OR: 1.24, [95% CI 1.09-1.42]), ER visit (OR: 1.33, [95% CI 1.17-1.52]), and hospitalization (OR: 1.53, [95%CI 1.32-1.76]). These findings highlight disparities in healthcare utilization. Longitudinal studies are needed to strengthen causality between physical impairment, health insurance, and healthcare utilization.
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Whitney, Robin L., Janice Bell, Daniel J. Tancredi, Patrick S. Romano, Richard J. Bold, and Jill G. Joseph. "Rehospitalization of advanced cancer patients in the year after diagnosis." Journal of Clinical Oncology 34, no. 26_suppl (October 9, 2016): 10. http://dx.doi.org/10.1200/jco.2016.34.26_suppl.10.
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10 Background: Among individuals with advanced cancer (AC), frequent hospitalization is often at odds with patient preference and is increasingly viewed as a hallmark of poor quality care. Hospitalization contributes substantially to costs and regional spending variation in this population, but patterns and reasons are poorly described in the literature. Methods: California Cancer Registry data linked with hospital claims were used to quantify hospitalization in the year after diagnosis among individuals with AC [colorectal, pancreatic, prostate, breast, non-small cell lung cancer (NSCLC)] between 2009-2012 (n = 25, 032). Multi-state models and multilevel log-linear Poisson regression were used to model re-hospitalizations as a function of individual and hospital characteristics, accounting for the competing risk of mortality. Results: Among individuals with AC, 71% were hospitalized, 16% had at least 3 hospitalizations, and 64% of hospitalizations originated in the emergency department. Re-hospitalization rates were significantly higher for black, non-Hispanic (IRR 1.3; 95% CI: 1.1-1.4); Hispanic (IRR 1.1; 95% CI: 1.0-1.2); or Asian/Pacific Islander (IRR 1.1; 95% CI: 1.0-1.2) race/ethnicity vs. white, non-Hispanic; for public (IRR 1.4; 95% CI: 1.3-1.5) or no insurance (IRR 1.2; 95% CI: 1.0-1.5) vs. private; for lower SES quintiles (IRRs 1.1-1.3) vs. the highest; for 1 and 2 or more (IRR 1.1-1.6) comorbidities versus none, and for pancreatic cancer (IRR 2.1; 95% CI 1.9-2.2) and NSCLC (IRR 1.7; 95% CI 1.5-1.9) vs. colorectal cancer. Re-hospitalization rates were significantly lower after discharge from a hospital reporting an outpatient palliative care program (IRR 0.90; 95% CI 0.84-0.96). Conclusions: Individuals with AC experience a heavy burden of hospitalizations, many of which originate in the ED. Discharge from a hospital reporting an outpatient palliative care program appears to protect against re-hospitalization. Efforts to reduce hospitalization and provide care congruent with patient preferences might focus on improving access to outpatient palliative care, particularly among subgroups at greater risk, including racial/ethnic minority groups, those with lower SES, comorbidities and pancreatic or NSCLC.
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Ohsfeldt, Robert L., Pengxiang Li, John E. Schneider, Ivana Stojanovic, and Cara M. Scheibling. "Outcomes of Surgeries Performed in Physician Offices Compared With Ambulatory Surgery Centers and Hospital Outpatient Departments in Florida." Health Services Insights 10 (January 1, 2017): 117863291770102. http://dx.doi.org/10.1177/1178632917701025.
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Background: The proportion of outpatient surgeries performed in physician offices has been increasing over time, raising concern about the impact on outcomes. Objective: To use a private insurance claims database to compare 7-day and 30-day hospitalization rates following relatively complex outpatient surgical procedures across physician offices, freestanding ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPDs). Methods: A multivariable logistic regression model was used to compare the risk-adjusted probability of hospitalization among patients after any of the 88 study outpatient procedures at physician offices, ASCs, and HOPDs over 2008-2012 in Florida. Results: Risk-adjusted hospitalization rates were higher following procedures performed in physician offices compared with ASCs for all procedures grouped together, for most procedures grouped by type, and for many individual procedures. Conclusions: Hospitalizations following surgery were more likely for procedures performed in physician offices compared with ASCs, which highlights the need for ongoing research on the safety and efficacy of office-based surgery.
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Rashidian, Arash, Sedigheh Salavati, Hanan Hajimahmoodi, and Mehrnaz Kheirandish. "Does rural health system reform aimed at improving access to primary health care affect hospitalization rates? An interrupted time series analysis of national policy reforms in Iran." Journal of Health Services Research & Policy 24, no. 2 (January 12, 2019): 73–80. http://dx.doi.org/10.1177/1355819618815721.
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Objectives To evaluate the effects of rural health insurance and family physician reforms on hospitalization rates in Iran. Methods An interrupted time series analysis of national monthly hospitalization rates in Iran (2003–2014), starting from two years before the intervention. Segmented regression analysis was used to assess the effects of the reforms on hospitalization rates. Results The analyses showed that hospitalization rates increased one year after the initiation of the reforms: 1.55 (95% CI: 1.24–1.86) additional hospitalizations per 1000 rural inhabitants per month (‘immediate effect’). This increase was followed by a further gradual increase of 0.034 per 1000 inhabitants per month (95% CI: 0.02–0.04). The gradual monthly increase continued for two years after the reforms. The higher hospitalization rates were maintained in the following years. We observed a significant increase in hospitalization rates at a national level in rural areas that continued for over 10 years after the policy implementation. Conclusion Primary health care reforms are often proposed for their efficiency outcomes (i.e. reduction in costs and use of hospitals) as well as their impact on improving health outcomes. We demonstrated that in populations with unmet needs, such reforms are likely to substantially increase hospitalization rates. This is an important consideration for successful design and implementation of interventions aimed at achieving universal health coverage in low- and middle-income countries.
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Brousseau, David C., Claudia A. Steiner, Pamela Owens, Andrew Mosso, and Julie A. Panepinto. "Emergency Department Treat-and-Release Visits for Sickle Cell Disease: A sIgn of acute events to come." Blood 118, no. 21 (November 18, 2011): 169. http://dx.doi.org/10.1182/blood.v118.21.169.169.
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Abstract Abstract 169 Background: Patients with sickle cell disease have very high rates of rehospitalization, with rates as high as 40% for young adults. Many institutions have invested significant resources to utilize an inpatient hospitalization as a trigger to alter care and prevent further hospital utilization. While this focus on hospitalizations is important, there has been little attention given to return visits following treat-and-release emergency department (ED) visits. It has been shown that patients with sickle cell disease have high use of acute care resources, including the ED. Given that only half of ED visits by patients with sickle cell disease result in an inpatient stay, it may be possible to use an ED visit as a trigger for improved care rather than waiting for an inpatient hospitalization. We hypothesized that patients with sickle cell disease who were treated and released from the ED would have high rates of return for acute care utilization, both to the ED and the inpatient unit, within 14 days. We further hypothesized that young adults and those with public insurance would have the highest return for acute care utilization rates. Methods: We conducted a retrospective cohort study using 2005 and 2006 State Emergency Department Databases and State Inpatient Databases. The data are from the Healthcare Cost and Utilization Project (HCUP), a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality. Data for all sickle cell-related ED visits and hospitalizations within the following eight states (AZ, CA, FL, MA, MO, SC, TN, and NY) were extracted for each patient. One-third of patients with sickle cell disease in the United States live within these states. All sickle cell related visits were linked via encrypted person-level identifiers to allow linkage of record level information, thus clustering visits by patient. Each treat-and-release ED visit served as an index visit; all subsequent ED treat-and-release visits and inpatient hospitalizations (whether through the ED or not) were tracked for periods of 7 and 14 days. ED treat-and-release visits within the seven days following a hospital discharge were excluded from being index visits. Results: A total of 12,109 patients with sickle cell disease made 39,775 ED treat-and-release visits during the two-year study period. Of the index ED treat-and-release visits, 4,162 (34.4%) children (ages 1–17 yrs) made 8,636 (21.7%) visits compared to 4,166 (34.4%) 18–30 year olds who made 17,070 (42.8%) ED treat-and-release visits. Overall, 16,731 (42.1%) of the ED treat-and-release visits had either an inpatient hospitalization or another ED treat-and-release visit within 14 days of the index ED visit; 39.7% of those return visits were inpatient hospitalizations meaning that 16.7% of ED treat-and-release visits are followed by an inpatient hospitalization within 14 days. Analyzing the 42.1% return visit rate by age and payer revealed that 49.0% of ED treat-and-release visits by 18 – 30 year old patients resulted in return visits compared to 24.7% of children and 38.6% of 46–64 year olds. 46.5% of ED treat-and-release visits by those with public insurance resulted in a return visit compared to 32.2% of visits by those with private insurance and 35.0% of those who were uninsured. As the timing of return visits might direct the intervention, we also evaluated 7 day return visits. Of the 16,731 return visits within 14 days, 12,561 (75.1%) occurred in the first 7 days; 41.1% of the 7 day return visits were inpatient hospitalizations meaning that 13% of ED treat-and-release visits were followed by an inpatient hospitalization within 7 days. Conclusions: A significant proportion of patients with sickle cell disease return for acute care following an ED treat-and-release visit, with young adults and those with public insurance having the highest rates of return visits. A high percentage of those return visits are hospitalizations. Given these findings, ED treat-and-release visits should serve as a trigger to focus enhanced outpatient comprehensive care on these patients in order to prevent a subsequent inpatient hospitalization and to ultimately improve care for patients with sickle cell disease. Disclosures: No relevant conflicts of interest to declare.
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Wojciak, Armeda Stevenson, Brandon Butcher, Aislinn Conrad, Carol Coohey, Resmiye Oral, and Corinne Peek-Asa. "Trends, Diagnoses, and Hospitalization Costs of Child Abuse and Neglect in the United States of America." International Journal of Environmental Research and Public Health 18, no. 14 (July 16, 2021): 7585. http://dx.doi.org/10.3390/ijerph18147585.
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We conducted a secondary analysis of the National Inpatient Sample (NIS) to examine child abuse and neglect hospitalization from 1998–2016. The NIS is the largest all-payer, inpatient care database in the United States and is maintained by the Health Care Utilization Project. Participants were youth 18 years and younger with discharged diagnoses of child abuse and neglect from hospitals. The rate of child abuse or neglect hospitalizations did not vary significantly over the study period (1998–2016), which on average was 6.9 per 100,000 children annually. Males (53.0%), infants (age < 1; 47.3%), and young children (age 1–3; 24.2%) comprised most of the child maltreatment cases. Physical abuse was the most frequent type of maltreatment leading to hospitalization. Government insurance was the most common payer source, accounting for 77.3% of all child maltreatment hospitalizations and costing 1.4 billion dollars from 2001–2016. Hospitalizations due to child abuse and neglect remain steady and are costly, averaging over $116 million per year. The burden on government sources suggests a high potential for return on investment in effective child abuse prevention strategies.
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I Nyoman Sudastra, Mokhamad Khoirul Huda, and Asmuni. "Legal Protection for Patient of Independent National Health Insurance’s Participant: Restriction on Hospitalization Upgrade." Jurnal Hukum Prasada 7, no. 2 (September 21, 2020): 111–17. http://dx.doi.org/10.22225/jhp.7.2.2013.111-117.
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The government issued Regulation of the Minister of Health Number 51 of 2018 which regulates the increase in inpatient classes which are difficult to understand. After the issuance of the Minister of Health's regulation regarding the imposition of fees and the difference in costs in the Health Insurance program, causing confusion in the community. This study aims to analyze the legal protection for independent national Health Insurance Participants after the issuance of the Minister of Health Regulation concerning imposition of cost and difference in the health insurance Program. In addition, to analyze the existence of a norm conflict between the Minister of Health Regulation about Imposition of cost and Difference in cost toward the laws and regulations above. This study uses a statutory, conceptual and comparative approach. The type of research used in this study is normative legal research. The results showed that the legal protection of JKN participants independently after the enactment of Permenkes Number 51 of 2018 regarding the Imposition of Costs and Difference in Costs in the Health Insurance Program was unclear and caused legal uncertainty. Besides that, it turns out there has been a norm conflict between the Minister of Health Imposition of Imposition of costs and costs difference in Health Insurance with the Perpres Health Insurance, the National Social Security Act, the Consumer Protection Law and Human Rights. Settlement that can be taken to harmonize the norm conflict is to revoke Article 10 paragraph (5) Permenkes Number 51 of 2018, set aside the Article and conduct a judicial review to the Supreme Court.
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Mehrizi, Reza, Ali Golestani, Mohammad-Reza Malekpour, Hossein Karami, Mohammad Mahdi Nasehi, Mohammad Effatpanah, Mehdi Rezaee, Zahra Shahali, Ali Akbari Sari, and Rajabali Daroudi. "Patterns of case fatality and hospitalization duration among nearly 1 million hospitalized COVID-19 patients covered by Iran Health Insurance Organization (IHIO) over two years of pandemic: An analysis of associated factors." PLOS ONE 19, no. 2 (February 23, 2024): e0298604. http://dx.doi.org/10.1371/journal.pone.0298604.
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Background Different populations and areas of the world experienced diverse COVID-19 hospitalization and mortality rates. Claims data is a systematically recorded source of hospitalized patients’ information that could be used to evaluate the disease management course and outcomes. We aimed to investigate the hospitalization and mortality patterns and associated factors in a huge sample of hospitalized patients. Methods In this retrospective registry-based study, we utilized claim data from the Iran Health Insurance Organization (IHIO) consisting of approximately one million hospitalized patients across various hospitals in Iran over a 26-month period. All records in the hospitalization dataset with ICD-10 codes U07.1/U07.2 for clinically/laboratory confirmed COVID-19 were included. In this study, a case referred to one instance of a patient being hospitalized. If a patient experienced multiple hospitalizations within 30 days, those were aggregated into a single case. However, if hospitalizations had longer intervals, they were considered independent cases. The primary outcomes of study were general and intensive care unit (ICU) hospitalization periods and case fatality rate (CFR) at the hospital. Besides, various demographic and hospitalization-associated factors were analyzed to derive the associations with study outcomes using accelerated failure time (AFT) and logistic regression models. Results A total number of 1 113 678 admissions with COVID-19 diagnosis were recorded by IHIO during the study period, defined as 917 198 cases, including 51.9% females and 48.1% males. The 61–70 age group had the highest number of cases for both sexes. Among defined cases, CFR was 10.36% (95% CI: 10.29–10.42). The >80 age group had the highest CFR (26.01% [95% CI: 25.75–26.27]). The median of overall hospitalization and ICU days were 4 (IQR: 3–7) and 5 (IQR: 2–8), respectively. Male patients had a significantly higher risk for mortality both generally (odds ratio (OR) = 1.36 [1.34–1.37]) and among ICU admitted patients (1.12 [1.09–1.12]). Among various insurance funds, Foreign Citizens had the highest risk of death both generally (adjusted OR = 2.06 [1.91–2.22]) and in ICU (aOR = 1.71 [1.51–1.92]). Increasing age groups was a risk of longer hospitalization, and the >80 age group had the highest risk for overall hospitalization period (median ratio = 1.52 [1.51–1.54]) and at ICU (median ratio = 1.17 [1.16–1.18]). Considering Tehran as the reference province, Sistan and Balcuchestan (aOR = 1.4 [1.32–1.48]), Alborz (aOR = 1.28 [1.22–1.35]), and Khorasan Razavi (aOR = 1.24 [1.20–1.28]) were the provinces with the highest risk of mortality in hospitalized patients. Conclusion Hospitalization data unveiled mortality and duration associations with variables, highlighting provincial outcome disparities in Iran. Using enhanced registry systems in conjunction with other studies, empowers policymakers with evidence for optimizing resource allocation and fortifying healthcare system resilience against future health challenges.
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Kröger, Knut, Tino Schulz, Frans Santosa, Olga von Beckerath, Gabor Gäbel, and Benjamin Juntermanns. "Correlation between obesity and manual lymphatic drainage in Germany – a retrospective analysis from 2008 to 2016." Vasa 49, no. 2 (March 1, 2020): 115–20. http://dx.doi.org/10.1024/0301-1526/a000822.
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Summary: Backgrounds: Costs for manual lymphatic drainage (MLD) paid by the Statutory Health Insurances (SHI) have increased disproportionately in Germany in the last decade. There is no obvious reason that this increase is due to an increasing number of patients with lymph edema. We therefore assume that there are large numbers of patients with obesity and obesity-associated dependency syndrome who drive the cost of MLD and did a retrospective analysis of the correlation between hospitalization rates for lymph edema and obesity and MLD prescription rates in outpatients. Patients and methods: Roughly 90 % of the German population is insured by the Statutory Health Insurance. From its reports we extracted data regarding costs and numbers of MLD session prescribed annually. Hospitalization rates for lymph edema (codes I89.*, I97.2 and Q82.0) and for obesity (ICD E66.*) were provided by the Federal Statistical Office after a specific remote analyses. Results: In the years 2008 to 2016, the MLD prescriptions in the individual federal states increased by + 43.5 % in Berlin to + 109.3 % in Mecklenburg-Western Pomerania. Number of hospitalizations with the principal diagnosis (condition, which caused the admission) hereditary and postmastectomy lymph edema are low and decreased in most federal states. Number of hospitalizations with the additional diagnosis (conditions that coexist at the time of admission or develop subsequently) obesity increased with a range from + 4.8 % in Baden-Württemberg to + 86.4 % in Mecklenburg-Western Pomerania. The correlation between the increase in prescribed MLD in the individual federal state and the increase in hospitalization rates per 1000 inhabitants of cases with obesity is greater (R2 0.4696) than with lymph edema (R2 0.0987). Conclusions: Our analysis is in line with the hypothesis that there is a correlation between the increasing prescription rate of MLD and the increasing burden of obesity in Germany.
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Trivedi, Amal N. "Insurance Parity and Outpatient Care Following a Psychiatric Hospitalization—Reply." JAMA 301, no. 18 (May 13, 2009): 1880. http://dx.doi.org/10.1001/jama.2009.634.
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Banerjee, Abhijit, Esther Duflo, and Richard Hornbeck. "Bundling Health Insurance and Microfinance in India: There Cannot be Adverse Selection if There Is No Demand." American Economic Review 104, no. 5 (May 1, 2014): 291–97. http://dx.doi.org/10.1257/aer.104.5.291.
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Microfinance institutions have started to bundle their basic loans with other financial services, such as health insurance. Using a randomized control trial in Karnataka, India, we evaluate the impact on loan renewal from mandating the purchase of actuarially-fair health insurance covering hospitalization and maternity expenses. Bundling loans with insurance led to a 16 percentage points (23 percent) increase in drop-out from microfinance, as many clients preferred to give up microfinance than pay higher interest rates and receive insurance. In a Pyrrhic victory, the total absence of demand for health insurance led to there being no adverse selection in insurance enrollment.
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Choi, Woohyeok, Sung Woo Joo, Soojin Ahn, Young Jae Choi, Sun Min Kim, and Jungsun Lee. "One-Year Clinical Outcomes After Diagnosis According to Early Medication Adherence in First-Episode Schizophrenia: A Nationwide, Health Insurance Data-Based Retrospective Cohort Study." Korean Journal of Schizophrenia Research 26, no. 1 (April 30, 2023): 24–31. http://dx.doi.org/10.16946/kjsr.2023.26.1.24.
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Objectives: Early pharmacologic intervention is considered necessary for improving the prognosis in patients with first-episode schizophrenia (FES). However, few nationwide population-based studies have focused on early medication adherence. We investigated the status of early adherence to antipsychotics and the effect of early adherence on later clinical outcomes in FES.Methods: We used data from the South Korean Health Insurance Review Agency database (2009-2021). We selected 28,931 patients with FES who had a prescription record of at least one antipsychotic medication within 180 days after their diagnosis. We measured early medication adherence using the medication possession ratio (MPR) and compared demographic characteristics and results of psychiatric hospitalization between the adherence group (0.6≤MPR<1.1) and the non-adherence group (MPR<0.6).Results: The average early medication adherence was 0.82 by MPR, and the non-adherence group accounted for 15.6% of all subjects. From 1 to 2 years after diagnosis, the adherence group showed a higher number of psychiatric hospitalizations per hospitalized patient but a shorter duration than the non-adherence group. Additionally, the proportion of patients who experienced psychiatric hospitalizations was smaller in the adherence group.Conclusion: In patients with FES, early medication adherence is associated with lower rates of psychiatric hospitalization and shorter hospitalization durations.
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Pugnet, Grégory, Laurent Sailler, Jean-Pascal Fournier, Robert Bourrel, Jean-Louis Montastruc, and Maryse Lapeyre-Mestre. "Predictors of Cardiovascular Hospitalization in Giant Cell Arteritis: Effect of Statin Exposure. A French Population-based Study." Journal of Rheumatology 43, no. 12 (September 1, 2016): 2162–70. http://dx.doi.org/10.3899/jrheum.151500.
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Objective.To identify predictors and protectors for cardiovascular hospitalization in a giant cell arteritis (GCA) population-based cohort.Methods.Using the French National Health Insurance system, we included patients with incident GCA from the Midi-Pyrenees region, southern France, from January 2005 to December 2008 and randomly selected 6 controls matched by sex and age at calendar date. We used a Cox model to identify independent predictors for cardiovascular hospitalization [combining stroke, coronary artery disease (CAD), heart failure, peripheral arterial disease, or cardiac arrhythmias].Results.Among 103 patients with GCA followed 48.9 ± 14.8 months, the incidence rates of hospitalization for cardiovascular disease, atherosclerotic disease (combining stroke, CAD, and peripheral arterial disease), heart failure, and cardiac arrhythmias were 48.6, 17.5, 14.8, and 9.8 events per 1000 person-years versus 14.9, 4.6, 6.2, and 2.5 events per 1000 person-years among controls, respectively. In patients with GCA, cardiovascular comorbidities at diagnosis (HR 6.2, 2.0–19.2), age over 77 years (HR 5.0, 1.40–17.54), as well as the cumulative defined daily dose of statins (HR 0.993, 0.986–0.999) were independent predictors for subsequent cardiovascular hospitalization. None of the 25 patients with GCA who were taking platelet aggregation inhibitors experienced a cardiovascular hospitalization during followup.Conclusion.Patients with GCA present a high risk of cardiovascular hospitalization after diagnosis. In patients with incident GCA from the Midi-Pyrenees region, southern France, statin therapy was associated with reduced cardiovascular hospitalizations.
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Gao, Jieying, Dongxiao Chu, and Tao Ye. "Empirical Analysis of Beneficial Equality of the Basic Medical Insurance for Migrants in China." Discrete Dynamics in Nature and Society 2021 (June 16, 2021): 1–11. http://dx.doi.org/10.1155/2021/7708605.
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The fairness of the benefits of basic medical insurance for the migrants is drawing increasing attention. This paper examined the beneficial equality of the basic medical insurance for the floating population in China using the “2014 National Internal Migrant Dynamic Monitoring Survey.” The Heckman model was employed due to selection bias among inpatients, and the random forest algorithm of machine learning was used to analyze the importance of factors affecting the hospitalization decision-making, hospitalization consumption, and reimbursement proportion of the floating population. The results show significant differences in the fairness of basic medical insurance benefits among different income groups, and the highest-income group benefits the most. In contrast, the higher-income group benefits the least. Further verification by introducing the commercial medical insurance indicated that the differences among different income groups did not disappear but reduced the degree of difference among the groups. Although China’s healthcare reform has progressed greatly, the study’s findings confirm that the government’s fair medical insurance can lead to unfair problems and the phenomena of low-income groups subsidizing high-income groups under the equalized basic medical insurance system. Adjusting the design of equalized medical insurance and allowing different income groups to pay different premium levels according to the payment level may be more conducive to the fairness of benefits based on achieving universal health coverage in China.
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Dürr, Pauline, Florian Meier, Katja Schlichtig, Anja Schramm, Lukas Schötz, Martin F. Fromm, and Frank Dörje. "Characteristics and Cost of Unscheduled Hospitalizations in Patients Treated with New Oral Anticancer Drugs in Germany: Evidence from the Randomized AMBORA Trial." Journal of Clinical Medicine 11, no. 21 (October 28, 2022): 6392. http://dx.doi.org/10.3390/jcm11216392.
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Drug-related problems (e.g., adverse drug reactions, ADR) are serious safety issues in patients treated with oral anticancer therapeutics (OAT). The previously published randomized AMBORA trial showed that an intensified clinical pharmacological/pharmaceutical care program within the first 12 weeks of treatment reduces the number and severity of ADR as well as hospitalization rates in 202 patients. The present investigation focused on unscheduled hospitalizations detected within AMBORA and analyzed the characteristics (e.g., frequency, involved OAT) and cost of each hospital stay. To estimate the potential savings of an intensified care program in a larger group, the absolute risk for OAT-related hospitalizations was extrapolated to all insureds of a leading German statutory health insurance company (AOK Bayern). Within 12 weeks, 45 of 202 patients were hospitalized. 50% of all unscheduled hospital admissions were OAT-related (20 of 40) and occurred in 18 patients. The mean cost per inpatient stay was EUR 5873. The intensified AMBORA care program reduced the patients’ absolute risk for OAT-related hospitalization by 11.36%. If this care program would have been implemented in the AOK Bayern collective (3,862,017 insureds) it has the potential to reduce hospitalization rates and thereby cost by a maximum of EUR 4.745 million within 12 weeks after therapy initiation.
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Silveira, Marysabel Pinto Telis, Vanessa Iribarrem Avena Miranda, Mariângela Freitas da Silveira, Tatiane Da Silva Dal Pizzol, Sotero Serrate Mengue, and Andréa Dâmaso Bertoldi. "Drug use in delivery hospitalization: Pelotas births cohort, 2015." Revista de Saúde Pública 53 (May 23, 2019): 51. http://dx.doi.org/10.11606/s1518-8787.2019053000913.
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OBJECTIVE: Trace the pattern of drug use during delivery hospitalization. METHOD: Cross-sectional study carried out from June to October 2015, included in the 2015 Pelotas births cohort. All women living in the urban area of the city who were hospitalized for delivery were part of the sample. We collected information regarding drug prescription and drug use by mothers during the whole period of hospitalization. Sociodemographic data were obtained in interview after delivery, and other data were obtained from medical charts. The drugs were classified according to the Anatomical Therapeutic Chemical system. RESULTS: All study participants (1,392 women) used at least one drug, with the mean amount being larger the higher the age of the mother, both prepartum/during delivery and postpartum. It was also higher in cases of spinal anesthesia or general anesthesia, cesarean deliveries, school hospitals, and longer hospitalizations. Analysis of the sample as a whole showed no significant difference in the number of drugs used according to hospitalization type, but when stratified by length of hospital stay the mean was higher in SUS hospitalizations than in private and health insurance hospitalizations. Drugs for the nervous system were the most used (30.5%), followed by drugs for the alimentary tract and metabolism (13.8%). The use of anti-infective agents and drugs that act on the cardiovascular and respiratory systems was higher in mothers who underwent cesarean delivery. This study showed high drug consumption in the delivery hospitalization period, and showed cesarean delivery and epidural anesthesia as the main factors related to high drug consumption in this period. CONCLUSIONS: We found high drug consumption in the delivery hospitalization period, and the main factors were cesarean delivery and epidural anesthesia. Drugs that act on the nervous system were the most used.
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Kurniawaty, Mila, Maulana Muhamad Arifin, Bagus Kurniawan, Sadam Laksamana Sukarno, and Muhammad Teguh Prayoga. "Actuarial Modeling of COVID-19 Insurance." CAUCHY: Jurnal Matematika Murni dan Aplikasi 7, no. 3 (October 11, 2022): 362–69. http://dx.doi.org/10.18860/ca.v7i3.14999.
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In this article, we provide an actuarial model expected to be able to help financial arrangements to cover losses due to the outbreak of coronavirus disease (COVID-19). We construct the dynamical models of premium and benefit based on generalized SEIR (Susceptible-Exposed-Infected-Recovered). Based on its dynamical model, we formulate the premium and the premium reserves on hospitalization and death benefits of the COVID-19 insurance.
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Santi, Brock M., and Philip A. Verhoef. "COVID-19 Hospitalization in Hawaiʻi and Patterns of Insurance Coverage, Race and Ethnicity, and Vaccination." JAMA Network Open 7, no. 5 (May 1, 2024): e243696. http://dx.doi.org/10.1001/jamanetworkopen.2024.3696.
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ImportanceThe people of Hawaiʻi have both high rates of health insurance and high levels of racial and ethnic diversity, but the degree to which insurance status and race and ethnicity contribute to health outcomes in COVID-19 remains unknown.ObjectiveTo evaluate the associations of insurance coverage, race and ethnicity (using disaggregated race and ethnicity data), and vaccination with outcomes for COVID-19 hospitalization.Design, Setting, and ParticipantsThis retrospective cohort study included hospitalized patients at a tertiary care medical center between March 2020 and March 2022. All patients hospitalized for acute COVID-19, identified based on diagnosis code or positive results on polymerase chain reaction–based assay for SARS-CoV-2, were included in analysis. Data were analyzed from May 2022 to May 2023.ExposureCOVID-19 requiring hospitalization.Main Outcome and MeasuresElectronic medical record data were collected for all patients. Associations among race and ethnicity, insurance coverage, receipt of at least 1 COVID-19 vaccine, intensive care unit (ICU) transfer, in-hospital mortality, and COVID-19 variant wave (pre-Delta vs Delta and Omicron) were assessed using adjusted multivariable logistic regression.ResultsA total of 1176 patients (median [IQR] age of 58 [41-71] years; 630 [54%] male) were hospitalized with COVID-19, with a median (IQR) body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 30 (25-36) and Sequential Organ Failure Assessment score of 1 (0-2). The sample included 16 American Indian or Alaska Native patients, 439 Asian (not otherwise specified) patients, 15 Black patients, 66 Chinese patients, 246 Filipino patients, 76 Hispanic patients, 107 Japanese patients, 10 Korean patients, 299 Native Hawaiian patients, 523 Pacific Islander (not otherwise specified) patients, 156 Samoan patients, 5 Vietnamese patients, and 311 White patients (patients were able to identify as &gt;1 race or ethnicity). When adjusting for age, BMI, sex, medical comorbidities, and socioeconomic neighborhood status, there were no differences in either ICU transfer (eg, Medicare vs commercial insurance: odds ratio [OR], 0.84; 95% CI, 0.43-1.64) or in-hospital mortality (eg, Medicare vs commercial insurance: OR, 0.85; 95% CI, 0.36-2.03) as a function of insurance type. Disaggregation of race and ethnicity revealed that Filipino patients were more likely to die in the hospital (OR, 1.79; 95% CI, 1.04-3.03; P = .03). When considering variant waves, mortality among Filipino patients was highest during the pre-Delta time period (OR, 2.72; 95% CI, 1.02-7.14; P = .04), when mortality among Japanese patients was lowest (OR, 0.19; 95% CI, 0.03-0.78; P = .04); mortality among Native Hawaiian patients was lowest during the Delta and Omicron period (OR, 0.35; 95% CI, 0.13-0.79; P = .02). Patients with Medicare, compared with those with commercial insurance, were more likely to have received at least 1 COVID-19 vaccine (OR, 1.85; 95% CI, 1.07-3.21; P = .03), but all patients, regardless of insurance type, who received at least 1 COVID-19 vaccine had reduced ICU admission (OR, 0.40; 95% CI, 0.21-0.70; P = .002) and in-hospital mortality (OR, 0.42; 95% CI, 0.21-0.79; P = .01).Conclusions and RelevanceIn this cohort study of hospitalized patients with COVID-19, those with government-funded insurance coverage (Medicare or Medicaid) had similar outcomes compared with patients with commercial insurance, regardless of race or ethnicity. Disaggregation of race and ethnicity analysis revealed substantial outcome disparities and suggests opportunities for further study of the drivers underlying such disparities. Additionally, these findings illustrate that vaccination remains a critical tool to protect patients from COVID-19 mortality.
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Kochorova, L. V., M. V. Okulov, and B. L. Givyan. "Organization of health care for the patients with benign diseases: the problem of one-day hospitalization." Scientific Notes of the I. P. Pavlov St. Petersburg State Medical University 20, no. 4 (December 30, 2013): 14–16. http://dx.doi.org/10.24884/1607-4181-2013-20-4-14-16.
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The article analises the volume of medical care to the citizens of St. Petersburg, suffering with benign diseases and hospitalized for one day. It is shown,that the level of one-day hospitalization is a marker of not approved hospitalization and unreasonable spending of funds in the state system of obligatory insurance.
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Schweitzer, Jeremy, Nathan Fairman, Kristin Schreyer, and Kenneth Waxman. "Appendicitis, 2002: Relationship between Payors and Outcome." American Surgeon 69, no. 10 (October 2003): 902–8. http://dx.doi.org/10.1177/000313480306901017.
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As the status of health-care insurance changes in the United States, studies have indicated that uninsured patients are less likely to receive timely and quality health care. Previous studies of appendicitis have shown that insurance status may effect the stage of presentation and outcome. However, these studies were based on databases lacking information regarding stage of presentation, timeliness of diagnosis and treatment, and character of hospitalization (length of stay, duration of antibiotic therapy, hospital costs). We accomplished a case control study, retrospective analysis of 975 patients treated for acute appendicitis between January 1996 and December 1999. Times to operation, number of preoperative outpatient visits, number of studies, severity of presentation, length of antibiotics and hospital stay, and hospital costs were analyzed [analysis of variance (ANOVA) techniques, P < 0.05 significant]. We sought answers to the following: (1) Did insurance status affect the timeliness of diagnosis and treatment? (2) Did insurance status affect the stage of presentation? (3) Did insurance status affect hospitalization, as measured by length of stay, duration of antibiotic therapy, and hospital costs? (4) Did age affect outcome independent of insurance status? There were no correlations between insurance status and timeliness of diagnosis or severity of presentation. Length of stay and hospital costs were also not different between insurance categories. Pediatric patients (<12 years old) and the elderly (>65 years old) presented with more advanced appendicitis, independent of insurance category. In contrast to previously published data, the treatment of acute appendicitis is not affected by insurance coverage in the sample community. Age and timeliness of presentation were the only factors correlating to outcomes.