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2.
Bull World Health Organ ; 100(11): 699-708, 2022 Nov 01.
Article in English | MEDLINE | ID: covidwho-2113057

ABSTRACT

The demographic transition towards an ageing population and the epidemiological transition from communicable to noncommunicable diseases have increased the demand for rehabilitation services globally. The aims of this paper were to describe the integration of rehabilitation into the Japanese health system and to illustrate how health information systems containing real-world data can be used to improve rehabilitation services, especially for the ageing population of Japan. In addition, there is an overview of how evidence-informed rehabilitation policy is guided by the analysis of large Japanese health databases, such as: (i) the National Database of Health Insurance Claims and Specific Health Checkups; (ii) the long-term care insurance comprehensive database; and (iii) the Long-Term Care Information System for Evidence database. Especially since the 1990s, the integration of rehabilitation into the Japanese health system has been driven by the country's ageing population and rehabilitation is today provided widely to an increasing number of older adults. General medical insurance in Japan covers acute and post-acute (or recovery) intensive rehabilitation. Long-term care insurance covers rehabilitation at long-term care institutions and community facilities for older adults with the goal of helping to maintain independence in an ageing population. The analysis of large health databases can be used to improve the management of rehabilitation care services and increase scientific knowledge as well as guide rehabilitation policy and practice. In particular, such analyses could help solve the current challenges of overtreatment and undertreatment by identifying strict criteria for determining who should receive long-term rehabilitation services.


Tant la transition démographique vers un vieillissement de la population que la transition épidémiologique des maladies transmissibles vers les maladies non transmissibles ont entraîné une augmentation de la demande en services de réadaptation dans le monde. Le présent document poursuit plusieurs objectifs: décrire l'intégration de la réadaptation dans le système de santé au Japon, et illustrer comment les systèmes de santé contenant des données réelles peuvent être utilisés en vue d'améliorer de tels services, en particulier pour une population nipponne vieillissante. En outre, il offre un aperçu de la manière dont la politique de réadaptation étayée par des faits s'inspire de l'analyse de vastes bases de données sanitaires japonaises, parmi lesquelles: (i) la base de données nationale des demandes de remboursement au titre de l'assurance-maladie et des bilans de santé spécifiques; (ii) la base de données complète de l'assurance pour les soins longue durée; et enfin, (iii) la base de données du système d'information relatif aux attestations de soins longue durée. Le vieillissement de la population a poussé le Japon à inclure la réadaptation dans son système de santé, surtout depuis les années 1990; aujourd'hui, un nombre croissant de personnes âgées ont aisément accès à des services de réadaptation. Au Japon, l'assurance-maladie globale prend en charge la réadaptation intensive aiguë et post-aiguë (ou de rétablissement). De son côté, l'assurance pour les soins longue durée couvre la réadaptation dans les établissements dédiés et les infrastructures collectives accueillant des personnes âgées, avec pour but de contribuer à préserver l'autonomie au sein d'une population vieillissante. L'analyse de vastes bases de données sanitaires peut favoriser une meilleure gestion des services de réadaptation et accroître les connaissances scientifiques, mais aussi orienter les politiques et pratiques en la matière. Ce type d'analyse peut surtout aider à s'attaquer aux enjeux actuels que représentent les traitements excessifs ou insuffisants, en identifiant des critères stricts permettant de déterminer qui doit faire l'objet d'une réadaptation sur le long terme.


La transición demográfica hacia el envejecimiento de la población y la transición epidemiológica de las enfermedades transmisibles a las no transmisibles han aumentado la demanda de servicios de rehabilitación en todo el mundo. Los objetivos de este artículo son describir la integración de la rehabilitación en el sistema sanitario japonés e ilustrar cómo los sistemas de información sanitaria que contienen datos del mundo real se pueden utilizar para mejorar los servicios de rehabilitación, en especial para la población que envejece en Japón. Además, se ofrece una visión general de cómo la política de rehabilitación fundamentada en la evidencia se guía por el análisis de las grandes bases de datos sanitarias japonesas, como: (i) la Base de Datos Nacional de Reclamaciones al Seguro de Enfermedad y Chequeos Médicos Específicos; (ii) la base de datos integral del seguro de cuidados de larga duración; y (iii) la base de datos del Sistema de Información de Cuidados de Larga Duración para la Evidencia. En particular, desde la década de 1990, la integración de la rehabilitación en el sistema sanitario japonés se ha visto impulsada por el envejecimiento de la población del país y, en la actualidad, la rehabilitación se ofrece de forma generalizada a una cantidad cada vez mayor de adultos mayores. El seguro médico general de Japón cubre la rehabilitación intensiva aguda y posaguda (o de recuperación). El seguro de cuidados de larga duración cubre la rehabilitación en instituciones de larga estancia y centros comunitarios para adultos mayores con el objetivo de ayudar a mantener la independencia en una población que envejece. El análisis de las grandes bases de datos sanitarias puede servir para mejorar la gestión de los servicios de atención a la rehabilitación y aumentar los conocimientos científicos, así como para orientar la política y la práctica de la rehabilitación. En concreto, estos análisis podrían ayudar a resolver los problemas actuales de sobretratamiento y subtratamiento, al identificar criterios estrictos para determinar quién debe recibir servicios de rehabilitación de larga duración.


Subject(s)
Insurance, Long-Term Care , Long-Term Care , Humans , Aged , Japan , Insurance, Health , Databases, Factual
3.
Health Aff (Millwood) ; 41(11): 1598-1606, 2022 11.
Article in English | MEDLINE | ID: covidwho-2109345

ABSTRACT

Research demonstrates that receiving unemployment insurance decreases mental health problems. But researchers have also found racial and ethnic disparities in unemployment insurance receipt resulting from differences in work history and location. We examined a population disproportionately affected by job loss and unemployment insurance exclusions, using a survey of service workers from a single city who were parents of young children and who overwhelmingly had eligible work histories. During the COVID-19 pandemic, workers not identifying as White non-Hispanic in our sample were more likely to get laid off than White workers. Among those who were laid off, these workers and White workers experienced similar increases in material and mental health difficulties and similar gains when they received unemployment insurance. However, these workers were less likely than White workers to receive unemployment insurance at all. These results indicate that unemployment insurance has unrealized potential to reduce material and health disparities. Policies should be implemented to make this coverage more effective and equitable through increased access.


Subject(s)
COVID-19 , Pandemics , Child , Humans , United States , Child, Preschool , Healthcare Disparities , Unemployment , Insurance, Health
4.
JAMA Health Forum ; 3(11): e224814, 2022 Nov 04.
Article in English | MEDLINE | ID: covidwho-2094113

ABSTRACT

This JAMA Forum discusses Medicaid continuous enrollment and coverage under the American Rescue Plan Act and the Inflation Reduction Act and ways that the government can continue to decrease Medicaid churn (individuals cycling in and out of the program) after the COVID-19 Public Health Emergency Ends.


Subject(s)
COVID-19 , Medicaid , United States , Humans , Public Health , Insurance Coverage , Insurance, Health
5.
Can Fam Physician ; 68(9): 703, 2022 09.
Article in English | MEDLINE | ID: covidwho-2091742
6.
Health Syst Transit ; 24(3): 1-180, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2083929

ABSTRACT

This analysis of the Kyrgyz health system reviews developments in its organization and governance, financing, provision of services, health reforms and health system performance. A mandatory health insurance is in place, with the Mandatory Health Insurance Fund (MHIF) under the Ministry of Health acting as single public payer for almost all hospitals and providers of primary care. The benefits package of publicly covered services is defined in the State-Guaranteed Benefits Programme (SGBP). However, many services require co-payments and in 2019 only 69% of the population was covered by mandatory health insurance. Health expenditure per capita is one of the lowest in the WHO European Region, due to the country's small GDP per capita. Private spending, almost entirely in the form of out-of-pocket expenditure and including informal payments, accounted for 46.3% of health expenditure in 2019. Financial protection is undermined by low levels of public spending for health, resulting in financial hardship for people using health services. While there is a well-developed network of health facilities, the geographical distribution of health workers is uneven and there is an overall shortage of family doctors. Access to health services remains a challenge, which has been exacerbated by the COVID-19 pandemic. While improvements have been made in recent years, communicable and noncommunicable diseases still pose a major problem and life expectancy prior to the COVID-19 pandemic was one of the lowest in the WHO European Region.


Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , Kyrgyzstan , Pandemics , Health Expenditures , Government Programs , Insurance, Health , Health Care Reform
7.
PLoS One ; 17(8): e0272740, 2022.
Article in English | MEDLINE | ID: covidwho-2079725

ABSTRACT

Uninsured or underinsured individuals with cancer are likely to experience financial hardship, including forgoing healthcare or non-healthcare needs such as food, housing, or utilities. This study evaluates the association between health insurance coverage and financial hardship among cancer survivors during the COVID-19 pandemic. This cross-sectional analysis used Patient Advocate Foundation (PAF) survey data from May to July 2020. Cancer survivors who previously received case management or financial aid from PAF self-reported challenges paying for healthcare and non-healthcare needs during the COVID-19 pandemic. Associations between insurance coverage and payment challenges were estimated using Poisson regression with robust standard errors, which allowed for estimation of adjusted relative risks (aRR). Of 1,437 respondents, 74% had annual household incomes <$48,000. Most respondents were enrolled in Medicare (48%), 22% in employer-sponsored insurance, 13% in Medicaid, 6% in an Affordable Care Act (ACA) plan, and 3% were uninsured. Approximately 31% of respondents reported trouble paying for healthcare during the COVID-19 pandemic. Respondents who were uninsured (aRR 2.58, 95% confidence interval [CI] 1.83-3.64), enrolled in an ACA plan (aRR 1.86, 95% CI 1.28-2.72), employer-sponsored insurance (aRR 1.70, 95% CI 1.23-2.34), or Medicare (aRR 1.49, 95% CI 1.09-2.03) had higher risk of trouble paying for healthcare compared to Medicaid enrollees. Challenges paying for non-healthcare needs were reported by 57% of respondents, with 40% reporting trouble paying for food, 31% housing, 28% transportation, and 20% internet. In adjusted models, Medicare and employer-sponsored insurance enrollees were less likely to have difficulties paying for non-healthcare needs compared to Medicaid beneficiaries. Despite 97% of our cancer survivor sample being insured, 31% and 57% reported trouble paying for healthcare and non-healthcare needs during the COVID-19 pandemic, respectively. Greater attention to both medical and non-medical financial burden is needed given the economic pressures of the COVID-19 pandemic.


Subject(s)
COVID-19 , Cancer Survivors , Neoplasms , Aged , COVID-19/epidemiology , Cross-Sectional Studies , Financial Stress/epidemiology , Humans , Insurance Coverage , Insurance, Health , Medically Uninsured , Medicare , Neoplasms/epidemiology , Pandemics , Patient Protection and Affordable Care Act , United States/epidemiology
8.
Sci Rep ; 12(1): 17460, 2022 Oct 19.
Article in English | MEDLINE | ID: covidwho-2077101

ABSTRACT

In Europe, tax-based healthcare systems (THS) and social health insurance systems (SHI) coexist. We examined differences in 30-day mortality among critically ill patients aged ≥ 70 years treated in intensive care units in a THS or SHI. Retrospective cohort study. 2406 (THS n = 886; SHI n = 1520) critically ill ≥ 70 years patients in 129 ICUs. Generalized estimation equations with robust standard errors were chosen to create population average adjusted odds ratios (aOR). Data were adjusted for patient-specific variables, organ support and health economic data. The primary outcome was 30-day-mortality. Numerical differences between SHI and THS in SOFA scores (6 ± 3 vs. 5 ± 3; p = 0.002) were observed, but clinical frailty scores were similar (> 4; 17% vs. 14%; p = 0.09). Higher rates of renal replacement therapy (18% vs. 11%; p < 0.001) were found in SHI (aOR 0.61 95%CI 0.40-0.92; p = 0.02). No differences regarding intubation rates (68% vs. 70%; p = 0.33), vasopressor use (67% vs. 67%; p = 0.90) and 30-day-mortality rates (47% vs. 50%; p = 0.16) were found. Mortality remained similar between both systems after multivariable adjustment and sensitivity analyses. The retrospective character of this study. Baseline risk and mortality rates were similar between SHI and THS. The type of health care system does not appear to have played a role in the intensive care treatment of critically ill patients ≥ 70 years with COVID-19 in Europe.


Subject(s)
COVID-19 , Critical Illness , Humans , Retrospective Studies , Intensive Care Units , Delivery of Health Care , Insurance, Health
9.
Am J Manag Care ; 28(8): 398-402, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2067691

ABSTRACT

OBJECTIVES: Many patients report financial stress following hospitalization for COVID-19. Although many COVID-19 survivors require extensive care after discharge, the degree to which this care contributes to financial stress is unclear. Using national data, we assessed out-of-pocket spending during the 180 days after discharge among patients hospitalized for COVID-19. STUDY DESIGN: Retrospective cohort analysis of Optum's deidentified Clinformatics Data Mart, a national database of medical and pharmacy claims. METHODS: Among privately insured and Medicare Advantage patients hospitalized for COVID-19 between March and June 2020, we calculated median out-of-pocket spending during the 180 days after discharge. For comparison, we repeated this calculation among patients hospitalized for pneumonia. RESULTS: Of 7932 patients with COVID-19 included in analyses, 2061 (26.0%) had private insurance. Among privately insured and Medicare Advantage patients, median (25th-75th percentile) out-of-pocket spending after discharge was $287 ($59-$842) and $271 ($63-$783), respectively. Out-of-pocket spending exceeded $2000 for 10.9% and 9.3% of these patients, respectively. Among privately insured and Medicare Advantage patients hospitalized for pneumonia, median (25th-75th percentile) out-of-pocket spending after discharge was $276 ($62-$836) and $570 ($181-$1466). Out-of-pocket spending exceeded $2000 for 12.1% and 17.2% of these patients, respectively. CONCLUSIONS: For most patients hospitalized for COVID-19, postdischarge care may not be a major source of financial stress. Although this is reassuring, our findings also suggest that a sizable minority of COVID-19 survivors have substantial out-of-pocket spending after discharge. These survivors could be particularly vulnerable to financial toxicity if they also receive bills for the hospitalization owing to the expiration of insurer cost-sharing waivers. Insurers should consider this possibility when deciding whether to reinstate cost-sharing waivers for COVID-19 hospitalizations.


Subject(s)
COVID-19 , Pneumonia , Aftercare , Aged , COVID-19/epidemiology , Health Expenditures , Hospitalization , Humans , Insurance, Health , Medicare , Patient Discharge , Retrospective Studies , United States
10.
Cad Saude Publica ; 38(8): e00000122, 2022.
Article in Portuguese | MEDLINE | ID: covidwho-2054509

ABSTRACT

The economic crisis that began in the United States in 2008 and its impact in Brazil starting in 2014 preceded the health crisis triggered by the COVID-19 pandemic. Considering these three time intervals, this article analyzes the susceptibility of health plan and insurance companies to economic cycles of recession in Brazil and the United States. There is evidence of a relationship between periods of economic crisis and retraction of actions and services in national health systems. However, both the United States and Brazil showed a growth in the number of health and insurance plans. The vectors driving the expansion of the private market in both countries have similarities and singularities. The "Obamacare" marks the beginning of the inclusion of population segments in the coverage of programs that use private care schemes, funded with government resources. In Brazil, despite negative general economic indices and reduction in the public health budget, health plan companies increased revenues and profits, even in the context of the pandemic and the growing economic crisis in the country. Business strategies to attract foreign investors were combined with actions to obtain credits from public institutions and increase tax deductions and exemptions, preserving financial gains. A comparison between the impacts of the financial crisis on the Brazilian and American private health markets allowed us to identify the weaknesses of our universal public system absorbed by market rationality.


A crise econômica deflagrada nos Estados Unidos em 2008 e suas repercussões no Brasil a partir de 2014, se superpuseram à crise sanitária desencadeada pela pandemia de COVID-19. Considerando esses três intervalos temporais, este artigo analisa a suscetibilidade de empresas de planos e seguros de saúde a ciclos econômicos recessivos, tanto no Brasil como nos Estados Unidos. Há evidências sobre as relações entre períodos de crise econômica e retração de ações e serviços em sistemas nacionais de saúde. Contudo, os Estados Unidos e o Brasil assistiram ao crescimento da adesão a planos e seguros de saúde. Os vetores que impulsionam a expansão do mercado privado nos dois países possuem similaridades e singularidades. O "Obamacare" marca o início da inclusão de segmentos populacionais às coberturas de programas que se valem de esquemas assistenciais privados, financiados com recursos governamentais. No Brasil, apesar de índices econômicos gerais negativos e de corte no orçamento público para saúde, constatou-se que as empresas de planos de saúde ampliaram receitas e lucros, mesmo no contexto da pandemia e de aprofundamento da crise econômica no país. As estratégias empresariais de atração de investidores estrangeiros combinaram-se com a atuação para obtenção de créditos junto a instituições públicas e ampliação de deduções e isenções fiscais, preservando ganhos financeiros. A comparação entre os impactos da crise financeira nos mercados privados de saúde brasileiro e americano permitiu identificar as fragilidades do nosso sistema público universal absorvido pela racionalidade do mercado.


La crisis económica que estalló en los EE.UU. en 2008 y sus repercusiones en Brasil, a partir de 2014, se superpusieron con la crisis sanitaria desencadenada por la pandemia de COVID-19. Teniendo en cuenta estos tres intervalos temporales, el artículo analiza la susceptibilidad de las compañías de planes y seguros de salud a los ciclos económicos recesivos en Brasil y los EE.UU. Existe evidencia sobre las relaciones entre los períodos de crisis económica y la retracción de acciones y servicios en los sistemas nacionales de salud. Sin embargo, tanto en EE.UU. como en Brasil hubo crecimiento de los planes y seguros de salud. Los vectores que impulsan la expansión del mercado privado en los dos países tienen similitudes y singularidades. El "Obamacare", marca el inicio de la inclusión de segmentos de la población a las coberturas de programas que se valen de esquemas asistenciales privados, financiados con recursos gubernamentales. En Brasil, a pesar de los índices económicos generales negativos y de recorte en el presupuesto público para salud, se constató que las empresas de planes de salud aumentaron sus ingresos y ganancias, incluso en el contexto de la pandemia y la profundización de la crisis económica en el país. Las estrategias empresariales para atraer a los inversores extranjeros se combinaron con acciones para obtener créditos de las instituciones públicas y aumentar las deducciones y exenciones fiscales, preservando ganancias financieras. La comparación entre los impactos de la crisis financiera en los mercados de salud privados brasileño y americano permitió identificar las fragilidades de nuestro sistema público universal absorbido por la racionalidad del mercado.


Subject(s)
COVID-19 , Pandemics , Brazil , Humans , Insurance, Health , United States
11.
BMC Womens Health ; 22(1): 378, 2022 09 16.
Article in English | MEDLINE | ID: covidwho-2038723

ABSTRACT

BACKGROUND: Health insurance coverage is one of the several measures being implemented to reduce the inequity in access to quality health services among vulnerable groups. Although women's empowerment has been viewed as a cost-effective strategy for the reduction of maternal and child morbidity and mortality, as it enables women to tackle the barriers to accessing healthcare, its association with health insurance usage has been barely investigated. Our study aims at examining the prevalence of health insurance utilisation and its association with women empowerment as well as other socio-demographic factors among Rwandan women. METHODS: We used Rwanda Demographic and Health Survey (RDHS) 2020 data of 14,634 women aged 15-49 years, who were selected using multistage sampling. Health insurance utilisation, the outcome variable was a binary response (yes/no), while women empowerment was assessed by four composite indicators; exposure to mass media, decision making, economic and sexual empowerment. We conducted multivariable logistic regression to explore its association with socio-demographic factors, using SPSS (version 25). RESULTS: Out of the 14,634 women, 12,095 (82.6%) (95% CI 82.0-83.2) had health insurance, and the majority (77.2%) were covered by mutual/community organization insurance. Women empowerment indicators had a negative association with health insurance utilisation; low (AOR = 0.85, 95% CI 0.73-0.98) and high (AOR = 0.66, 95% CI 0.52-0.85) exposure to mass media, high decision making (AOR = 0.78, 95% CI 0.68-0.91) and high economic empowerment (AOR = 0.63, 95% CI 0.51-0.78). Other socio-demographic factors found significant include; educational level, wealth index, and household size which had a negative association, but residence and region with a positive association. CONCLUSIONS: A high proportion of Rwandan women had health insurance, but it was negatively associated with women's empowerment. Therefore, tailoring mass-media material considering the specific knowledge gaps to addressing misinformation, as well as addressing regional imbalance by improving women's access to health facilities/services are key in increasing coverage of health insurance among women in Rwanda.


Subject(s)
Empowerment , Insurance, Health , Child , Cross-Sectional Studies , Female , Health Surveys , Humans , Rwanda
12.
J Health Care Poor Underserved ; 33(3): 1555-1568, 2022.
Article in English | MEDLINE | ID: covidwho-2021454

ABSTRACT

Under the Affordable Care Act, the federal Health Insurance Navigator Program aims to reduce the rate of uninsured in the United States. Under this program, navigators help people obtain insurance coverage through federally facilitated Marketplaces. However, the program's financial instability and substantial budget cuts created a severe shortage of navigator assistance for the uninsured and underserved. The COVID-19 pandemic added further pressure to the already-strained program. Our study examined how unstable and unpredictable federal funding and the COVID-19 pandemic affected organizations' navigator work in the federal program in 2020. The results study show (1) that navigator organizations provide vital, year-round resources; (2) that organizations feel pushed to direct scarce resources to grant management and cut service provision; and (3) that there are policy changes that can support navigator organizations in the future. Increased and ongoing federal investment is needed to support this vital health workforce and expand enrollment assistance for underserved communities.


Subject(s)
COVID-19 , Medically Uninsured , COVID-19/epidemiology , Humans , Insurance Coverage , Insurance, Health , Pandemics , Patient Protection and Affordable Care Act , United States
13.
BMC Res Notes ; 15(1): 298, 2022 Sep 10.
Article in English | MEDLINE | ID: covidwho-2021329

ABSTRACT

OBJECTIVE: This study adapted Improving Cancer Patients' Insurance Choices (I Can PIC), an intervention to help cancer patients navigate health insurance decisions and care costs. The original intervention improved knowledge and confidence making insurance decisions, however, users felt limited by choices provided in insurance markets. Using decision trees and frameworks to guide adaptations, we modified I Can PIC to focus on using rather than choosing health insurance. The COVID-19 pandemic introduced unforeseen obstacles, prompting changes to study protocols. As a result, we allowed users outside of the study to use I Can PIC (> 1050 guest users) to optimize public benefit. This paper describes the steps took to conduct the study, evaluating both the effectiveness of I Can PIC and the implementation process to improve its impact. RESULTS: Although I Can PIC users had higher knowledge and health insurance literacy compared to the control group, results were not statistically significant. This outcome may be associated with systems-level challenges as well as the number and demographic characteristics of participants. The publicly available tool can be a resource for those navigating insurance and care costs, and researchers can use this flexible approach to intervention delivery and testing as future health emergencies arise.


Subject(s)
COVID-19 , Neoplasms , COVID-19/epidemiology , COVID-19/therapy , Decision Making , Health Policy , Humans , Implementation Science , Insurance, Health , Neoplasms/therapy , Pandemics
14.
Cancer ; 128(20): 3727-3733, 2022 10.
Article in English | MEDLINE | ID: covidwho-1999841

ABSTRACT

BACKGROUND: Cancer survivors represent a population with high health care needs. If and how cancer survivors were affected by the first year of the coronavirus disease 2019 (COVID-19) pandemic are largely unknown. METHODS: Using data from the nationwide, population-based Behavioral Risk Factor Surveillance System (2017-2020), the authors investigated changes in health-related measures during the COVID-19 pandemic among cancer survivors and compared them with changes among adults without a cancer history in the United States. Sociodemographic and health-related measures such as insurance coverage, employment status, health behaviors, and health status were self-reported. Adjusted prevalence ratios of health-related measures in 2020 versus 2017-2019 were calculated with multivariable logistic regressions and stratified by age group (18-64 vs. ≥65 years). RESULTS: Among adults aged 18-64 years, the uninsured rate did not change significantly in 2020 despite increases in unemployment. The prevalence of unhealthy behaviors, such as insufficient sleep and smoking, decreased in 2020, and self-rated health improved, regardless of cancer history. Notably, declines in smoking were larger among cancer survivors than nonelderly adults without a cancer history. Few changes were observed for adults aged ≥65 years. CONCLUSIONS: Further research is needed to confirm the observed positive health behavior and health changes and to investigate the role of potential mechanisms, such as the national and regional policy responses to the pandemic regarding insurance coverage, unemployment benefits, and financial assistance. As polices related to the public health emergency expire, ongoing monitoring of longer term effects of the pandemic on cancer survivorship is warranted.


Subject(s)
COVID-19 , Cancer Survivors , Neoplasms , Adult , COVID-19/epidemiology , Humans , Insurance Coverage , Insurance, Health , Neoplasms/epidemiology , Pandemics , Self Report , United States/epidemiology
15.
Am J Manag Care ; 28(7): 310-312, 2022 07.
Article in English | MEDLINE | ID: covidwho-1994988

ABSTRACT

COVID-19 hospitalizations among unvaccinated individuals cost billions of dollars. More employers are considering imposing a premium surcharge on employees participating in the company's health plan who are not vaccinated against COVID-19. These employers see this approach as similar to health premium surcharges for tobacco use, justifying the higher premiums on the basis that unvaccinated individuals could cause the plan to experience higher hospitalization and related costs. However, imposing a surcharge on unvaccinated employees will require employers to think through legal and policy implications and the interests of their employees and their businesses. Employers should weigh their vaccination goals against these interests and consider whether a legally compliant surcharge would further their goals. Employers should carefully consider the prevailing culture among their employees and assess whether the policy would be effective and noncoercive. Premium surcharges may be effective for some but not all employers.


Subject(s)
COVID-19 , Health Benefit Plans, Employee , COVID-19/epidemiology , Commerce , Humans , Insurance Coverage , Insurance, Health , Tobacco Use , United States
16.
Am J Public Health ; 112(S6): S586-S590, 2022 08.
Article in English | MEDLINE | ID: covidwho-1993610

ABSTRACT

Objectives. To quantify socioeconomic inequalities in COVID-19 mortality in Colombia and to assess the extent to which type of health insurance, comorbidity burden, area of residence, and ethnicity account for such inequalities. Methods. We analyzed data from a retrospective cohort of COVID-19 cases. We estimated the relative and slope indices of inequality (RII and SII) using survival models for all participants and stratified them by age and gender. We calculated the percentage reduction in RII and SII after adjustment for potentially relevant factors. Results. We identified significant inequalities for the whole cohort and by subgroups (age and gender). Inequalities were higher among younger adults and gradually decreased with age, going from RII of 5.65 (95% confidence interval [CI] = 3.25, 9.82) in participants younger than 25 years to RII of 1.49 (95% CI = 1.41, 1.58) in those aged 65 years and older. Type of health insurance was the most important factor, accounting for 20% and 59% of the relative and absolute inequalities, respectively. Conclusions. Significant socioeconomic inequalities exist in COVID-19 mortality in Colombia. Health insurance appears to be the main contributor to those inequalities, posing challenges for the design of public health strategies. (Am J Public Health. 2022;112(S6):S586-S590. https://doi.org/10.2105/AJPH.2021.306637).


Subject(s)
COVID-19 , Adult , Colombia/epidemiology , Health Status Disparities , Humans , Insurance, Health , Retrospective Studies , Socioeconomic Factors
17.
Lancet ; 398(10306): 1118-1120, 2021 09 25.
Article in English | MEDLINE | ID: covidwho-1432166
18.
Health Aff (Millwood) ; 41(8): 1098-1106, 2022 08.
Article in English | MEDLINE | ID: covidwho-1974336

ABSTRACT

Billing and insurance-related costs are a significant source of wasteful health care spending in Organization for Economic Cooperation and Development nations, but these administrative burdens vary across national systems. We executed a microlevel accounting of these costs in different national settings at six provider locations in five nations (Australia, Canada, Germany, the Netherlands, and Singapore) that supplements our prior study measuring the costs in the US. We found that billing and insurance-related costs for inpatient bills range from a low of $6 in Canada to a high of $215 in the US for an inpatient surgical bill (purchasing power parity adjusted). We created a taxonomy of billing and insurance-related activities (eligibility, coding, submission, and rework) that was applied to data from the six sites and allows cross-national comparisons. Higher costs in the US and Australia are attributed to high coding costs. Much of the savings achieved in some nations is attributable to assigning tasks to people in lower-skill job categories, although most of the savings are due to more efficient billing and insurance-related processes. Some nations also reduce these costs by offering financial counseling to patients before treatment. Our microlevel approach can identify specific cost drivers and reveal national billing features that reduce coding costs. It illustrates a valuable pathway for future research in understanding and mitigating administrative costs in health care.


Subject(s)
Accounting , Insurance, Health , Delivery of Health Care , Germany , Health Care Costs , Humans , Organisation for Economic Co-Operation and Development
19.
Health Lit Res Pract ; 6(3): e182-e190, 2022 07.
Article in English | MEDLINE | ID: covidwho-1934307

ABSTRACT

BACKGROUND: How individuals perceive their health literacy may differ based on demographic and individual characteristics. OBJECTIVE: The purpose of this study was to understand the dispersion of health literacy across demographics in the state of Georgia in 2021 and to determine which factors influence health literacy. METHODS: Study participants were age 18 years and older and completed an on-line Health Literacy Questionnaire (N = 520). The participant pool was stratified to mirror state-wide demographics of geography and race. Results were further collapsed into composite scales reflecting basic, communicative, and critical health literacy. Descriptive statistics, bivariate Pearson's correlations, and multiple regression analyses were used. A two-step cluster analysis was performed with the nine health literacy scales. KEY RESULTS: Rural county and no health insurance were negatively related to all three composite scales (rs = .093-.254, ps < .05). Demographic predictors accounted for 6.7% of the variance in basic (F[6, 439] = 5.287, p < .001), 10% in communicative (F[6, 438] = 8.154, p < .001), and 6% for critical (F[6, 439] = 4.675, p < .0010. In all scales, health insurance status was the strongest primary unique predictor (ßs = .236, .295, .181, ps <.05, respectively). In a two-step cluster analysis only health insurance status differentiated the health literacy level clusters (X2(3) = 9.43, 34.51, ps = 024, <.001 respectively). CONCLUSION: Lacking health insurance is the most consistent and largest contributor to low health literacy across the state of Georgia; population demographics are not. Health literacy policies and practices should be developed for universal application and not focus on specific populations. [HLRP: Health Literacy Research and Practice. 2022;6(3):e182-e190.] Plain Language Summary: In this study, demographics that are usually associated with low health literacy like age, sex, race, educational attainment, and type of county (rural or urban) were not associated with; the only significant factor was lack of health insurance. This relationship strengthens the case for universal health literacy precautions that go beyond population demographics.


Subject(s)
Health Literacy , Adolescent , Educational Status , Health Status , Humans , Insurance, Health , Surveys and Questionnaires
20.
Health Serv Res ; 57(6): 1321-1331, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1927539

ABSTRACT

RESEARCH OBJECTIVE: To explore whether expanded Medicaid helps mitigate the relationship between unemployment due to COVID and being uninsured. Unanticipated unemployment spells are generally associated with disruptions in health insurance coverage, which could also be the case for job losses during the COVID-19 pandemic. Expanded access to Medicaid may insulate some households from long uninsurance gaps due to job loss. DATA SOURCE: Phase 1 of the Census Bureau's Experimental Household Pulse Survey covering April 23, 2020-July 21, 2020. STUDY DESIGN: We compare differences in health insurance coverage source and status linked to recent lob losses attributable to the COVID-19 pandemic in states that expanded Medicaid against states that did not expand Medicaid. DATA COLLECTION/EXTRACTION METHODS: Our analytical dataset was limited to 733,181 non-elderly adults aged 20-64. PRINCIPAL FINDINGS: Twenty-six percent of our study sample experienced an income loss between March 13, 2020, and the time leading up to the survey-16% experienced job losses (e.g., layoff, furlough) due to the COVID-19 crisis, and 11% had other reasons they were not working. COVID-linked job losses were associated with a 20 (p < 0.01) percentage-point (PPT) lower likelihood of having employer-sponsored health insurance (ESI). Relative to persons in states that did not expand Medicaid, persons in Medicaid expansion states experiencing COVID-linked job losses were 9 PPT (p < 0.01) more likely to report having Medicaid and 7 PPT (p < 0.01) less likely to be uninsured. The largest increases in Medicaid enrollment were among people who, based on their 2019 incomes, would not have qualified for Medicaid previously. CONCLUSIONS: Our findings suggest that expanded Medicaid eligibility may allow households to stabilize health care needs and they should become detached from private health coverage due to job loss during the pandemic. Households negatively affected by the pandemic are using Medicaid to insure themselves against the potential health risks they would incur while being unemployed.


Subject(s)
COVID-19 , Medicaid , Adult , United States , Humans , Middle Aged , Insurance Coverage , COVID-19/epidemiology , Pandemics , Medically Uninsured , Patient Protection and Affordable Care Act , Insurance, Health , Health Services Accessibility
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