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Haze pollution not only affects the quality of economic growth and the image of the government, but also seriously affects public health. With the improvement of climate risk perception, the public is actively seeking all kinds of risk management measures to combat the hazards of haze pollution. The study of the relationship between haze pollution, climate risk perception and the development of commercial health insurance is of great significance to the formulation of haze control policies and the improvement of social security system. This paper attempts to explore the relationship between haze pollution, climate risk perception and commercial health insurance demand by establishing static and dynamic models based on panel data from 31 provinces in China from 2005 to 2022. Also, the spatial spillover effects of haze pollution in different regions on the development of commercial health insurance in other regions are investigated by establishing a spatial Durbin model. It is found that (1) haze pollution has a lagged positive effect on the demand for commercial health insurance; (2) haze pollution has a significant spatial spillover effect on the development of commercial health insurance; (3) this study used Python technology to construct a climate risk perception index, and found that the moderating effect of the residents' perception of climate risk existed significantly, and that the residents might take other measures to manage the risk in the short term, but in the long term, the climate risk perception showed a positive correlation with the level of education. This paper provides implications for government departments and social media to strengthen education and publicity, improve residents' awareness of risk diversification, and deepen the concept of commercial health protection. [ABSTRACT FROM AUTHOR]

Objective: When prescribed with opioids, sedative-hypnotics substantially increase the risk of overdose. The objective of this paper was to describe characteristics and trends in opioid sedative-hypnotic co-prescribing in a network of safety-net clinics serving low-income, publicly insured, and uninsured individuals. Methods: This retrospective longitudinal analysis of prescription orders examined opioid sedative-hypnotic co-prescribing rates between 2009 and 2018 in the OCHIN network of safety-net community health centers. Sedative-hypnotics included benzodiazepine and non-benzodiazepine sedatives (eg, zolpidem). Co-prescribing patterns were assessed overall and across patient demographic and co-morbidity characteristics. Results: From 2009 to 2018, 240 587 patients had ≥1 opioid prescriptions. Most were White (65%), female (59%), and had Medicaid insurance (43%). One in 4 were chronic opioid users (25%). During this period, 55 332 (23%) were co-prescribed a sedative-hypnotic. The prevalence of co-prescribing was highest for females (26% vs 19% for males), non-Hispanic Whites (28% vs 13% for Hispanic to 20% for unknown), those over 44 years of age (25% vs 20% for <44 years), Medicare insurance (30% vs 21% for uninsured to 22% for other/unknown), and among those on chronic opioid therapy (40%). Co-prescribing peaked in 2010 (32%) and declined steadily through 2018 (20%). Trends were similar across demographic subgroups. Co-prescribed sedative-hypnotics remained elevated for those with chronic opioid use (27%), non-Hispanic Whites (24%), females (23%), and those with Medicare (23%) or commercial insurance (22%). Conclusions: Co-prescribed sedative-hypnotic use has declined steadily since 2010 across all demographic subgroups in the OCHIN population. Concurrent use remains elevated in several population subgroups. [ABSTRACT FROM AUTHOR]

This paper summarizes emerging practice and research issues in the health insurance industry. We provide an industry overview, epitomize business analytics applications, and outline current and emerging problems of interest to key stakeholders and researchers in information systems, operations management, and healthcare management. Specifically, we focus on three areas of research that are of importance to the health insurance industry as well as the healthcare system: (i) management and evaluation of intervention programs, (ii) creation of effective provider networks, and (iii) emerging issues such as the impact of a pandemic, patient communication and steering, and technological innovations in health care. We lay out brief details of how each of these problems can be formulated, where the data can be acquired (public and/or proprietary data sets), and provide guidance for solving them. For several of these problems, we provide models that span causal modeling, predictive modeling, and prescriptive modeling. [ABSTRACT FROM AUTHOR]

This paper examines the role of universal healthcare on patient choice and quality of care. Lack of health insurance is a leading contributor to emergency department (ED) visits from the uninsured. Using a natural experiment from Massachusetts, we follow previously uninsured individuals over time—both before and after the implementation of universal healthcare—to study the effects of insurance availability on their healthcare seeking behavior. We find that the availability of health insurance has a significant impact on the type of healthcare sought by the previously uninsured. Specifically, individuals are less likely to continue visiting the ED and instead more likely to choose hospital inpatient and outpatient services. We find that frequent fliers and patients with chronic conditions, who are both known to account for a substantial share of healthcare costs, exhibit heterogeneity in this behavior. Finally, we examine the effect of the policy on quality of care, as measured by short‐term ED revisits. Although the overall revisit rates remain unchanged, frequent ED users and chronic patients experience a decline in short‐term ED revisits. With key features of the Affordable Care Act being frequently criticized for repeal, understanding how these changes influence patient choice and quality of care is significantly policy relevant. [ABSTRACT FROM AUTHOR]

Most migrant workers in mainland China are officially covered by the New Rural Cooperative Medical System (NRCMS), a rural health insurance system that operates in their home communities. The NRCMS and the system of household registration (hukou) are tightly linked and systemicaOy interdependent institutions. Migrant workers have difficulties benefitting from this social protection because it remains spatially separated from them. Only a minority have access to urban health insurance systems. This paper sheds light on the institutional origins of the coverage problem of migrant workers and examines crucial policy initiatives that attempt to solve it. In the context of the ongoing hukou reforms, these policies aim to partially dissolve the systemic interdependence of hukou and health insurance. While the policies provide feasible, yet conflict-prone, solutions in short-distance and concentrated bilateral migration systems, covering migrants who cross provincial boundaries remains a challenge. [ABSTRACT FROM AUTHOR]

Context: Public health policies are designed for specific subsets of the population. Evidence that a policy is effectively designed should be based on whether it effectively addresses its mission. A critical factor is determining whether utilization patterns reflect the mission and the efficacy of public health policies, particularly during early stages of implementation. We assert that utilization patterns can be effectively assessed using geographic information systems (GIS).Objective: This paper uses the Silver Alert program, a recently implemented public health policy, as a case for how and why GIS can be used to examine utilization patterns.Design: GIS are employed to visualize and spatially analyze a new health policy--North Carolina's Silver Alert policy. We use visualized data and spatial statistics to assess utilization patterns and mission adherence.Results: Results show disproportionate utilization patterns of the Silver Alert policy. In particular, an outstanding number of Silver Alerts were used in Wake County and its surrounding counties, which are both the political and media center of North Carolina. Other counties, including populous counties, had few if any alerts.Conclusion: Findings suggest that the North Carolina's Silver Alert policy needs to be adjusted to more effectively address its mission. We identify several factors that need further examination prior to a statewide evaluation. From this case study, we propose ways future programs, particularly the introduction of the Affordable Care Act (ACA) in 2014, might use GIS to examine utilization patterns as a means to better understand whether and in what ways the health care needs of the public are being met with such a policy. [ABSTRACT FROM AUTHOR]

Commercial insurance is an important risk management tool whose demand is affected by psychological factors. Music can promote consumption by evoking non-random emotional and behavioral responses in consumers . Using data from the China Comprehensive Social Survey, we examined the impact of music on commercial insurance purchase behavior using a probit model, an instrumental variable, propensity score matching, and other methods. The results indicate that music can significantly increase the probability of residents purchasing commercial medical insurance and endowment insurance by 2.569% and 1.869%, respectively. Regarding the mechanism, music encourages residents to purchase insurance by increasing their general cognition, risk cognition, insurance cognition, and ability to manage risk. Furthermore, an analysis of heterogeneity shows that music plays a greater role in promoting the aforementioned behavior of residents with lower levels of education, lower frequencies of social interaction, internet usage, an agricultural household registration, and of residents with jobs. [ABSTRACT FROM AUTHOR]

Telepsychiatry is a cost-effective alternative to in-person psychiatric consultations. The COVID-19 pandemic brought about a sharp spike in the utilization of telepsychiatry due to ongoing restrictions on gatherings and traveling. In recognition of the importance of telemedicine in general, and telepsychiatry specifically, telemedicine practice guidelines and telepsychiatry operational guidelines have been released. Due to the rising trend in telemedicine, the Insurance Regulatory and Development Authority of India (IRDIA) incorporated teleconsultation health insurance coverage at a level on par with regular in-person consultations. In contrast, in the United States of America, private insurance coverage for telepsychiatry has been in vogue for some time. In this paper we draw comparisons between India and the United States on telepsychiatry and health insurance. We compare the evolving regulatory policies of these two countries in relation to existing insurances plans that are available, the challenges in implementation of new regulations and the possible ways to overcome the challenges to make telepsychiatry affordable to all. [ABSTRACT FROM AUTHOR]

Universal health insurance is widely believed to be a key strategy for improving health services. However, few studies have examined whether it increases the use of modern contraceptives. The purpose of the present research is to determine whether the policy of incorporating family planning services into the national health insurance policy in Indonesia (Jaminan Kesehatan Nasional [JKN], implemented in 2016) has led to an increase in the use of modern contraceptives. The data were obtained from the 2019 Government Performance and Accountability Survey (GPAS; T otal = 46,220 married women aged 15–49 years). The findings show that women who are covered by the health insurance scheme for non-poor families (JKN non-PBI) are 19.12 times more likely to use modern contraceptives than women who are uninsured. Women who are covered by health insurance scheme for poor families (JKN PBI) are 17.04 times more likely to use modern contraceptives than those who are uninsured. These results are robust against predisposing, enabling and need factors associated with modern contraceptive uptake (i.e., education, family economic status, religion, knowledge of modern contraception, age at time of first marriage, perception of the ideal number of children, number of children born alive, and area of residence). The findings suggest that the government should expand health insurance benefits in order to increase the uptake of modern contraceptives, particularly among disadvantaged group within communities. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of this study was to define the impact of socioeconomic factors, such as national area of deprivation index (ADI) and medical insurance type, on the access to orthopaedic care after an ACL rupture. The secondary aim was to determine if these variables, national ADI and medical insurance, were associated with second ACL injury after primary ACLR. We hypothesized that patients with a greater national deprivation index and Medicaid insurance will have less access to specialized care and an increased risk of re-injury. Methods: An IRB approved retrospective study was conducted evaluating 339 patients that underwent ACL reconstructions between November 2015 and August 2018 by 3 sports medicine fellowship-trained orthopaedic surgeons. Patients undergoing primary ACL reconstruction were included. Demographic and surgical characteristics data were obtained via chart review and telephone interviews. National ADI percentile was obtained utilizing the Neighborhood Atlas Website and the patients' home addresses. The relationship between national ADI percentile and care characteristics (e.g., time to specialized care) were investigated using Spearman's rank correlation coefficients (p) while the association between patient and care characteristics, and second ACL injury were investigated using multivariable logistic regression. Results: A total of 339 patients met inclusion criteria and had complete datasets for all variables of interest. Participants had an average age of 23 ± 7.4 yrs. 55.8% of the patients were males and identified themselves as: White 45.7%, African American 14.5%, Asian 11.8%, Hispanic 7.7% and Other 21.3%. Patients with a greater national ADI percentage took longer to seek specialized care from time of injury (p = 0.141, p = 0.009) as well as to undergo surgery from time of injury (p = 0.183, p < 0.001). Individuals who utilized Medicaid insurance had significantly greater odds of experiencing a second ACL injury (OR = 3.079, p = 0.023) when compared to individuals who utilized commercial insurance. National ADI percentile (p = 0.208), time from injury to specialized care (p = 0.342), and time from specialized care to surgery (p = 0.051) did not significantly contribute to the model. Conclusions: Lower socioeconomic status adversely affects timing of care and re-injury rates following an ACL injury. Patients with a greater national ADI percentage took significantly longer to seek specialized care and obtain surgery following ACL injury. Patients utilizing Medicaid insurance were more likely to sustain a re-injury following ACL Reconstruction. Future studies should look at factors that impede access to care and adversely affect post-operative outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To reduce the number of new HIV infections and improve HIV health care outcomes, the social conditions in which people live and work should be assessed. The objective of this study was to describe linkage to HIV medical care by selected demographic characteristics and social determinants of health (SDH) among US adults with HIV at the county level. Methods: We used National HIV Surveillance System data from 42 US jurisdictions and data from the American Community Survey to describe differences in linkage to HIV medical care among adults aged ≥18 with HIV infection diagnosed in 2017. We categorized SDH variables into higher or lower levels of poverty (where <13% or ≥13% of the population lived below the federal poverty level), education (where <13% or ≥13% of the population had

Objectives:Twenty-four-hour ambulatory blood pressure monitoring (ABPM) is recommended in patients with white coat hypertension (HTN) by national guideline, but was poorly utilized, and is available only in very limited subspecialty clinics. We aim to examine the feasibility and utility of ABPM in a primary care setting in the diagnosis and management of white coat HTN including the implementation and modification of antihypertensive therapy. Methods: Patients who have elevated blood pressure in clinic office but normal blood pressure readings at home are eligible for 24-h ambulatory BP monitoring. We analyzed data from patients who were suspected to have white coat HTN in the last 2 years underwent ABPM in our practice. Results: Among 68 patients, 54 patients met the selection criteria. ABPM showed that 13 patients had normal BP (24%), while 41 patients (76%) had persistent HTN. Among these patients with persistent HTN, 28 patients had intervention including 24 patients prescribed with new anti-hypertensive medication or medication increase, 3 patients prescribed with additional lifestyle modification and one started CPAP.13 patients with slightly elevated BP (133/77 for average daytime BP) didn't have medication adjustment. Conclusion: ABPM has substantial utility in the diagnosis and management of white coat HTN in a primary care setting. [ABSTRACT FROM AUTHOR]

Background: The sustainability of the National Health Insurance (NHI) program heavily relies on the premium of its member. The negligence of a large number of members at pay the premium lead to the failure of the Social Security Agency for Health (SSAH) to deliver its services. This study aims at analyzing important factors that influence the sustainability of premium payment of NHI's self-enrolled members in the Jakarta Greater Area. Design and methods: This study performed an econometric analysis from the panel and the same respondent's data in 2015 and 2017. The population of the study was NHI's self-enrolled members who lived in the City of Jakarta, Bogor, Depok, Tangerang, Bekasi, (Jakarta Greater Area) and it represents the urban area of Indonesia. The ordinal logistic regression model was used to determine the type of sustainability NHI premium payment. Results: The survey shows that around 28.3% of self-enrolled members do not pay the NHI insurance premium regularly. Applying ordered logit this study statistically confirms that age of household head, income per month, never experience economic hardship, 1st/2nd class registration, and benefits of SSAH are positively correlated with compliance rate to pay NHI insurance premium. Whereas tobacco consumption, health-seeking behavior, and the 2016 increase of premium are negatively correlated with regular premium payment. Conclusions: This study calls for policy intervention to improve compliance of premium payment such as i) massive promotion of insurance literacy and benefits of insurance through a health professional, internet, and government officer; ii) expanding auto-debit and installment premium payment; iii) incentive for paying premium regularly and not smoking; and iv) improving access and quality of health services. [ABSTRACT FROM AUTHOR]

Objectives: Rural residents comprise approximately 15% of the United States population. They face challenges in accessing and using a health care system that is not structured to meet their unique needs. It is important to understand rural residents' perceptions of health and experiences interacting with the health care system to identify gaps in care. Methods: Our team conducted focus groups with members of the Michigan Farm Bureau during their 2019 Annual Meeting. Topics explored included resources to manage health, barriers to virtual health care services, and desired changes to localized healthcare delivery. Surveys were used to capture demographic and internet access information. Conclusion: Analysis included data from 2 focus groups (n = 14). Participants represented a wide age range and a variety of Michigan counties. The majority were full-time farm owners with most—93% (n = 13)—reporting they had access to the internet in their homes and 86% (n = 12) reporting that their cellphones had internet capabilities. Participants identified challenges and opportunities in 4 categories: formal health care; health and well-being supports; health insurance experiences; and virtual health care. Conclusion: The findings from this study provide a useful framework for developing interventions to address the specific needs of rural farming residents. Despite the expressed challenges in access and use of health care services and resources, participants remained hopeful that innovative approaches, such as virtual health platforms, can address existing gaps in care. The study findings should inform the design and evaluation of interventions to address rural health disparities. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Despite compelling evidence of clinical and economic benefits, adherence to colorectal cancer (CRC) screening remains low. Increasing public awareness through various outreach methods may improve screening uptake. The objective of this study was to evaluate the uptake of non-invasive multi-target stool DNA (mt-sDNA) by different outreach methods in an average-risk employer population. Methods: This retrospective observational study included CRC screening-eligible individuals aged ≥50 years insured by the Metropolitan Nashville Public Schools (MNPS) employee healthcare plan. The study intervention arms included population-based outreach and office visit-based interaction. The mt-sDNA completion rate (proportion of individuals who return the mt-sDNA kit after consenting to have it shipped to their home), proportion of patients who performed follow-up colonoscopy after a positive test, and time to follow-up colonoscopy were assessed. Results: A total of 167 mt-sDNA kits were shipped to eligible participants (aged 50-64 years) in the population-based outreach arm. In the office visit-based interaction arm, a total of 132 mt-sDNA kits were shipped to eligible participants (aged ≥50 years). The mt-sDNA completion rate was significantly higher for office visit-based interaction as compared to population-based outreach (76.8% vs 53.5%; P <.001) among those aged 50 to 64 years. While all patients aged 50 to 64 years with a positive mt-sDNA result received a follow-up colonoscopy in both arms, the median time to follow-up colonoscopy was shorter among the population-based outreach (55 vs 136 days; P <.05). Conclusions: Office visit-based interaction was associated with a higher mt-sDNA completion rate as compared to the population-based outreach among average-risk, CRC screening-eligible individuals aged 50 to 64 years old. [ABSTRACT FROM AUTHOR]

Low-income young Black men experience a disproportionate burden of violent injury in the United States. These men face significant disparities in healthcare insurance coverage and access to care. The Affordable Care Act (ACA) created a new healthcare workforce, Navigators and In-Person Assisters (IPAs), to support low-income minority populations with insurance enrollment. Using a longitudinal qualitative case study approach with Navigators and IPAs at the two busiest urban trauma centers in Maryland, this study identifies the culturally and structurally responsive enrollment strategies used by three Navigators/IPAs as they enrolled violently injured young Black men in healthcare insurance coverage. These approaches included gaining their trust and building rapport and engaging female caregivers during enrollment. Navigators and IPAs faced significant barriers, including identity verification, health literacy, privacy and confidentiality, and technological issues. These findings offer novel insight into the vital work performed by Navigators and IPAs, as they attempt to decrease health disparities for young Black male survivors of violence. Despite high rates of victimization due to violent firearm injury, little is known about how this population gains access to healthcare insurance. Although the generalizability of this research may be limited due to the small sample size of participants, the qualitative case study approach offers critical exploratory data suggesting the importance of trauma-informed care in insurance enrollment by Navigators and IPAs. They also emphasize the need to further address structural issues, which affect insurance enrollment and thus undermine the well-being of young Black men who have survived violent injury. [ABSTRACT FROM AUTHOR]

This study will highlight the diagnostic potential that radar plots display for reporting on performance benchmarking from patient admissions to hospital for surgical procedures. Two drawbacks of radar plots – the presence of missing information and ordering of indicators – are addressed. Ten different orthopaedic surgery procedures were considered in this study. Moreover, twelve outcome indicators were provided for each of the 10 surgeries of interest. These indicators were displayed using a radar plot, which we call a scorecard. At the hospital level, we propose a facile process by which to consolidate our 10 scorecards into one. We addressed the ordering of indicators in our scorecards by considering the national median of the indicators as a benchmark. Furthermore, our the consolidated scorecard facilitates concise visualisation and dissemination of complex data. It also enables the classification of providers into potential low and high performers that warrant further investigation. In conclusion, radar plots provide a clear and effective comparative tool for discerning multiple outcome indicators against the benchmarks of patient admission. A case study between two top and bottom performers on a consolidated scorecard (at hospital level) showed that medical provider charges varied more than other outcome indicators. [ABSTRACT FROM AUTHOR]

Although the number of men with health insurance has increased, men are less likely to utilize health services than females, and experience difficulty in paying medical bills. Understanding the details of health insurance can be challenging and the lack of understanding can have financial consequences. This study, guided by Andersen's model of health-care utilization, assessed the relationship between confidence level in understanding health insurance terms and difficulty in paying medical bills among American men. Data were drawn from the Health Reform Monitoring Survey, 2015-2016. The study included 6,643 men aged between 18 and 64. Descriptive statistics examined participants' difficulty in paying medical bills by predisposing, enabling, and need characteristics, and by confidence in understanding health insurance terms. A modified Poisson regression analysis examined the association between difficulty in paying medical bills, confidence in understanding health insurance terms score, and predisposing, enabling, and need characteristics. An increase in confidence in understanding health insurance terms score was associated with significantly lower reported difficulty in paying medical bills (PR = .98; 95% CI = [.97-.99]; p = .002). Participants with a college degree or higher were less likely to report difficulty in paying their medical bills compared to participants with less than a high school degree (PR = .72; 95% CI = [.56-.92]; p = .009). A better understanding of health insurance might prevent men from experiencing difficulties in paying medical bills. Additional research should be performed to understand the relationship between the level of confidence in understanding health insurance, knowledge level of health insurance terms, use of health insurance, and their impact on difficulty in paying medical bills. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to explore variations in cost and choice of travel insurance in patients with cardiac disease. Methods: Clinical data from patients with myocardial infarction (MI, n = 20), Marfan syndrome (MFS, n = 10) and dilated cardiomyopathy (DCM, n = 10) were input to insurance websites for a proposed ten-day holiday and data for premium cost (£) and choice of quotes (n) collated for each condition. Age-matched healthy individuals were used as controls. Results: Median cost of insurance was significantly higher for MI (£233.07; interquartile range (IQR) = £222.95–£245.47 versus £24.29; IQR = £11.9–£34.09, p = <0.001), MFS (£37.43; IQR = £23.61–58.83 versus £19.20; IQR = £9.09–£27.31, p = 0.0378)) and DCM (£166.87; IQR = £129.71–£198.62 versus £23.96; IQR = £11.99–£32.44, p = <0.001) compared to controls. Choice of quotes was also significantly reduced for MI (5; IQR = 5–14 versus 89; IQR = 26–110, p = <0.001) MFS (61; IQR = 26–83 versus 105; 26–105, p = <0.001) and DCM (19; IQR = 16–28 versus 89; IQR = 26–106, p = <0.001) compared to controls. Modifiable factors, such as time after cardiac event or awaiting further investigations, and clinical factors, such as persistent symptoms and disease severity, lead to a significant increase in cost. Conclusions: This study provides insight into the factors affecting cost and choice of travel insurance for patients with cardiac disease. The findings highlight ways in which healthcare professionals can support patients to obtain travel insurance. [ABSTRACT FROM AUTHOR]

Universal Health Coverage always persevered as a pro poor policy in many countries, characterized by a major impact on higher out-of-pocket healthcare costs, with low-cost alternative prescription drugs and capitation payments made to physicians, in order to reduce inequity. These concerns have been discussed widely on social media, including Facebook, but social media are consistently neglected as a source of scientific information. The purpose of this study, therefore, is to analyze the thought process or feelings of individuals about the policies, also focusing on the possible reactions. Hence, a systematic review in the form of discussion forums on the Facebook page of the National Health Insurance Agency, Indonesia was conducted from 2015 to 2016, with regards to the implementation of National Health Insurance, within a year and half after the policy was launched. In addition, the contents of 148 discussions were deductively analyzed, and the findings showed the pragmatic disposition of most Facebook users towards health care utilization, the costs of Insurance, and the possible benefits of payment. Furthermore, the debate conducted in social media related with the policy and its practice issues ought to be countered through appropriate modification. [ABSTRACT FROM AUTHOR]

The primary objective of "all-payer" rate setting—regulatory regimes through which states set hospital payment rates for all insurers—was to control costs through consistent, centrally regulated payments. These regimes were often linked, however, to an ancillary goal of financing care for the uninsured. We show that the surcharge mechanism used to achieve this secondary objective decreased the stability of these payment regimes. This instability reflected a feedback loop from surcharge rates to insurance coverage and back to the quantities of uncompensated care in need of financing. Instability was exacerbated when Health Maintenance Organizations were exempted from surcharge collections, creating a regulatory arbitrage opportunity. Legal challenges connected to the incidence of uncompensated care surcharges contributed to the abandonment of all-payer rate regulation by several states. These developments illustrate the wisdom of the Tinbergen Rule, which recommends that independent policy objectives be met with independent policy instruments. [ABSTRACT FROM AUTHOR]

Objectives: Research suggests that persons who are aware of the risk factors for cardiovascular disease (CVD) are more likely to engage in healthy behaviors than persons who are not aware of the risk factors. We examined whether patients whose insurance claims included an International Classification of Diseases, Ninth Revision (ICD-9) code associated with hypertension who self-reported high blood pressure were more likely to fill antihypertensive medication prescriptions and less likely to have CVD-related emergency department visits and hospitalizations (hereinafter, CVD-related events) and related medical expenditures than patients with these codes who did not self-report high blood pressure. Methods: We used a large convenience sample from the MarketScan Commercial Database linked with the MarketScan Health Risk Assessment (HRA) Database to identify patients aged 18-64 in the United States whose insurance claims included an ICD-9 code associated with hypertension and who completed an HRA from 2008 through 2012 (n = 111 655). We used multivariate logistic regression analysis to examine the association between self-reported high blood pressure and (1) filling prescriptions for antihypertensive medications and (2) CVD-related events. Because most patients with hypertension will not have a CVD-related event, we used a 2-part model to analyze medical expenditures. The first part estimated the likelihood of a CVD-related event, and the second part estimated expenditures. Results: Patients with an ICD-9 code of hypertension who self-reported high blood pressure had a significantly higher predicted probability of filling antihypertensive medication prescriptions (26.5%; 95% confidence interval, 25.7-27.3; P <.001), had a significantly lower predicted probability of a CVD-related event (0.6%, P <.001), and on average spent significantly less on CVD-related events ($251, P =.01) than patients who did not self-report high blood pressure. Conclusion: This study affirms that self-knowledge of high blood pressure, even among patients who are diagnosed and treated for hypertension, can be improved. Interventions that improve patients' awareness of their hypertension may improve antihypertensive medication use and reduce adverse CVD-related events. [ABSTRACT FROM AUTHOR]

This study randomized a sample of households covered by one large health plan to two different surveys on health insurance coverage and matched person-level survey reports to enrollment records. The goal was to compare accuracy of coverage type and uninsured estimates produced by the health insurance modules from two major federal surveys – the redesigned Current Population Survey Annual Social and Economic Supplement (CPS) and the American Community Survey (ACS) – after implementation of the Affordable Care Act. The sample was stratified by coverage type, including two types of public coverage (Medicaid and a state-sponsored program) and three types of private coverage (employer-sponsored, non-group, and marketplace plans). Consistent with previous studies, accurate reporting of private coverage is higher than public coverage. Generally, misreporting the wrong type of coverage is more likely than incorrectly reporting no coverage; the CPS module overestimated the uninsured by 1.9 and the ACS module by 3.5 percentage points. Other differences in accuracy metrics between the CPS and ACS are relatively small, suggesting that reporting accuracy should not be a factor in decisions about which source of survey data to use. Results consistently indicate that the Medicaid undercount has been substantially reduced with the redesigned CPS. [ABSTRACT FROM AUTHOR]

Most research on health insurance in the United States uses the Current Population Survey Annual Social and Economic Supplement. However, a recent redesign of the health insurance questions disrupted the historical time trend in 2013. Using data from the American Community Survey, which has a parallel trend in the uninsured rate, we model a bridge estimate of the uninsured rate using the traditional questions. Also, we estimate the effect of changing the questionnaire. We show that the impact of redesigning the survey varies substantially by subgroup. This approach can be used to produce bridge estimates when other questionnaires are redesigned. [ABSTRACT FROM AUTHOR]

This article uses the longitudinal aspect of the Health and Retirement Study to explore the characteristics associated with reversals in retirement (referred to here as “unretirement”). Through the use of survival-time analysis with time-variant covariates, this article shows that health insurance status and its source are significant predictors of unretirement decisions. The relationship is important, as the potential impacts of the Affordable Care Act (ACA) are considered. The analysis finds that insurance is equally as predictive of retirement reversals as other financial explanations such as pensions and wealth at retirement. The analysis also shows that health insurance sources play a particularly predictive role for early retirees and those who were previously open to the idea of working in retirement. Rough estimates suggest that the ACA might reduce the number of reversals by between two and four percentage points, which would translate to 80,000 and 170,000 retirees annually. [ABSTRACT FROM AUTHOR]

A greater level of government involvement in the financing of health care is generally viewed unfavorably by organizations monitoring economic freedom. However, increased government provision of health insurance could be associated with improved economic freedom through enhanced labor market mobility. For example, job-lock alleviation accompanying a public insurance expansion could lead to increased innovation or a higher likelihood of self-employment. In this article, we use the Affordable Care Act (ACA)’s recent Medicaid expansions to examine the effect of an increase in public health insurance provision on labor market outcomes by gender and race/ethnicity. Our results lend support to the notion that state Medicaid expansions are associated with improved labor market autonomy for white men and white women; however, we find mixed results for black and Hispanic men and women. Notably, our findings cast doubt on earlier claims that the ACA would lead to large reductions in labor force participation and employment. [ABSTRACT FROM AUTHOR]

Individual-level research has found self-employment positively linked to regulations that facilitate health insurance access outside the large group market. Since self-employment can aid regional economies, if such a relationship holds at the state level, insurance regulation may bolster state economic development. Yet such regulations may spawn high insurance premiums, which can depress self-employment. This study tested whether state self-employment rates from 2009 to 2011 related positively to states’ use of “guaranteed issue” mandates in the individual and small group markets from 2008 to 2010. These mandates require insurers to offer coverage to all applicants. Self-employment rates are measured as the share of the nonagricultural labor force self-employed, and alternately as the number of individual proprietorships per 1,000 population. Both measures are statistically higher in states that mandate guaranteed issue for groups of one in the small-group market than in states that do not; however, they are insensitive to individual market-guaranteed issue and inversely related to premiums. [ABSTRACT FROM AUTHOR]

Background: Surveillance of disparities in healthcare insurance, services and quality of care among children are critical for properly serving the medical/healthcare needs of underserved populations. The purpose of this study was to assess racial/ethnic differences in children's (0 to 17 years old) health insurance adequacy and consistency (child has insurance coverage for the last 12 months). Design and methods: We used data from the 2011/2012 National Survey of Children's Health (n=79,474). Descriptive statistics and logistic regression analyses were conducted to examine the distribution and influence of several sociodemographic/family related factors on insurance adequacy and consistency across different racial/ethnic groups. Results: Stratified analyses by race/ethnicity revealed that white and black children living in households at or below 299% of the Federal Poverty Level (FPL) were approximately 29 to 42% less likely to have adequate insurance compared to children living in families of higher income levels. Regardless of race/ethnicity, we found that children with public health insurance were more likely to have adequate insurance than their privately insured counterparts, while adolescents were at greater risk of inadequate coverage. Hispanic and black children were more likely to lack consistent insurance coverage. Conclusions: This study provides evidence that racial/ethnic differences in adequate and consistent health insurance exists with both white and minority children being affected adversely by poverty. Establishing outreach programs for low income families, and cross-cultural education for healthcare providers may help increase health insurance adequacy and consistency within certain underserved populations. [ABSTRACT FROM AUTHOR]

Objective To assess and compare health system performance across six middle-income countries that are strengthening their health systems in pursuit of universal health coverage. Design Cross-sectional analysis from the World Health Organization Study on global AGEing and adult health, collected between 2007 and 2010. Setting Six middle-income countries: China, Ghana, India, Mexico, Russia and South Africa. Participants Nationally representative sample of adults aged 50 years and older. Main outcome measures We present achievement against key indicators of health system performance across effectiveness, cost, access, patient-centredness and equity domains. Results We found areas of poor performance in prevention and management of chronic conditions, such as hypertension control and cancer screening coverage. We also found that cost remains a barrier to healthcare access in spite of insurance schemes. Finally, we found evidence of disparities across many indicators, particularly in the effectiveness and patient centredness domains. Conclusions These findings identify important focus areas for action and shared learning as these countries move towards achieving universal health coverage. [ABSTRACT FROM AUTHOR]

In the current value-based health-care environment, 30-day unplanned hospital readmissions have been identified as a quality measure and an opportunity to help reduce health-care costs. The LACE Index Scoring Tool for Risk Assessment of Death and Readmission utilizes length of stay, acuity of admission, comorbidities, and emergency department visits to stratify patients into high and low risk of readmission. A retrospective chart review of 161 patients who underwent a tracheotomy or laryngectomy for head and neck indications at a tertiary care academic center demonstrated that the readmitted patient cohort was not statistically or clinically different from the nonreadmitted cohort when comparing LACE scores (P = .789), length of hospital stay (P = .237), discharge disposition (P = .569), or insurance status (P = .85). Addressing the problem of unplanned 30-day readmissions will likely require enhanced patient education, improved coordination of care, and further research. [ABSTRACT FROM AUTHOR]

Measurement error can be very difficult to assess and reduce. While great strides have been made in the field of survey methods research in recent years, many ongoing federal surveys were initiated decades ago, before testing methods were fully developed. However, the longer a survey is in use, the more established the time series becomes, and any change to a questionnaire risks a break in that time series. This article documents how a major federal survey - the health insurance module of the Current Population Survey (CPS) - was redesigned over the course of 15 years through a systematic series of small, iterative tests, both qualitative and quantitative. This overview summarizes those tests and results, and illustrates how particular questionnaire design features were identified as problematic, and how improvements were developed and evaluated. While the particular topic is health insurance, the general approach (a coordinated series of small tests), along with the specific tests and methods employed, are not uniquely applicable to health insurance. Furthermore, the particular questionnaire design features of the CPS health module that were found to be most problematic are used in many other major surveys on a range of topic areas. [ABSTRACT FROM AUTHOR]

While politicians wage legislative battles about welfare benefits, bureaucratic procedures represent a less visible means to shape access to those benefits. By constructing complex and time-consuming application procedures, the state can effectively create administrative barriers that limit access to benefits. What explains the variation in the level of administrative burden that individuals face? We address this question by examining Medicaid procedures across the 50 U.S. states, identifying different types of administrative barriers. We find that such barriers tend to be lower in states with unified Democratic control of political institutions. [ABSTRACT FROM AUTHOR]

In late 2002, the Chinese government launched an initiative to extend the coverage of health insurance in rural China with the New Rural Cooperative Medical System (NRCMS). It covered all of rural China by 2008 and is being continuously adapted and developed. This study explores two conflicting goals in the policy design: universal coverage and voluntary enrolment. Local governments often faced the problem that only insufficient numbers of villagers were enrolling voluntarily. They developed different strategies to cope with it: Complementary outpatient reimbursement via medical savings accounts (MSAs) effectively transferred villagers' premiums back to them, thus making the NRCMS more attractive. Adapting the premium-collection process to the local context or utilising collusive practices allowed them to pay premiums on behalf of the villagers from the insurance funds. These strategies undermine the effectiveness of the NRCMS as a risk-pooling mechanism, facilitate latent coverage gaps and turn it into a tax-funded service. [ABSTRACT FROM AUTHOR]

Objectives. This study examined the impact of the Great Recession of 2007-2009 on public health insurance enrollment and expenditures in Alabama. Our analysis was designed to provide a framework for other states to conduct similar analyses to better understand the relationship between macroeconomic conditions and public health insurance costs. Methods. We analyzed enrollment and claims data from Medicaid and the Children's Health Insurance Program (CHIP) in Alabama from 1999 through 2011. We examined the relationship between county-level unemployment rates and enrollment in Medicaid and CHIP, as well as total county-level expenditures in the two programs. We used linear regressions with county fixed effects to estimate the impact of unemployment changes on enrollment and expenditures after controlling for population and programmatic changes in eligibility and cost sharing. Results. A one-percentage-point increase in a county's unemployment rate was associated with a 4.3% increase in Medicaid enrollment, a 0.9% increase in CHIP enrollment, and an overall increase in public health insurance enrollment of 3.7%. Each percentage-point increase in unemployment was associated with a 6.2% increase in total public health insurance expenditures on children, with Medicaid spending rising by 7.5% and CHIP spending rising by 1.8%. In response to the 6.4 percentage-point increase in the state's unemployment rate during the Great Recession, combined enrollment of children in Alabama's public health insurance programs increased by 24% and total expenditures rose by 40%. Conclusion. Recessions have a substantial impact on the number of children enrolled in CHIP and Medicaid, and a disproportionate impact on program spending. Programs should be aware of the likely magnitudes of the effects in their budget planning. [ABSTRACT FROM AUTHOR]

Objectives. A major responsibility of a local health department (LHD) is to assure public health service availability throughout its jurisdiction. Many LHDs face expanded service needs and declining budgets, making billing for services an increasingly important strategy for sustaining public health service provision. Yet, little practice-based data exist to guide practitioners on what to expect financially, especially regarding timing of reimbursement receipt. This study provides results from one LHD on the lag from service delivery to reimbursement receipt. Methods. Reimbursement records for all transactions at Maricopa County Department of Public Health immunization clinics from January 2013 through June 2014 were compiled and analyzed to determine the duration between service and reimbursement. Outcomes included daily and cumulative revenues received. Time to reimbursement for Medicaid and private payers was also compared. Results. Reimbursement for immunization services was received a median of 68 days after service. Payments were sometimes taken back by payers through credit transactions that occurred a median of 333 days from service. No differences in time to reimbursement between Medicaid and private payers were found. Conclusions. Billing represents an important financial opportunity for LHDs to continue to sustainably assure population health. Yet, the lag from service provision to reimbursement may complicate budgeting, especially in initial years of new billing activities. Special consideration may be necessary to establish flexibility in the budget-setting processes for services with clinical billing revenues, because funds for services delivered in one budget period may not be received in the same period. LHDs may also benefit from exploring strategies used by other delivery organizations to streamline billing processes. [ABSTRACT FROM AUTHOR]

A lack of health insurance has long been associated with negative effects on individual and family health due to access barriers. However, we know little about how a lack of health insurance affects wider communities beyond health care. Based on in-depth interviews in two Los Angeles communities, we report how a lack of health insurance affects the functioning of religious institutions and schools from kindergarten to 12th grade. We find a negative spillover effect at the individual and institutional levels for schools experiencing greater absenteeism due to health insurance problems of pupils. However, we find that religious organizations are little affected by a lack of health insurance of adherents. Instead, churches offer health programs as a means to engage their communities. Besides documenting a negative and a positive spillover effect, we offer a conceptual framework for the qualitative study of health spillover effects and examine the policy implications of our findings. [ABSTRACT FROM PUBLISHER]

Background: Despite the availability of a universal influenza vaccination program in the United States and Canada, seasonal influenza vaccine (SIV) uptake among the elderly remains suboptimal. Understanding the factors that determine SIV uptake in this important population subgroup is essential for designing effective interventions to improve seasonal influenza vaccination among the elderly. We evaluated the determinants of SIV uptake in the elderly in the United States and Canada. Methods: We systematically searched relevant bibliographic databases and websites from 2000 to 2017 for population-based clinical trials or observational studies conducted in community-based elderly individuals in the United States or Canada, irrespective of health status. Two reviewers independently screened the identified citations for eligibility using a two-stage sifting approach to review the title/abstract and full-text article. We gathered data on determinants of uptake (any vaccine receipt) and adherence (receipt of vaccine in more than one season) to seasonal influenza vaccination. Where possible, we pooled the data using inverse variance methods to minimize the variance of the weighted average. Results: Five cross-sectional studies on SIV uptake (none on adherence) from the United States met our eligibility criteria. Being older (pooled odds ratio [POR] = 1.44, 95% Confidence Interval [CI] = 1.11, 1.86); White (POR = 1.33, 95% CI = [1.10, 1.64]); and having higher income (POR = 1.06, 95% CI = [1.04, 1.09]); and health insurance (POR = 1.40, 95% CI = [1.25, 1.55]) were associated with increased SIV uptake. Conclusion: Older, ethnically White, higher income elderly individuals with access to health insurance coverage and a regular health care provider have higher SIV uptake in the United States. There was limited evidence for other socioeconomic and health-related determinants. Further studies are needed to provide an evidence base for planning more effective influenza vaccination programs in the United States. [ABSTRACT FROM AUTHOR]

Background Disease-modifying therapies benefit individuals with relapsing forms of multiple sclerosis, but their utility remains unclear for those without relapses. Objective To determine disease-modifying therapy use and costs in 2009, compare use in 2009 and 2000, and examine compliance with evidence-based guidelines. Methods We determined the extent and characteristics of disease-modifying therapy use by participants in the Sonya Slifka Longitudinal Multiple Sclerosis Study (Slifka) in 2000 (n=2156) and 2009 (n=2361) and estimated out-of-pocket and total (payer) costs for 2009. Two multivariable logistic regressions predicted disease-modifying therapy use. Results Disease-modifying therapy use increased from 55.3% in 2000 to 61.5% in 2009. In 2009, disease-modifying therapy use was reported by 76.5% of participants with relapsing-remitting multiple sclerosis, 73.2% with progressive-relapsing multiple sclerosis, 62.5% with secondary progressive multiple sclerosis, and 41.8% with primary progressive multiple sclerosis. Use was significantly associated with relapsing-remitting multiple sclerosis, shorter duration of illness, one to two relapses per year, non-ambulatory symptoms, using a cane, younger age, higher family income, and having health insurance. Average annual costs in 2009 were US$939–3101 for patients and US$16,302–18,928 for payers. Conclusion Use rates were highest for individuals with relapsing-remitting multiple sclerosis, but substantial for those with progressive courses although clinical trials have not demonstrated significant benefits for them. [ABSTRACT FROM AUTHOR]