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Health care costs for U.S. employers have tripled over the past 20 years. Using firm-specific health expense data, I show that firms negatively adjust capital expenditures and R&D expenses in response to increases in health care costs. The effects are more pronounced for firms that are financially constrained, employ more high-skilled workers, and have less bargaining power relative to insurers. Furthermore, policy uncertainty surrounding health care costs is substantial and discourages capital investment. These findings suggest that an elevated level of health care costs and the associated uncertainty limit a firm's ability to expand physically or through innovation. [ABSTRACT FROM AUTHOR]

Most US workers have health insurance plans sponsored and subsidized by their employers. The US Affordable Care Act (ACA) improved and expanded the availability of non-employer-based health insurance, with protections for pre-existing conditions, guaranteed issue, and community rating in non-group markets. Using National Health Interview Survey data for 2009 to 2018 and a difference-in-differences modeling approach, this study finds that the ACA increased self-employment in 2015 and 2016 among US adults with higher demand for health insurance. The probability of self-employment increased by 1.4 to 1.8 percentage points among adults ages 30 to 64 with at least one pre-ACA declinable condition and no alternative source of health insurance through a spouse's employer or public programs. However, these effects were short-lived. As uncertainty about the long-term viability of the ACA's health insurance exchanges increased in 2017 and 2018, the probability of self-employment among individuals with high demand for insurance fell to pre-ACA levels. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases are rising rapidly in low- and middle-income countries, leading to increased morbidity and mortality. Reducing sedentary behavior (SB) and increasing physical activity (PA) offer numerous health benefits. Workplaces provide an ideal setting for promoting SB/PA interventions; however, understanding the barriers and enablers is crucial for optimizing these interventions in workplace environments. Methods: Nested within a cluster randomised controlled trial (the SMART-STEP trial), the present study employed in-depth interviews with 16 office workers who have completed 24 weeks of two distinct (technology assisted and traditional) workplace SB/PA interventions. Using a deductive analysis, semi-structured interviews were administered to explore the barriers and enablers to the SB/PA interventions at individual, interpersonal and organisational level using the socio-ecological model. Results: Several individual (poor goal setting, perceived health benefits & workload, attitude, intervention engagement), interpersonal (lack of peer support) and organisational (task prioritisation, lack of organisational norm and material or social reward) barriers were identified. Indian women engaged in desk-based office jobs often find themselves burdened with intense home and childcare responsibilities, often without sufficient support from their spouses. A primary concern among Indian office workers is the poor awareness and absence of cultural norms regarding the health risks associated with SB. Conclusions: Raising awareness among workplace stakeholders—including office workers, peers, and the organization—is crucial before designing and implementing SB/PA interventions in Indian workspaces. Personalized interventions for Indian female office workers engaged in desk-bound work are warranted. [ABSTRACT FROM AUTHOR]

The Employee Retirement Income Security Act (ERISA) of 1974 regulates employer-sponsored retirement benefits and also applies to employer-sponsored health plans. ERISA preemption prevents state and local regulation of self-funded, employer-provided health benefits. Proponents argue that ERISA preemption creates a uniform regulatory environment for employers, reduces administrative costs, and fosters innovation. Detractors believe that state and local governments should have a greater role in healthcare reform. Large employers value ERISA preemption for its regulatory certainty, ability to offer consistent benefits across states, and cost reduction. The article discusses the benefits of ERISA preemption for employers in offering consistent and equitable benefits across different states. Executives in a roundtable discussion expressed appreciation for the ability to provide a uniform set of benefits regardless of employee location. They highlighted the advantages of consistency in administration, lower compliance costs, and increased workforce mobility. ERISA preemption also allows for innovation in benefit design and strategies tailored to the specific needs of different workforces. Additionally, it enables employers to deliver high-quality benefits while mitigating costs and provides a competitive advantage in attracting and retaining talent. The potential erosion of ERISA preemption could lead to challenges in providing health benefits and may cause employers to reconsider their approach. However, the executives expressed a commitment to continue offering health benefits for the foreseeable future. [Extracted from the article]

Objective: To understand variation in enrollment in tiered network health plans (TNPs) and the local provider market characteristics associated with TNP penetration. Data Sources and Study Setting: We used 2013–2017 Massachusetts three‐digit ZIP code level employer‐sponsored health insurance enrollment data, data on physician horizontal and vertical affiliations from the Massachusetts Provider Database, state hospital reports in 2013, 2015, and 2017, and the 2013–2017 Massachusetts All‐Payer Claims database. Study Design: Linear regressions were used to estimate associations between TNP and local provider market characteristics. Data Extraction: We constructed measures of TNP penetration and local provider market characteristics and linked these data using three‐digit ZIP code. Principal Findings: TNP penetration was at least 10% in all employer market sectors and highest among jumbo sized employers. All state employee health plan enrollees were in a tiered network health plan. Among enrollees not in the state employee health plan, TNP penetration varied from 6.0% to 19.6% across three‐digit ZIP codes in Massachusetts. TNP penetration was higher in areas with less horizontal and vertical physician market concentration. Conclusions: Market competition, rather than the absolute quantity of physicians in an area, is associated with TNP penetration. [ABSTRACT FROM AUTHOR]

Indonesian laws mandate that every employer should provide health insurance and work accident insurance to their employees. Nevertheless, there is a significant gap in the coverage of employer-sponsored insurance among Indonesian workers. This study examines the coverage of employer-sponsored insurance and work accident insurance and analyses the characteristics of the uninsured working population in Indonesia. We analysed nationally representative cross-sectional data from the National Labour Force Survey (NLFS) conducted between 2018 and 2022. The primary dependent variable was the provision of health insurance and work accident insurance by employers. The independent variables included having any physical disabilities, number of working hours, duration of employment, labour union membership, earning at least the provincial minimum wage, having a written contract and working in high risk jobs. Logistic regression was employed using the R statistical software. The findings indicate that coverage of employer-sponsored health insurance is low in Indonesia—ranging from 36.1% in 2018 to 38.4% in 2022. Workers with a written contract, earning at least the provincial minimum wage, were members of a labour union, employed for at least 5 years and working more than 40 hours a week were more likely to be insured. By contrast, workers who had physical disabilities or were employed in high-risk jobs were less likely to be insured. Our study concludes that having a written employment contract is the single most influential factor that explains the provision of employer-sponsored health insurance in Indonesia. The country's labour laws should therefore formalize the provision of written employment contracts for all workers regardless of the type and nature of work. The existing laws on health insurance and work accident insurance should be enforced to ensure that employers meet their constitutionally mandated obligation of providing these types of insurance to their workers, particularly those engaged in high risk jobs. [ABSTRACT FROM AUTHOR]

Hanjin Heavy Industries Construction Philippines Inc. offers CSR services to motivate employees and ensure security. Employees receive free shuttle buses, food allowances, medical and dental missions, schools, and housing loans. However, the infrequent utilization of these services could potentially impact job performance. Employee satisfaction with these services may influence their satisfaction, leading to lower working conditions. This study aimed to assess employee awareness and satisfaction with Hanjin social responsibility services in 2019. The research involved 11 employees (85) and 25 department managers from the Hanjin Subic Shipyard. The study used questionnaires to gather data on employees' profiles and awareness of the company's benefits. The results were analyzed using descriptive statistical tools and gathered through a pilot data-gathering process. The survey shows that all respondents benefit from the company's annual physical examinations, which are both the company's and employees' responsibility. The services include free shuttles, food allowances, medical and dental assistance, housing, and educational assistance. Basic occupational safety and health training was taken by 41.82 percent of respondents. Management training and development was received by 0.91% of employees. Higher awareness contributes to employee satisfaction with Hanjin CSR services. The management of Hanjin raises employee awareness of CSR services by holding a symposium and disseminating various information, for example. [ABSTRACT FROM AUTHOR]

This article estimates the effect of labor-market concentration on labor compensation across the US private sector since 2000. The authors distinguish between concentration in local labor markets and local product markets while guarding against bias from confounded product-market concentration. The analysis extends beyond wages to rates of employment-based health insurance coverage. Reported results suggest negative effects of labor-market concentration on labor compensation. These effects are exacerbated when product-market concentration is higher or when workers are older. [ABSTRACT FROM AUTHOR]

Background: The economic assessment of health care models in palliative care promotes their global development. The purpose of the study is to assess the cost-effectiveness of a palliative care program (named Contigo) with that of conventional care from the perspective of a health benefit plan administrator company, Sanitas, in Colombia. Methods: The incremental cost-utility ratio (ICUR) and the incremental net monetary benefit (INMB) were estimated using micro-costing in a retrospective, analytical cross-sectional study on the care of terminally ill patients enrolled in a palliative care program. A 6-month time horizon prior to death was used. The EQ-5D-3 L questionnaire (EQ-5D-3 L) and the McGill Quality of Life Questionnaire (MQOL) were used to measure the quality of life. Results: The study included 43 patients managed within the program and 16 patients who received conventional medical management. The program was less expensive than the conventional practice (difference of 1,924.35 US dollars (USD), P = 0.18). When compared to the last 15 days, there is a higher perception of quality of life, which yielded 0.25 in the EQ-5D-3 L (p < 0.01) and 1.55 in the MQOL (P < 0.01). The ICUR was negative and the INMB was positive. Conclusion: Because the Contigo program reduces costs while improving quality of life, it is considered to be net cost-saving and a model with value in health care. Greater availability of palliative care programs, such as Contigo, in Colombia can help reduce existing gaps in access to universal palliative care health coverage, resulting in more cost-effective care. [ABSTRACT FROM AUTHOR]

Background: Evaluating healthcare interventions for their impacts beyond health outcomes may result in recognition of changes in human capital, income level, tax revenue, and government spending, which could affect economic growth and population health. In this paper, we document instances where current health technology assessment (HTA) practices fail to account for the impacts of healthcare interventions on broader society beyond the healthcare sector. Methods: We propose a novel conceptual framework, highlighting its three components (distributional cost-effectiveness analysis [DCEA], input-output model, and voting scheme) and their contributions to capturing the economic and societal ripple effects of healthcare interventions. This manuscript also outlines a case study in which the framework is applied to the reassessment of a previously evaluated digital health therapeutic for the treatment of opioid use disorder (OUD) compared with standard of care, demonstrating its practical application. Results: The DCEA health value metric indicates that digital therapeutic is more equitable, favoring socioeconomically disadvantaged groups, while standard of care exacerbates health inequality by benefiting the already advantaged. Additionally, digital therapeutic shows potential for boosting productivity, raising income, and creating jobs, supporting its consideration by employer-sponsored health plans to optimize resource allocation for treating OUD. Conclusion: The conceptual framework provides insights for enhancing HTAs to incorporate the broader economic and societal impacts of healthcare interventions. By integrating DCEA, extended HTA analysis with input-output modeling, and a voting scheme, decision makers can make informed choices aligned with societal priorities, although further research and validation are necessary for practical implementation across diverse healthcare contexts. [ABSTRACT FROM AUTHOR]

Objective: The authors assessed changes in state insurance laws related to coverage for substance use disorder treatment across public and private insurance sectors from 2006 through 2020 in all 50 U.S. states. Methods: Structured policy surveillance methods, including a coding protocol with duplicate coding and quality controls, were used to track changes in state laws during the 2006–2020 period. The legal database Westlaw was used to identify relevant statutes within each state's commercial insurance (large group, small group, and individual), state employee health benefits, and Medicaid codes. The legal coding instrument included six questions across four themes: parity, mandated coverage, definition of substance use disorders, and enforcement and compliance. Scores were calculated to reflect the comprehensiveness of states' laws and to interpret changes in scores over time. Results: Comprehensiveness scores across all sectors (on a 0–9 scale) increased, on average, from 1.47 in 2006 to 2.84 in 2020. In 2006, mean scores ranged from 0.47 (state employee sector) to 2.80 (large-group sector) and in 2020, from 1.22 (state employee) to 4.26 (large group). Conclusions: Comprehensiveness of state insurance laws in relation to substance use disorder treatment improved across all insurance sectors in 2006–2020. The State Substance Use Disorder Insurance Laws Database created in this study will aid future legal epidemiology studies in assessing the cumulative effects of parity-related insurance laws on outcomes of substance use disorder treatments. [ABSTRACT FROM AUTHOR]

We provide the first evidence on employer health insurance decisions regarding same-sex domestic partner (SSDP) benefits before and after nationwide legal same-sex marriage (SSM) was adopted in the United States by Obergefell v. Hodges , 576 U.S. 644 (2015). Using rich microdata on over 250,000 establishments from the 2013–19 Medical Expenditure Panel Survey–Insurance Component (MEPS-IC), we show that private employers were 7 percentage points more likely to offer SSDP benefits than different-sex domestic partner (DSDP) benefits prior to 2015. After Obergefell , however, the likelihood of SSDP benefits among these employers fell significantly, back to the DSDP benefit offer rate. Novel linkages between MEPS-IC establishments and Internal Revenue Service data allow us to show that these reductions were driven by establishments whose parent firms were more exposed to legal SSM prior to Obergefell owing to the geographic distribution of their workforce. Our results suggest the importance of within-firm pay equity norms as a reason for SSDP benefits prior to nationwide SSM and provide the first direct evidence that legal access to SSM was associated with significantly reduced SSDP benefit offer rates. [ABSTRACT FROM AUTHOR]

This article explores the challenges of measuring total-premium inflation for health insurance in the Consumer Price Index (CPI). The current method used in the CPI only captures the price of services provided by insurance companies, not the total price of health insurance. However, an implied total-premium measure can be constructed from CPI data. The article compares this implied measure with total-premium inflation as measured by the Producer Price Index (PPI) and discusses the strengths and limitations of both direct and indirect pricing methods. The Committee on National Statistics (CNSTAT) recommends continuing with the indirect pricing method for now, but also suggests improvements to address its limitations. The article also introduces the concept of a CPI total-premium index, which combines the CPI for health insurance with indexes for noninsurance medical goods and services to create an index for implied total-premium inflation. The results show that the CPI total-premium index increased less than the CPI for health insurance but more than the CPI for medical care and the industry PPI for health insurance. The article concludes that the CPI for medical care can be used as an approximation of total-premium inflation and mentions recent improvements to the CPI health insurance index. [Extracted from the article]

The vital role of healthcare financing in achieving universal health coverage is indisputable. However, most countries, including Malaysia, face challenges in establishing an equitable and sustainable healthcare financing system due to escalating healthcare costs, an ageing population and a growing disease burden. With desirable pre-payment and risk pooling features, private health insurance (PHI) is considered an alternative financing option to reduce out-of-pocket (OOP) medical expenditure. However, ongoing theoretical and empirical debates persist regarding the adequacy of financial risk protection provided by PHI largely because it depends on its role, the benefit design and the regulations in place. Our study aimed to investigate the effect of supplementary PHI on OOP inpatient medical expenditure in Malaysia. Secondary data analysis was conducted using the Malaysian National Health and Morbidity Survey 2019 dataset. A total of 983 respondents with a history of inpatient hospitalization in the past 12 months were included in the study. Instrumental variable analysis using a two-stage residual inclusion was performed to address endogeneity bias, with wealth status and education level as the instrumental variables. Tobit regression model was used in the second stage considering the censored distribution of the outcome variable. Missing data were handled using multiple imputation. About one-fifth of the respondents had PHI. In this study, we found that having PHI significantly increased OOP inpatient medical expenditure in all three marginal effects. Additionally, age, residential location, ethnicity (citizenship), being covered by government guarantee letter, government funding and employer-sponsored health insurance were other significant factors associated with OOP inpatient medical expenditure. Our findings undermine a key justification to advocate PHI uptake among the population, with a need for the Malaysian government to reassess the role of PHI in healthcare financing and reconsider PHI subsidization policy. Regulations should also be strengthened to enhance the financial risk protection provided by PHI. [ABSTRACT FROM AUTHOR]

Despite the existence of effective treatments, obesity continues to present a severe public health crisis. Limited access to treatments works against efforts to reduce obesity prevalence. A major barrier to treatment access is a lack of insurance coverage. This study focused on an important population of stakeholders: benefits managers. The purpose of this study was to explore the relationships between attitudes about insurance coverage of obesity treatments and obesity stigma. Benefits managers have the ability to advocate for insurance coverage of medical interventions. We assessed whether attitudes toward covering obesity benefits for employees could be modified by receiving targeted information or were associated with particular factors. We recruited participants from Dun & Bradstreet's employer database using emails. Participants were randomized to one of three conditions that provided written information about: (1) prevalence of obesity (control), (2) prevalence + financial implications of obesity, and (3) prevalence + physiology of obesity. Questionnaires were self-administered online. The response rate was 4.8%, with 404 participants meeting eligibility criteria. While attitudes toward coverage of obesity interventions did not differ significantly based on condition (p > 0.05), gender, history of previous obesity treatment, and an individual's likelihood to attribute obesity to biological and environmental factors showed significant associations with supporting coverage of obesity treatment (p < 0.05). Findings suggest that understanding obesity as a condition caused by biological factors as opposed to personal responsibility and behavior is associated with greater support for coverage of all its treatments. • Lack of insurance coverage is a frequently cited barrier to obesity treatment. • Little is known about the views of key stakeholders such as benefits managers. • The literature yields mixed findings on ways to influence attitudes toward obesity. • Certain characteristics were associated with benefits managers' support of coverage. • Greater awareness of the biological factors of obesity may increase coverage support. [ABSTRACT FROM AUTHOR]

Key Points: Question: Do health care workers benefit from improved health sector finances? Findings: In this difference-in-differences study, only health care workers in higher-earning occupations (eg, registered nurses, physicians, and managers) experienced increases in annual income after state-level Medicaid expansion, which has been shown to improve health care organization finances. Health care workers in lower-earning occupations (eg, health aides, attendants, service staff) were more likely to report coverage under the Medicaid program after expansion and less likely to hold employer–sponsored health insurance. Meaning: Improved health care organization finances may increase inequality in the health care workforce, with implications for compounding structural inequalities within the industry and worker and patient health and well-being. Importance: The extent to which changes in health sector finances impact economic outcomes among health care workers, especially lower-income workers, is not well known. Objective: To assess the association between state adoption of the Affordable Care Act's Medicaid expansion—which led to substantial improvements in health care organization finances—and health care workers' annual incomes and benefits, and whether these associations varied across low- and high-wage occupations. Design, Setting, and Participants: Difference-in-differences analysis to assess differential changes in health care workers' economic outcomes before and after Medicaid expansion among workers in 30 states that expanded Medicaid relative to workers in 16 states that did not, by examining US individuals aged 18 through 65 years employed in the health care industry surveyed in the 2010-2019 American Community Surveys. Exposure: Time-varying state-level adoption of Medicaid expansion. Main Outcomes and Measures: Primary outcome was annual earned income; secondary outcomes included receipt of employer–sponsored health insurance, Medicaid, and Supplemental Nutrition Assistance Program benefits. Results: The sample included 1 322 263 health care workers from 2010-2019. Health care workers in expansion states were similar to those in nonexpansion states in age, sex, and educational attainment, but those in expansion states were less likely to identify as non-Hispanic Black. Medicaid expansion was associated with a 2.16% increase in annual incomes (95% CI, 0.66%-3.65%; P =.005). This effect was driven by significant increases in annual incomes among the top 2 highest-earning quintiles (β coefficient, 2.91%-3.72%), which includes registered nurses, physicians, and executives. Health care workers in lower-earning quintiles did not experience any significant changes. Medicaid expansion was associated with a 3.15 percentage point increase in the likelihood that a health care worker received Medicaid benefits (95% CI, 2.46 to 3.84; P <.001), with the largest increases among the 2 lowest-earning quintiles, which includes health aides, orderlies, and sanitation workers. There were significant decreases in employer–sponsored health insurance and increases in SNAP following Medicaid expansion. Conclusion and Relevance: Medicaid expansion was associated with increases in compensation for health care workers, but only among the highest earners. These findings suggest that improvements in health care sector finances may increase economic inequality among health care workers, with implications for worker health and well-being. This study examines the difference in health care worker compensation between states that expanded and those that did not expand Medicaid after the passage of the Affordable Care Act. [ABSTRACT FROM AUTHOR]

COVID-19 changed the landscape of employment and financial security in the USA, contributing to multi-systemic disruptions in family life. Using dyadic, daily-diary parent–adolescent data from a nationwide American sample (18,415 daily assessments; 29 days: 4/8/2020–4/21/2020 and 5/18/2020–6/1/2020; N = 635 parent–adolescent dyads), this intensive longitudinal study investigated how COVID-19-related job loss and working-from-home (WFH) arrangements influenced parents' and children's daily affect indirectly through family functioning (i.e., parent–adolescent conflict, inter-adult conflict, and parental warmth) and whether these links varied by family socioeconomic status (SES). Parental employment status was linked to these family relational dynamics, which were then connected to parents' and adolescents' daily affect. Although SES did not moderate these links, low-income families were more likely to experience job loss, parent–adolescent conflict, and inter-adult conflict and less likely to WFH than higher-income families. As inter-relations within the family are a malleable point for intervention, clinicians working with families recovering from the fiscal impact of the COVID-19 pandemic are encouraged to use approaches that strengthen family relationships, especially between adolescents and their parents. Unemployment subsidies are discussed as a means to support families struggling with job loss, and organizations are urged to consider the benefits of WFH on employee health and work-life balance. [ABSTRACT FROM AUTHOR]

Abstract Objectives To explore the perceptions that Colombians have about voluntary private health insurance plans (VPHI) in the health system to identify the tensions that exist between the public and private systems. Methods A qualitative case study approach with 46 semi structured interviews of patients, healthcare workers, healthcare administrators, decision-makers, and citizens. Interviews were recorded, transcribed, anonymized, digitally stored, and analyzed following grounded theory guidelines. Results We developed a paradigmatic matrix that explores how, in a context mediated by both the commodification of health and social stratification, perceptions about the failures in the public health system related to lack of timely care, extensive administrative procedures, and the search for privileged care led to positioning VPHI as a solution to these failures. The interviewees identified three consequences of using VPHI: first, the worsening of problems of timely access to care in the public system; second, higher costs for citizens translated into double payment for technologies and services to which they are entitled; third, the widening of inequity gaps in access to health services between people with similar needs but different payment capacities. Conclusions These findings can help decision makers to understand citizens´ perceptions about the implications that VPHI may have in worsening equity gaps in the Colombian health system. It also shows, how VPHI is perceived as a double payment for services covered within social security plans and suggests that the perceived lack of timely access to care in the public systems and the fear that citizens have for themselves or their family members when using suboptimal healthcare are important drivers to purchase these private insurances.

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The article focuses on the challenges faced by caregivers in the workplace, highlighting findings from the 2023 Workplace Wellness Survey. Topics covered include the demographics and socioeconomic differences between caregivers and non-caregivers, their caregiving duties, well-being, access to workplace benefits, and their opinions on employer responsibilities and the value of benefits.

In "Divorce, American Style: Fighting for Women's Economic Citizenship in the Neoliberal Era," Suzanne Kahn explores the experiences of women navigating divorce in the United States between the 1970s and 1990s. As divorce rates rose, women who had relied on their husbands for financial support found themselves facing economic hardships. Divorce reformers, inspired by the feminist movement, sought to redefine women's economic citizenship and challenge the unequal distribution of marital assets. While some progress was made, compromises and conservative political power limited the reforms, resulting in wealthier women gaining more access to family property while lower-income women still faced inequality. The book highlights the complex history of marriage, the welfare state, and the feminist movement during this period. [Extracted from the article]

Abstract Premiums and eligibility for health insurance may cause a “marriage lock,” in which couples stay married for the sake of maintaining health insurance coverage. By using the Health and Retirement Study for adults aged 60–70, I examine whether employer‐based health insurance coverage for the spouse discourages divorce for spousal health insurance coverage‐dependent individuals. Diverse difference‐in‐difference models provide evidence of a 7 percentage points increase in the number of divorces upon achieving Medicare eligibility at age 65 for people with spousal insurance coverage relative to those without it. The estimates thus provide evidence that marriage lock exists.

Background: Recent advancements in the clinical management of metastatic prostate cancer include several costly therapies and diagnostic tests. The objective of this study was to provide updated information on the cost to payers attributable to metastatic prostate cancer among men aged 18 to 64 years with employer‐sponsored health plans and men aged 18 years or older covered by employer‐sponsored Medicare supplement insurance. Methods: By using Merative MarketScan commercial and Medicare supplemental data for 2009–2019, the authors calculated differences in spending between men with metastatic prostate cancer and their matched, prostate cancer‐free controls, adjusting for age, enrollment length, comorbidities, and inflation to 2019 US dollars. Results: The authors compared 9011 patients who had metastatic prostate cancer and were covered by commercial insurance plans with a group of 44,934 matched controls and also compared 17,899 patients who had metastatic prostate cancer and were covered by employer‐sponsored Medicare supplement plans with a group of 87,884 matched controls. The mean age of patients with metastatic prostate cancer was 58.5 years in the commercial samples and 77.8 years in the Medicare supplement samples. Annual spending attributable to metastatic prostate cancer was $55,949 per person‐year (95% confidence interval [CI], $54,074–$57,825 per person‐year) in the commercial population and $43,682 per person‐year (95% CI, $42,022–$45,342 per person‐year) in the population covered by Medicare supplement plans, both in 2019 US dollars. Conclusions: The cost burden attributable to metastatic prostate cancer exceeds $55,000 per person‐year among men with employer‐sponsored health insurance and $43,000 among those covered by employer‐sponsored Medicare supplement plans. These estimates can improve the precision of value assessments of clinical and policy approaches to the prevention, screening, and treatment of prostate cancer in the United States. Annual spending attributable to metastatic prostate cancer was $55,949 per person‐year in the population covered by commercial insurance and $43,682 in the population covered by employer‐sponsored Medicare supplement plans, both in 2019 US dollars. These estimates can improve the precision of value assessments of clinical and policy approaches to the prevention, screening, and treatment of prostate cancer in the United States. [ABSTRACT FROM AUTHOR]

Employers may evaluate employee claims data for various reasons, including assessment of medical insurance and wellness plan efficacy, monitoring employee health trends, and identifying focus areas for wellness measures. The objective of this scoping review (ScR) is to describe the available literature reporting the use, applications, and outcomes of employee health claims data by self-insured employers. The ScR was conducted in a stepwise manner using an established framework: identifying the research question, identifying and selecting relevant studies, charting the data, and collating and reporting results. Literature searches were conducted in PubMed and Embase. Studies of self-insured employee populations that were conducted by the employer/s through May 2022 were identified using predefined criteria. Forty-one studies were included. The majority (90%) were cohort study designs; most employers (51%) were in industries such as aluminum production and health insurance providers. Twenty-four (59%) studies supplemented claims data with other sources such as human resource data to evaluate programs and/or health outcomes. A range of exposures (eg, chronic conditions, wellness program participation) and outcomes (eg, rates or costs of conditions, program effectiveness) were considered. Among the 25 studies that reported on patient confidentiality and privacy, 68% indicated institutional review board approval and 48% reported use of deidentified data. Many self-insured employers have used employee health claims data to gain insights into their employees' needs and health care utilization. These data can be used to identify potential improvements for wellness and other targeted programs to improve employee health and decrease absenteeism. [ABSTRACT FROM AUTHOR]

This article studies whether corporate environmental performance affects its health benefit costs. I find a firm's environmental performance is negatively associated with its employee health benefit costs. Cross‐sectional tests also show the effect is stronger for companies with improving employee health or located in a region with higher population health risks. In addition, the correlation only exists for chemicals released onsite as opposed to offsite release, indicating the effect is driven by the pricing of health risks, rather than pure ethical reasons. These results suggest that insurance companies promote corporate policyholders' green behavior indirectly by rationally pricing corporate environmental efforts. [ABSTRACT FROM AUTHOR]

Background: Dysfunction in the hypothalamic-pituitary-adrenal axis has been associated with depressive and anxiety disorders. Little is known about the risk for these disorders among individuals with congenital adrenal hyperplasia (CAH), a form of primary adrenal insufficiency. Objective: We investigated the prevalence of depressive and anxiety disorders and antidepressant prescriptions in two large healthcare databases of insured children, adolescents, and young adults with CAH in the United States. Methods: We conducted a retrospective cohort study using administrative data from October 2015 through December 2019 for individuals aged 4--25 years enrolled in employer-sponsored or Medicaid health plans. Results: Adjusting for age, the prevalence of depressive disorders [adjusted prevalence ratio (aPR) = 1.7, 95% confidence interval (CI): 1.4-2.0, p<0.001], anxiety disorders [aPR = 1.7, 95% CI: 1.4-1.9, p<0.001], and filled antidepressant prescriptions [aPR = 1.7, 95% CI: 1.4-2.0, p<0.001] was higher among privately insured youth with CAH as compared to their non-CAH peers. Prevalence estimates were also higher among publicly insured youth with CAH for depressive disorders [aPR = 2.3, 95% CI: 1.9-2.9, p<0.001], anxiety disorders [aPR = 2.0, 95% CI: 1.6-2.5, p<0.001], and filled antidepressant prescriptions [aPR = 2.5, 95% CI: 1.9-3.1, p<0.001] as compared to their non-CAH peers. Conclusions: The elevated prevalence of depressive and anxiety disorders and antidepressant prescriptions among youth with CAH suggests that screening for symptoms of depression and anxiety among this population might be warranted. [ABSTRACT FROM AUTHOR]

The 2003 Medicare Modernization Act introduced income-related premiums on Medicare coverage for professional services (Part B) for the first time. Beginning in 2007, higher-income households were required to pay higher premiums for Part B coverage, which raises the price of Medicare relative to employer-sponsored health insurance for these households. The authors exploit this exogenous change in Medicare policy to examine the impact of Part B premiums on the labor supply decisions of older adults. They find that higher Medicare premiums delay retirement. Findings have important implications for Medicare policy and labor markets. [ABSTRACT FROM AUTHOR]

Little is known about how a consumer would choose a health plan if cost was not an option such as in the Military Health System. We sought to identify how to recruit TRICARE beneficiaries into new pilot programs challenged by low recruitment. We developed a semistructured interview guide by adapting a framework established by Klinkman to assess factors in choosing a health plan. Using social media platforms, we recruited TRICARE Prime and Select beneficiaries to participate in key informant interviews from October to December 2022. We conducted inductive thematic analysis to determine key areas of concern. We interviewed a total of 20 TRICARE Prime and Select beneficiaries. The majority were women, above age 40, had a master's degree, a sponsor in the US Army and of senior officer rank. Four overarching themes emerged: (I) patient choice; (II) access to care; (III) quality of care; and (IV) cost. This evaluation of TRICARE beneficiaries explores how to motivate high-quality value-based care in a traditionally fee for service system. [ABSTRACT FROM AUTHOR]

The new, employee health plan (EHP) focused, population health initiative was established at Atrium Health Wake Forest Baptist in October 2020. The initiative's goals are to reduce health care costs and optimize patient care by providing patient-specific recommendations to help manage chronic disease states in the ambulatory care setting. This project's purpose is to quantify and categorize pharmacist recommendations implemented and not implemented. Describe the implementation of pharmacist recommendations in a new, population health program. Eligible patients: >18 years of age, diagnosed with type 2 diabetes, baseline HbA1c > 8%, and enrolled in the EHP. Patients were identified retrospectively through an electronic health record report. The primary endpoint assessed the proportion of pharmacist recommendations implemented. Interventions implemented and not implemented were categorized and reviewed for timely optimization of patient care and quality improvement. Overall, 55.7% of pharmacist recommendations were implemented. The most common reason recommendations were not implemented was that they were not addressed by the provider. The most common pharmacist recommendation was a drug therapy addition. Recommendations were implemented in a median time of 44 days. Over half of pharmacist recommendations were implemented. Provider communication and awareness was identified as a barrier for this new initiative. Increasing provider education and advertisement of pharmacist services should be considered to increase future implementation rates. The project identified a need for optimization of timely patient care by prioritizing patient charts prior to their next applicable provider visit. [ABSTRACT FROM AUTHOR]

Competition policy, Healthcare markets, Hospital monopolies, Provider consolidation, D42, D42, I13, K21, L4 I. HOSPITAL CONSOLIDATION AND THE GRADUAL EMERGENCE OF 1990s ANTITRUST POLICY Consolidation by healthcare providers began with an aggressive wave of hospital mergers in the 1990s. Keywords: Competition policy; Healthcare markets; Hospital monopolies; Provider consolidation; D42; I13; K21; L4 EN Competition policy Healthcare markets Hospital monopolies Provider consolidation D42 I13 K21 L4 265 271 7 08/11/23 20230701 NES 230701 Antitrust policy in the healthcare sector is perennially 10 years behind the industry. "Cross-market" mergers A third consolidation challenge emerging with greater frequency is the so-called "cross-market" hospital merger. [Extracted from the article]

Introduction: Among urological malignancies, the diagnosis and treatment of urinary bladder cancer (UBC) incurs the highest cost per patient. Our objective was to broaden the current understanding of how demographic, socioeconomic, education, and insurance-related factors influence UBC management. Methods: Between January 2017 and December 2019, all patients with nonmetastatic bladder cancer were included. The demographic, treatment, and follow-up details were retrieved from a prospectively maintained database, and the Modified Kuppuswamy Index was used to evaluate the patients' socioeconomic level. Patients were divided into the completed treatment group, or the incomplete treatment group based on adherence to the initially intended treatment plan. Patients who presented with benign disease or metastases were not included. Results: Eighty-nine patients did not complete the initially intended course of treatment out of 132 patients who needed additional management after the initial transurethral resection. Comparable risk factors and demographic profiles existed in both groups. Patients with intermediate-risk disease are more likely to fail to adhere to the initial intended treatment (odds ratio [OR] = 0.09; 95% confidence interval [CI]: 0.02-0.30). On logistic regression analysis, upper socioeconomic status (OR = 6.8; 95% CI: 0.35-132.1) patients and patients with higher educational status of graduation or above (OR = 3.62; 95% CI: 0.75-17.43) had higher chances of treatment completion. Education status significantly impacted treatment completion on multivariate analysis (P = 0.01). Patients who utilized employer-funded insurance had better treatment compliance (OR = 4.1; 95% CI: 0.90-18.7). The compliance was unaffected by smoking, occupation, or other demographic factors. Conclusion: Patients with low economic status, low levels of education, and who need adjuvant intravesical therapy had considerably greater treatment dropout rates. [ABSTRACT FROM AUTHOR]

The article discusses the pricing differences and cost implications of biologic medications and biosimilars based on the site of treatment. It highlights that while the use of biosimilars is increasing and can potentially lead to savings, the markups on biologics in hospital outpatient departments (HOPDs) are higher than those on biosimilars, impacting cost savings and hindering the full potential of biosimilar competition.