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Individuals' health status is an essential indicator of the overall strength of a country. Existing literature has studied the determinants of individuals' health, but there is no direct evidence to date on the impact of mobile payment on health. To supplement relevant research and provide insightful policy suggestions to families, government and societies, based on data of 32,058 observations from the 2017 China Household Finance Survey, we estimate the effects of mobile payment on physical health using ordinary least squares and two-stage least squares strategy. This paper provides direct evidence that mobile payment has a positive impact on citizens' physical health. Heterogeneity analysis shows that mobile payment has a more profound impact on the health of citizens who are rural and less educated. Finally, further findings in this paper suggest that commercial insurance and leisure consumption are the mechanism through which the link between mobile payment and individuals' health operates., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhang, Zhang and Xia.)

Background: The purpose of this study was to assess select medication utilization prior to duloxetine initiation among patients with major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, fibromyalgia, and musculoskeletal pain associated with osteoarthritis or low back pain. Methods: Commercially insured duloxetine initiators between January 1, 2007 and March 31, 2010 were identified from a large US administrative claims database. Disease subgroups were constructed based on diagnosis from medical claims during the 12 months prior to duloxetine initiation. Prior use of antidepressants, anticonvulsants, opioids, nonsteroidal anti-inflammatory drugs, and muscle relaxants was assessed during the 12-month preinitiation period. Results: This study identified 56,845 (2007), 44,838 (2008), and 65,840 (January 2009 to March 2010) duloxetine initiators. Among the 2009 initiators, utilization patterns were similar for patients with major depressive disorder and generalized anxiety disorder, with antidepressants being the most used (84% and 80%, respectively), followed by opioids (58% and 55%, respectively). Patients across pain-related conditions also had similar utilization patterns, with opioid use being the highest (76%-82%), followed by antidepressants (65%-72%). Use of other medication classes was common (29%-63%) but less frequent, and over 50% of the patients used any antidepressants, 70% used any antidepressants or anticonvulsants, and 90% used any antidepressants, anticonvulsants, or opioids. Trends in the use of these select medications were similar between 2007 and 2009. Conclusion: Patients used several types of medications over the 12 months prior to initiating duloxetine across disease states, with antidepressants and opioids being the most frequently used medications. Trends of select medication use were similar over time. [ABSTRACT FROM AUTHOR]

An extensive literature has demonstrated geographic variation in medical services and this variation has been largely attributed to the health care system and not to regional differences in patient behavior. We use empirical Bayes shrinkage models, conditional on patient, firm, and market covariates, to investigate geographic variation in adherence to prescription medications across hospital referral regions (HRRs). Models are estimated for commercially insured patients in 11 combinations of chronic diseases and drug classes. We use factor analysis to create a market-level composite measure of adherence that we relate to adjusted market-level spending on non-drug services. We find that there is a very small amount of variation in adherence to prescription drugs across HRRs supporting the widely held assumption that geographic variation is attributable to the health system. Markets with high adherence have systematically lower medical spending, and this inverse correlation is more likely due to unobserved market traits. [ABSTRACT FROM AUTHOR]

Objective: To profile women treated for uterine leiomyomas who are covered by commercial insurance from large, self-insured employers in the United States. Design: Retrospective, observational study. Setting: Inpatient, outpatient, and prescription drug experience of women with employer-sponsored insurance in the United States. Patient(s): Data were obtained from the MarketScan insurance databases for 1999 through 2004 and weighted to represent the population of women with employer-sponsored health insurance in the United States. Intervention(s): None. Main Outcome Measure(s): The proportion of women with clinically significant leiomyomas was determined in each year, based on inpatient and outpatient medical claims with diagnostic codes indicating leiomyoma. Patient characteristics, comorbidities, prescription drug treatments, and surgical interventions were profiled in 2004. Result(s): Approximately 1% of women had clinically significant leiomyomas. Comorbid genital or menstrual conditions were common and much more prevalent for women with leiomyomas. Of women with leiomyomas, 18.4% received no surgical or prescription drug treatment, whereas 16.8% received only surgical treatment, 22.4% received only prescription drug treatment, and 42.4% received both. Hysterectomy was the most common surgical treatment. Conclusion(s): Generalizing from this sample, we estimate that 443,445 women with employer-sponsored insurance in the United States had clinically significant leiomyomas in 2004. [Copyright &y& Elsevier]

Objective : To demonstrate the effect of risk adjustment methodologies compared to crude rates in evaluating the rate of primary cesarean deliveries in managed care plans, after accounting for known demographic and clinical factors. Risk adjustment allows for a more accurate comparison of primary cesarean delivery rates among plans, eliminating potential confounding factors that could influence rates. Methods : Data was collected from managed care plans as part of their 1998 Quality Assurance Reporting Requirements (QARR). Medicaid and commercial populations were matched to New York State Department of Health Vital Statistics birth file to produce a crude measure of cesarean deliveries per plan. Logistic regression models were then used to adjust for maternal education, age, race/ethnicity, obstetrical history, preexisting comorbid conditions, obstetrical conditions, and pregnancy-related conditions to produce adjusted rates. Results : For Medicaid, the crude analysis showed four plans that were significantly lower than the statewide Medicaid managed care rate of 9.5 per 100 live births. One plan was significantly higher. The risk-adjusted results showed one plan being significantly lower than the statewide average and none being higher. For the commercial population, seven plans were significantly lower than the average of 16.3 and four plans were higher. After risk-adjusting, three plans were significantly lower and three plans were significantly higher than the statewide average. Conclusions : Risk-adjustment of primary cesarean delivery rates allows for a more accurate comparison among managed care plans. It is hoped that the generation and publication of more accurate rates will facilitate the acceptance and use of this information by clinicians in managed care plans to focus on improving health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine the relative importance of enrollee, physician, medical group, and healthcare plan characteristics as determinants of healthcare use and expenditures in commercially insured children <18 years of age enrolled in managed care health plans. We focused on the effects of age and benefit level, the two most important predictors of cost and utilization in our study of adults. Methods: This study included 67,432 commercially insured children who were between 1 and 18 years of age, and were cared for by 790 primary care physicians, who practiced in 60 medical care groups in Washington State. Plan enrollment and utilization data for 1994 were linked to a survey of medical care groups contracting with three managed care health plans. Benefit level for each enrollee was defined as low, medium, or high and was based on cost sharing by the health plan for hospitalization, outpatient care, and emergency department services. The three outcome measures included estimated total per member per year charges, number of ambulatory visits, and hospital days. Results: In multivariate analysis, enrollee age was the most important determinant of total charges, with younger children incurring higher charges and utilization. For children 5 years and younger, mean total per member per year charges were $617 in the low-benefit category and $878 in the high category (p < .0001). These differences were less apparent for children 6–12 years ($355 versus $420, p = .012), and were not statistically significant for children 13 years and older ($503 versus $552, p = .14). The annual number of visits increased with benefit level for children of all ages. Conclusions: Enrollee age and benefit level were the most important determinants of healthcare use and expenditures in children enrolled in managed care health plans. [ABSTRACT FROM AUTHOR]

Background: Research has shown buprenorphine/naloxone to be an effective medication for treating individuals with opioid use disorder. At the same time, treatment discontinuation rates are reportedly high though much of the extant evidence comes from studies of the Medicaid population.Objectives: To examine the pattern and determinants of buprenorphine/naloxone treatment discontinuation in a population of commercially insured individuals.Research Design: We performed a retrospective observational analysis of Massachusetts All Payer Claims Data (MA APCD) covering years 2013 through 2017. We defined treatment discontinuation as a gap of 60 consecutive days without a prescription for buprenorphine/naloxone within a time frame of 24 months from the initiation of treatment. A mixed-effect Cox proportional hazard model examined the associated risk of discontinuing treatment with baseline predictors.Subjects: A total of 5134 individuals who were commercially insured during the study period.Measures: Buprenorphine/naloxone treatment discontinuation.Results: Overall 75% of individuals had discontinued treatment within two years of initiating treatment, and median time to discontinuation was 300 days. Patients aged between 18 and 24 years (HR = 1.436, 95%, CI = 1.240-1.663) and receiving treatment from prescribers with high panel-size (HR = 1.278, 95% CI = 1.112-1.468) had higher risk of discontinuing treatment. On the contrary, patients receiving treatment from multiple prescribers had lower associated risk of treatment discontinuation.Conclusions: A substantial percentage of patients discontinue treatment well before they can typically meet criteria for sustained remission. Further investigations should assess the clinical outcomes following premature discontinuation and identify strategies for retaining patients in treatment. [ABSTRACT FROM AUTHOR]

Hospitals must do more with less, making efficiency a priority. Discharge delays create challenges for acute care hospitals. Some delays are due to patients waiting for a guardian-a person appointed to assist an adult who lacks decision-making capacity. Previous studies examine the burden of excess days in a single academic medical center (AMC); however, these institutions do not represent the entire hospital system. This descriptive study expands upon previous analyses by calculating the financial implications of medically unnecessary days in a state's hospitals to payers. Two models are presented: one calculates the gross patient service revenues required to support excess days; the other calculates the expense to hospitals. Results suggest that substantial funds are required to support excess days. Funds may be better allocated to support the health and well-being of people needing medical care or to address the cause of delays due to waiting for guardianship.

Under the context of rapid economic and social development, and growing demands for a better life, Chinese residents have been increasingly concerned with their health status and issues. In this study, the internal relations between the purchase of commercial insurance by residents and their health status are analyzed and studied with a polytomous logit model based on the data of Chinese General Social Survey (CGSS) in 2015. According to the research result, purchase of commercial insurance significantly improved the health status of residents, with an improving effect for rural residents apparently better than that among urban residents. In addition, purchase of commercial insurance can promote the health status of residents by increasing their household income. This research will provide an effective reference for the innovative development and medical reform of the commercial insurance of China in the future, which is theoretically and practically significant to the implementation of the Healthy China Strategy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Xu, Li and Gao.)

Deepening the reform of insurance companies and improving commercial insurance protection capabilities become issues important to national strategy. They involve improving China's multi-tiered social security system to analyze the deep-seated reasons impacting the purchasing behavior of commercial health insurance for rural residents in China. Using the DEA-CCR model, this paper evaluates the development of China's insurance industry, inspects the impact of insurance industry development on purchasing behavior of rural commercial health insurance based on the data of tracking survey projects from China's household, and carries out empirical analysis. The research result shows that the development of the insurance industry has obviously promoted the purchase behavior of commercial health insurance for rural residents. This research has significant practical value on protection and promotion of production and life quality of rural residents, which will also provide beneficial reference on the formulation and implementation of future operation strategy in China's commercial health insurance companies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Li, Wang, Liu and Wang.)

To help strategize efforts to optimize value (relative improvement in health for resources invested), we analyzed the factors associated with the cost of care and use of resources for painful, nontraumatic conditions of the upper extremity. The following were the most common upper extremity diagnoses in the Truven Health MarketScan database: shoulder pain and rotator cuff tendinopathy, shoulder stiffness, shoulder arthritis, lateral epicondylitis, hand arthritis, trigger finger, wrist pain, and hand pain. Multivariable generalized linear regression models were constructed accounting for sex, age, employment status, enrollment year, payer type, emergency room visit, joint injection, magnetic resonance imaging (MRI), physical or occupational therapy, outpatient and inpatient surgery, and insurance type. In addition, we assessed the use of the following 4 diagnostic and treatment interventions: joint injection, surgery, MRI, and physical or occupational therapy. Inpatient and outpatient surgery are the largest contributors to the total amount paid for most diagnoses. Older patients had more injections for the majority of conditions. Efforts to improve the value of care for nontraumatic upper extremity pain can focus on the relative benefits of surgery compared with other treatments and interventions to lower the costs of surgery (eg, office surgery and limited draping for minor hand surgery). Economic II. [ABSTRACT FROM AUTHOR]

Background Approximately 300,000 cases of Lyme disease occur annually in the UNITED STATES, with children aged 5–9 years disproportionately affected. A single dose of doxycycline administered within 72 hours of a high-risk tick bite is recommended for post-exposure prophylaxis (PEP) to prevent Lyme disease in areas of high incidence. However, it is not known how often or for which patients PEP is used. We aimed to describe recent patterns of single-dose doxycycline medication claims in states with high and low Lyme disease incidence, and the associated patient and prescription characteristics in a large national commercial insurance claims database. Methods Outpatient medication claims in the IBM Watson Health MarketScan Database®, a large nation-wide database of de-identified insurance claims filed between January 1, 2014–December 31, 2017 were reviewed. Claims of single-dose doxycycline were identified and associated patient demographics and medication characteristics were analyzed. Results During 2014–2017, 66,210 medication claims for single-dose doxycycline were filed by 63,112 enrollees; mean annual incidence of receiving at least one single-dose doxycycline prescription was 56 per 100,000 enrollees. Mean patient age was 43 years (IQR 33–56 years); only 8% were for children aged <18 years. About half (46%) were male patients. Most claims (71%) were made by patients residing in the 14 states with high Lyme disease incidence, defined as an average annual incidence of ≥ 10 confirmed Lyme disease cases per 100,000 population. The majority (80%) of medication claims were during the 6 months of peak tick activity (April–July for nymphal ticks and October–November for adult ticks). Conclusion Single-dose doxycycline medication claims are common in states with high Lyme disease incidence and are highest during months of peak tick activity, consistent with the assumption that most single-dose doxycycline is used for Lyme disease PEP. Use of single-dose doxycycline to prevent Lyme disease is infrequent in children, despite being a group at high risk for Lyme disease. Efforts to educate pediatric healthcare providers and parents should be made to increase Lyme disease PEP access for children. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Federally qualified health centers (FQHCs) serve diverse communities in the United States (US) and could function as important venues to manage hepatitis C virus (HCV) infections. Little is known on HCV outcomes in underserved communities as most of the current data are derived from clinical trials, commercially insured patients, or small health center samples. We aimed to determine the proportion of HCV testing, factors associated with treatment initiation, and real-world treatment outcomes in a large, national diverse sample of US FQHCs during the opioid epidemic. Methods We created a retrospective cohort of adults seen at 341 participating FQHCs in 19 US states. Inclusion criteria were: (1) clinical visit between January 01, 2012 and June 30, 2017; (2) ≥18 years of age. Outcomes included HCV testing proportion, stratified by diagnosis of opioid use disorder (OUD); treatment initiation rates; and sustained virologic response (SVR), defined as undetectable HCV RNA 3 months after treatment completion. We identified factors associated with testing, treatment initiation, and SVR using logistic regression. Results Of the 1,508,525 patients meeting inclusion criteria, 88,384 (5.9%) were tested for HCV, and 8,694 (9.8%) of individuals tested had reactive results. Of the 6,357 with HCV RNA testing, 4,092 (64.4%) had detectable RNA. Twelve percent of individuals with chronic HCV and evaluable data initiated treatment. Of those, 86% reached SVR. Having commercial insurance (aOR, 2.10, 95% CI, 1.45–3.02), older age (aOR, 1.07, 95% CI, 1.06–1.09) and being Hispanic/Latino (aOR, 1.35, 95% CI, 1.33–1.38) or Asian/Pacific Islander (aOR, 1.84, 95% CI, 1.79–1.90) were independently associated with higher odds of treatment initiation after multivariable adjustment. Only 8% of individuals with chronic HCV were tested for HIV, and 15% of individuals with identified OUD were tested for HCV. Conclusion During the opioid epidemic, fewer than 20% of individuals with identified OUD were tested for HCV at evaluated FQHCs. In addition, approximately 10% of patients initiated treatment and SVR was lower than expected. Expansion of HCV management into community clinics must consider measures to monitor and evaluate treatment effectiveness, and to improve outcomes if cure rates are low. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background Clostridioides difficile infection (CDI) and recurrent CDI (rCDI) are associated with substantial economic burden, quality-of-life impairment, and increased morbidity and mortality. Fecal microbiota transplant (FMT) is an investigational, non-antibiotic approach to attempt to prevent recurrences in patients with multiple CDI. In controlled trials, efficacy rates of 62–76% have been reported with a single FMT, and up to 90% with multiple FMTs. This study evaluated real-world outcomes in patients with CDI, most of whom had a single FMT. Methods Data from the Optum® de-identified Integrated Claims-Clinical dataset were extracted for patients with a first-observed CDI diagnosis between 4/2011 and 3/2018 that occurred within ±7 days of initial CDI antibiotics. Each patient had a > = 4-year look-back period with no CDI claims prior to the index episode. rCDI was defined as a subsequent antibiotic prescription between 7 and 365 days after the prior CDI episode. The proportion of patients with rCDI, use of FMT, and recurrences after FMT were reported. Results Of the 98,895 patients included in the analysis, 71,189 (72.0%) had one CDI episode, 27,706 (28.0%) had > = 1 rCDI, and 10,233 (10.4%) had multiple rCDI. The mean age was 64.2 years (56% > = 65 years), and 61% were female. Medicare was used by 48% of patients, and commercial insurance was used by 32%. A total of 522 (0.5%) patients (mean age, 61.9 years) received a total of 541 FMT procedures. 36% of the FMT procedures occurred after the first observed CDI episode, 22% after the 1st rCDI, and 42% after the second and/or subsequent rCDI episode. Of those who received FMT, 71.4% (n = 373) of patients had no subsequent CDI events by 3/2018. Conclusion As an investigational procedure, only a very small proportion of patients with CDI were identified as undergoing FMT, and the timing of the procedure for some patients may not have aligned with current guidance. This study provides data on real-world efficacy outcomes after a single FMT, with an efficacy rate of 71.4%, which is consistent with rates reported in controlled trials. A small number of patients received more than one FMT procedure, potentially due to treatment failures. Further research is needed to examine potential improvements in efficacy with multiple FMTs. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Social Security is one of the most extensive systems that are designed to meet people’s basic needs so that it now has about one -third of GDP in many countries and covers the entire process of people’s lives from cradle to grave. Social Security is not found in the Islamic teachings under such a title but it is seen under titles such as supporting the poor, lost, orphaned and gharimin and maintained through strategies such as zakat , khums , fay’ and anfal , charities , and endowments. In the last century a new pattern of social security emerged in the context of the intellectual and cultural foundations and Western industrialized growth which gradually stationed in Muslim countries. Since the new model was different from that of Islam, particularly in the insurance strategy, it was to provide Islamic world with an updated theory in this area. However, regardless of the few thinkers like Shahid Sadr, who fundamentally explained the Islamic approach to this phenomenon, Muslim scholars, especially scholars of jurisprudence, have not considered it in proportion to its importance and status. This paper follows the assumption that the existing legal literature especially in Imami jurisprudence is faced with a kind of reductionism regarding the importance of this issue due to lack of proper understanding of the nature of the new social security and considering social insurance the same as commercial insurance. The author of the present paper tries to explain the nature of new social security and its disadvantages and clarify the disparities between social insurance and commercial insurance. Restating the important issues and legal challenges of social security, he elucidates the need for fiqh to enter seriously into this realm and find solutions for them.

The extent of price variation across a local market has important implications for value-based purchasing. Using a new data set containing health care prices for nearly every insurer-provider-service triad across a large local market, we comprehensively examined variation in fee-for-service paid commercial prices in Massachusetts for 291 predominantly outpatient medical services. Prices varied considerably across hospital service areas. Prices for medical services at acute hospitals were, on average, 76 percent higher than at all other providers. The service categories with the widest price variation were ambulance/transportation services, physical/occupational therapy, and laboratory/pathology testing. In this market, simulations suggested that steering patients toward lower-price providers or setting price ceilings could generate potential savings of 9.0-12.8 percent. Marketwide price information at the insurer-provider-service level could help target policy interventions to reduce health care spending.

Context: Hiring athletic trainers (ATs) in high schools may lower medical payments by third-party payers such as Medicaid or commercial insurers by reducing injury risks or may increase medical payments due to more referrals to other health care providers. To date, evidence is lacking on the actual financial effect of high school ATs based on an analysis of medical claims., Objective: To assess the overall cost-benefit of hiring ATs in Oregon high schools based on medical claims data across years., Design: Cost-benefit study., Setting: Oregon public high schools., Patients or Other Participants: Patients aged 14 to 18 years old., Main Outcome Measure(s): We analyzed the 2011-2014 limited dataset from the Oregon Health Authority's All Payer All Claims database. Paired t tests were used to compare claims payments at the zip code level between periods of having and not having ATs in Oregon high schools. We also used the percentage of AT effort to adjust for AT investment. The main outcome measure was the return on investment associated with hiring ATs in high schools., Results: The presence of ATs in Oregon high schools may have had different effects on medical payments for Medicaid and commercial insurance. With every dollar invested in hiring ATs in Oregon public high schools from 2011 to 2014, Medicaid payments increased by 24 cents per month at the zip code level, while commercial insurance payments decreased by 24 cents, although the changes were not statistically significant., Conclusions: Hiring ATs in an outreach model for high schools may not necessarily generate medical savings for Medicaid or commercial insurers. Further research is needed to determine if the lack of cost savings in our study was a factor of the employment model, resulted from increased health care utilization, or reflected the need for ATs to deliver more on-site AT services.

This study was undertaken to examine two aspects of care at the end of life. First, we wanted to see whether the cost savings demonstrated repeatedly in the US Medicare hospice population would also be observed in a commercial population in Tennessee. They were. The second primary interest we had was whether there were certain medical services that seemed to presage death. We found four categories of services that profoundly increase in number as the end of life is approached: primary care, hospital-based specialist, non-hospital based specialist, and oncologist services. It is hoped that these findings could lead to a simple predictive model based on readily available claims data to help identify candidates for Hospice Care earlier., (© The Author(s) 2013.)

Objective: We compared risk of injury among children with autism spectrum disorder (ASD) to those without ASD, adjusting for demographic and clinical characteristics., Methods: We used claims data from 2001 to 2009 from a commercial health plan in the United States. A validated ASD case identification algorithm identified 33,565 children (ages 0-20 years) with ASD and 138,876 children without. Counting process models tested the association between ASD status and injury episodes with separate regressions run for children during different age periods., Results: Unadjusted results demonstrated that children with ASD had a 12% greater injury risk than children without ASD (hazard ratio [HR] = 1.119; P < .001). After including demographic variables, the HR was 1.03 (P < .05); after controlling for co-occurring conditions, such as seizures, depression, etc, HR decreased to 0.889 (P < .001). For the age period analysis, HR values were as follows: for 0 to 2 years, HR 1.141; 3 to 5 years, HR 1.282; 6 to 10 years, HR not significant; and 11 to 20 years, HR 0.634 (P < .05 for all significant results)., Conclusions: Children with ASD have more injuries than children without ASD. After controlling for demographic factors and co-occurring conditions, children with ASD are at lower risk of injury, suggesting that co-occurring conditions or the ways these conditions interact with ASD is related to injuries. Clinicians should understand that injury risk in children with ASD may be driven by co-occurring conditions. Treating these conditions could thus decrease injury risk as well as have other benefits. Injury prevention interventions are especially warranted for younger children with ASD and those with seizures, depression, visual impairment, or attention-deficit disorders., (Copyright © 2014. Published by Elsevier Inc.)