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After CLASS--Is a voluntary public insurance program a realistic way to meet the long-term support and service needs of adults with disabilities?

BACKGROUND: The CLASS Act, which was part of the Affordable Care Act of 2010, established a voluntary personal assistance services (PAS) insurance program. However, concerns about enrollment and adverse selection led to repeal of the CLASS Act in 2013. OBJECTIVES: To estimate the number of middle-aged adults interested in purchasing PAS insurance, the sociodemographic, socioeconomic and disability attributes of this population, and the maximum monthly premium they would be willing to pay for such coverage. METHODS: A total of 13,384 adults aged 40-65 answered questions about their interest i…

[Pleural effusion cytology of asbestos-associated malignant mesothelioma and lung carcinoma in the diagnosis of occupational diseases by the statutory accident insurance funds].

Pleural effusion often represents the first clinical symptom of lung carcinoma and malignant mesothelioma. As pleural punctation is performed quite early in the diagnostic procedure, effusion cytology frequently gives the first evidence about the presence of tumour cells and tumor histogenesis. In this study, we report on seven cases which were evaluated in our institution for the Employers' Liability Insurance Association, based solely on cytology findings.The mean age of the seven patients with a given long-term asbestos exposure during their working life was 81.7 years. On average eight sme…

Incidence and cost of treatment-emergent comorbid events in insured patients with chronic hepatitis C virus infection: a retrospective cohort study.

BackgroundTreatment-emergent comorbid events (TECs) are common In patients initiating treatment with pegylated interferon alpha (PEG-IFN-alfa) and ribavirin for chronic hepatitis C virus (HCV) infection. The purpose of this study was to estimate the incidence and incremental cost of these events.MethodsIn a retrospective cohort analysis of healthcare claims, we studied patients with HCV who were newly treated with PEG-IFN-alfa/ribavirin between 2006 and 2008. TECs were defined by new medical/pharmacy claims for predefined conditions in the 12 months after treatment initiation. The net incremen

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… The objective of this study was to estimate the incidence of TECs and the incremental costs of treating these events in insured patients initiating PEG-IFN-alfa/ribavirin treatment for chronic HCV infection. … This database is a Health Insurance Portability and Accountability Act (HIPAA)-compliant administrative claims database of 8–10 million covered lives, representing all major regions of the US. …

Delivery Timing, Out-Of-Pocket Maternity Costs, and Postpartum Care Utilization: An Instrumental Variable Analysis Among Commercially Insured Women.

OBJECTIVE: To examine whether out-of-pocket costs during pregnancy and delivery affect use of postpartum care. STUDY SETTING AND DESIGN: Because health insurance deductibles and limits reset annually, the timing of childbirth within that year quasi-randomly assigns people to different levels of cost-sharing during pregnancy+delivery versus postpartum. We use a novel instrumental variable approach that leverages this variation to analyze whether higher maternity spending due to delivering early in the plan year affects postpartum care utilization. The exposure is maternity out-of-pocket spendi…

Trojan horse? The perils of a private health insurers' buying group for clinical independence, patient confidentiality, and the viability of private hospital care.

Private psychiatric care comprises outpatient as well as private hospital care. The three major funders of private hospital care in Australia are private health insurers, the Australian federal government and, through out-of-pocket costs not covered by the preceding, individual patients. Three big companies, Medibank, BUPA, and nib, dominate the private health insurance market in Australia, resulting in high returns on equity, while private hospitals are being progressively squeezed, resulting in falling profits and a loss in 2024-25. Nonetheless, private health insurers have sought increased …

Predictors of incident anxiety and stress-related diagnoses following buprenorphine initiation among commercially insured patients with opioid use disorder.

BACKGROUND: Anxiety and stress-related disorders (ASRD) are common among people with opioid use disorder (OUD), yet many initiate buprenorphine treatment without a documented psychiatric diagnosis. How often these disorders become identifiable after initiation, and which patient characteristics are associated with diagnosis, remains unclear. METHODS: We conducted a retrospective cohort study using Merative MarketScan® Commercial Claims data (2018-2023). People with OUD initiating buprenorphine after ≥ 180 days without treatment and without an ASRD (ICD-10: F40-F43) during the baseline period

Impact of outpatient palliative care on healthcare costs in Germany - an analysis of cancer and non-cancer patients based on health insurance data.

BACKGROUND: Palliative care (PC) aims at improving the quality of life of patients suffering from life-threatening and life-limiting illness … ient PC. METHODS: The study involved a retrospective, cross-sectional analysis of statutory health insurance data for individuals who died in 2019 and were older than 18 years at the time of death (34,012 individuals). To explore the impact of outpatient PC on end-of-life costs, three groups were formed: (1) all individuals, (2) individuals with a cancer d …

Status of diagnostic test, diagnosis, and treatment of influenza using the national database of health insurance claims and specific health checkups of Japan.

BACKGROUND: We previously reported the status of diagnostic tests, diagnoses, and prescriptions for influenza in Japan using a large-scale nationwide database, in which the type of health insurance plan was limited and older people were omitted. In this study, we examined the status using a comprehensive Japanese health insurance claims database. METHODS: This cross-sectional study used the National Database of Health Insurance Claims and Specific Health Checkups of Japan from April 2009-March 2020. Among the target patients with at least one record of any tests, diagnoses, or prescriptions, …

Real-world longitudinal treatment trajectories following opioid use disorder diagnosis among commercially insured beneficiaries in the United States.

INTRODUCTION: Early initiation and continuity of treatment are critical for the effective management of opioid use disorder (OUD). Despite t … 2019. The study included beneficiaries aged 18-85 years with an OUD diagnosis, requiring continuous insurance enrollment for at least 6 months before and 3 months after the first date of OUD diagnosis (index date). Beneficiaries with any prescription or medical service claims for MOUD or with OUD remission codes during the 6-month baseline period were exclu …

Health Care Utilization for Chronic Low Back Pain Among Medicaid Patients Versus Privately Insured Patients - A Retrospective Study.

BACKGROUND: Poor socioeconomic status and low access to care among patients have been identified as potential reasons for increased in disab … are utilization data were collected. RESULTS: Of the 424 patients, 206 (49%) patients had Medicaid insurance, and 218 (51%) patients had private insurance. Individuals in the Medicaid group attended more physical therapy sessions (mean: 7.1, median: 2) than did those with private insurance (mean: 5.2, median: 0, P < 0.001). With respect to "no-show" appoin …

Group-based trajectory modeling to assess adherence to chronic urate-lowering therapies among commercially insured US adults with gout.

BACKGROUND: The benefits of urate-lowering therapies (ULTs) for the long-term management of gout are well established. However, suboptimal adherence remains a significant challenge, resulting in increased gout flares and higher health care utilization. The proportion of days covered (PDC) is commonly used to assess adherence but provides only a single value that fails to distinguish among individuals with differing and dynamic adherence patterns over time. Understanding fluctuations in adherence and their associated characteristics can inform interventions aimed at improving adherence. OBJECT

The clinical outcomes and healthcare resource utilization in IgG4-related disease: a claims-based analysis of commercially insured adults in the United States.

OBJECTIVES: IgG4-related disease (IgG4-RD) can affect nearly any organ and is often treated with glucocorticoids, which contribute to organ damage and toxicity. Comorbidities and healthcare utilization in IgG4-RD are poorly understood. METHODS: We conducted a cohort study using claims data from a US managed care organization. Incident IgG4-RD cases were identified using a validated algorithm; general population comparators were matched by age, sex, race/ethnicity and index date. The frequency of 21 expert-defined clinical outcomes associated with IgG4-RD or its treatment and healthcare-associ

Use of Palliative Care Among Adults With Newly Diagnosed Heart Failure: Insights From a US National Insured Patient Sample.

BACKGROUND: Despite the known benefits for individuals with heart failure (HF), incomplete data suggest a low use of palliative care (PC) for HF in the United States. We aimed to investigate the national PC use for adults with HF by determining when they received their first PC consultation (PCC) and the associations with clinical factors following diagnosis of HF. METHODS AND RESULTS: We conducted a retrospective cohort study in a national all-payer electronic health record database to identify adults (aged ≥18 years) with newly diagnosed HF between 2011 and 2018. The proportion of those who

Complication Analysis in Korean Patients With Hemophilia A From 2007 to 2019: A Nationwide Study by the Health Insurance Review and Assessment Service Database.

BACKGROUND: There has been remarkable progress in hemophilia A (HA) treatment in Korea. Viral inactivation products were developed in 1989, use of recombinant factor VIII (FVIII) concentrates started in 2002, and prophylaxis expanded thereafter. This study was conducted to identify the changes in complications in HA before and after 1989 or 2002. METHODS: The study was performed using the 2007-2019 Healthcare Big Data Hub of the Health Insurance Review and Assessment Service. RESULTS: Among 2,557 patients, 1,084 had ≥ 1 complication; 829 had joint problems, 328 had viral infections, 146 had …

Tramadol utilization among patients with higher risk of adverse drug events: A claims analysis of commercially insured and Medicare Advantage members.

OBJECTIVE: To assess prescribing of tramadol among patients with contraindications and higher risks of adverse events in a large population of commercially insured and Medicare Advantage members. DESIGN: We performed a cross-sectional analysis evaluating tramadol utilization in patients with higher risk of adverse outcomes. SETTING: This study utilized 2016-2017 data from the Optum Clinformatics Data Mart. PATIENTS AND PARTICIPANTS: Patients with at least one tramadol prescription without a cancer or sickle cell diagnosis during the study period. MAIN OUTCOME MEASURES: We first determined

Access to Medications for Opioid Use Disorder During COVID-19: Retrospective Study of Commercially Insured Patients from 2019-2022.

INTRODUCTION: This study assesses disparities in medications for opioid use disorder in adults with opioid use disorder and examines the associations between state-level COVID-19 lockdown and telehealth policies and medications for opioid use disorder utilization rates during the COVID-19 pandemic. METHODS: This retrospective cohort study of 396,872 adults with opioid use disorder analyzed monthly medications for opioid use disorder utilization rates between January 2019 and June 2022 using data from Clinformatics Data Mart Database. Primary outcome measure was monthly medications for opioid