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[Home medical care using long-term care insurance--centered on home oxygen therapy].

About two-thirds of the patients undergoing home oxygen therapy apply for the Long-term Care Insurance. Most of them are aged 75 or over but the degree of necessity of care is relatively low. Two-thirds of them apply for the insurance for the medical care-related reason, which are twice as many as those apply for the insurance because for the medical care-related reason. Medical cares covered by the Long-term Care Insurance include disease control by the visiting nurse, the assistance for the hospital visit using visiting care or day service/day care and respiratory rehabilitation using day ca…

Reproductive and sexual health benefits in private health insurance plans in Washington State.

CONTEXT: Although unintended pregnancy and sexually transmitted diseases (STDs) are considerable problems in the United States, private health insurance plans are inconsistent in their coverage of reproductive and sexual health services needed to address these problems. METHODS: A survey administered to a market-representative sample of 12 health insurance carriers in Washington State assessed benefit coverage for gynecologic services, maternity services, contraceptive services, pregnancy termination, infertility services, reproductive cancer screening, STD services, HIV and AIDS services, an…

Low serum cholesterol and haemorrhagic stroke in men: Korea Medical Insurance Corporation Study.

BACKGROUND: In some prospective studies, haemorrhagic stroke occurs more frequently in individuals with low serum cholesterol than in those with higher concentrations. We aimed to determine whether low total serum cholesterol is an independent risk factor for haemorrhagic stroke (intracerebral haemorrhage and subarachnoid haemorrhage) in South Korea, a country that has a population with relatively low concentrations of total serum cholesterol. METHODS: We measured total serum cholesterol and other cardiovascular risk factors in 114,793 Korean men, aged between 35-59 years in 1990 and 1992, in

Current national health insurance coverage policies for breast and ovarian cancer prophylactic surgery.

BACKGROUND: The efficacy of prophylactic mastectomy and oophorectomy in reducing breast and ovarian carcinoma has recently been reported in … policies were identified (P > .05). CONCLUSIONS: Significant variations currently exist for health insurance coverage of prophylactic mastectomy and oophorectomy. As genetic testing becomes widespread, more uniform policies should be established to enable appropriate high-risk candidates equal access and coverage for these procedures.

Influence of provider characteristics and insurance status on maternal serum alpha-fetoprotein screening.

BACKGROUND: The maternal serum alpha-fetoprotein test (MSAFP) was developed to screen for neural tube defects. Little is known about the adoption of the MSAFP test. This study examines the effect of provider specialty and geographic location and patient insurance status on MSAFP test use in Washington State. METHODS: We conducted a retrospective cohort study of MSAFP use in low-risk obstetric patients of five provider groups. MSAFP use was examined for Medicaid and privately insured patients, as well as for the patients of the five provider types. RESULTS: Patients of urban and rural obstetr…

Implementation and Assessment of Facilitation Support for Improving Health Insurance Coverage in Achham.

Health insurance is a critical strategy for achieving universal health coverage, reducing out-of-pocket (OOP) healthcare expenditures, and improving access to healthcare services. Despite the implementation of the National Health Insurance Program (NHIP) in Nepal, enrolment and renewal rates remain low, particularly in districts like Achham. This study aimed to assess the effectiveness of facilitation support, delivered through patient navigators, enrolment assistants, and community health workers (CHWs), in increasing health insurance coverage.  Methods: A mixed-methods approach was employed.…

Unequal Utilization of Overactive Bladder Treatment: The Role of Socioeconomic and Insurance Disparities.

OBJECTIVE: To evaluate the association between neighborhood-level socioeconomic disadvantage (SED) and insurance type with pharmacologic and procedural treatment patterns in the management of overactive bladder (OAB). METHODS: We conducted a retrospective cohort study of patients diagnosed with OAB at a tertiary academic medical center between 2011 and 2023. Variables included receipt of pharmacotherapy, and minimally invasive therapy (MIT), corresponding to guideline-defined procedural interventions for OAB, such as sacral neuromodulation (SNM), posterior tibial nerve stimulation (PTNS), and…

National Analysis of Insurance Coverage for Gender-Affirming Surgery in the United States.

PURPOSE: This study reviewed the U.S. insurance landscape for gender-affirming surgery (GAS) and examined how regional, legislative, and health care infrastructure factors influence coverage patterns to inform policy reform and advocacy. METHODS: Policies from the top three insurers in each state, identified via the National Association of Insurance Commissioners, were analyzed in November 2024. Coverage was compared across census regions, and criteria concordance with the World Professional Association for Transgender Health (WPATH) Standards of Care, Version 8, was assessed. GAS fellowship …

Medicare Advantage Plan Bid Risk Underestimates and Corresponding Insurer Revenues.

OBJECTIVE: To estimate the extent to which Medicare Advantage (MA) plans underestimate risk, the additional Part A and Part B (A&B) revenue insurers receive as a result, and how this differs across insurers and over time. STUDY SETTING AND DESIGN: We compared projected risk in plan-level bids submitted by insurers to the actual plan-level risk as subsequently reported by the Centers for Medicare and Medicaid Services (CMS). We estimated the additional A&B revenue MA insurers received due to underestimates. DATA SOURCES AND ANALYTICAL SAMPLES: A total of 34,604 MA plans offered by 317 insurer

Retinal Coronary Artery Calcium Scoring - A Scalable Tool for Life Insurers.

BACKGROUND.—: Cardiovascular risk estimation for life insurance underwriting relies on risk estimation from conventional metrics: age, sex, smoking status, body mass index, systolic and diastolic blood pressure, total and high-density lipoprotein cholesterol and stress electrocardiogram. Coronary artery calcium (CAC) scoring via CT is a validated predictor of cardiovascular risk but remains costly, invasive, and unsuitable for large-scale underwriting. A novel artificial intelligence (AI) model, RetiCAC, predicts CAC scores from retinal photographs, offering a non-invasive and scalable alterna…

Key Indicators of Performance-Based Payment to Physicians by Insurance Organizations in Iran.

BACKGROUND: A fair and transparent payment system has been shown to influence workforce motivation and quality of work. Performance-based payment initiatives are designed to strengthen this relationship by linking compensation to measurable outcomes. This study aimed to identify the key indicators of performance-based payment for physicians in Iran. METHODS: This mixed-method study employed a scoping review and semi-structured interviews with key professionals and practitioners in health insurance, health economics, and management. The scoping review followed the Arksey and O'Malley framework…

Income and Insurance-Based Disparities in Primary Soft Tissue Sarcoma of the Extremities.

BACKGROUND AND OBJECTIVES: Soft tissue sarcomas (STSs) are rare but can be devastating. Paradigm shifts in adjuvant treatment have expanded … rs following resection (HR 1.66, p < 0.001). CONCLUSION: We report significant race-, income-, and insurance-based disparities in amputation risk and overall survival for patients with STS of the extremities. We also report a significantly increased risk of amputation for patients with delayed clinical presentation. Multidisciplinary sarcoma care teams sho …

Health Insurance and Racial and Ethnic Differences in Postpartum Contraception in the United States.

OBJECTIVE: To explore variations in postpartum contraception in the United States by race and ethnicity among patients receiving publicly versus privately funded health care. STUDY DESIGN: We analyzed Phase 8 (2016-2021) Pregnancy Risk Assessment Monitoring System (PRAMS) data using multivariate logistic regression models with interaction terms to examine relationships between maternal race and ethnicity, health insurance, and postpartum contraceptive use, controlling for maternal age, education, marital status, parity, prepregnancy depression, and whether ever breastfed. RESULTS: Of U.S. bi…

Variability in Insurance Coverage for Adult Voice Therapy in The United States of America.

OBJECTIVES: Voice therapy is often the first-line treatment and an adjunct to medical or surgical management of dysphonia. However, a minority of patients with dysphonia utilize voice therapy. Insurance coverage can affect patients' decisions and ability to pursue voice therapy. The objective of this study was to investigate variability in insurance coverage of voice therapy for treatment of dysphonia in the United States of America. METHODS: A cross-sectional study was performed to review insurance policies from the top three commercial insurers and Medicaid in all 50 states and District of …

Prevalence and Types of Chronic Pain among Insured Individuals with Tic Disorders.

BACKGROUND: Tic disorders are neurodevelopmental disorders characterized by motor and vocal tics. Individuals with tic disorders can experie … d corresponding P-values using SAS software. RESULTS: Among enrollees with commercial and Medicaid insurance, we identified 27,262 and 19,980 individuals with tic disorders, respectively. Overall, approximately 20% (21.4% commercial; 22.5% Medicaid) of individuals with tic disorders had any chronic pain. After stratifying by insurance type, age, and sex, p …

Использование и управление аптеками, принадлежащими страховщикам и управляющими пособиями в области фармацевтики в Медикаре.

IMORTANS: Все большую озабоченность в области нормативного регулирования вызывает преобладание аптек, принадлежащих интегрированным страховщикам и менеджерам по выплате пособий по аптекам (УБМ), или страховщикам-УПМ. Однако мало что известно о роли этих аптек в Медикаре, где защита сети аптек может повлиять на динамику рынка. ЦЕЛЬ: Оценить распространенность аптек, принадлежащих страховщикам, и степень, в которой страховщики-ПБР направляют пациентов в аптеки, которыми они владеют в Медикаре. DESIGN, SETTING, И УЧАСТНИКИ: В рамках этого межсекторального исследования использовались данные о прет

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… Introduction There is growing regulatory concern regarding the prevalence of pharmacies owned by insurers and pharmacy benefit managers (PBMs), which are organizations that negotiate pharmacy and manufacturer contracts and have increasingly integrated with insurers to form insurer-PBM firms. 1 Pharmacies … Moreover, for each insurer-PBM and drug category, a significantly greater share of insurer-PBM insurance claims were filled at owned pharmacies than would be expected without steering ( Table ). …

Disparities in Alcohol Treatment Use at the Intersection of Race, Ethnicity, Gender, and Insurance.

BACKGROUND: Treatment for alcohol use disorder (AUD) has the potential to improve health and quality of life. Little is known about disparities in AUD treatment utilization at the intersection of race and gender. We examined disparities in AUD treatment utilization among those diagnosed with AUD in a community sample, by race, ethnicity, and gender, and whether disparities varied by insurance. We also examined whether criminal legal history and socioeconomic status moderated disparities in treatment. METHODS: We used data from the nationally representative 2017 to 2019 National Survey on Drug…

The Effect of Insurance Type on Length of Stay Following Total Knee Arthroplasty.

BACKGROUND: With the expansion of the Affordable Care Act in 2014, there has been a growing interest in how the Medicaid population will affect postoperative outcomes following total knee arthroplasty (TKA). Studies have shown that lower socioeconomic status, non-Caucasian race, women, cardiac and renal disorders, and younger age have been associated with increased lengths of stay (LOS) after TKA. The primary purpose of our study was to compare the total complications and LOS among patients undergoing TKA who have cash, commercial, government, Medicaid, and Medicare insurances. METHODS: We qu…