Financial Burden Of Health Care Research Articles

Financial Burden of Health Care in the Privately Insured US Population.

Financial Burden of Health Care in the Privately Insured US Population.

Early vs. late lead extraction in CIED infections: evaluating the interplay of infection type, timing, and comorbidities

Abstract Background Cardiovascular Implantable Electronic Devices (CIEDs) may be associated with peri- and post-procedural complications like device-related infection, one of the most serious challenge of CIEDs therapy associated with significant morbidity, mortality, and financial healthcare burden. Despite a routine use of antibiotics, recent studies reported an increase in CIEDs infections, with or without systemic involvement, that often require surgical interventions like transvenous lead extraction. Purpose This study evaluates the outcomes of transvenous lead extraction in patients with infected CIEDs, focusing on the impact of early versus delayed extraction timing on patient outcomes. Methods A retrospective analysis of 165 patients who underwent transvenous lead extraction for CIED infections between 2019 and 2022 was conducted. Patients were categorized into systemic (n=64) or local (n=101) infection groups and further into early (within 7 days from admission, n=102) or delayed (after 7 days, n=63) extraction groups. Post-procedural outcomes, including septic shock, complications, and mortality rates were described. Results The majority of patients were male (75%) with a median age of 73 (IQR 64-80) years. In the early extraction group, the 1-year mortality rate was significantly lower at 6.4%, compared to 25% in the delayed group. Patients with systemic infections had higher 1-month and 1-year mortality rates compared to those with local infections. The success rates of complete device removal were similar across groups. However, the delayed extraction group exhibited higher rates of comorbidities like anemia, chronic kidney disease, and elevated C-reactive protein levels, which were prevalent in 70% of these patients, compared to 45% in the early extraction group. Conclusions Timely management of CIED infections is crucial for improving patient outcomes. Early extraction within 7 days from hospital admission is associated with significantly lower mortality, regardless of local or systemic infection. Patients undergoing delayed extraction often present with greater comorbidity, which may contribute to their higher mortality rates. This underscores the importance of considering patient comorbidities and prompt intervention in managing CIED infections.

Reducing the Burden of Neonatal Mortality in Pakistan

The chances of dying on the first day of life are second only to the last day of life. Newborns, thus, represent a very vulnerable subset of population. This is especially the case in low- and middle-income countries like Pakistan. Although our Neonatal Mortality Rate has declined during the last few decades, it failed to keep pace with the targets set in the Millennium Development Goals (MDGs). Pakistan continues to have one of the highest neonatal Mortality Rates in the world. As we enter the era of Sustainable Development Goals, every effort should be made to meet the new targets set in the SDGs.With the ever-increasing financial burden of healthcare (especially in a struggling economy like ours), careful thought should be given to adopting measures to save newborn lives and improve their health status. These measures should not only be efficacious but also cost effective and sustainable. Keeping in mind the mother newborn dyad, measures to improve neonatal outcome must address maternal health simultaneously. Reducing neonatal mortality in low- and middle income countries (LMICs) is thus a multifaceted challenge that requires a combination of strategies addressing various factors contributing to newborn deaths. Here are some effective approaches

Does the increase in health insurance benefits have different effects on the health of middle-aged and older people individuals in rural areas? Analysis based on quantile difference-in-differences method.

In the context of healthy aging, enhancing health performance is an intrinsic requirement for the development and reform of the health insurance system. This paper mainly discusses the health effects of increasing medical insurance benefits on people with different levels of health. So this paper utilizes multiple rounds of data from the China Health and Retirement Longitudinal Study (CHARLS) and employs the quantile difference-in-differences method to systematically investigate the impact effects of the integration of urban and rural residents' health insurance on the frailty levels of rural middle-aged and older people individuals. The research findings are as follows: Firstly, the integration of urban and rural resident health insurance has mitigated the frailty level of rural older people individuals, with a more pronounced impact on those with poorer health statuses. Secondly, in terms of heterogeneity analysis, the health performance effects of the urban-rural health insurance integration policy are more significant among the older people population and in the western regions. Thirdly, the integration of urban and rural resident health insurance primarily improves health by reducing the burden of medical expenses, with a greater impact on the older people population with poorer health statuses. Based on the research findings, we recommend addressing the disparities in healthcare benefits across various insurance systems, alleviating the financial burden of healthcare for impoverished individuals, and consistently improving the coordination of healthcare insurance policies for both urban and rural residents.

Evaluation of Osteoporosis Perception Among Saudi Arabian Premenopausal Women: A Cross-Sectional Survey Study Using the Osteoporosis Knowledge Assessment Tool (OKAT).

Osteoporosis is a major clinical problem that affects the whole population, especially women. It is a condition that is becoming more prevalent with aging. The increase in bone fragility associated with the disease can lead to fractures, even from minor trauma. Our goal is to evaluate the extent of knowledge about osteoporosis and perceptions of it among premenopausal women in Saudi Arabia. This descriptive cross-sectional study was conducted among premenopausal women during the months of June and July 2021. We distributed an online questionnaire on social networking sites and applications that Saudi women use on a daily basis. We used the Osteoporosis Knowledge Assessment Tool (OKAT) to evaluate the responses. A total of 661 women took part in our study; 159 of them were excluded because they had either reached the menopausal period or had already been diagnosed with the disease. The overall perception of osteoporosis is noticeably poor, as only 55% of respondents had an acceptable level of knowledge. In addition, we found a statistically significant association between education level and knowledge level (p-value = 0.044). The findings revealed that more than half the participants scored "acceptable" in terms of their understanding of the disease, which indicates a serious awareness gap. This outcome demonstrates the necessity of increasing community awareness about osteoporosis to reduce potential harm and the financial burden of healthcare.

Predictors of Length of Stay, Rehospitalization and Mortality in Community-Acquired Pneumonia Patients: A Retrospective Cohort Study.

Community-acquired pneumonia (CAP) represents one of the leading causes of hospitalization and has a substantial impact on the financial burden of healthcare. The aim of this study was to identify factors associated with the length of hospital stay (LOHS), rehospitalization and mortality of patients admitted for CAP. A retrospective cohort study was conducted with patients presenting to a Swiss public hospital between January 2019 and December 2019. Zero-truncated negative binomial and multivariable logistic regression analyses were performed to assess risk factors. A total of 300 patients were analyzed (median 78 years, IQR [67.56, 85.50] and 53% males) with an average LOHS of 7 days (IQR [5.00, 9.00]). Of the 300 patients, 31.6% (97/300) were re-hospitalized within 6 months, 2.7% (8/300) died within 30 days and 11.7% (35/300) died within 1 year. The results showed that sex (IRR = 0.877, 95% CI = 0.776-0.992, p-value = 0.036), age (IRR = 1.007, 95% CI = 1.002-1.012, p-value = 0.003), qSOFA score (IRR = 1.143, 95% CI = 1.049-1.246, p-value = 0.002) and atypical pneumonia (IRR = 1.357, 95% CI = 1.012-1.819, p-value = 0.04) were predictive of LOHS. Diabetes (OR = 2.149, 95% CI = 1.104-4.172, p-value = 0.024), a higher qSOFA score (OR = 1.958, 95% CI = 1.295-3.002, p-value = 0.002) and rehabilitation after discharge (OR = 2.222, 95% CI = 1.017-4.855, p-value = 0.044) were associated with a higher chance of being re-hospitalized within 6 months, whereas mortality within 30 days and within one year were both associated with older age (OR = 1.248, 95% CI = 1.056-1.562, p-value = 0.026 and OR = 1.073, 95% CI = 1.025-1.132, p-value = 0.005, respectively) and the presence of a cancer diagnosis (OR = 32.671, 95% CI = 4.787-369.1, p-value = 0.001 and OR = 4.408, 95% CI = 1.680-11.43, p-value = 0.002, respectively). This study identified routinely available predictors for LOHS, rehospitalization and mortality in patients with CAP, which may further advance our understanding of CAP and thereby improve patient management, discharge planning and hospital costs.

Assessment Of Funding in the Implementation of National Health Insurance Scheme in the Federal Capital Territory (FCT), Abuja, Nigeria

The National Health Insurance Scheme (NHIS) is an initiative of the federal government of Nigeria targeted at easing the financial burden of healthcare on the general public while enabling access to quality healthcare services. However, progress checks in implementation suggest that there is a considerable gap between policy objectives and outcomes. In light of this observation, the paper examines the extent to which funding affects the implementation of NHIS in the Federal Capital Territory (FCT), Abuja. The study, which is survey research, was anchored on Grossman’s health production function theory and employed the instrument of questionnaire to elicit data from Health workers in nine health institutions spread across four Area Councils in Abuja, namely, AMAC, Gwagwalada, Kuje and Kwali and NHIS staff. The data were analysed using Statistical Package for Social Science (SPSS). The study observed that the paucity of funds affects the effective implementation of NHIS in FCT to a high extent. It concludes that the problem of paucity of funds is a hindrance to the effective implementation of NHIS in the FCT. The paper recommends that the community and voluntary sectors of NHIS should be aggressively implemented; that government budgetary allocation to the health sector should be upwardly reviewed and sustained; and finally, that the HMOs should be closely monitored to ensure that capitations to accredited NHIS health facilities are remitted as at when due.

Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch.

Transcatheter aortic valve implantation (TAVI) has become an alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis in elderly and comorbid population. Significant improvement in heart function has been observed in patients undergoing TAVI, but numerous patients are readmitted to hospital for heart failure (HF). Moreover, repeat HF hospitalization is strongly associated with an adverse prognosis and increases the financial burden of health care. Although studies have identified pre-existing and post-procedural factors that contribute to HF hospitalization after TAVI, there is a paucity of data regarding optimal post-procedural pharmacological treatments. This review aims to provide an overview of the current understanding of mechanisms, determinants, and potential treatments of HF following TAVI. We first review the pathophysiology of left ventricular (LV) remodelling, coronary microcirculation disorder, and endothelial dysfunction in patients with aortic stenosis and then examine the impact of TAVI on these conditions. We then present evidence of various factors and complications that may interplay with LV remodelling and contribute to HF events after TAVI. Next, we describe the triggers and predictors of early and late HF rehospitalizations following TAVI. Lastly, we discuss the potential of conventional pharmacological treatments, including renin-angiotensin blockers, beta-blockers, and diuretics in TAVI patients. The paper explores the potential of newer drugs, including sodium-glucose co-transporter 2 inhibitors, anti-inflammatory drugs, and ion supplementation. Comprehensive knowledge in this field may aid in recognizing successful existing therapies, developing effective new treatments, and establishing dedicated patient care strategies during follow-up after TAVI.

Palliative care and end of life care in decompensated cirrhosis.

Palliative care and end of life care in decompensated cirrhosis.

Prevention, diagnosis and treatment of cardiac implantable electronic device infections. Position paper of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC)

The number of cardiac implantable electronic device (CIED) implantations has increased over recent years as a result of population growth, increasing life expectancy, adoption of guidelines, and better access to healthcare. Device-related infection is, however, one of the most serious complications of CIED therapy associated with significant morbidity, mortality, and financial healthcare burden. Although many preventive strategies such as administration of intravenous antibiotic therapy before implantation are well recognized, uncertainties still exist about other regimens. Uncertainties have remained about the role of various preventive, diagnostic, and treatment measures such as skin antiseptics, pocket antibiotic solutions, anti-bacterial envelopes, prolonged antibiotics post-implantation, and others. The key aspect to successful treatment of definite CIED infections is complete removal of all parts of the system and transvenous hardware, including the device and all leads. Thus, transvenous lead extraction has been increasing. Expert consensus statements on how to prevent, diagnose, and treat CIED infections and on lead extraction have been published by the European Heart Rhythm Association in 2020 and 2018, respectively. The aim of this AIAC position paper is to describe the current knowledge on the risks for device-related infections and to assist healthcare professionals in their clinical decision making regarding its prevention, diagnosis, and management by providing the latest update of the most effective strategies.

LYMPHOMA DIAGNOSTIC EFFICIENCY: PREDICTORS FOR DIAGNOSTIC DELAY AND PROLONGED REFERRAL TO TREATMENT TIME

Introduction: Lymphoma is one of the most prevalent cancers diagnosed in the Republic of Ireland, with approximately 800 cases of Non-Hodgkin lymphoma and 150 cases of Hodgkin lymphoma (HL) diagnosed annually. Previous studies have demonstrated that time to diagnosis can range substantially, with diagnosis to treatment interval associated with survival outcomes. Aims & Methods: The primary aim of this study was to compare the diagnostic efficiency according to histology specimen type. The secondary aims included time to lymphoma diagnosis, and predictors associated with diagnostic delays. A retrospective analysis was performed on all patients diagnosed at a tertiary (non-fee paying) centre in Ireland between 2016 and 2021. Baseline demographic data and diagnostics were obtained from electronic records. Referral to treatment interval (RTI) was calculated from the date of initial review in the referral centre to commencement of therapy. Results: A total of 225 new lymphoma diagnoses were made during the study period. The median age was 63.3 years (IQR 44.2, 73.6) Males accounted for 54.7% (n = 123) of the population. DLBCL was the most common subtype (n = 94; 41.8%); followed by classical HL (n = 40; 17.8%) and Follicular lymphoma (n = 32; 14.2%). Fifty four percent (n = 122) had their diagnostic histology attained during an inpatient episode. The median time to diagnosis was 24 days (IQR 13.0, 58.0). A total of 350 histology specimens were attained. Core biopsy yielded a diagnosis in 64% (n = 144), excision biopsy in 35.6% (n = 80) and FNA in 0.4% (n = 1). The positive diagnostic rate was 69.5% for core biopsy, 93% for excision biopsy and 1.7% for FNA. The median financial cost of diagnosis was €13714 (IQR €4050, €24044). The total cost for this patient group was €3.7 million over a 5 year period. The median RTI was 47 days (IQR 23.0, 91.0). In the univariate analysis, we confirmed patients with older age are more likely to have longer RTI (p = 0.0007). Diagnostic biopsy performed as inpatient was associated with a shorter RTI (p ≤ .0001). Patients referred direct to haematology services had a longer RTI (p = 0.0004). In the multivariable analysis, patients with older age remained significant associated with prolonged RTI (p = 0.0251). Diagnostic biopsy performed as an inpatient remained significant (p ≤ .0001). Similarly, patients referred directly to Haematology services has significantly longer RTI (p = 0.0051). Conclusion: In this review, we confirm the higher diagnostic yield of excision biopsy for diagnosis. Older age at presentation and referral direct to haematology was associated with longer RTI. Inpatient diagnostic’s was associated with shorter RTI. We confirm an over reliance on inpatient diagnostics. With the increasing financial burden of healthcare and increased demand on resources including bed utilisation, the appropriate choice of investigations and diagnostic sampling is ever more critical. Encore Abstract - previously submitted to regional or national meetings (up to <1000 attendees) Keywords: cancer health disparities, diagnostic and prognostic biomarkers, Imaging and Early Detection - Other No conflicts of interests pertinent to the abstract.

Use of granulocyte colony-stimulating factor in patients with chemotherapy-induced neutropaenia.

Febrile neutropaenia (FN) and resultant infections are the major cause of treatment-related morbidity and mortality in patients receiving chemotherapy. Clinical practice guidelines recommend the use of granulocyte colony-stimulating factors (G-CSF) to reduce the risk of FN and ensuing complications in patients receiving chemotherapy. Despite these recommendations, inappropriate usage of G-CSF has been reported. To assess prescribing patterns and adherence to international guidelines of G-CSF in adult patients with chemotherapy-induced neutropaenia (CIN) at the haematology oncology wards of the Dr George Mukhari Academic Hospital (DGMAH) and compliance to guidelines. Medical records of adult patients who received G-CSF were reviewed retrospectively between 01 January 2018 and 31 July 2018. Of the 128 patient files screened, 57 cases met the inclusion criteria. Duration of treatment with G-CSF was not in accordance with guidelines in more than 50% of the patients and in 43.86%, G-CSF dosing deviated from recommended guidelines. The study demonstrated over-prescribing of G-CSF due to either increased doses or duration of G-CSF therapy. Although prescribed for the correct indication, the dosage was often too high or the duration was too long, even once an acceptable neutrophil nadir count was reached. Interventions to optimise the use of G-CSF are required and the pharmacist may play a role in this regard. The administration of the correct doses of G-CSF can reduce both the severity and duration of neutropaenia. Over-prescribing and incorrect dosing may contribute to patient morbidity and add to the financial burden of healthcare.

Financial toxicity in pregnancy and postpartum.

The financial burden of pregnancy in the United States can be high and is associated with worse mental health and birth outcomes. Research on the financial burden of health care, such as the development of the COmprehensive Score for Financial Toxicity (COST) tool, has been conducted primarily among patients with cancer. This study aimed to validate the COST tool and use it to measure financial toxicity and its impacts among obstetric patients. We used survey and medical record data from obstetric patients at a large medical center in the United States. We validated the COST tool using common factor analysis. We used linear regression to identify risk factors for financial toxicity and to investigate associations between financial toxicity and patient outcomes including satisfaction, access, mental health, and birth outcomes. The COST tool measured two distinct constructs of financial toxicity in this sample: current financial toxicity and concern over future financial toxicity. Racial/ethnic category, insurance, neighborhood deprivation, caregiving, and employment were associated with current financial toxicity (P < 0.05 for all). Only racial/ethnic category and caregiving were associated with concern over future financial toxicity (P < 0.05 for all). Both current and future financial toxicity were associated with worse patient-provider communication, depressive symptoms, and stress (P < 0.05 for all). Financial toxicity was not associated with birth outcomes or keeping obstetric visits. The COST tool captures two constructs among obstetric patients, current and future financial toxicity, both of which are associated with worse mental health and patient-provider communication.

Does Universal Health Insurance in Korea provide a Lesson for U.S. Health Care Financing?

This note provides a commentary on Lee, C. "Is Universal Health Insurance Superior in Terms of Healthcare Payment? Estimating the Financial Burden of Healthcare in Korea: 2009 to 2019." INQUIRY, 2022, 59:1-8. Lee, using a unique data set, shows that the Korean single payer system is regressive, despite previous attempts to increase public expenditures. The policy recommendation, to improve access by making public payments even more progressive to household income, is examined. This note concludes that making health expenditures progressive to household income does not solve the root cause of the demand for health care, a key factor in health care access, nor can the policy implications generalize to the multi-payer U.S. system.

Sex differences in allometry for phenotypic traits in mice indicate that females are not scaled males

Sex differences in the lifetime risk and expression of disease are well-known. Preclinical research targeted at improving treatment, increasing health span, and reducing the financial burden of health care, has mostly been conducted on male animals and cells. The extent to which sex differences in phenotypic traits are explained by sex differences in body weight remains unclear. We quantify sex differences in the allometric relationship between trait value and body weight for 363 phenotypic traits in male and female mice, recorded in >2 million measurements from the International Mouse Phenotyping Consortium. We find sex differences in allometric parameters (slope, intercept, residual SD) are common (73% traits). Body weight differences do not explain all sex differences in trait values but scaling by weight may be useful for some traits. Our results show sex differences in phenotypic traits are trait-specific, promoting case-specific approaches to drug dosage scaled by body weight in mice.

A higher Asthma Medication Ratio (AMR) predicts a decrease in ED visits among African American and Hispanic children

Introduction Higher rates of ED visits and hospitalizations for asthma among African American and Hispanic children may indicate suboptimal management of asthma, leading to a greater financial burden of healthcare. It is not well known if an association of race/ethnicity with controller medication and hospital-based care utilization exists. Objective This study examines whether the Asthma Medication Ratio (AMR) predicts healthcare utilization for asthma by race/ethnicity. Methods 4,584 Medi-Cal children (Ages 5–11) with persistent asthma in Los Angeles were identified and their AMRs (2018) were calculated based on the HEDIS criteria. Healthcare utilization data were used, including hospitalizations, ED visits, and pharmacy claims to examine whether a higher AMR predicts decreases in healthcare utilization by race/ethnicity in the subsequent 3,6, and 12 months (2019). Results The average AMR was lowest among African American children (0.401). In the subsequent 12 months, they were highest in ED visits (0.249) and hospitalizations (0.121), but lowest in outpatient visits (0.793). The results of logistic regression showed that a higher value of AMR (>0.5) contributed to decreases in ED visits in the subsequent 12 months only among African Americans (OR = 0.551, 95% CI 0.364–0.832) and Hispanics (OR = 0.613, 95% CI 0.489–0.770). No association between AMR and hospitalizations was found. Conclusions Our findings indicate that increased use of controller medication contributes to a decrease in ED visits among African American and Hispanic children with persistent asthma. Increased use of controller medications and caregiver’s efforts for medication adherence may contribute to a reduction in asthma disparities.

Where Do Real-Time Prescription Benefit Tools Fit in the Landscape of High US Prescription Medication Costs? A Narrative Review.

The problem of unaffordable prescription medications in the United States is complex and can result in poor patient adherence to therapy, worse clinical outcomes, and high costs to the healthcare system. While providers are aware of the financial burden of healthcare for patients, there is a lack of actionable price transparency at the point of prescribing. Real-time prescription benefit (RTPB) tools are new electronic clinical decision support tools that retrieve patient- and medication-specific out-of-pocket cost information and display it to clinicians at the point of prescribing. The rise in US healthcare costs has been a major driver for efforts to increase medication price transparency, and mandates from the Centers for Medicare & Medicaid Services for Medicare Part D sponsors to adopt RTPB tools may spur integration of such tools into electronic health records. Although multiple factors affect the implementation of RTPB tools, there is limited evidence on outcomes. Further research will be needed to understand the impact of RTPB tools on end results such as prescribing behavior, out-of-pocket medication costs for patients, and adherence to pharmacologic treatment. We review the terminology and concepts essential in understanding the landscape of RTPB tools, implementation considerations, barriers to adoption, and directions for future research that will be important to patients, prescribers, health systems, and insurers.

Identifying Characteristics Associated with the Concentration and Persistence of Medical Expenses among Middle-Aged and Elderly Adults: Findings from the China Health and Retirement Longitudinal Survey.

Medical expenses, especially among middle-aged and elderly people, have increased in China over recent decades. However, few studies have analyzed the concentration or persistence of medical expenses among Chinese residents or vulnerable groups with longitudinal survey data. Based on the data of CHARLS (China Health and Retirement Longitudinal Study), this study sought to identify characteristics associated with the concentration and persistence of medical expenses among Chinese middle-aged and elderly adults and to help alleviate medical spending and the operational risk of social medical insurance. Concentration was measured using the cumulative percentages of ranked annual medical expenses and descriptive statistics were used to define the characteristics of individuals with high medical expenses. The persistence of medical expenses and associated factors were estimated using transfer rate calculations and Heckman selection modeling. The results show that total medical expenses were concentrated among a few adults and the concentration increased over time. People in the high medical expense group were more likely to be older, live in urban areas, be less wealthy, have chronic diseases, and attend higher-ranking medical institutions. Lagged medical expenses had a persistent positive effect on current medical expenses and the effect of a one-period lag was strongest. Individuals with chronic diseases during the lagged period had a higher likelihood of experiencing persistent medical expenses. Policy efforts should focus on preventive management, more efficient care systems, improvement of serious illness insurance level, and strengthening the persistent protection effect of social medical insurance to reduce the high medical financial risk and long-term financial healthcare burden in China.

Changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes in Beijing, China

BackgroundChina expanded health coverage to residents in informal economic sectors by the rural new cooperative medical scheme (NCMS) for rural population and urban resident basic medical insurance scheme (URBMI) for non-working urban residents. Fragmentation of resident social health insurance schemes exacerbated the health inequity and China started the integration of urban and rural resident medical insurance schemes since 2016. Beijing finished the insurance integration in 2017 and has been implementing a unified urban and rural resident basic medical insurance scheme (URRBMI) since the beginning of 2018. This study aims to examine changes in health care utilization and financial protection after integration of the rural and urban social health insurance schemes.MethodsWe used household survey data from Beijing Health Services Survey in 2013 and 2018. Respondents who were 15 or older and covered by URBMI, NCMS or URRBMI were included in this study. Our study finally included 8,554 individuals in 2013 and 6,973 individuals in 2018, about 70% of which were rural residents in each year. Descriptive analysis was used to compare the healthcare utilization, healthcare expenditure and incidence of catastrophic health expenditure between different groups. A series of two-part regression models were used to analyze the changes of healthcare utilization, healthcare expenditure and incidence of catastrophic health expenditure.ResultsFrom 2013 to 2018, urban–rural disparity in outpatient care utilization seemed widened because urban residents’ utilization of outpatient care increased 131% while rural residents’ utilization only increased 72%; both rural and urban residents’ spending on outpatient care increased about 50%. Utilization of inpatient care changed little and poor residents still used significantly less inpatient care compared with the rich residents. Poor residents still suffered heavily catastrophic health expenditures.ConclusionFrom 2013 to 2018, residents’ utilization of healthcare, especially outpatient care, increased in Beijing. Health insurance reforms increased residents’ utilization of healthcare but failed to reduce their healthcare financial burden, especially for poor people. Our study advocates more pro-poor insurance policies and more efforts on the efficiency of health system.

Trends and Burden of Firearm-Related Injuries Among Children and Adolescents: A National Perspective

IntroductionFirearm-related injuries in America have been under increasing scrutiny over the last several years. Few studies have examined the burden of these injuries in the pediatric population. The objective of this study was to describe the incidence of firearm-related injuries in hospitalized pediatric patients in the United States and identify the risk factors associated with readmission in this young population. MethodsThe Nationwide Readmission Database was examined from 2010 to 2017. Pediatric patients (aged ≤18 y) who survived their index hospitalization for any firearm injury were analyzed to determine incidence rate, case fatality rate, risk factors for 30-d readmission, and financial health care burden. ResultsThere were 35,753 pediatric firearm injuries (86.8% male) with an overall incidence rate of 10.49 (95% confidence interval [CI]: 9.26-11.71) per 100,000 pediatric hospitalizations. Adolescents aged >12 y had the highest incidence rate (60.51, 95% CI: 55.19-65.84). In-hospital mortality occurred in 1948 cases (5.5%), with higher case fatality rates in males. There were 1616 (5.7%) unplanned 30-d readmissions. Multivariate analysis showed abdominal firearm injuries (hazard ratio: 1.13, 95% CI: 1.03-1.24; P = 0.006) and longer length of stay (hazard ratio: 1.27, 95% CI: 1.04-1.55; P = 0.016) were associated with a greater risk of 30-d readmission. The median health care cost for firearm-related injuries was $36,535 (interquartile range: $19,802-$66,443), 22% of which was due to readmissions. Cost associated with 30-d readmissions was $7978 (interquartile range: $4305-$15,202). ConclusionsFirearm-related injury is a major contributor to pediatric morbidity, mortality, and health care costs. Males are disproportionately affected by firearm injury, but females are more likely to require unplanned 30-d readmissions. Interventions should target female sex, injuries of suicidal intent, psychiatric comorbidities, prolonged index hospitalization, and abdominal injuries.