Full Subsidy Research Articles

Assessing willingness to pay for children's COVID-19 vaccination among healthcare providers and users using a theory-based discrete choice experiment

Improving vaccine coverage among children is crucial to prevent the long-term consequences of COVID-19 infections and the emergence of resistant COVID-19 variants, especially in resource-scarce settings. This study determined factors influencing the willingness to take and pay for COVID-19 vaccine for children among Vietnamese healthcare professionals and the public. A Theory-Based discrete-choice experiment was focused on a different topic related to vaccines, including the COVID-19 vaccine for children, Monkeypox, the adult COVID-19 booster, the HIV vaccine, and a potential future pandemic. The recruitment period was from April to August 2022, and a total of 5700 Vietnamese individuals aged 16 and above from various regions of the country participated in the study. The data for the sub-study on the COVID-19 vaccination for children was completed by 891 of these participants. Most participants agreed on vaccination for all children. Among healthcare professionals it was 76.2% and 69.3% for the general population. Healthcare professionals were the main source of vaccine information (70.7%). Payment options of 50%, 100%, and full subsidy were the most popular. Concerns about vaccine characteristics were associated with lower acceptance among healthcare professionals and the general public. The burden of historical medical expenses negatively correlated with willingness to pay for vaccination, while service satisfaction positively correlated with willingness to pay. To develop an effective vaccination program among children in Vietnam, providing accurate information and satisfying vaccine services, primarily through knowledgeable and professional healthcare providers, can improve the willingness to vaccinate and pay for the COVID-19 vaccine.

A Majority Of Americans Have No Or Low Awareness Of Paxlovid, The At-Home COVID-19 Treatment.

Oral Paxlovid (nirmatrelvir-ritonavir) is highly effective at preventing hospitalization and death from COVID-19, yet it has been remarkably underused, even by patients at highest risk from COVID-19, since its December2021 introduction in the US. The reasons behind this underuse are still unclear. To examine public awareness and perceptions of Paxlovid that might help explain its underuse, we conducted a nationally representative survey of 1,430 US adults in July2023. A majority of respondents (85percent) had no or low awareness of Paxlovid, including 31percent who had never heard of it. Even among those who were aware of the drug, many held misperceptions about its effectiveness (39percent), adverse effects (86percent), and requisite timing (61percent) that could lead to underuse. Lower awareness and misperceptions were more common among medically vulnerable and disadvantaged populations who might benefit most from Paxlovid access, including adults unvaccinated against COVID-19, those with lower levels of education, and Black and Hispanic or Latino adults. Results suggest that Paxlovid underuse may be partly driven by a lack of effective public communication to generate awareness and knowledge about the drug, leading to low demand. As Paxlovid loses full government subsidies, further public outreach is needed to ensure that the public accesses it when needed.

Analisis Kelayakan Tarif Bus Trans Koetaradja Berdasarkan Ability To Pay (ATP) Koridor 2A Pusat Kota-Blang Bintang

Since in 2018, Trans Koetaradja Urban Mass Transit is expected to provide maximum service to the community as users. Corridor 2A with the route Masjid Raya Baiturrahman-Lambaro-Blang Bintang. For now, the government applies full subsidies for bus users, meaning that bus users can ride this bus without paying. However, this condition will certainly not last forever. Calculation of the feasibility of bus fare based on Ability to pay is done to see the ability of this bus user to pay the bus fare. This study uses a Quantitative Descriptive Research Method through Survey Techniques involving 392 respondents to bus users given a survey form containing questions regarding: frequency of bus use, average monthly income and expenses and expenses to pay for transportation Respondents were selected based on activities, which were divided into 7 categories based on occupation, including: Students, Self-employed, Workers, Civil Servants, Non-workers and Housewives. The results of the questionnaire were then tabulated and calculated to see the distribution of ATP rates by considering income, percentage of expenditure on transportation and frequency of use. From the research results, the percentage of gender is 57% female and 43% male. The average frequency of use of the bus in 1 week is 4 times the transportation costs obtained range between Rp. 10,000 and Rp. 200,000 The average ATP value is Rp. 2,400.

Affordability and adherence gains for Medicare Part D low-income subsidy recipients when low-income subsidy benefits expanded in 2024.

The lowest-income beneficiaries enrolled in the Medicare Part D prescription drug program receive "full subsidies" that waive the premium and deductible and impose minimal copayments. Those with slightly higher incomes and assets may be eligible for "partial subsidies." Prior to 2024, individuals receiving partial subsidies faced reduced Part D premiums and deductibles and paid 15% coinsurance. Under provisions of the Inflation Reduction Act, recipients of partial subsidies were upgraded to full subsidies beginning in 2024. The objective of this pilot study was to assess whether the new policy is likely to reduce cost-related nonadherence to prescribed medications- a common problem faced by older adults even among those receiving subsidies. To compare cost-related nonadherence among partial- vs full-subsidy recipients with similar characteristics. We used 2019 Medicare Current Beneficiary Survey data for the study. The Medicare Current Beneficiary Survey is uniquely suited for this work because it contains administrative data on low-income subsidy enrollment plus extensive survey-based information on financial resources necessary to establish program eligibility and rates of cost-related nonadherence. Explanatory variables included sociodemographic characteristics, economic resources, work status, and health variables. We found that the partial-subsidy group reported significantly more cost-related nonadherence (39% vs 22%; P = 0.01) arising both from a lower propensity to fill some prescriptions (23% vs 12%; P = 0.03) and to more delays in filling others (29% vs 8%; P = 0.03). The differences were more pronounced for women and racial and ethnic minority groups in contrast to men and majority populations, respectively. Because the study samples were small, we could not conduct a detailed regression analysis. The magnitude of cost-related nonadherence effects associated with partial-subsidy cost sharing suggests that the Inflation Reduction Act policy to expand low-income subsidies may boost medication adherence, most notably among women and racial and ethnic minority groups.

Medicare Part D low-income subsidies expanded in January 2024, but more needs to be done to ensure that eligible beneficiaries enroll.

The Inflation Reduction Act of 2022 extended full low-income subsidies (LIS) to a small group of Medicare Part D recipients with limited assets and incomes between 135% and 150% of the Federal Poverty Level beginning in January 2024. This policy may result in small enrollment gains among beneficiaries eligible for the new benefits, but the biggest problem with the current LIS program is underenrollment across all eligibility groups. Prior research has shown that underenrollment has been a persistent problem since the LIS program began in 2006, yet little has been done to correct the situation. To identify individual-level factors associated with failure to enroll among low-income beneficiaries eligible for both full subsidies and partial subsidies under the LIS program. We used 2019 Medicare Current Beneficiary Survey data for the study. The Medicare Current Beneficiary Survey is uniquely suited for this work because it contains administrative data on LIS enrollment plus extensive survey information on financial resources necessary to establish program eligibility. We conducted descriptive and multivariate analyses to identify factors associated with failure to enroll when eligible for either full or partial subsidies. Explanatory variables included sociodemographic characteristics, economic resources, work status, health variables, and source of prescription coverage (for nonsubsidized beneficiaries). In 2019, 73% of beneficiaries eligible for full subsidies under pre-Inflation Reduction Act LIS provisions were enrolled, compared with only 25% eligible for partial subsidies. The number of those estimated to be eligible for full subsidies but not enrolled (N = 3.9 million) was more than double that of those eligible but not enrolled for partial subsidies (N = 1.5 million). Factors associated with failure to enroll (older age, male sex, White race, married, higher education, higher income and assets, and excellent/very good health status) were similar for both groups. In multivariate analyses, the single strongest predictor of failure to enroll was receipt of income from work (odds ratio = 5.50; P < 0.001). Among the nonenrolled, 64% eligible for full subsidies and 75% eligible for partial subsidies maintained unsubsidized Part D coverage. Significant numbers of low-income Medicare beneficiaries are eligible for Part D subsidies but fail to enroll. Common characteristics distinguishing nonenrollees from enrollees include older age with higher proportions of White individuals, married individuals, higher income and assets, and better overall health. Two promising targets for increasing LIS enrollment are evidence of work income and unsubsidized Part D coverage.

Free public transit and voter turnout

Transportation costs are an under-studied barrier to political participation. In many elections worldwide, subsidies to voter transportation are already provided or are under discussion. However, these types of incentives have not been rigorously evaluated. Here we examine possibly the world's largest-ever intervention to lower these costs, the adoption of a fare-free public transit policy in Brazil during the 2022 national election, when about half of Brazilian voters were granted the right to use public transit for free on election days. However, while some cities adopted the benefit for both rounds of the election, others adopted it only for the second round. Using an event study design, we exploit this difference in adoption timing to examine the policy's causal impact on voter turnout rates and human mobility levels. We find that fare-free transit increased ridership between 7.2% and 17.5% on election days, however, we estimate a precise and robust null effect of the policy on voter turnout (Coef. −0.03p.p. with standard error of 0.22p.p.). Our results illustrate that monetary transport costs may not always be a critical factor behind non-participation. Although reducing transportation costs improves access to polling places, we show that even a full transit subsidy may not be sufficient to increase voter turnout.

Association between low-income subsidies and inequities in orally administered antimyeloma therapy use.

The Medicare Part D low-income subsidy program drastically reduces patient cost sharing and may improve access to and equitable use of high-cost antimyeloma therapy. We compared initiation of and adherence to orally administered antimyeloma therapy between full-subsidy and nonsubsidy enrollees and assessed the association between full subsidies and racial/ethnic inequities in orally administered antimyeloma treatment use. Retrospective cohort study. We used Surveillance, Epidemiology, and End Results-Medicare data to identify beneficiaries diagnosed with multiple myeloma between 2007 and 2015. Separate Cox proportional hazards models assessed time from diagnosis to treatment initiation and time from therapy initiation to discontinuation. Modified Poisson regression examined therapy initiation in the 30, 60, and 90 days following diagnosis and adherence to and discontinuation of treatment in the 180 days following initiation. Receipt of full subsidies was not associated with earlier initiation of or improved adherence to orally administered antimyeloma therapy. Full-subsidy enrollees were 22% (adjusted HR [aHR], 1.22; 95% CI, 1.08-1.38) more likely to experience earlier treatment discontinuation than nonsubsidy enrollees. Receipt of full subsidies did not appear to reduce racial/ethnic inequities in orally administered antimyeloma therapy use. Black full-subsidy and nonsubsidy enrollees were 14% less likely than their White counterparts to ever initiate treatment (full subsidy: aHR, 0.86; 95% CI, 0.73-1.02; nonsubsidy: aHR, 0.86; 95% CI, 0.74-0.99). Full subsidies alone are insufficient to increase uptake or equitable use of orally administered antimyeloma therapy. Addressing known barriers to care (eg, social determinants of health, implicit bias) could improve access to and use of high-cost antimyeloma therapy.

Out-of-Pocket Drug Costs for Medicare Beneficiaries With Cardiovascular Risk Factors Under the Inflation Reduction Act

BackgroundHigh out-of-pocket prescription drug costs contribute to financial toxicity, medication nonadherence, and adverse cardiovascular (CV) outcomes. Policymakers recently passed the Inflation Reduction Act, which will cap Medicare out-of-pocket drug costs at $2,000/year and expand full low-income subsidies (LIS). It is unclear how these provisions will affect Medicare beneficiaries with CV risk factors and/or conditions. ObjectivesThe authors sought to characterize the population of Medicare beneficiaries with CV risk factors/conditions experiencing out-of-pocket prescription drug costs >$2,000/year and estimate their potential savings under the Inflation Reduction Act’s spending cap; identify sociodemographic characteristics associated with out-of-pocket costs >$2,000/year; and characterize beneficiaries newly eligible for LIS under the Inflation Reduction Act. MethodsThis was a cross-sectional study of Medicare beneficiaries aged ≥65 years with ≥1 CV risk factor/condition from 2016 to 2019. ResultsAn annual estimated 34,056,335 ± 855,653 Medicare beneficiaries (mean ± SE) had ≥1 CV risk factor/condition, of whom 1,020,484 ± 77,055 experienced out-of-pocket drug costs >$2,000/year. The likelihood of experiencing out-of-pocket drug costs >$2,000/year was lower among adults ≥75 years vs 65 to 74 years (adjusted OR: 0.67; 95% CI: 0.49-0.93) and for low-income vs higher-income adults. Among beneficiaries currently spending >$2,000/year, estimated median out-of-pocket drug savings would be $855/year and total annual savings $1,723,031,307 ± $91,150,609 under the Inflation Reduction Act. An estimated 1,289,861 beneficiaries would also become newly eligible for LIS. ConclusionsMore than 1 million older adults with CV risk factors and/or conditions spend >$2,000/year out-of-pocket on prescription drugs and will likely benefit from the Inflation Reduction Act’s cap, with estimated total out-of-pocket savings of $1.7 billion/year, while another 1.3 million will also become newly eligible for LIS.

Energy poverty, housing conditions, and self-assessed health: evidence from Poland

Energy poverty, i.e., inefficient heating and insufficient access to energy services, can turn a shelter into a health hazard. We find that substandard housing and ineffective heating is associated with a higher risk of poor health in an urban context. We surveyed people living in two middle-sized cities in a coal-dependent region of Poland and used objective and subjective indicators of energy poverty and self-assessed health status. We demonstrate that people who live in substandard housing are more likely to exhibit poor musculoskeletal and cardiovascular outcomes, by 10 and 6 pp, respectively than otherwise similar people living in suitable housing conditions. We show that energy-poor people who use coal or a wood stove have a 24 pp higher likelihood of respiratory disease than the energy-poor who live in flats connected to district heating. We also find that a significant amount of the explained variance in the probability of respiratory disease is attributable to energy poverty. To improve the housing conditions and reduce the risk of poor health outcomes, we recommend two policy instruments: 1) a full subsidy for thermal retrofits and connecting multi-family buildings to the district heating network and 2) a targeted energy voucher for clean heating.

Economic Evaluation of Selected Interleukin Inhibitors Versus Methotrexate for Moderate-to-Severe Plaque Psoriasis From the Philippine Payer Perspective

ObjectivesWe conducted an economic evaluation of interleukin inhibitors (ILIs) guselkumab, ixekizumab (IXE), secukinumab (SEC), and ustekinumab to a methotrexate (MTX) comparator for biologic-naive adult Filipino patients with moderate-to-severe chronic plaque psoriasis. MethodsA 1-year decision tree and 5-year Markov model were used to estimate incremental cost-effectiveness ratios (ICERs) in Philippine pesos (PHP) per Psoriasis Area Severity Index improvement of at least 75%. For health technology assessment purposes, we also estimated the budget impact of subsidies for SEC to a Government of the Philippines (GoP) payer. Deterministic and probabilistic sensitivity analyses were performed. Data sources included global literature and local intervention prices. ResultsAll ILIs were more effective but also more expensive than MTX. In the base case, only IXE and SEC were cost-effective treatments at a gross domestic product–benchmarked threshold, yielding ICERs of PHP468 098.01 and PHP483 525.32 per PASI responder, respectively. GUS and UST were less likely to be cost-effective throughout a range of simulated thresholds. ICERs were most responsive to discontinuation rates and drug prices. Full subsidy of SEC for 5 years would cost the GoP PHP1.83 billion more than a similar subsidy for MTX. ConclusionsILIs were clearly more effective than MTX, but only IXE and SEC were potentially cost-effective for a GoP payer. Any case in which SEC is fully subsidized is more expensive to the GoP than the base case. This study was limited by a lack of country-specific effectiveness data, underestimation of comparator costs, exclusion of noncutaneous and quality-of-life effects, and indirect costs.

Research on Cancer Screening Promotion and Employment Support for Employees with Cancer at Business Establishments.

Increasing cancer screening rates among working-age populations and providing employment support for employees with cancer are issues that need to be addressed in Japan. Therefore, this study aimed to clarify the situation regarding cancer screening promotion and employment support for employees with cancer at business establishments and the support they seek from medical professionals regarding these issues. This survey covered 1,058 business establishments and included the following items: attributes of the business establishments, cancer screening rate, support for employees to promote cancer screening, support sought by business establishments from medical professionals to promote cancer screening, presence of employees with cancer, support programs for employees with cancer, awareness of the resources available for employment support for employees with cancer, difficulties in supporting employees with cancer in the workplace, and support sought by business establishments from medical professionals in providing employment support for employees with cancer. Data analysis was primarily conducted using summary statistics. This study included 153 establishments. The median cancer screening rate ranged from 50.00 to 99.15. Employee support for promoting cancer screening ranged from approximately 30% to 40% for "ensuring time for screening" and from 20% to 30% for "providing full subsidies for cancer screening cost." The median screening rate for breast and cervical cancers was 50.00, and support for promoting screening was less than 30% for each. Business establishments sought support from medical professionals regarding cancer and study sessions on cancer prevention to promote cancer screening. Regarding support systems for employees with cancer, 49.7% of the establishments offered sickness benefits, and 42.5% offered paid leave on an hourly basis. Less than 10% were aware of the websites provided by public organizations regarding employment support for patients with cancer. Approximately 50% of the establishments reported difficulties regarding treatment policies and duration uncertainties. Business establishments sought the provision of relevant knowledge and specific information to increase cancer screening rates and provide employment support for employees with cancer. Furthermore, this study suggests that employees with cancer need to manage the information they provide their establishments.

Minimizing emissions from grid-based hydrogen production in the United States

Low-carbon hydrogen could be an important component of a net-zero carbon economy, helping to mitigate emissions in a number of hard-to-abate sectors. The United States recently introduced an escalating production tax credit (PTC) to incentivize production of hydrogen meeting increasingly stringent embodied emissions thresholds. Hydrogen produced via electrolysis can qualify for the full subsidy under current federal accounting standards if the input electricity is generated by carbon-free resources, but may fail to do so if emitting resources are present in the generation mix. While use of behind-the-meter carbon-free electricity inputs can guarantee compliance with this standard, the PTC could also be structured to allow producers using grid-supplied electricity to qualify subject to certain clean energy procurement requirements. Herein we use electricity system capacity expansion modeling to quantitatively assess the impact of grid-connected electrolysis on the evolution of the power sector in the western United States through 2030 under multiple possible implementations of the clean hydrogen PTC. We find that subsidized grid-connected hydrogen production has the potential to induce additional emissions at effective rates worse than those of conventional, fossil-based hydrogen production pathways. Emissions can be minimized by requiring grid-based hydrogen producers to match 100% of their electricity consumption on an hourly basis with physically deliverable, ‘additional’ clean generation, which ensures effective emissions rates equivalent to electrolysis exclusively supplied by behind-the-meter carbon-free generation. While these requirements cannot eliminate indirect emissions caused by competition for limited clean resources, which we find to be a persistent result of large hydrogen production subsidies, they consistently outperform alternative approaches relying on relaxed time matching or marginal emissions accounting. Added hydrogen production costs from enforcing an hourly matching requirement rather than no requirements are less than $1 kg−1, and can be near zero if clean, firm electricity resources are available for procurement.

ASSESSING THE NEW INFLATION REDUCTION ACT’S IMPACT ON EXPANDING MEDICARE PART D LOW-INCOME SUBSIDIES

Abstract The recently enacted Inflation Reduction Act (IRA) of 2022 extends full low-income subsidies (LIS) to Medicare Part D recipients with limited assets and incomes up to 150% of the Federal Poverty level (FPL) beginning in 2024. Under current law, full Part D subsidies (no annual premiums and nominal cost sharing) are available only to those with incomes up to 135% of the FPL. Partial subsidies are available to those with incomes between 135% and 150% of FPL. Increasing the level of benefits to those currently only eligible for partial subsidies has the potential of significantly lowering out-of-pocket medication costs that pose a barrier to adherence for many low-income Medicare beneficiaries, but the outcome of the new policy will depend on how many enroll. Historically, enrollment among those eligible for partial subsidies has hovered around 30%, but the latest data on LIS participation rates are for 2014. We undertook this study to update LIS eligibility and enrollment numbers to 2019, with a particular emphasis on identifying characteristics of beneficiaries who may benefit from the new policy. Using data from the Medicare Current Beneficiary Survey, we determined that 73% of beneficiaries eligible for full subsidies under current law were enrolled, but only 25% eligible for partial subsidies were enrolled. We conclude that while the IRA will raise the overall level of Part D subsidies, it will be important to engage stakeholders and promote outreach to maximize participation in the leadup to implementation.

Effect of CGM Access Expansion on Uptake Among Patients on Medicaid With Diabetes.

Current studies on continuous glucose monitor (CGM) uptake are revealing for significant barriers and inequities for CGM use among patients from socially underprivileged communities. This study explores the effect of full subsidies regardless of diabetes type on CGM uptake and HbA1c outcomes in a U.S. adult patient population on Medicaid. This retrospective cohort study examined 3,036 adults with diabetes enrolled in a U.S. Medicaid program that fully subsidized CGM. CGM uptake and adherence were assessed by CGM prescription and dispense data, including more than one fill and adherence by medication possession ratio (MPR). Multivariate logistic regression evaluated predictors of CGM uptake. Pre- and post-CGM use HbA1c were compared. CGM were very well received by both individuals with type 1 diabetes and individuals with type 2 diabetes with similar high fill adherence levels (mean MPR 0.78 vs. 0.72; P = 0.06). No significant difference in CGM uptake outcomes were noted among major racial/ethnic groups. CGM use was associated with improved HbA1c among those with type 2 diabetes (-1.2% [13.1 mmol/mol]; P < 0.001) that was comparable between major racial/ethnic groups and those with higher fill adherence achieved greater HbA1c reduction (-1.4% [15.3 mmol/mol]; P < 0.001) compared with those with lower adherence (-1.0% [10.9 mmol/mol]; P < 0.001). CGM uptake disparities can largely be overcome by eliminating CGM cost barriers. CGM use was associated with improved HbA1c across all major racial/ethnic groups, highlighting broad CGM appeal, utilization, and effectiveness across an underprivileged patient population.

COVID-19 Pandemic, Oil Slump and the Nigerian Economy

The COVID-19 pandemic came as a shock to the global economy and its impact was well felt. However, it came with the possibility of implementing structural policies and reforms. The pandemic slowed down economic activities in the global market and translated into crashed oil prices, which gave room for reforms such as subsidy removal. Nigeria maximized the opportunity to remove the full subsidy on petroleum products, especially Premium Motor Spirit (PMS). But the possibility was not last enough for the populace to enjoy. COVID-19 pandemic and its consequence on oil price had affected the Nigerian economy by ways of fiscal constraint, loss of revenue, the exit of businesses in the market, job cuts and soaring unemployment rate. Exchange rate fluctuation is prevalent, the inflation rate is on the rise and thereby, poverty incidence has increased. In cushioning the effect of the pandemic, governments at all levels, religious bodies, businesses and individuals donated towards the fight and support of people during the pandemic. Nigeria should maintain a strong economic basis, single its double sides of being exporter and importer at the same time; and ensure local refining of the petroleum products. Also, it has come of age for developing a national package to forestall a similar crisis in an instance of similar occurrence.

Payment options: An analysis of 6 years of payment plan data and potential implications for for-profit clinics, non-profit veterinary providers, and funders to access to care initiatives.

Analyzing a dataset of payment plans disassociated with traditional credit scoring, this research, for the first time, offers insights into the mitigation of cash flow and credit ineligibility challenges in access to veterinary care. Specifically, this paper explores financial fragility among pet families and whether payment options offer substantial bridges in access to care challenges for veterinarians and clients. Researchers introduce a veterinary care multiplier to estimate the potential increase in veterinary care that may be provided by for-profit and non-profit clinics from additional payment options. The implications for non-profits working to address access to care is that by directing donor dollars to cover the 6.9% that is potentially left unpaid in meeting pet families simply facing cash flow challenges, a non-profit clinic could provide 14.5 times the veterinary care vs. full subsidies. In for-profit clinics, allocating some of a clinic's discount budget may similarly yield 14.5 times the care for clients likely to be declined by the traditional credit options. Further research is recommended to explore how deeply these options penetrate all financially fragile pet owners and outcomes in the absence of these tools for credit-declined clients. Additional research to determine the levels at which payment options reduce economic euthanasia decisions, reduce the client and staff stress, increase the value perception and compliance with suggested care, enable better outcomes for patients, and increase clinic revenue is also recommended. The researchers conclude that payment options that are independent of traditional credit scoring mitigate financial barriers to obtaining veterinary care.

Addressing child health inequity through case management of under-five malaria in Nigeria: an extended cost-effectiveness analysis

BackgroundUnder-five malaria in Nigeria is a leading cause of global child mortality, accounting for 95,000 annual child deaths. High out-of-pocket medical expenditure contributes to under-five malaria mortality by discouraging care-seeking and use of effective anti-malarials in the poorest households. The significant inequity in child health outcomes in Nigeria stresses the need to evaluate the outcomes of potential interventions across socioeconomic lines.MethodsUsing a decision tree model, an extended cost-effectiveness analysis was done to determine the effects of subsidies covering the direct and indirect costs of case management of under-five malaria in Nigeria. This analysis estimates the number of child deaths averted, out-of-pocket (OOP) expenditure averted, cases of catastrophic health expenditure (CHE) averted, and cost of implementation. An optimization analysis was also done to determine how to optimally allocate money across wealth groups using different combinations of interventions.ResultsFully subsidizing direct medical, non-medical, and indirect costs could annually avert over 19,000 under-five deaths, 8600 cases of CHE, and US$187 million in OOP spending. Per US$1 million invested, this corresponds to an annual reduction of 76 under-five deaths, 34 cases of CHE, and over US$730,000 in OOP expenditure. Due to low initial treatment coverage in poorer socioeconomic groups, health and financial-risk protection benefits would be pro-poor, with the poorest 40% of Nigerians accounting for 72% of all deaths averted, 55% of all OOP expenditure averted, and 74% of all cases of CHE averted. Subsidies targeted to the poor would see greater benefits per dollar spent than broad, non-targeted subsidies. In an optimization scenario, the strategy of fully subsidizing direct medical costs would be dominated by a partial subsidy of direct medical costs as well as a full subsidy of direct medical, nonmedical, and indirect costs.ConclusionSubsidizing case management of under-five malaria for the poorest and most vulnerable would reduce illness-related impoverishment and child mortality in Nigeria while preserving limited financial resources. This study is an example of how focusing a targeted policy-intervention on a single, high-burden disease can yield large health and financial-risk protection benefits in a low and middle-income country context and address equity consideration in evidence-informed policymaking.

A mechanism to enhance multi-participant’s prevention efforts under pandemic

Frequently emerging pandemics have caused participants’ low prevention cooperation. This paper studies a reward and punishment mechanism for a health system and individuals to enhance their prevention. In the traditional way of responding to the pandemic, health systems generally obtain full subsidies by government and pay attention to treatment. Meanwhile, individuals need to cooperate according to their treatment. However, emerging pandemics are increasing and spreading quickly. This has forced the government to change its full-subsidy treatment strategy to prevention incentive strategy. However, participants (individuals and the health system) appear to have a low motivation to do prevention. The aim of this paper is to give a new mechanism based on reward and punishment policies, which can be offered by the government to the participants to improve their prevention efficiency. We develop a game-theoretic model with three nonlinear programs (NLP) to identify the optimal policies, and obtain the factors that influence the optimal policies. Our findings show that under the proposed mechanism, all participants are willing to make decisions in accordance with the requirements of the government. Furthermore, we indicate that the designed mechanism has a positive network externality. We also prove that the given mechanism is effective regardless of whether the information of the individuals’ prevention efforts is available. A numerical example indicates that the proposed mechanism is more suitable for applications in areas with a large population.

Selection and Behavioral Responses of Health Insurance Subsidies in the Long Run: Evidence from A Field Experiment in Ghana

We conduct a randomized experiment that varies one-time health insurance subsidy amounts (partial and full) in Ghana to study the impacts of subsidies on insurance enrollment and health care utilization. We find that both partial and full subsidies promote insurance enrollment in the long run, even after the subsidies expired. Although the long run enrollment rate and selective enrollment do not differ by subsidy level, long run health care utilization increased only for the partial subsidy group. We show that this can plausibly be explained by stronger learning-through-experience behavior in the partial than in the full subsidy group.

823. Characteristics, Comorbidities, and Medication Burden among People Living with HIV in the U.S. Medicare Program

Abstract Background Among the 1.2 million people living with HIV (PLWH) in the U.S., many are covered by Medicare, a federally funded health insurance program for elderly (≥65 years) and disabled (&amp;lt; 65 years) individuals. Medicare has emerged as a major source of HIV care for PLWH. Given limited research in this population, a better understanding of patient characteristics, comorbidities, and comedication use among PLWH in the Medicare program is needed to help optimize clinical care. Methods A retrospective claims analysis of a national cross-sectional sample of fee-for-service (FFS) Medicare beneficiaries with continuous medical and prescription coverage in 2018 was conducted using 100% Medicare administrative claims. The PLWH group included individuals with ≥1 HIV diagnosis code in medical claims and ≥1 pharmacy claim for an anchor antiretroviral (ARV) drug (i.e., NNRTI, PI or InSTI) in 2018. The comparison group included a random sample of Medicare beneficiaries without HIV (PLWoH). Sociodemographic characteristics, comorbidities, and medication use were compared between PLWH and PLWoH. Results The study sample included 86,856 PLWH and 552,645 PLWoH. PLWH were more likely to be younger (mean age: 57.4 vs 71.1 years and &amp;lt; 65 years: 72% vs 18%), male (75% vs 42%), Black (42% vs 10%), eligible for Medicare due to disability (83% vs 27%) and receiving full low-income subsidies (77% vs 31%); all p&amp;lt; 0.001. Prevalence of &amp;gt;3 comorbidities was high in PLWH (70.2%) and only slightly lower than in PLWoH (71.7% p&amp;lt; 0.001). Prevalence of neuropsychiatric conditions, chronic kidney disease, liver disease, COPD, hepatitis B, and hepatitis C were higher in PLWH (Figure 1). The mean hierarchical condition categories risk score was higher in PLWH vs PLWoH (1.81 vs. 1.32; p&amp;lt; 0.001). On average, polypharmacy was higher among PLWH vs PLWoH (annual number of unique medications: 12.6 vs. 9.4 for all drugs and 10.3 vs. 9.4 for non-ARV drugs, both p&amp;lt; 0.001). Figure 1. Percentage of PLWH and PLWoH with multimorbidity and selected comorbid conditions. Abbreviations: COPD=chronic obstructive pulmonary disease; GI=gastrointestinal; PLWH=people living with HIV; PLWoH=people living without HIV All p-values &amp;lt;0.001 except GI Disorders (p=0.14). Conclusion In the Medicare FFS population, multimorbidity and polypharmacy were highly prevalent in PLWH despite their substantially younger age compared to PLWoH. Our findings highlight the need to consider comorbidities and comedications in HIV management including ARV regimens to minimize medication burden and drug interactions, which might improve clinical outcomes. Disclosures Pengxiang Li, PhD, Avalon Health Economics LLC (Consultant)COVIA Health Solutions (Consultant)Healthstatistics, LLC (Consultant) Jianbin Mao, PhD, Merck (Employee)Merck (Shareholder) Girish Prajapati, M.B.B.S., MPH , Merck &amp; Co., Inc. (Employee, Shareholder) Robert Gross, MD, MSCE, Pfizer (Other Financial or Material Support, Serve on DSMB for drug unrelated to HIV) Jalpa A. Doshi, PhD, Acadia (Consultant, Advisor or Review Panel member)Allergan (Advisor or Review Panel member)Biogen (Grant/Research Support)Boehringer Ingelheim (Other Financial or Material Support, Scientific lecture)Catabasis (Consultant)Humana (Grant/Research Support)Janssen, Inc. (Consultant, Grant/Research Support)MeiraGTX (Consultant)Merck (Grant/Research Support, Advisor or Review Panel member)Novartis (Grant/Research Support)Otsuka (Advisor or Review Panel member)Regeneron (Grant/Research Support)SAGE Therapeutics (Consultant)Sanofi (Grant/Research Support)Shire (Advisor or Review Panel member)The Medicines Company (Advisor or Review Panel member)