Government-run Health Insurance Research Articles

Abstract PO5-26-08: Caveats behind the improved outcomes observed in recent clinical trials for women with breast cancer: Korean breast cancer consensus meeting 2023

Abstract Introduction Korean Breast Cancer Society has organized the biennial Korean Breast Cancer Consensus Conference to find solutions to clinical situations that cannot be answered by randomized clinical trials or other definitive treatment research data. Unlike guidelines which are designed to apply to the majority of patients with early or advanced breast cancer encountered in daily practice, consensus meetings yield answers from clinicians’ perspectives and experiences. Therefore, this meeting aimed to integrate patient preferences, treatment availability, or other individual circumstances upon recent medical advances and available evidence. Materials and methods. Panelists were invited from various filed, such as medical oncology, surgical oncology, radiation oncology, pathology, radiology, nuclear medicine, hereditary cancer specialist. Results. 1. caveats behind optimizing treatment There had been strong interests in refinening thresholes for treatment and it can be more or less than previous standard treatment. Some patients clearly required escalated treatment, such as ovarian function suppression, combined HER2-targeted treatment, and utilization of immunotherapy during neoadjuvant systemic treatment. However, even same agent which showed great success for high risk patients showed Disappointing results and even failure. Furthermore, we need more sophisticated decision even for successful stories which introduced above, because of their serious adverse events. AntiPd-1/PD-L1 showed different serious adverse events profiles and Trastuzumab-deruxtecan is related with life-threatening pulmonary complication. Therefore, there is a clinical equipoise for an appropriate therapeutic threshold not only for low-risk patients but also high-risk patients who can safely forgo recommend treatment escalation in the newly introduced clinical trials. 2. Completely new serious adverse events observed in new drugs. Unlike chemotherapy, most targeted therapies cause lethal damage that clinicians may not have experienced. Some, such as pulmonary complications from trastuzumab deruxtecan, can be fatal if not treated immediately. Even if patients survive, they may suffer catastrophic outcomes because these agents leave a fatal disability that is too great for the patient's quality of life. Moreover, in South Korea, where government-run health insurance is the only payer and at the same time policy maker, non-medical constraints such as passive reimbursement plans, value-based medicine, and intentional delay or denial of certain drugs, panelist delivered varing opinions on the extent to which new agents can be utilized and which treatment plan could offer equal clinical benefit with less toxicity, or provide for a measurable improvement in outcomes. 3. utilizing genomic signatures Panelist raised issues genetic assay which analyzed genes currently we do not have treatment options which can modify disease process. Many questions were addressed such as, appropriate sampling time, which sample, liquid or tumor, can yield meaningful information. Conclusion Korean Breast Cancer consensus meeting highlighted important caveats behinds new promising findings. Clinical unmet need and uncertainty should be disclosed before patients because what clinician and patients work with is their life. Shared decision making is essential and patients should become well aware of science and medicine. Proactive approach of clinician is critical for these movements. Citation Format: Airi Han, Young-Joon Kang, Sei Hyun Kim, Eui Su Chae, Han Cho Kim, Kyong Hwa Park. Caveats behind the improved outcomes observed in recent clinical trials for women with breast cancer: Korean breast cancer consensus meeting 2023 [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-26-08.

Level of service satisfaction of health BPJS patients with drug services at pharmacy X Sibolga City

Health-related issues are one of the most pressing needs of society. Indonesia has government-run health insurance that is directly under its control. When patients obtain services that are considered appropriate or above expectations, patient satisfaction is achieved. This research uses a survey research approach and is descriptive. Surveys distributed to respondents were used to collect data. Eighty respondents who met the inclusion requirements were sampled. The data used is primary data, information obtained directly from respondents, with data collection methods such as providing questionnaires, which are filled in by the respondents themselves and sent back to the researcher. The findings of the study, which were based on SPSS patient characteristics analysis, showed that females accounted for the most significant percentage of respondents (43), followed by the 46-55 years age group (32.5%) and housewives (27.5%), (n=26; 32.5%) had the highest hypertension diagnosis on SPSS analysis, while (n=18; 69%) had the highest drug name of amlodipine. The results, according to the Servqual model, showed that the guarantee dimension had the largest average of 98%(Assurance), while the responsiveness dimension had the lowest average of 92% (waiting time).

Who Feels the Bern? An Analysis of Support for Bernie Sanders in the 2020 Democratic Primary

Researchers remain divided over the cause of Bernie Sanders’ strong appeal in recent Democratic primaries, alternately positing identity or ideology as decisive drivers of Sanders support. Using data from 2020 Nationscape, we conduct linear probability models that show how identity, ideology, and their interaction all explain Sanders support. Demographically, we find that Sanders voters are disproportionately young, Hispanic, and Independent. Sanders voters also differ significantly from other Democratic primary voters across several ideology variables, and are especially supportive of policies that were central to Sanders’ campaign, such as providing government-run health insurance to all Americans. Finally, we demonstrate that age cohort, the most important predictor of Sanders support, has an effect that is highly dependent upon key ideology variables. Overall, those who did not vote for Sanders in the 2020 Democratic primary are quite demographically and ideologically distinct from those voters that “felt the Bern.”

Universal health insurance in Africa: a narrative review of the literature on institutional models

IntroductionSeveral African countries have introduced universal health insurance (UHI) programmes. These programmes aim to extend health insurance to groups that are usually excluded, namely informal workers and the indigent. Countries...

Health Insurance Ownership among Moluccans in Indonesia.

Expanding the reach of health insurance in Maluku aims to increase public access with the archipelago topography to healthcare facilities. The study aimed to analyze factors related to health insurance ownership among Moluccans. The study employed 788 respondents. The variables analyzed included health insurance, age, gender, education, and employment. The study used multinomial logistic regression in the final stage. The age group ≤19 years was 0.182 times more likely than the ≥50 years of age group to have government-run type health insurance. The 20-29 years of age group was 0.219 times more likely than the ≥50 years of age group to have government-run health insurance. On the other hand, Moluccans with primary education were 0.196 times more likely than Moluccans with higher education to have a government-run type of health insurance. Moluccans with secondary education were 0.415 times more likely than Moluccans with higher education to have government-run health insurance. Unemployed have a probability of 0.358 times than employed to have the government-run health insurance type. Finally, unemployed is 0.056 times more likely than employed to have private-run health insurance. Three variables prove associated with health insurance ownership among Moluccans in Indonesia, namely age, education, and employment.

Health Services Utilization among Older Adults in Pokhara Metropolitan City

ABSTRACT The Government of Nepal provides a range of welfare schemes to senior citizens, but little is known about the use of public benefits by older adults. This community-based cross-sectional survey thus aims to assess the utilization and correlates of health services (through both private and public health facilities), free essential health services (provided by the government through public health facilities), and other welfare schemes – discounts in health treatment for certain diseases, monthly senior citizen allowance, reservation and concession in transportation, and the government-run health insurance program – among 201 Nepali older adults. Notably, a sizable proportion of the participants (22.4%) did not visit a health facility despite having a health problem. Females and those with higher co-morbidity had higher odds of health facility visits. Only 8% utilized the free essential health services, and 47% one or more of the other welfare schemes. Lack of awareness of free health services and welfare schemes were associated with lower odds of their utilization, respectively.

Outcomes for Patients with Sepsis Following Admission to the Intensive Care Unit Based on Health Insurance Status: A Study from the Medical Information Mart for Intensive Care-III (MIMIC-III) Database.

BackgroundPrevious research has focused on poor outcomes from a lack of insurance, but the effects of different types of insurance for patients with sepsis in the intensive care unit (ICU) have not been well studied. We aimed to investigate whether private health insurance was better than government-run health insurance in the United States in terms of clinical outcomes of patients with sepsis in the ICU.Material/MethodsPatients with sepsis were identified from the Medical information Mart for Intensive Care-III database. Patients were grouped as having private and government-run health insurance. Clinical outcomes were compared in univariate and multivariate analyses. Propensity score match (PSM) and subgroup analysis were used to check the robustness of results.ResultsData from 13,957 patients were extracted. After adjustment by multivariate model, the private insurance group had similar rates of ICU mortality (relative risk [RR] [95% confidence interval CI]=1.052 [0.919–1.205], P=.463) and 90-day (RR [95% CI]=.964 [0.885–1.051], P=.406) compared with the group with government-run insurance. The private insurance group had longer ICU stays (strictly standardized mean difference=0.092, P<.001) and better long-term survival (hazard ratio [95% CI]=0.875 [0.825–0.928], P<.001) than the government-run insurance group in the PSM cohorts. Subgroup analysis indicated little variation in results for specific conditions.ConclusionsPatients with sepsis who had private insurance had longer ICU stays but similar ICU mortality and 90-day mortality rates than similar patients with government-run insurance; they seemed to have better long-term survival, but more evidence may be required to support this conclusion.

Encouraging Health Insurance for the Informal Sector: A Cluster Randomized Experiment in Vietnam.

Subsidized voluntary enrollment in government-run health insurance schemes is often proposed as a way of increasing coverage among informal sector workers and their families. We report the results of a cluster randomized experiment, in which 3000 households in 20 communes in Vietnam were randomly assigned at baseline to a control group or one of three treatments: an information leaflet about Vietnam's government-run scheme and the benefits of health insurance, a voucher entitling eligible household members to 25% off their annual premium, and both. At baseline, the four groups had similar enrollment rates (4%) and were balanced on plausible enrollment determinants. The interventions all had small and insignificant effects (around 1 percentage point or ppt). Among those reporting sickness in the 12months prior to the baseline survey the subsidy-only intervention raised enrollment by 3.5ppts (p = 0.08) while the combined intervention raised enrollment by 4.5ppts (p = 0.02); however, the differences in the effect sizes between the sick and non-sick were just shy of being significant. Our results suggest that information campaigns and subsidies may have limited effects on voluntary health insurance enrollment in Vietnam and that such interventions might exacerbate adverse selection. Copyright © The World Bank Health Economics © 2015 John Wiley & Sons, Ltd.

Use of Chinese medicine correlates negatively with the consumption of conventional medicine and medical cost in patients with uterine fibroids: a population-based retrospective cohort study in Taiwan

BackgroundChinese medicine is commonly used and covered by health insurance to treat symptoms of uterine fibroids in Taiwan. This retrospective cohort study compared the consumption of conventional western medicine and medical cost between Chinese medicine (CM) users and nonusers among patients with uterine fibroids.MethodsWe extracted 44,122 patients diagnosed with uterine fibrosis between 1996 and 2010 from the National Health Insurance reimbursement database, which is a population-based database released by a government-run health insurance system. Multivariate linear regression models were used to find association between using Chinese medicine and the consumption of conventional medicine, and between using Chinese medicine and medical cost.ResultsThe total fibroid-related conventional western medicine consumed by CM users was less than that by nonusers (β = -10.49, P < 0.0001). Three categories of conventional medicines, including antianemics (-3.50 days/year/patient, P < 0.0001), hemostatics (- 1.89 days/year/patient, P < 0.0001), and hormone-related agents (-3.13 days/year/patient, P < 0.0001), were used less in patients who were CM users. Moreover, although using CM increased 16.9 USD per patient in CM users annually (P < 0.0001), the total annual medical cost for treating fibroid was 5610 USD less in CM users than in nonusers (P < 0.0001).ConclusionsOur results suggested that CM reduced the consumption of conventional medicine, and might be a potential therapeutic substitute for conventional western medicines to treat uterine fibroids with low cost.

This Could Be the Start of Something Big: Linking Early Managerial Choices with Subsequent Organizational Performance

This Could Be the Start of Something Big: Linking Early Managerial Choices with Subsequent Organizational Performance

Physician Knowledge of and Attitudes toward the Patient Protection and Affordable Care Act

To assess otolaryngology physician knowledge of and attitudes toward the Patient Protection and Affordable Care Act (PPACA) and compare the association of bias toward the PPACA with knowledge of the provisions of the PPACA. Cross-sectional survey. Nationwide assessment. Members of the American Academy of Otolaryngology-Head and Neck Surgery. Otolaryngology physicians answered 10 true/false questions about major provisions of the PPACA. They also indicated their level of agreement with 9 statements about health care and the PPACA. Basic demographic information was collected. Email solicitation was sent to 9972 otolaryngologists and 647 responses were obtained (6.5% response rate). Overall correct response rate was 74%. Fewer than 60% of physicians correctly answered questions on whether small businesses receive tax credits for providing health insurance, the effect of the PPACA on Medicare benefits, and whether a government-run health insurance plan was created. Academic center practice setting, bias toward the PPACA, and Democratic Party affiliation were associated with significantly more correct responses. Overall physician knowledge of the PPACA is assessed as fair, although better than the general public in 2010. There are several areas where knowledge of physicians regarding the PPACA is poor, and this knowledge deficit is more pronounced within certain subgroups. These knowledge issues should be addressed by individual physicians and medical societies.

Few Insurance-Based Differences in Upper Extremity Elective Surgery Rates After Healthcare Reform

Before the US Patient Protection and Affordable Care Act of 2010, there were documented insurance-based disparities in access to orthopaedic surgeons and care of orthopaedic conditions. While Massachusetts passed healthcare reform in 2007 with many similar provisions, it is unknown whether the disparities were present during the period of the law's enactment. We asked whether differences in rates of surgery between patients with novel government-subsidized healthcare plans and other forms of insurance, and between uninsured and insured patients, were similar after institution of the Massachusetts reform laws. We identified 7577 patients diagnosed with upper extremity injuries between January 1, 2007 and October 1, 2010. From an institutional administrative database, we extracted demographics, insurance status, and plan of care. Insurance categories included government-subsidized healthcare plan (Commonwealth Care), private insurance, workers compensation, military-related (TriCare), Medicare, Medicaid (MassHealth), non-Commonwealth Care, and other insured and uninsured. After adjusting for age, gender, and diagnosis, we compared the proportions of patients who underwent elective surgery. Of 7577 patients, 1685 (22%) underwent elective upper extremity surgery. The adjusted rates of surgery were similar across most insurance categories, with higher rates in the workers compensation and TriCare categories compared with Commonwealth Care. Uninsured patients were as likely to undergo surgery as insured patients. In a population with near-universal health insurance, a government-run health insurance exchange, and novel, government-subsidized, managed care plans, we found few insurance-based differences in rates of elective upper extremity orthopaedic surgery in a cohort of patients after healthcare reform.

Designing a Mixed Public and Private System for the Health Insurance Market

This paper considers some design features of a health care reform proposal that would make a government-run health insurance plan available to all. The details of any health care reform proposal are important, and details of this proposal still are under development. However, some details are available and discussed here. The analysis begins with a description of problems in markets for health insurance that reforms might address. It then considers a specific reform proposal: offering a public plan and competing private plans in a government-run purchasing pool. The Medicare program provides an important precedent for such a system, and offers a practical guide to problems and opportunities offered by such a mixed public and private system. The analysis then turns to application of mixed public and private system to commercial insurance market, discussing likely problems and ways to resolve them. An important assumption underlying this analysis is that public and private plans have inherent advantages and disadvantages, and neither type of plan needs to be favored with special subsidies or regulations. Both plans can be offered on a relatively level playing field. The best judges of advantages, disadvantages and economic value of each plan are not politicians, bureaucrats, or policy analysts, but consumers supported by good data systems.In this analysis, the commercial health insurance means market for health insurance faced by people who are not currently enrolled in Medicare, Medicaid, government-subsidized high-risk pools or other public insurance program. For example, non-elderly disabled population that is enrolled in Medicare would not be part of commercial insurance market as discussed here; nor would low-income individuals enrolled in Medicaid; nor would aged-entitled Medicare-enrolled population, even though many Medicare beneficiaries are enrolled in private health plans (the Medicare Advantage [MA] program, private supplementary policies, or private Part D drug coverage plans).

Does universal health care coverage mean universal accessibility? Examining the Canadian experience of poor, prenatal women.

R ecently, Americans have been grappling with the complexities of health care reform. President Clinton advocated for radical reform. He wanted guaranteed health coverage for every individual. However, this push towards universal health care coverage met with considerable opposition from a variety of sectors. Opponents ranged from insurance companies to doctors and the small business lobby. Many concerns were voiced including the high cost of such coverage and the possibility that client confidentiality could be compromised by a government-run health insurance system. Ultimately, the possibility of universal health care coverage became less and less likely, but some interest in this type of reform remains. Presumably, universal coverage would have meant increased accessibility to health care and, therefore, better health. This system of universal coverage could have been of great benefit to women whose health care is frequently compromised. The current health care system has historically failed to fund women's health concerns adequately.1 Universal health care coverage could have helped address this discrepancy.

Physician payment reform in the United States

With the recent strengthening of the physician expenditure cost control mechanisms of the “Gesundheitsstrukturgesetz” of 1993, Germany has again affirmed its belief in the need for and success of global budgeting for physician payments. In 1992 Medicare, the U. S. government-run health insurance program for the elderly, first implemented the new Medicare Fee Schedule based on a point value system, known as the Resource-Based Relative Value Scale (RBRVS), which is very similar to the German “Einheitlichen Bewertungsmasstab” (EBM) and uses a similar system for budgeting physician payments. Although this policy has only been in place in the United States for two years, many policy makers are considering expanding the payment mechanism to all payers, private and public, in an effort to control costs. In order to inform German health policy makers of this trend in the United States, both the historical and analytical framework of physician payment reform in the United States are described, as well as some insight into its future direction is provided. The first section is on the pressures during thel980’s that led to the new Medicare Fee Schedule and the implementation of the Resource-Based Relative Value Scale on which it is based. Second the analytical methodology and budget considerations are dealt with that were used to implement the Medicare Fee Schedule. Third, the potential affects of the resulting reform on costs, quality, access and individual physician payment are analyzed. Lastly, the role of physician payment in the debate on U. S. health care reform is examined, as well as, the Medicare Fee Schedule’s applicability to other payers

Management of human resources in health care: The Canadian experience

Each of Canada's ten provinces has a publicly administered system of health insurance, funded by provincial and federal taxes, that is accessible to all citizens and covers all medically necessary services provided by physicians and hospitals. Canadians spend an estimated 9.2 percent of their gross national product on health care (about 2.8 percentage points below US spending), of which three quarters is public-sector spending. According to the Organization for Economic Cooperation and Development, Canada's health status is equal to or better than that of the United States, despite lower per capita health spending. About seven percent of the Canadian labour force works in health care, and attempts to introduce coordinated planning of human resources in health care have not as yet proceeded far. The predominant policy issue here is the supply and the role of physicians. It has been argued that entrenching within the system the fee-for-service method of paying physicians has created a disincentive to the delegation of responsibility to health personnel other than doctors. It is also argued that introduction of government-run health insurance provided the opportunity for human resource planning, but that the decision by governments to act only as the payer resulted in ad-hoc planning approaches. However, governments' concern over health care costs has led to a more direct role by them in the planning of the human resources in health. They are re-examining the autonomy and jurisdictional rights of the professions that deliver health care to Canadians.

Free Enterprise, Professional Ideology, and Self-Interest: An Analysis of Resistance by Canadian Physicians to Universal Health Insurance

Under Canada's universal health care system, physicians are remunerated through government-run health insurance plans; a private market for physicians' services is virtually nonexistent. A proposal to ban the practice of extra-billing, whereby some physicians billed patients for amounts over and above insured rates, met with physicians' opposition. The particular constellation of legislative, social, and political events that followed the proposed ban presented a unique opportunity to explore the nature of the medical profession's resistance to encroachment on professional autonomy. The results of this survey of physicians in four specialties (N = 313) in metropolitan Toronto suggest that resistance to universal health insurance is complex; it involves a prevailing social ideology among physicians, which happens to be antiwelfare and conservative generally, entangled with economic self-interest and a specific set of beliefs about medical practice and physicians' rights and privileges.