Health Insurance Expenditures Research Articles

PCN18 - Budget Impact Analysis of Regorafenib in the Third-Line Treatment of Patients with Metastatic Colorectal Cancer

To evaluate the impact of Regorafenib in the third-line treatment of patients with metastatic colorectal cancer (mCRC) on the insurance budget when incorporated in the reimbursement list. Building a budget impact model to assess the impact of Stivarga on health insurance expenditure over three years after the inclusion of Regorafenib in China's national reimbursement drug list (NRDL). In the model, the disease incidence data were abstracted from literatures, disease diagnosis rate, treatment rate and direct medical costs were obtained from an expert opinion survey. Other data such as market share of third-line treatments were derived from market research. Total annual reimbursement expenditure in 1, 2, and 3 years following the NRDL inclusion was decreased by 90 million RMB, 67 million RMB and 47 million RMB respectively. The cost reduction is mainly due to the potential elimination of the current non evidence-based salvage therapies. Sensitivity analysis was carried out on the parameters of monthly treatment cost, market shares and reimbursement ratio. The sensitivity analysis did not change the direction of the results indicating that the basic analysis results are robust. The analysis estimated that, following the inclusion of Regorafenib in China's NRDL for third-line treatment of patients with metastatic colorectal cancer (mCRC), the overall health care expenditures were reduced due to the potential elimination of the current non evidence-based salvage therapies.

PDB15 - Budget Impact Analysis of Dapagliflozin for the Treatment of Type 2 Diabetes Mellitus in China

To estimate the potential budget impact of dapagliflozin as an alternative in treating T2DM from Chinese payer’s perspective. An Excel-based budget impact model was developed to compare the differences of annual health insurance expenditure in two scenarios which were listing dapaglifozin or not in national reimbursement drug list (NRDL) over a 5-year time horizon (2018-2022). Target population was calculated according to China Statistical Yearbooks and epidemiology statistics of T2DM in China, then divided into two programs of Urban Employee Basic Medical Insurance (UEBMI) or Urban and Rural Resident Basic Medical Insurance (URRBMI), respectively. The model assumed an increasing market share of dapagliflozin with a consequent decreasing of branded drugs of alpha-glucosidase inhibitors, sulfonylureas and DPP-4 inhibitors according to expert opinions and IMS market monitoring data. Both drug costs and medical costs associated with adverse events (AEs), which were severe hypoglycemia, major adverse cardiovascular events, and hospitalization for heart failure or renal diseases, were considered in the model. Drug costs were calculated by daily dosages, unit prices and days of utilization. The incidence and annual medical costs of AEs were derived from published literature. If dapagliflozin was listed in NRDL, the number of T2DM patients treated with dapagliflozin was increased from 0.16 to 1 million from 2018 to 2022. The estimated incremental annual health insurance expenditure would be +$10.44, +$20.81, +$37.56, +$27.67 and -$1.21 million for years 2018 to 2022, respectively. Because of the lower rates of AEs, especially of cardiovascular events, the cost-savings of AEs exceeded the incremental drug costs among patients with dapagliflozin in 2022. One-way sensitivity analyses indicated the results did not change dramatically when parameters varied. Listing dapagliflozin in NRDL may have a modest increasing impact of short-term budget while would lead to long-term net cost-savings caused by lower rates of AEs, especially the long-term cardiovascular benefits.

PHP63 - Economic Performance and Health Expenditures: Development Of Governmental Health Insurance Expenditures in Hungary Between 2005-2014

PHP63 - Economic Performance and Health Expenditures: Development Of Governmental Health Insurance Expenditures in Hungary Between 2005-2014

The increase in total knee replacement surgery in Taiwan: A 15-year retrospective study.

Total knee replacement (TKR) is considered as one of the most success among clinical interventions for patients with who suffering from knee osteoarthritis (OA). We sought to estimate the incidence of TKR using demographics, incidence rates, lengths of hospital stay, and costs from 1996 to 2010 by analyzing Taiwan's National Health Insurance Research Database. A total of 154,553 patients obtained primary TKR surgery between 1996 and 2010. The diagnosis code for knee OA and the procedure code for TKR were selected from the records. To compare the rate of TKR between covariables, we calculated the TKR risk ratios and 95% confidence interval (CI) of these variables (gender, age, age group, and primary diagnoses). A 2-tailed P-value of .05 was considered statistically significant. The statistical package SPSS version 20.0 (SPSS, Chicago, IL) was used to conduct all the statistical analyzes. We analyzed 154,553 TKRs performed by surgeons in Taiwan from 1996 to 2010. The overall crude incidence increased from 26.4 to 74.55 TKR per 100,000 inhabitants from 1996 to 2010. TKR incidence for the 70 to 79 years age group increased from 227 to 505 per 100,000 people from 1996 to 2010. The age-standardized rate ratios for TKR of women to men ranged from 2.5 to 3.0. The mean average length of stay in hospital was 15 days in 1996 and decreased to 8 days in 2010. During the study period, the adjusted mean cost per patient decreased from US$7485 to US$4827. Health expenditures for TKR were 5% of total National Health Insurance expenditure every year. Over the 15-year period, Taiwan's TKR incidence tripled, which is consistent with population ageing. Arthritis will be a major public health issue in the ageing population in the future.

Private health insurance and catastrophic health expenditures of households with cancer patients in South Korea

This study examines the effects of private health insurance (PHI) on the incidence of catastrophic health expenditures (CHE) for households with a patient with cancer. This study uses 1-year data from 2013 and households with cancer patients as the unit of research rather than individual household members. The sample thus includes 468 households with members with cancer who also used emergency, outpatient and hospitalisation services. Households with PHI had a lower incidence of CHE for all thresholds than those without did. At the 10% threshold, the incidence became significantly lower, by 0.59 and 0.60 times, respectively, if householders had higher education and income levels. Moreover, the incidence of CHE was higher by 8.71 times if the householders are female, and lower by 0.84 times if the householders did not have a spouse at the 20% threshold. From the analysis of households with cancer patients that hold PHI as the key variable, these households showed a lower incidence of CHE than the others did. PHI provides healthcare payments not secured through national health insurance (NHI) and protects households from health expenditures, thereby complementing NHI to a certain degree.

Validating Persuasive Experience (PX) Theory: Preliminary Results of a Case Study on a Corporate Wellness Program’s Web-based Learning Interfaces

The objective of this study is to gain a clearer understanding of the role Persuasive Experience (PX) may play in wellness-oriented Web Based Learning (WBL) platforms in forming abilities to incite healthier lifestyle (or promoting health behavior) in technology-based systems use. Specifically, individual users’ interactions with a particular corporate wellness WBL platform was examined in relation to their State of Mind and Behavior. The results of this study may assist in better predicting behavior change and sustainable adherence to increased physical activity routines that could reduce risk of behavior sensitive conditions such as cardiovascular disease and its sequelae in U.S. workplaces. The findings of this case study also offer further validation of PX Theory and insight into its potential to aid in developing and implementing more effective persuasive technologies. The hope is that PX might contribute to technological systems design that can measurably and meaningfully assist employees in changing to healthier behaviors to improve their individual health outcomes. The results of this case study also suggest the potential PX driven design for wellness oriented WBL systems may have in improving overall organizational wellbeing and outcomes related to unplanned health insurance expenditures.

Effect of mass layoffs on health insurance expenditures: the case of the Ostrava region

Effect of mass layoffs on health insurance expenditures: the case of the Ostrava region

Social Health Insurance Difference in Inpatient Expenditure and Service Category in China.

China successfully achieved universal health insurance coverage in 2011. Previous work on the effects of social health insurance in China has overlooked the association between health insurance and inpatient service category as well as the mechanisms of institutional characteristics. This study seeks to estimate the social health insurance difference in inpatient expenditure and service category. The role of institutional characteristics was also studied. The logistic model was applied to estimate the association of social health insurance and service category. In addition, Heckman Selected Model and generalized linear model were used to examine the association of health insurance and inpatient expenditure. Estimations were done for 4076 individuals older than 45 years using pooled cross-sectional survey data from the China Health and Retirement Longitudinal Study conducted in 2011 and 2013. Patients with health insurance were more likely to spend more and receive more types of inpatient service. This relationship was partially explained by the institutional characteristics. Therefore, this study highlights the importance of enforcing the regulation of referral mechanisms, the tiered copayment requirement to guide people's care-seeking behavior, and reforming the allocation of limited health resources between different levels of facilities and also between private and public hospitals.

Projection models for health expenses

AbstractThis note proposes a practical way for modelling and projecting health insurance expenditures over short time horizons, based on observed historical data. The present study is motivated by a similar age structure generally observed for health insurance claim frequencies and yearly aggregate losses on the one hand and mortality on the other hand. As an application, the approach is illustrated for German historical inpatient costs provided by the Federal Financial Supervisory Authority. In particular, similarities and differences to mortality modelling are addressed.

Growth of National Health Insurance Expenditure Related To Antidiabetics And Their Projections Up Until 2020

Growth of National Health Insurance Expenditure Related To Antidiabetics And Their Projections Up Until 2020

How great is the medical burden of disease on the aged? Research based on \u201cSystem of Health Account 2011\u201d

BackgroundThe aging of population and the burden of disease among the aged have become one of the hot topics in the international health, and also brought tremendous pressure in the development of health service.MethodsA total of 1,377,681 patients aged 65 years and over were collected with multistage stratified cluster random sampling in 252 medical institutions in Liaoning China, and “System of Health Account 2011” was conducted to analyze the expenditure of disease for the elderly. Influencing factors were performed using multiple stepwise regression analysis.ResultsThe curative care expenditure for the aged was 233.18 billion RMB. Most of the expenditure for the old people was in hospital. Moreover, by the disease, the highest expenditure was incurred by non-communicable diseases. The financing scheme of the aged was concentrated on social health insurance and family health expenditure. Hospitalization expenditure was significantly associated with length of stay, operation, etc.ConclusionsThis study intends to capture large data from various medical institutions with a new accounting system. The finding illustrates that the burden of old people is still heavy.

인구구조의 변화를 반영한 건강보험 진료비 추계

Purpose: This study was conducted to suggest a method for financial projection of health insurance expenditures that reflects future changes in demographic structure. Methods: Using data associated with the number of patients and health insurance cost per patient, generalized linear models (GLM) were fitted with demographic explanatory variables. Models were constructed separately for individual medical departments, types of medical service, and types of public health insurance. Goodness-of-fit of most of the applied GLM models was quite satisfactory. By combining estimates of frequency and severity from the constructed models and results of the population projection, total annual health insurance expenditures were projected through year 2060. Results: Expenditures for medical departments associated with diseases that are more frequent in elderly peoples are expected to increase steeply, leading to considerable increases in overall health insurance expenditures. The suggested method can contribute to improvement of the accuracy of financial projection. Conclusion: The overall demands for medical service, medical personnel, and relevant facilities in the future are expected to increase as the proportion of elderly people increases. Application of a more reasonable estimation method reflecting changes in demographic structure will help develop health policies relevant to above mentioned resources.

What is the budget impact of a new treatment or new health technology arriving on the market?

In France, market access for innovative drugs (level I, II & III improvement of medical service rendered having significant impact on health insurance expenditure) involves medico-economic evaluation. In addition to cost-effectiveness analysis (CEA), budget impact analysis (BIA) can be performed, especially since the sustainability of the health insurance system has become a growing concern for all stakeholders. The members of the Giens 2016 round table discussed the contribution of BIA based on a review of the literature on distribution models, the participants' experiences including experience related to the modalities of hospital assessments, and examples from other countries. The round table established recommendations on four elements of interest: 1: the use of BIA from a contractual point of view -between manufacturers and the French Economic Committee for Health Products- during the price negotiations process, and from a prospective point of view within the framework of the annual review of budget expenditures; the definition of the target population and the rhythm of a health product's distribution are also major elements; 2: the interpretation of BIA results in light of CEA results: for what products and at what moment in the life cycle of these products; 3: the integration of the rhythm of a health product's distribution into the BIA; 4: preoccupations about how the level of health product implementation is integrated into the BIA in terms of opportunity cost and organisational quality for the promoter.

US health insurance expenditure increasing for mental health

US health insurance expenditure increasing for mental health

Effects of delisting nonprescription combination drugs on health insurance expenditures for pharmaceuticals in Korea

In November 2006, 727 combination drugs in 24 therapeutic classes were delisted in the national formulary in Korea to reduce the country's pharmaceutical expenditure, making these 727 drugs non-reimbursable. This study examines the effects of this delisting on national health insurance expenditures for pharmaceuticals.An interrupted time series analysis was conducted for the period from January 2005 to August 2007 by using administrative claims from Korea's National Health Insurance. The main outcome variable was the total pharmaceutical expenditure measured as a whole and based on the level of health care institutions and therapeutic classes. Comparison between exposure group (delisted drugs) and non-exposure group (listed drugs) were done. No changes in the level of or trend in the total pharmaceutical expenditure were detected. However, the delisting reduced pharmaceutical expenditures in clinics. Delisting effects were also observed according to therapeutic classes of drugs.The results indicate that any delisting should take into account the type of drug.

Voluntary Health Insurance expenditure in low- and middle-income countries: Exploring trends during 1995-2012 and policy implications for progress towards universal health coverage.

BackgroundMost low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI). This paper assesses VHI expenditure trends in LMIC and explores possible explanations. This illuminates challenges deriving from changes in VHI expenditure as countries aim to progress equitably towards universal health coverage (UHC).MethodsHealth expenditure data was retrieved from the WHO Global Health Expenditure Database to calculate VHI, OOP and general government health (GGHE) expenditure as a share of total health expenditure (THE) for the period of 1995–2012. A literature analysis offered potential reasons for trends in countries and regions.ResultsIn 2012, VHI as a percentage of THE (abbreviated as VHI%) was below 1 % in 49 out of 138 LMIC. Twenty-seven countries had no or more than five years of data missing. VHI% ranged from 1 to 5 % in 39 LMIC and was above 5 % in 23 LMIC. There is an upwards average trend in VHI% across all regions. However, increases in VHI% cannot be consistently linked with OOP falling or being redirected into private prepayment. There are various countries which exhibit rising VHI alongside a rise in OOP and fall in GGHE, which is a less desirable path in order to equitably progress towards UHC.Discussion and ConclusionReasons for the VHI expenditure trends across LMIC include: external influences; government policies on the role of VHI and its regulation; and willingness and ability of the population to enrol in VHI schemes. Many countries have paid insufficient attention to the potentially risky role of VHI for equitable progress towards UHC. Expanding VHI markets bear the risk of increasing fragmentation and inequities. To avoid this, health financing strategies need to be clear regarding the role given to VHI on the path towards UHC.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-016-0353-5) contains supplementary material, which is available to authorized users.

The Great Recession of 2007-2009 and Public Insurance Coverage for Children in Alabama: Enrollment and Claims Data from 1999-2011.

This study examined the impact of the Great Recession of 2007-2009 on public health insurance enrollment and expenditures in Alabama. Our analysis was designed to provide a framework for other states to conduct similar analyses to better understand the relationship between macroeconomic conditions and public health insurance costs. We analyzed enrollment and claims data from Medicaid and the Children's Health Insurance Program (CHIP) in Alabama from 1999 through 2011. We examined the relationship between county-level unemployment rates and enrollment in Medicaid and CHIP, as well as total county-level expenditures in the two programs. We used linear regressions with county fixed effects to estimate the impact of unemployment changes on enrollment and expenditures after controlling for population and programmatic changes in eligibility and cost sharing. A one-percentage-point increase in a county's unemployment rate was associated with a 4.3% increase in Medicaid enrollment, a 0.9% increase in CHIP enrollment, and an overall increase in public health insurance enrollment of 3.7%. Each percentage-point increase in unemployment was associated with a 6.2% increase in total public health insurance expenditures on children, with Medicaid spending rising by 7.5% and CHIP spending rising by 1.8%. In response to the 6.4 percentage-point increase in the state's unemployment rate during the Great Recession, combined enrollment of children in Alabama's public health insurance programs increased by 24% and total expenditures rose by 40%. Recessions have a substantial impact on the number of children enrolled in CHIP and Medicaid, and a disproportionate impact on program spending. Programs should be aware of the likely magnitudes of the effects in their budget planning.

Autism: mismatch between health insurance ratings and expenditure

Autism: mismatch between health insurance ratings and expenditure

국민건강보험 표본코호트 DB를 이용한 건강보험 재정추계

Abstract The change of the population pyramid due to low fertility and rapid aging threatens the financial sustainabil-ity of National Health Insurance. We construct statistical models for prevalence rates and medical expensesusing National Health Insurance Service (NHIS) sample cohort data from 2002–2013. We then projectyearly expenditures and income of national health insurance until 2060 that considers various assumptionsin regards to future population structure and economic conditions.We adopt a VECM-LC model for prevalence rates and the double exponentially smoothing method forthe per capita co-payment of healthcare expense (in which the two models are institution-disease-sex-agespecific) to project of national health insurance expenditures. We accommodate various assumptions ofeconomic situations provided by the national assembly and government to produce a financial projection fornational health insurance.Two assumptions of dependents ratios are used for the projection of national health insurance income toconduct two future population structures by the two assumptions of aging progresses and various assumptionson economic circumstances as in the expenditure projection. The health care deficit is projected to be 20–30trillion won by 2030 and 40–70 trillion won by 2060 in 2015 constant price.Keywords: national health insurance, projection of finance, NHIS sample cohort DB, prevalence rate, percapita co-payment for healthcare expenses, VECM-LC

National intelligence and private health expenditure: Do high IQ societies spend more on health insurance?

Studies show that high IQ people practice healthier lifestyles, which result in better health status. However, do such people spend more on healthcare? We employed hierarchical multiple regression analysis to examine the impact of national average IQ on private health expenditure, especially health insurance at cross-country level. Controlling for income, the old-age dependency ratio, and government expenditure on health, we found that IQ was positively significant on out-of-pocket healthcare expenditure but negatively associated with private health insurance expenditure. We suggest that high IQ societies pay less for health insurance because they are more capable of preventing illnesses or injuries and they live in healthier and safer environments, which are less vulnerable to diseases. In addition, they are more efficient at calculating risk and making choices according to their future healthcare needs. Hence, with price dispersion and various choices of health insurance plans available within the competitive market, high IQ people may be more efficient at obtaining lower effective prices of premiums.