The purpose of this study is to compare the economics of in-office tympanostomy tube placement using single use devices versus standard placement in the operating room (OR). A retrospective chart review was completed for all pediatric patients who underwent in-office tympanostomy tube placement (CPT 69433) along with insurance and date matched patients with placement in the OR (CPT 69436) between 12/1/21-3/1/24. Financial data were compared among the public vs. private insurance cohorts using the Wilcoxon rank-sum test with a two-sided significance level of 5%. One hundred and thirty-six in-office patients were identified, 102 private versus 34 public, and compared with 136 insurance and date matched OR patients. The average total payment for both privately insured patients, $647.14 in-office versus $6873.45 in the OR, and publicly insured patients, $312.74 in-office versus $2656.34 in the OR, was statistically significant. The average insurance payment for both privately insured patients, $301.58 in-office versus $5445.73 in the OR, and publicly insured patients, $310.63 in-office versus $2258.65 in the OR, was statistically significant. For the patient payment, public insurance usually has 0 copay and is therefore excluded. The patient payment of the private insurance cohort, $308.30 in-office versus $670.61 in the OR, was not found to be statistically significant. As expected, this study demonstrates significant reductions in overall cost with in-office tympanostomy tube placement even with the added cost of single-use devices compared to the standard placement in the OR, particularly for insurance companies, suggesting the potential benefit of providing reimbursement for these devices. N/A.

Mixed effects of area-level deprivation and healthcare access and individual-level health insurance on late-stage colorectal cancer diagnosis in Pennsylvania.

Job lock-when older workers cannot retire owing to financial or health insurance needs-is potentially an occupational safety issue. This study explored the longitudinal effect of job lock on work-related injuries to older workers, hypothesizing that job lock increases their injury rates. It then examined how this relationship varies across work arrangements. Analysis using 2010-2022 Health and Retirement Study data for workers aged 55-64 years and ≥65 years compared work exposures in each wave with injuries reported in the next wave. Repeated-measures negative binomial regression estimated longitudinal effects of job lock (financial, health insurance, or both) on work-related injuries, exploring effect modification by work arrangements (full time, part time, partly retired, self-employed). Analysis was conducted in 2025. Workers aged 55-64 years overall had 51.8 work-related injuries per 1,000 person-years, compared with 44.3 work-related injuries per 1,000 person-years for workers aged ≥65 years. Among those aged 55-64 years, these rates were 48% higher with job lock for financial reasons (incidence rate ratio=1.48 [95% CI=1.04, 2.13]) and similarly for health insurance reasons. Potentially stronger effects were observed for workers in full time (incidence rate ratio=1.57 [95% CI=1.15, 2.16]) and possibly part-time roles (incidence rate ratio=1.72 [95% CI=0.86, 3.46]). After age 65 years, these data suggest that workers had a 29% higher injury rate from financial job lock (incidence rate ratio=1.29 [95% CI=0.66, 2.51]). Job lock was associated with higher work-related injury rates, particularly for those in full- or part-time roles before age 65 years. For self-employed, partly retired, or workers aged >65 years, job lock presented less clear injury risk, possibly from differences in job tasks or selection into safer roles. Further research should address mechanisms of job lock to elevate injury risks. Improving access to retirement resources earlier in workers' careers may help to address work-related injuries and economic challenges of aging.

Jaminan Kesehatan Nasional (JKN), Indonesia’s National Health Insurance, is the world’s largest single-payer scheme. However, an estimated 35% of people with disabilities remain not-enrolled, and many enrolled individuals continue to face high out-of-pocket spending and catastrophic health expenditure. This study aims to explore barriers and facilitators to accessing and using JKN amongst people with disabilities, with a focus on Yogyakarta Province. We conducted a qualitative study using phenomenology approach. We interviewed 22 people with disabilities and 14 key informants (i.e., national and subnational government, organisation of people with disabilities (OPDs), and national disability representatives). Data collection and analysis were guided by the Universal Health Coverage framework. Enrolment was facilitated by formal employment, government subsidies, outreach by social workers and support from OPDs. Key enrolment barriers included lack of identity documents, restrictive poverty criteria for subsidies, and accessibility constraints. Service use was supported by improved referral mechanisms but limited by inadequate coverage of assistive technology (AT) and rehabilitation, uneven distribution and quality of health facilities, perceived negative attitude from health workers, and physical and informational inaccessibility. Financial protection under JKN remained limited, with high out-of-pocket payments driven by gaps in benefit coverage, indirect costs, and underutilisation of services. Improving equity for people with disabilities under JKN requires reforms that account for disability-related costs, expand benefit coverage for AT and rehabilitation, strengthen accessibility standards in health facilities, and pilot disability-inclusive reforms at sub-national level leveraging regional autonomy.

Clinical validation of CD16b as a standardized biomarker for inherited GPI deficiencies.

Safety of herbal medicine decoction for facial palsy: Coarsened exact matching analysis of the national health insurance database.

How representative are electronic health records? A record linkage study using individual-level census data.

Context: Despite precision medicine's promise to revolutionize health care, access remains uneven, and disparities persist. This study examines how conflicts between the institutional logics of genetic science (“discovering”) and market-based health insurance (“covering”) impede precision-driven health equity. Methods: The authors conducted 44 semistructured in-depth interviews with individuals at elevated risk for hereditary cancer. Data were analyzed using an abductive approach, combining thematic analysis with grounded theory tools. Findings: Analysis reveals seven “zones of conflict” where precision medicine's aspirations clash with insurance practices, creating barriers to genetic testing and related services. These zones span initial access barriers (e.g., complex billing, inconsistent guideline uptake) and downstream care factors (e.g., financial concerns, lack of retesting guidelines). The interplay between expanding genomic knowledge and the fragmented American health care system particularly disadvantages underrepresented and minority populations. Conclusions: Participant experiences reveal more unanticipated sources of inequity than precision medicine proponents anticipated. Incremental reforms targeting these conflict zones—such as guideline harmonization, expanding coverage mandates, and enhancing patient advocacy related to insurance coverage—could mitigate cascading disparities. This study highlights the importance of addressing institutional misalignments to realize the full equitable potential of precision medicine involving genetics.

Addressing financial and health-related social needs among patients with cancer: Study protocol for CAN-ASSIST pilot clinical trial.

Hospital inflation reflects changes in prices of labour, materials, energy, and capital. Depending on actual cost structures and contracts, individual hospitals may experience different price pressures on their budgets. If hospitals are compensated uniformly for inflation, high inflation can induce significant disparities in profitability. To analyse the differential impact of inflation on hospitals in the Netherlands. We test the hypothesis that differences in hospital-specific inflationary pressures were reflected in hospital compensation for inflation. Under this hypothesis, hospital-specific inflation rates correlate with overall budget growth. Using hospital financial data, we calculated hospital-specific inflation rates by combining cost categories with corresponding inflation rates for 2006-2023. Using linear regression analysis, we tested whether hospital-specific inflation rates correlated with reimbursements between 2006-2021. Next, we simulated differential impact for hospitals of high inflation in 2022-2023. Five stakeholder interviews validated results and explored inflation compensation mechanisms in practice. We found that inflation causes significant variance in individual hospital inflation rates, magnified after 2021 by high overall inflation. Linear regression showed no significant correlation between variation in observed hospital reimbursement and variation in hospital specific inflation rates, indicating that historically no differential inflation adjustments occurred. Interviewees stated that insurers do not explicitly take into account differential inflation impact between hospitals, and that hospitals were only partly compensated for general inflation. Dutch hospitals are not fully compensated for cost inflation and health insurers do not differentiate for differences in hospital-specific inflation rates. High inflation rates could thus induce significant disparities in hospital profitability.

Young adults aged 18 to 24 face increased risk for acquiring sexually transmitted infections (STIs) and reduced access to healthcare as they transition into adulthood and assume responsibility for their health. Furthermore, racial, ethnic, gender, and sexual minority young adults are at an increased risk for STIs and are less likely to have health insurance. This study evaluates the demographics of young adults undergoing STI and human immunodeficiency virus (HIV) testing at a sexual health clinic, and the impact of healthcare access and insurance status on the likelihood of STI diagnosis and treatment. Data were collected between January 1, 2021, and December 31, 2023, for all patients aged 18 to 24 presenting to a community-based clinic for youth ages 13 to 24 offering free STI and HIV testing and other low-cost sexual health services. Data analysis included test results for gonorrhea, chlamydia, syphilis, and HIV. Demographics of patients testing positive for STIs were similar to those seen nationally in the United States for this age group, apart from syphilis; however, overall infection rates were higher. Those who receive healthcare outside of the clinic were less likely to test positive for gonorrhea and chlamydia. Patients who visited the clinic before were less likely to test positive for chlamydia, while those who had not been seen before were more likely to test positive. Access to care, either at our clinic or elsewhere, may be associated with better screening or proactive preventative care, which could reduce the likelihood of testing positive for STIs in young adult populations.

Medical insurance and medical expenditure inequality in urban China

Health Insurance Payor Type as a Predictor of Clinical Presentation and Mortality in Patients Undergoing Urgent or Emergent TEVAR for Type B Aortic Dissection: Insights from Society for Vascular Surgery Vascular Quality Initiative Database.

Exposure to topiramate may not increase the risk of urolithiasis: A nationwide cohort study.

Development of death-risk score based on epidemiology of six mental disorders and application to mortality reduction via modifiable health behaviors.

Physical impairment as the dominant component of new-onset post-intensive care syndrome following in-hospital resuscitation.

Trends in cancer incidence among people with human immunodeficiency virus in South Korea: a nationwide National Health Insurance Service data-based study.

SGLT2 inhibitors and the risk of incident chronic kidney disease in type 2 diabetes: a nationwide emulated target trial in Taiwan.

Adolescents and young adults (AYAs) with brain tumors are at an increased risk of developing psychiatric disorders. We aimed to investigate the incidence and characteristics of psychiatric disorders in AYA patients with brain tumors. Using the Korean Classification of Diseases, we identified a cohort of AYA patients (aged 15-34 years) diagnosed with malignant brain neoplasms (C71) between 2003 and 2016 from the Korean National Health Insurance Claims Database. The analysis included 7052 patients. The 10-year cumulative incidence rate of psychiatric disorders was 21.5%. The most common psychiatric disorders were neurotic, stress-related, and somatoform disorders (11.4%), followed by mood (affective) disorders (9.4%). Factors associated with a higher incidence of psychiatric disorders included female sex (hazard ratio [HR] 1.16, 95% confidence interval [CI]: 1.05-1.28, p = 0.005), history of seizures (HR: 1.47, 95% CI: 1.31-1.66, p < 0.001), and brain tumor diagnosis during the latter part of the study period (HR: 1.14, 95% CI: 1.03-1.27, p = 0.010). Psychiatric hospital admissions were most frequent among patients with schizophrenia, schizotypal disorders, and delusional disorders (n = 5). The most common psychiatric disorders requiring psychotherapy were neurotic, stress-related, and somatoform (n = 580) and mood (n = 526) disorders. A significant number of AYA patients with brain tumors develop psychiatric disorders after diagnosis, and most require treatment. Early detection through screening programs and personalized psychological support during and after cancer treatment may improve the mental health and quality of life of AYA patients with brain tumors.

Impact of Pre-ICU benzodiazepine and Z-Drug exposure on mortality in critically ill Adults: A nationwide retrospective cohort study: A nationwide retrospective cohort study.