Health Insurance Research Articles

New health programs to address the demographic problem

Healthcare plays an important role in solving the demographic problem. In order to raise the birth rate, a new standard of obstetric and gynecological care has been introduced. A key element of the new standard is the creation of women’s health centers. It is planned to create women’s health centers on the basis of a multidisciplinary hospital. This will make it possible to use additional hospital resources for examination, pregnancy management, maternity care, and treatment, if necessary, of the mother and newborn. As part of the medical examination, an assessment of the reproductive health of working men and women is being introduced, including screening of anti-muller hormone in women, the possibility of carrying out a genetic test of embryos, IVF, cryopreservation. All services will be provided to women through compulsory health insurance.

Predictive Modeling of Personal Medical Insurance Costs: Analyzing Key Factors and Interactions

This study aims to use Kaggle's dataset to predict personal medical insurance costs, including age, sex, BMI, number of children, smoking status and regional variables. Through comprehensive statistical analysis and model improvement, we have determined important forecasting factors and interactions that affect charges. It is mainly found to include non-linear relationships between age and medical expenses, as well as the significant impact of interaction between BMI and smoking. The enhanced regression model combines these interactions and non-linear effects, showing great improvements in terms of interpretation capabilities, the R^2 value is 0.9642. The results provide actionable insights for insurance policy formulation, health management programs, and risk assessment, demonstrating the importance of considering complex variable interactions in predicting medical expenses. Future research should continue exploring these relationships to further refine predictive models.

Voluntarily Stopping Eating and Drinking: Systematic Review of Empirical Studies.

Objective: To systematically review studies presenting quantitative data on the experiences of patients and providers engaged in VSED. Background: Voluntarily stopping eating and drinking (VSED) to purposefully accelerate the end of life is uncommon but likely accounts for thousands of deaths per year. A single systematic review of literature was published in 2014. Methods: We systematically searched English-language articles and books in MEDLINE/PubMed and reference lists of retrieved articles and books. Studies that provided empirical results from surveys or qualitative studies were selected. We obtained from each study publication year, study type, country, population source, sample size, outcomes, and results, and graded each on quality. Results: Of the 17 empirical publications not included in the 2014 review, 3 were conducted in the US. Eight surveys were rated as moderately high/high quality and six as moderately low/low quality. Incidence estimates ranged from 0.4%-1.7% of all deaths. VSED was generally attempted among the elderly, often 80+ year-olds. About half of participants had dementia or other conditions that would make them ineligible for medical aid in dying. Incapacitating depression was rare. The mean time to death was 10 days with a range of one to two weeks. Most experiences were considered satisfactory by the patient. Caregivers often found preparation for and the emotional toll from VSED challenging. Theoretical support for VSED was ubiquitous among health care professionals in Europe, who expressed the importance of palliative support. However, professional experience was lacking. Conclusion: VSED, albeit uncommon, still accounts for many, typically satisfactory, deaths. Little research to guide best practice is available, particularly in the United States. Caregivers and health care providers generally indicate support however, extensive preparation and caregiver assistance make the practice challenging. Practitioners express a need for training.

Analysis of Online Crowdfunding Among Patients Pursuing Metabolic and Bariatric Surgery in the United States.

Use of online crowdfunding to mitigate health-related cost burden is common in the US, but its usage among candidates for metabolic and bariatric surgery (MBS) is unknown. We aimed to identify GoFundMe campaigns fundraising for MBS and characterize sources of financial strain. We also aimed to determine factors associated with successful crowdfunding. We searched GoFundMe for campaigns fundraising for MBS. Data items were extracted by two investigators with disagreements resolved by a third. We assessed associations between these data items and category of money raised using ordered logistic regression. We identified 539 campaigns, of which 33.6% were raising funds for sleeve gastrectomy, 24.1% for Roux-en-Y gastric bypass, and 2.0% for biliopancreatic diversion with duodenal switch. Most campaigns were created by the patient (73.1%) who had health insurance (53.4%) and at least one obesity-associated disease (56.8%). Over half (53.6%) sought funds for a direct medical expense and 35.1% sought funds for a non-medical expense, which included lost wages (15.6%), food (10.8%), transportation (10.2%), childcare (7.1%), and/or housing (5.8%). The median requested was $8000 (IQR 10,440) and the median raised was $860 (IQR 3173). The majority (63.1%) of campaigns earned less than 25% of their requested amount. Campaigns that shared mental health-related disease (aOR 0.55, 95% CI 0.32-0.95) and non-surgical attempts to lose weight (aOR 0.59, 95% CI 0.37-0.94) had lower odds of raising a higher category of money compared to campaigns not disclosing these details. Patients pursuing MBS in the US use online crowdfunding to subsidize both medical and non-medical expenses, but the majority of campaigns are unsuccessful. Our study highlights unmet financial need among MBS candidates.

Awareness, attendance, and attitudes toward cervical cancer screening among HIV-positive Chinese women in Yunnan province: a cross-sectional study

BackgroundCervical cancer is a major health threat in the female population. Human immunodeficiency virus (HIV)-positive women encounter a higher risk of cervical cancer. It is significant to promote cervical cancer screening attendance among HIV-positive women. Little is known about the awareness, attendance, and attitudes toward cervical cancer screening, as well as the associated factors, among Chinese HIV-positive women.MethodsA cross-sectional study was conducted among 411 HIV-positive women attending a large ART clinic in Yunnan, an HIV-endemic province in China. Participants were recruited using the convenient sampling method from January 2019 to August 2020. An interviewer-administered semi-structured questionnaire was utilized to collect information on socio-demographic and behavioral characteristics, clinical characteristics related to HIV infection, awareness, attendance, and attitudes toward cervical cancer screening. Binary logistic regression analyses were used to determine factors associated with awareness, attendance, and attitude toward cervical cancer screening.ResultsSome 69.8% (287) of the participants were aware of cervical cancer screening, but only 27.7% (114) had attended screening within 3 years. After receiving a brief health education, 72.3% (297) of the participants exhibited a positive attitude toward cervical cancer screening. Participants with a higher education background and longer duration of antiretroviral therapy were more likely to be aware of cervical cancer screening and have up-to-date screening. The up-to-date screening attendance was also influenced by age, smoking status, and health insurance. Single participants were less likely to show a positive attitude toward cervical cancer screening compared married or cohabiting counterparts. The main facilitators to attending cervical cancer screening were health promotion activity and well-organized programs, while the main barriers were high costs of the service and inadequate awareness.ConclusionsAlthough most HIV-positive women attending a large ART clinic in Yunnan were aware of cervical cancer screening, the up-to-date attendance was low. It is crucial to conduct health education and promotion through efficient channels to improve awareness and attendance. The discrepancy between awareness and attendance also emphasized the importance of adopting appropriate screening strategies and powerful health policies that can foster the attendance of cervical cancer screening among HIV-positive women. Efforts should be devoted to constructing a comprehensive healthcare system with high accessibility in China for cervical cancer prevention and management for HIV-positive women.

Factors Impacting the Adoption and Potential Reimbursement of a Virtual Reality Tool for Pain Management in Switzerland: Qualitative Case Study.

Pain and its adequate treatment are an issue in hospitals and emergency departments (EDs). A virtual reality (VR) tool to manage pain could act as a valuable complement to common pharmaceutical analgesics. While efficacy could be shown in previous studies, this does not assure clinical adoption in EDs. The main aim of this study was to investigate which factors affect the adoption and potential reimbursement of a VR tool for pain management in the ED of a Swiss university hospital. Key informant interviews were conducted using in-depth semistructured interviews with 11 participants reflecting the perspectives of all the relevant stakeholder groups, including physicians, nurses, patients, health technology providers, and health insurance and reimbursement experts. The interviews were recorded and transcribed, and the extracted data were systematically analyzed using a thematic analysis and narrative synthesis of emergent themes. A consolidated framework for eHealth adoption was used to enable a systematic investigation of the topic and help determine which adoption factors are considered as facilitators or barriers or as not particularly relevant for the tool subject of this study. According to the participants, the three key facilitators are (1) organizational environment; (2) tension for change, ease of use, and demonstrability; and (3) employee engagement. Further, the three key barriers to adoption are (1) workload, (2) changes in clinical workflow and habit, and (3) reimbursement. This study concludes that the adoption of a VR tool for pain management in the ED of the hospital subject of this study, although benefiting from a high tension for change in pain and workload management, is highly dependent on the respective organizational environment, engagement of the clinical staff, and reimbursement considerations. While tailored incentive structures and ambassador roles could benefit initial adoption, a change in the reimbursement landscape and further investigation of the positive effects on workflow effectiveness are required to drive long-term adoption.

Effect of traditional Chinese medicine on cardiovascular death and all-cause death among patients with heart failure and/or atrial fibrillation.

We tried to define the association of adverse cardiovascular (CV) events, such as CV death and all-cause death among patients with heart failure (HF) and/or atrial fibrillation (AF) receiving traditional Chinese medicine (TCM) or not. We used data from the Taiwan National Health Insurance Research Database in a retrospective cohort study using propensity scoring (PS) matching. We matched 54,859 and 18,307 patients each to the treatment vs. non-treatment group and found a significantly decreased risk of adverse CV events after PS score matching, suggesting that TCM reduces the risk of these adverse outcomes. Compared to HF patients without AF in non-TCM user, HF patients without AF in TCM user and HF patients with AF in TCM user had decreased risk of CV death by 0.50 times (95% CI 0.49, 0.52) and 0.84 times (95% CI 0.49,0.52), respectively. HF patients without AF in TCM user and HF patients with AF in TCM user had decreased risk of all-cause death relative to HF patients without AF in non-TCM user by 0.53 times (95% CI 0.52, 0.54) and 0.74 times (95% CI 0.72,0.76), respectively. The results said that there is significant reduction of decrease in risk of CV death and all death among the patients receiving TCM, especially those without AF.

Effects of Inpatient Hospice Care on Cost and Medication Use in Patients with Lung Cancer: A Population-Based Retrospective Study in South Korea.

Background: Inpatient hospices (IHs) can alleviate distress and address economic burdens on patients with terminal cancer. However, there have been inconsistent findings regarding IHs in terms of cost savings and medication use. Objective: We aimed to examine cost savings associated with IHs, according to the timing of first hospitalization before death, and analyze their use of medication, among Korean patients with terminal lung cancer. Methods: Using the South Korean national health insurance claim database, we identified 31,139 patients with lung cancer who died between 2017 and 2020. Their daily hospitalization costs were analyzed using a generalized linear model stratified by time of first hospitalization before death. Medication use was examined using a negative binomial model. Results: IHs spent $134, and $21 less on patients during days 1-7, and 8-30 before death, but $18, $44, $36, and $54 more during days 31-60, 61-90, and 91-180, respectively, compared with non-IHs (all p < 0.05). However, total hospitalization costs in the year preceding death did not differ (relative risk: 0.990, 95% confidence interval [CI]: 0.972-1.007, p > 0.05). IHs used 2.103 times more opioid analgesics (95% CI: 1.980-2.233, p < 0.001). They also used more antiemetics, delirium medications, and antianxiety agents, as well as fewer antidepressive agents, systemic steroids, diuretics, total parenteral nutrition, and antibiotics (all p < 0.05). Conclusions: Patients with terminal lung cancer in IHs in Korea were more likely to receive symptom-oriented medications and experienced reduced hospitalization costs only during the 30 days preceding death.

Autophagy activation in response to cigarette smoke: Exploring the disparity in laryngeal cancer incidence and outcomes between sexes in South Korea

IntroductionLaryngeal cancer (LC) presents a significant health challenge globally, with smoking being a major risk factor. Interestingly, LC incidence in females is significantly lower than in males; however, female smokers are more likely to develop Reinke edema (RE) than LC. This study sought to investigate whether autophagy, a major mechanism for RE development, acts as a defense mechanism in laryngeal tissue against cigarette exposure and suppresses LC development in females who smoke. MethodsThis study analyzed the National Health Insurance Service (NHIS) data of South Korea to explore sex differences in LC incidence and clinical outcomes. Protein expression was compared between tissues from LC and RE patients. The changes in autophagy-related markers were analyzed after exposure to human vocal fold fibroblast (hVFF) and cigarette smoke extract (CSE). In addition, to explore the relationship between the level of autophagy-related gene expression and clinical features, female LC patients were compared with male patients through an analysis of data from The Cancer Genome Atlas (TCGA). ResultsIn the NHIS data analyses, male LC patients had an 11 times higher incidence than female patients, even after adjusting for smoking and age. Additionally, female LC patients had significantly better survival rates. RE tissues exhibited increased autophagy-related protein expression compared with LC tissues. hVFFs after CSE exposure demonstrated elevated autophagy markers along with protein expression similar to RE tissue, suggesting autophagy's role in RE development over LC. The TCGA data analysis did not find a significant difference in autophagy-related gene expression, which would explain the favorable female clinical outcomes, between male and female LC patients. ConclusionsThis study implies autophagy activation by cigarette smoke is a crucial mechanism for lower LC incidence and better outcomes in females, highlighting the potential for autophagy-targeted LC prevention and treatment strategies.

Impact of COVID-19 on paediatric care in Japan: Analysis of national health insurance claims data.

To quantify the impact of the COVID-19 pandemic on paediatric care use compared to adult care and identify affected subdomains. Data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) for six fiscal years (FY2016-2021) were analysed. Pre-pandemic (FY2016-FY2019) and pandemic years (FY2020, FY2021) were compared to delineate changes in medical services for paediatric and adult patients. Virtually all individuals who received medical care in Japan during this period were included. In FY2019, healthcare utilisation by the paediatric population (under 15 years) accounted for 24% of 245 million first outpatient visits, 7% of 1.2 billion follow-up visits, and 2.6% of 297 million patient-days hospitalisations. In FY2020, outpatient visits of those aged 0-4 years decreased by 44% (first visit) and 24% (follow-up visit) compared to FY2019, and hospitalisations decreased by 47%, with the largest declines observed in community medical institutions across all age groups. The COVID-19 pandemic led to a substantial reduction in paediatric healthcare utilisation in Japan, varying by age and type of care. These findings may inform the rational allocation of healthcare resources during public health emergencies.

Association Between Higher Body Mass Index and the Risk of Lumbar Spinal Stenosis in Korean Populations: A Nationwide Cohort Study.

Background/Objectives: Despite the increasing prevalence of both spinal stenosis and obesity, their association remains controversial. This study aimed to investigate the relationship between body mass index (BMI) and the risk of lumbar spinal stenosis in the Korean population using nationwide data. Methods: We analyzed data from 2,161,684 adults aged ≥40 years who underwent health examinations in 2009 using the Korean National Health Insurance System database. Participants were categorized by BMI into five groups: underweight (<18.5), normal weight (18.5-22.9), overweight (23.0-24.9), obesity class I (25.0-29.9), and obesity class II and above (≥30). Cox proportional hazards models were used to evaluate the association between BMI and lumbar spinal stenosis risk, adjusting for demographic characteristics, lifestyle factors, and comorbidities. Results: During the 10-year follow-up period, the incidence rate of lumbar spinal stenosis increased progressively with higher BMI categories, from 32.77 per 1000 person-years in the underweight group to 51.51 in the obesity class II and above group. In the fully adjusted model, compared to the normal weight group, the hazard ratios (95% confidence intervals) were 0.801 (0.787-0.815) for underweight, 1.132 (1.126-1.139) for overweight, 1.245 (1.238-1.252) for obesity class I, and 1.348 (1.331-1.366) for obesity class II and above. The association was stronger in females and participants aged <65 years. Conclusions: A higher BMI was independently associated with an increased risk of lumbar spinal stenosis in the Korean population. This association remained robust after adjusting for various confounding factors, suggesting BMI as a significant risk factor for spinal stenosis.

Cost of Care Related to Treatment of Bone Metastases: Real World Data from a National Health Insurance Provider

Cost of Care Related to Treatment of Bone Metastases: Real World Data from a National Health Insurance Provider

May family routines impact oral health in American children?

The present study aimed to assess the association between family routines and dental caries and self-rated oral health status. Data from the 2020-2021 National Survey of Children's Health (NSCH) completed at United States were used. Our outcome variables were self-reported dental caries (yes/no) and poor oral health condition (yes/no). Our independent variables were related to family routines: (1) Going to bed at the same time (yes/no); (2) Days having dinner together (0-7days); (3) Hours spent in front of the TV, computer, cell phone or other electronic devices (screen time); and (4) adequate sleep (yes/no). We used socioeconomic factors, health insurance coverage, family structure and neighborhood characteristics as covariates. Univariate and multiple logistic regression were used to analyze the data. For the dental caries outcome, children with regular bedtimes (AOR = 0.68, 95% CI: 0.58-0.79), more frequent family dinners (AOR = 0.90, 95% CI: 0.85-0.96), and supportive neighborhoods (AOR = 0.88, 95% CI: 0.78-0.99) were less likely to report dental caries. Increased screen time (AOR = 1.10, 95% CI: 1.04-1.15) was associated with higher self-reported dental caries. For oral health status, children with regular bedtimes, (AOR = 0.60, 95% CI: 0.48-0.75), supportive neighborhoods (AOR = 0.81, 95% CI: 0.68-0.97), and with more neighborhood amenities (AOR = 0.92, 95% CI: 0.88-1.00) reported better health. More screen time (AOR = 1.11, 95% CI: 1.02-1.21) and poor neighborhood conditions (AOR = 1.13, 95% CI: 1.02-1.26) correlated with poor oral health. Findings from this study indicate that family routines play a significant role in children's oral health. Future research should focus on interdisciplinary family- and community-level interventions that are tailored to support healthy habits and address the needs of families.

Hospital system market share and commercial prices: a cross-sectional approach using price transparency data

BackgroundThe goal of this study is to estimate the association between hospital system market share and negotiated prices.Hospital system consolidation has led to many highly concentrated markets where systems can leverage their market share to negotiate higher commercial prices. Recently, the Centers for Medicare & Medicaid Services, under its Transparency in Coverage initiative, required health insurers to release all negotiated commercial prices, providing, for the first time, publicly available, nationally representative data on commercial rates. We utilize this newly available data on negotiated prices of healthcare services to show that a hospital with 10% higher market share charges 880-1,180 more per admission.Study designWe used commercial price data for national networks of three large, national insurers and performed a linear regression based on more than 1.3 million negotiated rates across 1,784 hospitals to estimate the association between a hospital’s system-level market share and commercial negotiated rates, adjusting for service (DRG), health system, and area level time-invariant characteristics.ResultsWe find that a one percentage point increase in hospital system market share is associated with an $88 to $118 higher negotiated rate per admission. All else equal, a hospital that is part of a system with a 10-percentage point higher market share can expect from $880 to $1,180 more per admission relative to a hospital with lower system market share (5.4% to 6.2% of the median price).ConclusionThese findings confirm that higher hospital system market share is strongly associated with higher commercial negotiated prices and should aid policymakers and decisionmakers in assessing the impact of various policy options aimed at reducing provider consolidation in the healthcare market.Trial registrationNot applicable.

Prenatal Exposure to Proton Pump Inhibitors and Risk of Serious Infections in Offspring During the First Year of Life: A Nationwide Cohort Study.

Proton pump inhibitor (PPI) use in children increases the risk of infections, prompting inquiry into the impact of prenatal PPIs exposure on serious infections in offspring. As a research gap in this area exists, this study aimed to address it by assessing the association between prenatal PPIs exposure and serious infections in infants during their first year of life. Using the French health insurance data warehouse (SNDS) (2013-2018), we conducted a retrospective cohort study on singleton, full-term liveborn non-immunocompromised infants, stratified by PPI use during the first three months of life (early-life use). Proton pump inhibitor dispensing in ambulatory care settings during pregnancy defined exposure. Outcomes concerned any serious infections in offspring aged between 3 and 12 months. Adjusted odds ratios (aORs) were estimated using logistic regression with multivariable models to control for potential confounders. Of the 2,485,545 infants included, 497,060 (23.3%) were prenatally exposed to PPIs and 97,767 (4.6%) had PPI use during the first three months of life. Prenatal PPI exposure was associated with serious infections in offspring (aOR, 1.09 [95% CI, 1.07-1.10]) in infants without early-life PPIs use. No association was found for infants with early-life PPI use (aOR, 1.05 [95% CI, 1.00-1.11]). Gastrointestinal infections were the sole site with persistent significance. Prenatal PPI exposure is common and is not associated with a major risk of serious infections in infants during their first year. However, even after adjusting for several confounding factors, a weak association remains, especially in infants without early-life PPI use. While offering reassurance, adherence to clinical guidelines is still crucial.

Move or Not to Move: Factors of Mind-Body Practice Engagement in a Population-Based Study.

Background: Mind-body practices (MBPs), which include seated- (meditation) and movement-based practices (yoga, Tai Chi, qigong), have grown increasingly popular in the United States for improving mental and physical wellness. While literature has identified socioeconomic and health-related factors related to seated- and movement-MBP engagement separately, no studies have explored the factors associated with combined-MBP use. This study accordingly used Anderson's behavioral model of health service utilization to explore sociodemographic and health-related factors associated with seated-, movement-, and combined-MBP engagement among a representative adult sample in the 2017 National Health Interview Survey. Methods: Descriptive statistics were used to summarize sample characteristics. Multinomial logistic regression using survey weights examined associations between predisposing (race-ethnicity, age, geographic region, sex, sexual minority status, and marital status), enabling (educational attainment, income, having continuous health insurance coverage, and having flexible spending accounts), and needs factors (psychological distress, self-reported health, and chronic pain) with type of MBP engagement. Results: Nearly 6% (5.8%) of the U.S. adult population practiced combined-MBPs. Results also showed that educational attainment was associated with increasingly higher odds of utilizing all forms of MBPs and revealed racial-ethnic disparities in movement- and combined-MBP engagement. Combined-MBP engagement was roughly two times higher among those with moderate psychological distress (relative risk ratio [RRR] = 1.92; 95% confidence interval [CI]: 1.58-2.32; p < 0.001), severe psychological distress (RRR = 1.96; 95% CI: 1.35-2.85; p < 0.001), and chronic pain. Conclusions and Implications: Findings suggest that combined-MBPs are utilized by a significant portion of the U.S. population and that engagement has varied distribution across sociodemographic and health factors. Considering the association of combined-MBP usage with mental and physical health needs, the authors recommend that health care providers suggest combined-MBPs as an additional resource for patients with psychological distress or mild chronic pain. Future practice and research can focus on increasing accessibility to MBPs in education settings to reduce racial-ethnic disparities.

A socio-ecological approach to understanding self-regulation among adolescents with developmental challenges and delays

Abstract Drawing from the socio-ecological model, this study examined the relationships between child, family, and neighborhood/community factors and self-regulation among five subgroups of adolescents aged 12–17 years with developmental challenges and delays (Attention Deficit Disorder/Attention-Deficit/Hyperactivity Disorder, Autism/Autism Spectrum Disorder, developmental delay, learning disability, and intellectual disability). Data for this study came from the 2019 National Survey of Children’s Health, a nationally representative dataset (n=3,181). Using multiple regression analyses, we found that not all five subgroups of adolescents shared similar experiences. In sum, having good health and health insurance was positively associated with self-regulation, while adverse childhood experiences and being bullied were negatively linked to self-regulation. Family and neighborhood/community-related variables that were positively related to adolescents’ self-regulation consisted of parent-child closeness, having college-educated parents, household food security, and parents’ knowledge of where to obtain help in their neighborhood. Family variables negatively associated with adolescents’ self-regulation included living in two-parent households and receiving public assistance, but only for adolescents with intellectual disabilities. Socio-demographic variables significantly linked to adolescents’ self-regulation were biological sex, age, Hispanic ethnicity, and race. Future research and practice should focus on identifying and addressing the diverse ecological factors influencing adolescents’ social-emotional development to improve behavioral outcomes and support their transition to adulthood.

POVERTY LEVELS MUST BE REDUCED TO IMPROVE ACCESSIBILITY TO HEALTH SERVICES

Background: Access to health services is a fundamental right for every citizen, but its equitable distribution remains challenging due to the influence of several variables. Indonesia has achieved Universal Health Coverage (UHC), but access to health services for those with health problems is still low. Aims: This study aims to determine the variables influencing access to health services in Indonesia. Methods: Longitudinal analysis of panel data was used, and the dataset was taken from the 34 provinces of Indonesia from 2018 to 2022. The data obtained were then analyzed descriptively and analytically by linear regression using STATA software. Results: Individual and family variables influencing access to health services for the population with health problems included variable need (health problem), ownership of health insurance, and ability to pay. Furthermore, the results showed that the number of areas with high poverty rates (socioeconomic) was a contextual factor with a higher level of influence. Conclusion: Based on the results, policies to improve access to health services, a basic human right, could not be solely achieved by the health sector. Therefore, integrated comprehensive planning collaboration of Penta-Helical elements was needed to reduce poverty enclaves. Keywords: ability to pay, access to health services, health insurance, poverty

Associations of Financial Toxicity with Employment Concerns and Cancer-Related Distress: A Cross-Sectional Survey among Korean Working-Age Cancer Survivors.

Although South Korea's health insurance has a co-payment-decreasing policy for cancer survivors, information on the extent of financial toxicity and its related factors is limited. We assessed the level of financial toxicity and the association of high levels of financial toxicity with employment concerns after diagnosis and cancer-related distress in working-age cancer survivors. A cross-sectional study was conducted. Study participants were recruited from the National Cancer Survivorship Center between November and December 2022. Financial burden was assessed using the Korean version of the Comprehensive Score for Financial Toxicity, and cancer-related distress was measured using the NCCN Distress Thermometer. Multivariate logistic regression analyses were used to explore the associations between high financial toxicity, cancer-related distress, and changes in employment status after cancer diagnosis. Of 1,403 working-age cancer survivors, approximately 62% reported high levels of financial distress. Survivors reporting early retirement and taking time off work with the intent to return were more likely to report high financial toxicity (adjusted OR 1.69, 95% CI 1.14-2.5; and adjusted OR 2.82, 95% CI 1.24-6.43, respectively) than those with a full-time or part-time job. Moreover, cancer survivors with high distress levels were more likely to report high financial toxicity than those with low distress levels (adjusted OR 4.36, 95% CI 3.17-5.99). High financial toxicity is associated with adverse employment concerns and cancer-related distress among working-age cancer survivors. Therefore, developing cancer survivorship interventions within the healthcare system is necessary to ensure improvements in financial well-being.

The Effect of Health Insurance on Racial Disparities in Patients With Isolated Colorectal Liver Metastases.

Although resection of colorectal liver metastases (CRLM) improves survival, factors including race and health insurance are associated with disparities in care. The aim of this study was to evaluate the effect of health insurance on racial disparities in CRLM resection. A retrospective study of patients with CRC with synchronous CRLM was performed using the National Cancer Database (2004-2020). The primary outcome was resection liver resection. Multivariable logistic regression (MVR) was performed to evaluate the association of race and insurance with the odds of resection. Forty-four thousand and six hundred sixteen patients were included. Resection rates were lower among Blacks compared to White patients (12.9% vs. 17.3%). By MVR, Black patients (OR 0.76 vs. White), uninsured and Medicaid-insured patients (OR 0.49 and OR 0.71 vs. private insurance) were less likely to undergo resection. On MVR of race stratified by insurance, Black patients with private and Medicare insurance had decreased odds of resection compared to White (OR 0.71 and OR 0.64). Although Black patients with CRLM have lower odds of hepatic resection compared to White, when stratified by insurance, this was only present among private- and Medicare-insured. Further investigation is warranted to understand other factors associated with racial disparities in this population.