Medical Bills Research Articles

Do transition to practice hour requirements make a difference in adverse action and medical malpractice payment reports: An analysis from the National Practitioner Data Bank

ABSTRACT Background: The transition to practice (TTP) hour requirement presents a barrier to full practice authority (FPA) for nurse practitioners (NPs). Since 2015, the predominant method of granting FPA entails a TTP hour requirement. Purpose: Adverse action reports (AARs) and medical malpractice payment reports (MMPRs) of NPs were compared in states with FPA on initial licensure and states with FPA requiring a TTP hour period using data from the National Practitioner Data Bank (NPDB). The relationship of TTP hours to AARs and MMPRs was also evaluated. Methodology: A secondary analysis was obtained from a review of retrospective data in the NPDB. States examined were those that grant FPA on initial advanced practice registered nurse licensure and states that require a TTP hour requirement as part of their criteria for granting FPA. Results: In a 5-year period, postimplementation of FPA or 5-year postexpiration of the TTP requirement in 23 states, plus the District of Columbia, revealed that states with FPA granted on initial licensure demonstrated a lower incidence of AARs and MMPRs at the 5-year period compared with states that require a TTP hour period. No relationship existed between the amount of TTP hours and the incidence of AARs and MMPRs. Conclusion: Transition to practice hours remains a barrier to NPs achieving FPA. It is important for nursing to continue to build the body of evidence that refutes or supports the need for TTP hours. Implications: These data can be used when lobbying at the state level in the remaining states seeking FPA.

Cervical precancer screening using self-sampling, HPV DNA testing, and mobile colposcopy in a hard-to-reach community in Ghana: a pilot study

BackgroundThe World Health Organization has set ambitious goals to eliminate cervical cancer, necessitating evidence on increasing coverage and access to screening and treatment in high-burden areas. We implemented a pilot program to assess the feasibility of obtaining self-collected specimens for high-risk human papillomavirus (hr-HPV) testing in Nzulezo stilt village, a hard-to-reach community in Ghana, and inviting only hr-HPV-positive women to a central location for colposcopy and possible treatment. Subsequently, this study aimed to investigate the prevalence of hr-HPV infection and cervical lesions among the women and to explore factors potentially associated with hr-HPV infection among them.MethodsThis pilot community-based cross-sectional study utilized data from screening sessions held from 2 to 20 November 2021 with specimens collected by participants using Evalyn brushes. HPV DNA testing was performed using the Sansure MA-6000 platform, while visual inspection utilized the Enhanced Visual Assessment (EVA) mobile colposcope. Univariate and multivariable nominal logistic regression was employed to explore factors associated with hr-HPV positivity.ResultsAmong 100 women screened (mean age, 43.6 ± 14.5 years), the overall hr-HPV prevalence rate was 39.0% (95% CI, 29.4–49.3). The prevalence rates of hr-HPV genotypes were stratified as follows: HPV16–8.0% (95% CI, 3.5–15.2), HPV18–5.0% (95% CI, 1.6–11.2), and other genotype(s) – 31.0% (95% CI, 22.1–41.0). Single-genotype infections with HPV16 and HPV18 were found in 4.0% (95% CI, 1.1–9.9) and 3.0% (95% CI, 0.6–8.5) of women, respectively. Mixed infections were observed in 1.0% (95% CI, 0.0–5.4) for HPV16 + 18, 3.0% (95% CI, 0.6–8.5) for HPV16 + other type(s), and 1.0% (95% CI, 0.0–5.4) for HPV18 + other type(s). The prevalence of cervical lesions among hr-HPV-positive women screened via colposcopy was 11.4% (95% CI, 3.2–26.7). In the multivariable model, reliance on other sources for medical bill payment was associated with hr-HPV infection (aOR, 0.20; 95% CI, 0.04–0.93), whereas age was not (aOR, 1.02; 95% CI, 0.99–1.05).ConclusionsA high hr-HPV infection prevalence was recorded among the women. Utilizing technologies such as self-sampling, HPV DNA testing, and mobile colposcopy enables screening and treatment in remote and hard-to-reach communities where access to cervical cancer screening and treatment would otherwise be limited. Further research is warranted to assess the value and scalability of this approach in similar remote areas and its potential implementation in future programs.

Survey of fear and compliance of Insulin Degludec and Insulin Aspart injection in type 2 diabetes mellitus patients and analysis of influencing factors

This study aims to investigate the fear and compliance of Insulin Degludec and Insulin Aspart (IDegAsp) injection in type 2 diabetes mellitus (T2DM) patients and study the factors influencing patient compliance. A total of 120 patients with T2DM treated from February 2019 to March 2022 were investigated and analyzed for fear and compliance on the Diabetes Fear of Injecting and Self-testing Questionnaire of diabetic patients and were divided into compliance and noncompliance groups according to the results to analyze the factors affecting patient compliance. The study found a high level of fear of IDegAsp injection among the 120 T2DM patients, with an average Diabetes Fear of Injecting and Self-testing Questionnaire score of (39.19 ± 4.59) points. Scores for medication compliance, dietary compliance, blood sugar monitoring, and lifestyle changes were (10.48 ± 1.52) points, (12.18 ± 2.27) points, (0.84 ± 0.12) points, and (9.13 ± 2.21) points, respectively. There was no significant difference between the compliance and noncompliance groups in terms of gender, age, lifestyle, educational level, occupation, current treatment method, family monthly income per capita, and medical payment method (P > .05). However, there were significant differences influenced by disease duration, complications, cognitive level, self-efficacy level, comorbidity count, and living status (P < .05). Multifactorial analysis showed that educational level, disease duration, complications, cognitive level, self-efficacy level, comorbidity count, and living status all affected patient compliance (P < .05). Educational level, disease duration, complications, cognitive level, self-efficacy level, comorbidity count, and living status are important factors affecting the fear and treatment compliance of IDegAsp injection in T2DM patients. These findings have implications for improving patient compliance and alleviating treatment fear.

Multimorbidity Patterns and Periodontal Diseases in a French Hospital-Based Dental School: A Retrospective Cross-Sectional Study

Objectives: To assess the prevalence of systemic pathologies associated with periodontal diseases to determine multimorbidity patterns and risk factors for periodontal care. Methods: A single-center cross-sectional study analyzed patient records from 1 January 2019 to 31 December 2021 at the Department of Periodontology, part of the Dental Service of a hospital-based dental school in Lyon, France. The anonymized data included patient-reported medical history (questionnaire) and billing for periodontal procedures. Data were compared between patients in the Department of Periodontology and from Other Departments of the Dental Service. The association between clinically relevant pathologies, as defined as multimorbidity, and admission in the Department of Periodontology were assessed with logistic regression. Prevalences between the Department of Periodontology and the Other Departments of the Dental Service were compared with chi-squared tests. Relationship among pathologies was described through correlation analysis. Statistical analyses were conducted using R software with a significance level set at p < 0.05. Results: This study included records of 20,945 patients in the Dental Service with 1205 periodontal procedures performed in the Department of Periodontology. Patients admitted for periodontal care were older and mostly female (p-value < 0.001). The most frequent systemic pathologies were hypertension and diabetes in the Department of Periodontology. Hypertension associated with diabetes was the most frequent multimorbidity pattern, while the most frequent triad of multimorbidity was hypertension/diabetes/cardiac rhythm disorders. Patients with diabetes had a 1.49 times higher likelihood of admission to the Department of Periodontology (OR = 1.49 [1.20; 1.86]), with age also being a significant risk factor but with a smaller effect size (OR = 1.02 [1.01; 1.03]). Conclusions: Within the limitations of this study, hypertension, diabetes, cardiac rhythm disorders, and chronic renal insufficiency were identified as prevalent multimorbidity in the Department of Periodontology. Multimorbidity including diabetes seems to constitute a risk factor requiring periodontal care.

Patient-reported disability progression outcomes among patients with multiple sclerosis: Results of an outcomes-based agreement.

Outcomes-based agreements (OBAs) are agreements between payers and manufacturers in which payment for medications is tied to patient outcomes. These contracts aim to measure the value of prescription medications on predefined clinical indicators in real-world patient populations. OBAs are gaining traction in the United States as the health care industry shifts from volume-based to value-based care. Multiple sclerosis (MS) is an appealing therapeutic area for OBAs because of its prevalence, high cost of medications, and multiple effective therapeutic options. To describe findings from an OBA that was prospectively conducted in a large regional health system for patients with MS taking interferon β-1a or dimethyl fumarate. In this prospective real-world analysis, commercial or health insurance exchange members were included based on the parameters of the OBA. Disability progression was assessed using a patient-reported outcome, patient-determined disease steps (PDDS). In the OBA, members aged 18 years or older with an MS diagnosis were included in the contract. A baseline score was collected for eligible members, with follow-up scores occurring between a 90-day and 180-day postbaseline score. If a follow-up score was greater than the baseline score, a subsequent PDDS score was collected between 90-days and 120-days to determine if the PDDS score remained elevated, indicating that the member had disability progression. During the contract period, 410 patients were eligible for PDDS collection, with 241 and 169 patients in the dimethyl fumarate and interferon β-1a cohorts, respectively. There were 162 patients who were lost to follow-up, and 64 patients who were ineligible per contract parameters. Of the remaining 184 eligible patients (107 on dimethyl fumarate and 77 on interferon β-1a), 21 (11%) patients had confirmed disability progression (6 on dimethyl fumarate [5.6%] and 15 on interferon β-1a [19.5%]). Our findings suggest that meaningful patient-reported outcomes, such as disability progression, can be operationalized in an innovative OBA.

QuickStats: Percentage* of Adults Aged ≥18 Years Who Were in Families Having Problems Paying Medical Bills in the Past 12 Months,† by Disability Status§ and Age Group - United States, 2023.

QuickStats: Percentage* of Adults Aged ≥18 Years Who Were in Families Having Problems Paying Medical Bills in the Past 12 Months,† by Disability Status§ and Age Group - United States, 2023.

Effect of Outpatient Pooling Scheme on the Medical Costs of Patients with Chronic Diseases -- Based on Multi-period DID Modeling

The establishment of a sound mechanism for covering outpatient medical bills under the basic medical insurance for urban employees is one of the major livelihood projects to deepen the reform of China's medical security system. This study utilizes the China Health and Retirement Longitudinal Study (CHARLS), combines the interview data from four periods from 2011 to 2018, empirically analyzes the impact of the outpatient pooling scheme on the total outpatient costs and personal burden of patients with chronic diseases by using a multi-period double-difference model and further validates it by using the double-difference propensity score matching method (PSM-DID). The results show that the implementation of the outpatient pooling scheme is conducive to reducing the healthcare burden of chronically ill patients. Although the outpatient co-ordination did not have a significant impact on the reduction of outpatient costs for patients with chronic diseases, it significantly reduced the self-treatment costs of patients with chronic diseases. Further research found that the policy had a greater impact on chronic disease patients with poorer health. Combined with the results of the study, this paper suggests gradually eliminating the differences in basic policy treatment between regions, guaranteeing the level of outpatient treatment for insured patients in different places, and promoting better utilization of the outpatient co-ordination policy effect.

An examination of caregiver burden and contributing factors in cases of congenital microtia deformity.

This study aimed to assess the burden and influencing factors among primary caregivers of children with congenital microtia. A total of 153 primary caregivers of children with congenital microtia who underwent auricular reconstruction surgery at a tertiary A-grade hospital in Xi'an between October 2019 and August 2022, were recruited using convenience sampling. The Zarit Caregiver Burden Interview (ZBI) was employed to evaluate caregiver burden. While convenience sampling allowed for the practical recruitment of participants, its limitations include potential selection bias, which may affect the generalizability of the results. The mean total ZBI score was 30.07 ± 12.29. Among the participants, 26 caregivers (17.0%) reported no burden, 102 caregivers (66.7%) reported mild burden, 22 caregivers (14.4%) reported moderate burden, and 3 caregivers (2.0%) reported severe burden. Multivariate regression analysis identified several significant factors influencing caregiver burden, including the location and severity of the lesion, educational level, method of medical payment, monthly household income, communication with others about the child's condition, caregiver self-blame or guilt, and family support (all P < .05). Primary caregivers of children with congenital microtia face substantial burdens, emphasizing the need for targeted healthcare interventions. Strategic approaches are essential to address the psychological, social, and financial challenges they encounter. Future research should focus on longitudinal studies and interventions to enhance caregiver well-being and patient outcomes. However, caution is advised when generalizing these findings due to the sampling limitations.

Addressing Surprise Medical Bills and Out-of-Network Prices

This Viewpoint discusses how the lack of agreement governing in-network and out-of-network care can harm patients and benefit aggressive pricing strategies.

Conformal Prediction and Large Language Models for Medical Coding

Abstract The assignment of current procedure terminology (CPT) codes to medical events is a highly cumbersome, logistic challenge for many healthcare organizations, as well as a significant contributor to medical expenses. Improvement in the allocation of medical resources and expenses dedicated to such tasks can be achieved through automation. However, because of the complex nature of medical records, automation of procedure terminologies is just now developing with the advent of machine learning methods. In this study, we develop a fine-tuned large language model (LLaMA-3B) as a high-reliability predictor for CPT codes. As input, we use 2018 pathology report text data, including gross report, microscopic description, brief medical history, and final diagnosis. We define our dataset with the top five most common technical component CPT codes, which account for 85% of all samples. As a (meta) predictor of the veracity of the large language model itself, we use the prediction’s softmax scalar value of the classification model, borrowing from similar recent approaches in conformal prediction. Specifically, the validation set, which is distinct from both the train and test set, is used to establish a prediction threshold below which the model withholds judgement. We show that, by fine tuning an off-the-shelf language model on pathology report text alone, we can achieve 95% prediction accuracy of the top 5 most common CPT codes on our dataset. We also then demonstrate the utility of combining large language models with conformal prediction. The two in combination raise our accuracy to 99.5% when we allow the model to abstain on making a prediction on 30% of the data, as is determined by a separate threshold on the scalar value of the predictor from the aforementioned validation set. We therefore present a highly flexible model for medical coding, which is simultaneously provably-reliable. Large language models can as such serve as a powerful tool for overcoming challenges in medical billing, thereby improving healthcare efficiency and reducing medical costs.

Financial burden of care greatest among rural beneficiaries in Medicare advantage.

To examine differences in access to care and financial burden between Traditional Medicare (TM) and Medicare Advantage (MA) beneficiaries in rural and urban areas and then explore whether there were potential differences in MA benefits between urban and rural areas. We conducted a cross-sectional study within the Medicare setting in the United States. Data from three distinct sources for 2017-2021: the Medicare Current Beneficiary Survey, the MA landscape data, and the Plan Benefit Package data. Our sample comprised 43,343 Medicare beneficiary-years, including TM and MA beneficiaries in urban and rural areas. Our adjusted analysis showed that rural MA beneficiaries experienced higher rates of delayed care due to costs (10.0% [95% confidence interval (CI): 8.8-11.1]) compared with rural TM (9.5% [8.8-10.2]), urban MA (7.9% [7.4-8.4]), and urban TM (7.9% [7.5-8.2]) beneficiaries. Similarly, rural MA beneficiaries (11.4% [95% CI: 10.3-12.5]) reported more difficulty paying medical bills compared with rural TM (9.4% [8.7-10.1]), urban MA (8.1% [7.7-8.6]), and urban TM (7.8% [7.5-8.2]) beneficiaries. This disparity was associated with less generous financial structures in rural MA plans. Compared to urban MA plans, rural MA plans offered lower out-of-pocket maximums for in-network care ($5918 vs. $5439), but required higher copayments ($1686 vs. $1724 for a 5-day hospitalization, $37 vs. $41 for a specialist visit, and $35 vs. $38 for a mental health visit). However, differences in quality of care and provision of supplemental benefits were small. Rural Medicare beneficiaries reported a greater financial burden of care than urban Medicare beneficiaries, but the most significant burden was observed among MA beneficiaries in rural areas. One possible mechanism could be the less generous financial structures offered by rural MA plans. These findings suggest the need for policies addressing the affordability of care for rural MA beneficiaries.

Effects of Medicare Eligibility at Age 65 Among Individuals With and Without Functional Disability.

Medicare coverage at age 65 improves access to and use of care and alleviates financial hardship for the general population. However, less is known whether the effects differ between individuals without and with functional disability. To examine the effects of Medicare eligibility at age 65 on health insurance coverage, financial burden of care, and access to care among individuals without and with functional disability. We used a regression discontinuity design, which exploits the discontinuity in eligibility for Medicare at age 65 and compares individuals just before and after age 65. Our analysis included 19,876 individuals (aged 59-71) without functional disability and 8376 individuals with functional disability from the 2014-2021 Medical Expenditure Panel Survey. We assessed health insurance coverage, financial burden of care, and access to care. Medicare eligibility led to increases in any and Medicare coverage for both groups, but those with functional disability had a decrease in Medicaid coverage by - 2.6 percentage points. Medicare eligibility resulted in lower financial burden of care for both groups, but the effects were greater among those with functional disability (- $578 vs. - $344 for out-of-pocket spending, - 3.7 vs. - 4.9 percentage points for cost-sharing, and - 2.5 vs. - 0.8 percentage points for paying medical bills over time). Although Medicare eligibility led to a decrease in delayed medical care among those without functional disability (- 2.1 percentage points), no change was observed among those with functional disability. Notably, access to care remained limited among those with functional disability after obtaining Medicare eligibility (8.6% and 3.9% for being unable to get medical care and experiencing delay in getting medical care). Medicare coverage can reduce financial hardship, especially for individuals with functional disability. However, there is a need to develop policies that ensure equitable access to care for those with functional disability.

Income, wealth, and debt among families with a history of cancer.

350 Background: Cancer survivors and their families often experience financial hardship due to high out-of-pocket medical costs and lost income from time away from work during treatment for patients and informal family caregivers. Little is known about detailed income, wealth, and debt among families with a history of cancer. Methods: The 2021 Panel Study of Income Dynamics was used to identify families with a cancer history. Family characteristics included survey response person’s age, sex, marital status, and race and ethnicity, number of dependent children living in the family, and time since cancer diagnosis. For families with multiple cancer diagnoses, time since cancer diagnosis was calculated according to the most recent cancer diagnosis. Family income was assessed by total income in tax year 2020, which consisted of combined taxable and transfer income of the response person, spouse/partner, and other family members. Wealth with and without equity (i.e., value of home minus mortgage) were assessed by sum of values of different types of assets (e.g. savings, checking, bonds, retirement accounts) net of debts (e.g., credit card debt, student loans, and medical bills). Results: A total of 701 families were identified with a cancer history. Within families, half of cancer survivors were 18-64 years and the other half were &gt;65 years at the survey. About two thirds were married or living with partners, three fourths of response persons were male, one fifth had dependent children living in the same family, two thirds were non-Hispanic white, and two thirds of cancer survivors were diagnosed &gt; 6 years prior to the survey. The median family income was $67,498 (inter-quartile range: $33,480 to $121,200), and the median wealth with and without equity were $188,000 and $5,5000, respectively. Moreover, 29.9% of families had credit debt (median: $4,500; inter-quartile range [IQR]: $1800-$14,000); 11.3% of families carried student loans (median: $4,500; IQR: $15,000-$60,000); and 10.7% of families had outstanding medical bills (median: $4,000; IQR: $2,000-$9,000). Conclusions: Families with a history of cancer have multiple types of debts, including medical debt, even years after diagnosis. Efforts to identify changes in wealth and income before and after cancer diagnosis are warranted. Income, wealth, and debt among families with a history of cancer. Family income Wealth without equity Wealth with equity Mean (Std) Median (IQR) Mean (Std) Median (IQR) Mean (Std) Median (IQR) $94,776(123,870) $67,498(33,480, 121,200) $459,956(1,142,647) $5,5000(4,000, 391,364) $649,912(1,307,959) $188,000(30,400, 645,000) Credit card debt (n=693) Student loans (n=698) Medical bills (n=627) n (%) Mean (Std) Median (IQR) n (%) Mean (Std) Median (IQR) n (%) Mean (Std) Median (IQR) 207(29.9%) $8,832 (10,300) $4,500(1800, 14,000) 79(11.3%) $55,948(75,256) $35,000(15,000, 60,000) 67(10.7%) $13,309(32,525) $4000(2,000, 9,000)

The association of disability and medical financial hardship among cancer survivors in the US.

136 Background: Medical financial hardship (MFH) in cancer survivors is well-documented. Little is known about how disability impacts healthcare needs and costs in cancer survivorship. We examined associations of disability and MFH among survivors in the US. Methods: We identified cancer survivors ≥18 years with (n=2,795) and without (n=12,263) a disability from the National Health Interview Survey 2019 to 2022. The Washington Group Short Set, a validated six-item measure intended to describe the functional status of adults (e.g. disability in seeing, hearing, or walking) was used to identify those with disabilities. MFH was categorized into three domains: 1) material (e.g. problems paying medical bills), 2) psychological (e.g. worrying about medical bills), and 3) behavioral (e.g. delaying/forgoing care due to cost). Adjusted logistic regressions were used to examine associations of disability and MFH among cancer survivors. Results: Cancer survivors with a disability were more likely to experience any MFH (57.2% vs. 47.0%, p&lt;0.05) or any individual domain (Material: 26.4% vs. 13.3%, p&lt;0.05; Psychological: 50.5% vs. 43.0%, p&lt;0.05; Behavioral: 23.2% vs. 12.9%, p&lt;0.05) compared with those without a disability. In addition, survivors with a disability were more likely to report experiencing multiple domains of MFH (29.1% vs. 15.9%; p&lt;0.05). Conclusions: Cancer survivors with a disability face higher risks of MFH. Our findings can inform interventions alleviating MFH in this especially vulnerable population. Association of disability with medical financial hardship among cancer survivors, National Health Interview Survey 2019-2022. Cancer Survivors with a Disabilityn = 2,795 Cancer Survivors without a Disabilityn = 12,263 AME(95% CI) AME(95% CI) Any material financial hardship 26.4(24.7, 28.0) 13.3(12.5, 14.2) Any psychological financial hardship 50.5(49.1, 52.0) 43.0(42.0, 44.0) Any behavioral financial hardship 23.2(21.7, 24.7) 12.9(12.0, 13.7) Any MFH 57.2(55.8, 58.6) 47.0(46.0, 48.0) 1 domain of MFH 57.2(55.8, 58.6) 47.0(46.0, 48.0) 2+ domains of MFH 29.1(27.5, 30.6) 15.0(14.1, 15.8) Note: In adjusted analyses, covariates included age, sex, race/ethnicity, marital status, education, family income as % of Federal Poverty Level, insurance, year, and survey design; AME=Average Marginal Effect; CI = Confidence Interval.

Access to patient assistance programs for rural cancer patients in an NCI designated comprehensive cancer center: A retrospective cohort study.

94 Background: 35% of Oregon’s and 14% of Washington’s populations live in rural/frontier communities. These populations often experience a higher incidence of cancer disparities across the care continuum and a disproportionate burden of the high costs associated with cancer care compared to urban populations. Methods: The Oregon Health &amp; Science University (OHSU) Knight Cancer Institute (KCI) operates a multidisciplinary cancer program catering to Oregon and Southwest Washington from its Portland-based campuses. OHSU launched an enterprise Patient Assistance (PA) program partnership with Atlas Health which included an Artificial Intelligence (AI)-powered platform integrated with the electronic health record and 4 Patient Advocates who enrolled patients into matched PA programs. Rural patients receiving intravenous (IV) infusion therapy who benefited from PA programs were compared to the overall treated population at OHSU infusion centers to determine if rural patients who are at high risk for financial toxicity were identified and provided an effective intervention. Patient zip codes were used to designate residence in urban or rural/frontier counties. Results: A retrospective analysis reviewed unique patients treated in the OHSU KCI infusion centers, PA Enrolled, and PA Awarded patient cohorts. Conclusions: The Enterprise PA program partnership notably and proportionately benefited rural communities who are at high risk for financial toxicity and experience significant cost barriers to care. OHSU collected over 599,000 which reduced the risk of bad debt for the institution and cancer related medical debt for patients. Average PA award of 1,426 was significant due to 40% of Americans cannot afford a 1,000 emergency or unexpected medical bill. This underscores that an enterprise PA program may be considered a care delivery intervention to decrease health disparities. Further study is needed to determine if increasing rural cancer patients’ access to PA programs helps improve clinical access and treatment outcomes across the spectrum of cancer care services. Patient cohort comparison 12/15/2023-3/31/2024. Patient Cohort OHSU Infusion Center Cohort Patient Assistance Enrolled Cohort Patient Assistance Awarded Cohort Total Number of Patients 9,197 554 420 Total Number of Patients Residing in Oregon and Washington 9,064 552 418 Total Number of Patients Residing in Oregon and Washington Rural Counties 1,668 117 122 Percentage Rural Patients 18% 21% 29% Drug Manufacturer Co-Pay Programs - $ 590,785.70 $ 459,095.08 Charitable Co-Pay Assistance Programs - $ 96,024.70 $ 139,981.33 Total - $ 686,810.40 $ 599,076.41 Average Expected/Received Award Per Patient - $ 1,239.73 $ 1,426.37

Differential impact of financial hardship on food security between lesbian, gay, and bisexual and heterosexual cancer survivors in the United States.

137 Background: Lesbian, gay, and bisexual (LGB) cancer survivors experience more food insecurity as well as financial hardship than heterosexual cancer survivors. However, how financial hardship impacts food security differently between LGB and heterosexual survivors has not been explored. Methods: National Health Interview Survey data from 2019-2022 were pooled and weighted. Outcomes included a food insecurity measure (food secure, low food security, very low food security) and the manifestations of food insecurity (e.g., cutting size of meals, losing weight due to lack of food). Financial hardship was captured as a binary measure, dichotomized from an 11-item scale which included ability to pay medical bills, worry about paying bills, and delayed or foregone care due to costs. Bivariate analyses were conducted using Chi-Squared tests. Multinomial logistic regression models with an interaction between LGB status and financial hardship status were used to generate relative risk ratios controlling for age, time since last cancer diagnosis, sex, race, region, and year. Results: Of N=13,131 cancer survivors, 2.8% (n=374) identified as LGB. Low/very low food security was reported by 15.6% of LGB survivors in comparison to 6.1% of heterosexual survivors (p&lt;0.001). When stratified by financial hardship, LGB survivors were more likely to report food insecurity in the presence of (22.3% vs. 11.2%, p&lt;0.001) and absence of (6.8% vs. 2.2%, P&lt;0.001) financial hardship. LGB survivors with very low food security often reported cutting the size/cutting meals (93.4%), eating less than they should (94.7%), and being hungry because they could not afford food (80.7%). In the multinomial model, LGB survivors with financial hardship had 5.6 (95%CI:2.9-10.7) times the relative risk of low food security, while heterosexual survivors with financial hardship had 3.9 the relative risk of low food security (95%CI: 2.9-5.2) in comparison to heterosexual survivors with no financial hardship. Furthermore, LGB survivors with financial hardship had 11.8 (95%CI:6.2-22.5) the relative risk of very low food security, LGB survivors with no financial hardship had 6.4 (95%CI: 2.0-20.2) the relative risk of very low food security, and heterosexual survivors with financial hardship had 5.3 the relative risk of low food security (95%CI: 3.6-7.7) in comparison to heterosexual survivors with no financial hardship. Conclusions: Experiencing financial hardship was associated with an increased risk of food insecurity among LGB and heterosexual cancer survivors. However, LGB survivors were more likely to experience food insecurity than heterosexual survivors even when controlling for financial hardship.

Does younger children's social health insurance alleviate household impoverishment due to illness?

The ambitious expansion of social health insurance in China has played a crucial role in preventing and alleviating poverty caused by illness. However, there is no government-sponsored health insurance program specifically for younger children and inequities are more pronounced in healthcare utilization, medical expenditure, and satisfaction in some households with severely ill children. This study assessed the effectiveness of child health insurance in terms of alleviating poverty caused by illness. Data were collected from two rounds of follow-up surveys using the China Family Panel Studies 2016 and 2018 child questionnaires to investigate the relationship between child health insurance and household medical impoverishment (MI). Impoverishing health expenditure (IHE) and catastrophic health expenditure (CHE) were measured to quantify "poverty due to illness" in terms of absolute and relative poverty, respectively. Propensity score matching with the difference-in-differences (PSM-DID) method, robustness tests, and heterogeneity analysis were conducted to address endogeneity issues. Social health insurance for children significantly reduced household impoverishment due to illness. Under the shock of illness, the incidences of IHE and CHE were significantly lower in households with insured children. The poverty alleviation mechanism transmitted by children enrolled in social health insurance was primarily driven by hospitalization reimbursements and the proportion of out-of-pocket medical payments among the total medical expenditure for children. Children's possession of social health insurance significantly reduced the likelihood of household poverty due to illness. The poverty-reducing effect of social medical insurance is most significant in rural areas, low-income families, no-left-behind children, and infants. Targeted poverty alleviation strategies for marginalized groups and areas would ensure the equity and efficiency of health system reforms, contributing to the goal of universal health insurance coverage in China.

"Trust Women": Characteristics of and learnings from patients of a Shield Law medication abortion practice in the United States.

The 2022 Massachusetts Shield Law protects telemedicine providers who care for abortion seekers in other states from criminal, civil, and licensure penalties. In this article we explore the characteristics of patients of The Massachusetts Medication Abortion Access Project (The MAP). The MAP is an asynchronous telemedicine service that offers mifepristone/misoprostol to abortion seekers in all 50 states who are at or under 11 weeks pregnancy gestation on initial intake. The MAP charges USD250 using a pay-what-you-can model. We analyzed medical questionnaires and payments submitted by patients who received care from The MAP during its first 6 months of operations using descriptive statistics and for content and themes. From October 1, 2023-March 31, 2024, 1994 patients accessed care through The MAP. Almost all (n = 1973, 99%) identified as women/girls and about half (n = 984, 49%) were aged 20-29. The MAP cared for patients in 45 states; 84% (n = 1672) of these patients received pills in abortion ban or restricted southern states. Patients paid USD134.50 on average; 29% (n = 577) paid USD25 or less. Nearly two-thirds (n = 1293, 65%) received subsidized care; financial hardship featured prominently in patient comments. Considerable demand exists for medication abortion care from Shield Law providers. The MAP demonstrates that providers can trust women and other pregnancy capable people to decide for themselves whether to obtain medication abortion pills by mail and to pay what they can afford without being required to justify their need. Identifying ways to support Shield Law provision and further subsidize abortion care are needed.

Impact of Financial Stress on Academic Performance of University Students in South East Nigeria

Abstract The purpose of this study is to examine how financial stress affects academic performance among university students in South East Nigeria. By using descriptive statistics and the Chi-Square model, we examined the relationship between financial stress and academic outcomes among 250 participants from five South Eastern universities. Several key factors contributing to financial stress were examined such as students’ monthly income, medical bills cost, ability to save, academic materials cost, student borrowing levels, and cost of feeding. The findings indicate that students’ monthly income and the cost of medical bills are the key determinants of financial stress among students. Based on the second objective, the study revealed that inability to pay bills as student, the inability to purchase required academic materials (books, course packs, supplies) due to their high costs, difficulties in paying school fees, and work schedules are the most significant factors that contribute to financial stress which negatively affect academic performance for students. Therefore, we recommend that government should enhance its financial assistance programs to alleviate financial stress among university students as this will improve their academic performance. Also, Collaboration with external stakeholders, can further enhance the resources available to students in need. Finally, this study illustrates the detrimental effects of financial stress on academic performance among university students in southeast Nigeria and should be interpreted with caution as its limited to South-East Nigeria.

Association between patient-reported financial burden and catastrophic health expenditures in cancer survivors

PurposeTo measure rates of patient-reported financial burden, compare them across cancer types, and determine whether they are predictive of catastrophic health expenditures (CHE). MethodsWe extracted data from the Medical Expenditures Panel Survey from 2011 to 2017 to conduct a retrospective population-based cohort study and multivariable logistic regression to assess the financial burden of cancer across 16 cancer types and compare patient-reported metrics to CHE rates. ResultsPatients with ovarian cancer were most likely to report inability paying bills (34.5 %) and filing for bankruptcy (9.4 %), while patients with thyroid cancer were most likely to incur debt (22.4 %). Patients with kidney cancer had the highest mean debt ($46,915). CHEs were independently predicted by inability to pay medical bills (OR [95 % CI], 1.96 [1.14–3.35]) and bankruptcy filing (OR [95 % CI], 3.90 [1.21–12.60]. Conclusions and implicationsWe report important variations in the financial burden across cancer types and underscore the importance of assessing how patient-reported measures are related to CHEs. Policy implications. The financial burden of cancer care could explain the lack of improved outcomes with increased national health spending.