Medical Cost of Cancer Care for Privately Insured Children in Chile.
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ABSTRACT:
SUBMITTER: Borrescio-Higa F
PROVIDER: S-EPMC8267683 | biostudies-literature | 2021 Jun
REPOSITORIES: biostudies-literature
Publications
Medical Cost of Cancer Care for Privately Insured Children in Chile.
Borrescio-Higa Florencia F Valdés Nieves N
International journal of environmental research and public health 20210623 13
Medical care for children with cancer is complex and expensive, and represents a large financial burden for families around the world. We estimated the medical cost of cancer care for children under the age of 18, using administrative records of the universe of children with private insurance in Chile in the period 2007-2018, based on a sample of 3853 observations. We analyzed total cost and out-of-pocket spending by patients' characteristics, type of cancer, and by service. Children with cancer ...[more]
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Project description:BackgroundUnderstanding experiences with private important to improving the quality of health care coverage.ObjectiveTo examine the association of health with cost-related access barriers, medical debt, and dissatisfaction with care among privately insured Americans.DesignWe classified Americans with private insurance by self-reported health status into five groups (excellent, very good, good, fair, and poor health). We examined self-reported difficulty seeing a doctor due to costs, not taking medications due to costs, medical debt, and dissatisfaction with care among individuals with differing health status. We used logistic regression to examine the association of health status with individuals' experiences after accounting for baseline characteristics. The analysis was repeated among individuals with different forms of private insurance. Odds ratios were converted to risk ratios to improve ease of interpretation of the results.SettingBehavioral Risk Factor Surveillance System of Americans in 17 states RESULTS: The sample included 82,494 US adults with private insurance. Following adjustment, compared to individuals with excellent health those in very good health, good health, fair health, and poor health reported increasingly higher risks of difficulty seeing a doctor due to costs with risk ratios of 1.02 (95% CI 1.01, 1.03), 1.07 (95% CI 1.06, 1.08), 1.18 (95% CI 1.17, 1.20), and 1.29 (95% CI 1.27, 1.31), respectively. Compared to individuals with excellent health, those in very good health, good health, fair health, and poor health reported increasingly higher risks of not taking medication due to costs, outstanding medical debt, and dissatisfaction with care. Similar relationships were seen across individually purchased and employer-sponsored insurance.ConclusionCost-related access barriers, medical debt, and dissatisfaction with care were common among individuals with private insurance and most pronounced among those with fair and poor health who likely need and use their health insurance the most.
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Project description:IntroductionNational Immunization Survey-Child data are used widely to assess childhood vaccination coverage in the U.S. This study compares National Immunization Survey-Child coverage estimates with estimates using other supplementary data sources.MethodsRetrospective analyses in 2021 assessed vaccination coverage of privately insured children for vaccines recommended by the Advisory Committee on Immunization Practices by age 2 years, using the 2015-2018 MarketScan Commercial Claims and Encounters databases and the 2018-2019 Healthcare Effectiveness Data and Information Set. The coverage estimates were compared statistically with those using the 2016-2018 National Immunization Survey-Child.ResultsEstimated coverage ranged from 69.9% (≥2 doses of influenza vaccine) to 95.0% (≥3 doses of diphtheria, tetanus toxoids, and acellular pertussis vaccine) using the MarketScan Commercial Claims and Encounters data and from 68.0% (≥2 doses of influenza vaccine) to 92.2% (≥1 dose of measles, mumps, and rubella vaccine) using the Healthcare Effectiveness Data and Information Set. The difference between the MarketScan Commercial Claims and Encounters and National Immunization Survey-Child estimates ranged from 0.1 to 4.3 percentage points and was statistically significant for 6 of the 13 assessed vaccines/doses and percentage of children receiving no vaccinations. The difference between the Healthcare Effectiveness Data and Information Set and National Immunization Survey-Child estimates ranged from 0.4 to 7.2 percentage points and was statistically significant for 6 of the 10 assessed vaccines/doses.ConclusionsFor certain vaccines and populations of interest, the National Immunization Survey-Child, MarketScan Commercial Claims and Encounters, and Healthcare Effectiveness Data and Information Set data might give comparable coverage of privately insured children.
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Project description:ObjectiveTo characterize physician health system membership in four states between 2012 and 2016 and to compare primary care quality and cost between in-system providers and non-system providers for the commercially insured population.Data sourcesPhysician membership in health systems was obtained from a unique longitudinal database on health systems and matched at the provider level to 2014 all-payer claims data from Colorado, Massachusetts, Oregon, and Utah.Study designUsing an observational study design, we compared physicians in health systems to non-system physicians located in the same state and geography on average cost of care (risk-adjusted using the Johns Hopkins' Adjusted Clinical Grouper), five HEDIS quality measures, one measure of developmental screening, and two Prevention Quality Indicator Measures.Data collection/extraction methodsPatients in commercial health plans were attributed to a primary care physician accounting for the plurality of office visits. A cohort for each quality measure was constructed based on appropriate measure specifications.Principal findingsThe share of physicians in health systems increased steadily from 2012 to 2016 and ranged from 48% in Colorado to 63% in Utah in 2016. Compared to physicians not in a system, system physicians performed similarly on most HEDIS quality metrics compared to non-system physicians. Patients attributed to in-system physicians had about 40% higher rates (P < .05) of Ambulatory Care Sensitive Admissions (measured in admissions per 100 000:921.33 in-system vs 674.61 not-in-system for acute composite; 2540.91 in-system vs 1972.17 for chronic composite In-system providers were associated with $29 (P < .05) higher average per member per month costs (453.37 vs 432.93). Overall, differences in performance by system membership were relatively small compared to differences across states and geography.ConclusionA growing share of physicians is part of a health system from 2012 to 2016. Providers in health systems are not delivering primary care more efficiently than non-system providers for the commercially insured.
| S-EPMC7720710 | biostudies-literature