Medical Insurance Coverage (medical + insurance_coverage)

Distribution by Scientific Domains


Selected Abstracts


Examining the Utility of In-Clinic "Rescue" Therapy for Acute Migraine

HEADACHE, Issue 6 2008
Veronica Morey RN
Background., Management options currently are limited for patients with acute migraine whose symptoms prove refractory to self-administered therapy. Objective., To evaluate the clinical utility and cost-effectiveness of a management program offering in-clinic "rescue" treatment for patients with acute migraine. Methods., Two hundred consecutive migraine patients presenting to a university-based headache clinic were randomized to receive either optimal self-administered medical therapy for acute migraine ("standard therapy") or similar therapy plus the option of in-clinic parenteral drug administration should self-administered therapy prove ineffective ("rescue therapy"). Patients randomized to the latter group were restricted to a maximum of 2 "rescue visits" per month, and all patients were followed for one year. Patients "rescued" in clinic were contacted by telephone 24 hours following treatment to evaluate their treatment response. The primary analysis involved a comparison of the number of emergency department (ED) visits for headache recorded within each group over the one-year period of study. For all ED visits in the rescue group and for a randomly selected and equal number of ED visits within the standard group, the direct costs associated with those visits were assessed, and the direct costs of all in-clinic rescue visits also were recorded and analyzed. Results., The 2 groups studied were similar in terms of age, gender ratio, migraine subtype, migraine-related disability status at baseline and type/extent of medical insurance coverage. Over the one-year study period, the rescue group recorded 423 in-clinic rescue visits and reported 27 ED visits for headache treatment. The standard therapy group reported 73 ED visits (27 vs 73 visits; P < .01). The total direct costs associated with ED visits were $45,330 for the rescue group (mean $1690 per ED visit) and (by extrapolation from the sample selected) $147,971 for the standard therapy group (mean $2027 per ED visit). The total direct cost of the 423 "rescue visits" was $33,647 (mean $80 per visit). In 79% of the 423 rescue encounters, the patients involved reported no residual functional disability 24 hours following treatment. Of those in the rescue group who sought in-clinic rescue, 89% reported themselves "very satisfied" with such management. Conclusion., Providing the alternative of in-clinic "rescue" for acute migraine refractory to self-administered therapy offers an attractive alternative for patients and appears to substantially lower use of an ED for headache treatment and the cost associated with that use. [source]


Autoimmune disease concomitance among inflammatory bowel disease patients in the United States, 2001-2002

INFLAMMATORY BOWEL DISEASES, Issue 6 2008
Russell Cohen MD
Abstract Background: Recent studies suggest that inflammatory bowel disease (IBD) may share an underlying pathogenesis with other autoimmune diseases. Methods: Two United States data sets with patient-level medical and drug claims were used to explore the occurrence of autoimmune diseases in patients with IBD, particularly Crohn's disease (CD) and ulcerative colitis (UC), with that in controls. From 2001 to 2002 IBD patients were identified using International Classification of Diseases, 9th revision, diagnosis codes in the IMS Health Integrated Administration Claims Database and the Market Scan Commercial Claims and Encounters Database. Controls were selected by matching on sex, age, Census Bureau region, and length of previous medical insurance coverage. Odds ratios (ORs) evaluated the risk relationship between IBD patients and controls within an estimated Mantel-Haenszel 95% confidence interval. Sensitivity analysis tested the case identification method used to select IBD patients. Results: The risk for ankylosing spondylitis (AS) was substantially increased across both data sets: OR (95% confidence interval [CI]) of 7.8 (5.6,10.8) in IMS Health and 5.8 (3.9,8.6) in MarketScan. The risk for rheumatoid arthritis (RA) was 2.7 (2.4,3.0) and 2.1 (1.8,2.3), respectively; for multiple sclerosis (MS); the ORs were 1.5 (1.2,1.9) and 1.6 (1.2,2.1), respectively. There was no increased risk for type 1 diabetes mellitus, and the results for psoriatic arthritis (PsA) were inconsistent. The sensitivity analysis supported these findings. Conclusions: A much higher risk for RA, AS, PsA, and MS was observed in IBD patients compared with controls. Prospective epidemiologic studies are needed to confirm these findings and explore the pathogenic mechanism of this relationship. (Inflamm Bowel Dis 2008) [source]


Self-reported use of mental health services versus administrative records: should we care?

INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 3 2002
Dr Anne E. Rhodes
Abstract Studies of mental health services have emphasized that people in need are not receiving treatment. However, these studies, based on self-reported use, may not be consistent with administrative records. This study compared self-reports of mental health service use with administrative records in a large representative sample. Respondent reports within the Ontario portion of the 1994/95 Household Component of the National Population Health Survey (NPHS) were individually linked to the provincial mental-health physician reimbursement claims. A total of 5,187 Ontarians, aged 12 years or more, reported on their use of mental healthcare within the NPHS and 4,621 (89%) consented and were successfully linked to administrative records. Comparisons between the two sources identified that the agreement for any use and volume of use was moderate to low and varied according to select respondent characteristics. These differences affected estimates of the associations with use and volume of use. People who reported high levels of distress reported more visits than those who did not and this effect was stronger in the self-reported data. These results suggest that recall bias may be present. Regardless of the definition of care, access for those in need remains a concern despite universal medical insurance coverage. Copyright © 2002 Whurr Publishers Ltd. [source]


Dental Service Utilization among Urban and Rural Older Adults in China , A Brief Communication

JOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2007
Bei Wu PhD
Abstract Objectives: China's health care system is bifurcated in nature between rural and urban areas. In addition, there is a huge gap in socioeconomic status between rural and urban residents. The purpose of the study was to examine the factors related to dental visits among elders in rural and urban areas of Shanghai, China. Methods: Using a stratified random sampling method, a cross-sectional, face-to-face survey was conducted among elders aged 60 years and above in Shanghai during 2003-04. A total of 1,044 older respondents were included in the sample. Results: There was a significant urban and rural difference in dental visit rates over the 12-month period of the study. Results from the logistic regression analysis suggested that residing in urban areas was a significant positive factor related to dental visits. In addition, being younger, being able to pay out-of-pocket medical expenses, having had regular medical checkups, having a higher number of limitations because of chronic conditions, and being more concerned about eating a healthy diet were associated with increased odds of dental visits. Conclusions: Results suggest that urban,rural differences, as reflected in the socioeconomic status gap, disparity in medical insurance coverage, and access to dental care, have a significant impact on the use of dental services by Chinese elders. Individual sociodemographic characteristics, health status, and health attitude are important explanatory variables. [source]


Insurance and quality of life in men with prostate cancer: data from the Cancer of the Prostate Strategic Urological Research Endeavor

BJU INTERNATIONAL, Issue 6 2008
Natalia Sadetsky
OBJECTIVE To evaluate the effect of medical insurance coverage on health-related quality of life (HRQoL) outcomes in men newly diagnosed with prostate cancer, as insurance status has been shown to be related to clinical presentation, and types of treatments received for localized prostate cancer, but the relationship of insurance and QoL has not been explored sufficiently. PATIENTS AND METHODS Data from the Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE), a national longitudinal database registry of men with prostate cancer, were used for this study. Men who were newly diagnosed at entry to CaPSURE and completed one questionnaire before treatment, and one or more afterwards, were included. Insurance groups specific to age distribution of the study population were assessed, i.e. Medicare, preferred provider organizations (PPOs), health maintenance organizations (HMOs), fee for service (FFS), and the Veterans Administration (VA) for the younger group, and Medicare only, Medicare plus supplement (+S), and HMO/PPO for the older group. Associations between patients' clinical and sociodemographic characteristics and insurance status were evaluated by chi-square and analysis of variance. Relationships between insurance status and HRQoL outcomes over time were evaluated by multivariate mixed model. RESULTS Of 2258 men who met the study criteria, 1259 were younger and 999 were older than 65 years. More than half of the younger patients belonged to an HMO or PPO (42.2% and 32.5%, respectively), with the remainder distributed between Medicare, FFS and VA. In the older group most men belonged to Medicare only and the Medicare +S groups (22.4% and 58.8%, respectively). There was greater variation in clinical risk categories at presentation by insurance groups in the younger group. In the multivariate analysis, insurance status was significantly associated with changes in most HRQoL outcomes over time in the younger group, while in the older patients the effect of insurance diminished. Men in the VA and Medicare systems had lower scores at baseline and a steeper decline in Physical Function, Role Physical, Role Emotional, Social Function, Bodily Pain, Vitality, and General Health domains over time, controlling for type of initial treatment received, timing of HRQoL assessment, number of comorbidities, clinical risk at presentation, and income. CONCLUSION Insurance was independently related to changes in a wide range of HRQoL outcomes in men aged <65 years treated for prostate cancer. With the latest advances in early diagnosis and treatment of prostate cancer, clinicians and researchers should be aware of the specific groups of patients who are more vulnerable to the adverse effects of treatment and subsequent decline in functioning. The present findings could provide important tools for understanding the process of recovery after treatment for prostate cancer, and identifying needs for specific services. [source]