Impact of Medicaid expansion on kidney transplantation in the State Oklahoma

BACKGROUND There is no data evaluating the impact of Medicaid expansion on kidney tran-splants(KT)in Oklahoma.AIM To investigate the impact of Medicaid expansion on KT patients in Oklahoma.METHODS The UNOS database was utilized to evaluate data pertaining to adult KT reci-pients in Oklahoma in the pre-and post-Medicaid eras.Bivariate analysis,Kaplan Meier analysis was used to estimate,and cox proportional models were utilized.RESULTS There were 2758 pre-and 141 recipients in the post-Medicaid expansion era.Post-expansion patients were more often non-United States citizens(2.3%vs 5.7%),American Indian,Alaskan,or Pacific Islander(7.8%vs 9.2%),Hispanic(7.4%vs 12.8%),or Asian(2.5%vs 8.5%)(P<0.0001).Waitlist time was shorter in the post-expansion era(410 vs 253 d)(P=0.0011).Living donor rates,pre-emptive transplants,re-do transplants,delayed graft function rates,kidney donor profile index values,panel reactive antibodies levels,and insurance types were similar.Patients with public insurance were more frail.Despite increased early(<6 months)rejection rates,1-year patient and graft survival were similar.In Cox proportional hazards model,male sex,American Indian,Alaskan or Pacific Islander race,public insurance,and frailty category were independent risk factors for death at 1 year.Medicaid expansion was not associated with graft failure or patient survival(adjusted hazard ratio:1.07;95%CI:0.26-4.41).CONCLUSION Medicaid expansion in Oklahoma is associated with increased KT access for non-White/non-Black and non-United States citizen patients with shorter wait times.1-year graft and patient survival rates were similar before and after expansion.Medicaid expansion itself was not independently associated with graft or patient survival outcomes.Ongoing research is necessary to determine the long-term effects of Medicaid expansion.

Utilization of access to colorectal cancer screening modalities in low-income populations after medicaid expansion

BACKGROUND Colorectal cancer(CRC)remains a relevant public health problem.Current research suggests that racial,economic and geographic disparities impact access.Despite the expansion of Medicaid eligibility as a key component of the Affordable Care Act(ACA),there is a dearth of information on the utilization of newly gained access to CRC screening by low-income individuals.This study investigates the impact of the ACA’s Medicaid expansion on utilization of the various CRC screening modalities by low-income participants.Our working hypothesis is that Medicaid expansion will increase access and utilization of CRC screening by low-income participants.AIM To investigate the impact of the Affordable Care Act and in particular the effect of Medicaid expansion on access and utilization of CRC screening modalities by Medicaid state expansion status across the United States.METHODS This was a quasi-experimental study design using data from the Behavioral Risk Factor Surveillance System,a large health system survey for participants across the United States and with over 2.8 million responses.The period of the study was from 2011 to 2016 which was dichotomized as pre-ACA Medicaid expansion(2011-2013)and post-ACA Medicaid expansion(2014-2016).The change in utilization of access to CRC screening strategies between the expansion periods were analyzed as the dependent variables.Secondary analyses included stratification of the access by ethnicity/race,income,and education status.RESULTS A greater increase in utilization of access to CRC screening was observed in Medicaid expansion states than in nonexpansion states[+2.9%;95%confidence interval(95%CI):2.12,3.69].Low-income participants showed a+4.02%(95%CI:2.96,5.07)change between the expansion periods compared with higher income groups+3.19%(1.70,4.67).Non-Hispanic Whites and Hispanics[+3.01%(95%CI:2.16,3.85)vs+5.51%(95%CI:2.81,8.20)]showed a statistically significant increase in utilization of access but not in Non-Hispanic Blacks,or Multiracial.There was an increase in utilization across all educational levels.This was significant among those who reported having a high school graduate degree or more+4.26%(95%CI:3.16,5.35)compared to some high school or less+1.59%(95%CI:-1.37,4.55).CONCLUSION Medicaid expansion under the Affordable Care Act led to an overall increase in self-reported use of CRC screening tests by adults aged 50-64 years in the United States.This finding was consistent across all low-income populations,but not all races or levels of education.

美国公共医保仿制药替代制度评价研究——基于Medicaid计划的实证分析

本文以Medicaid计划为研究对象,分析美国公共医疗保险仿制药替代体系运行机制,定量评估其在节省医保费用和促进仿制药产业发展方面的作用,为我国医疗保险制度改革提供借鉴。

中美公共医疗保险制度的比较研究——以美国Medicaid计划和我国新农合制度为实证研究对象

Medicaid计划系美国主流公共医疗保险项目,用以针对性补偿中低收入人群的医疗费用。自1965年推行以来,Medicaid计划的覆盖率和筹资额度保持较快增速,有效缓解了中低收入人群的就医压力。经过多年发展,Medicaid计划形成了较为成熟的筹资和补偿机制,值得我国新农合制度借鉴。

美国Medicaid公私政策合作及其启示

分析美国 Medicaid中公私政策合作在管理保健改革前后的发展演变及其特点 ,并从公私政策合作与私有化、如何走向公私政策合作、公私政策合作的作用、以及中国卫生领域改革如何借鉴 Medicaid的公私政策合作等几方面阐述Medicaid公私政策合作发展演变的启示。

美国Medicaid调剂费偿付方式经验介绍

目的:介绍美国Medicaid调剂费偿付方式。方法:通过文献调查和网页搜索获得美国Medicaid调剂费偿付方式资料并分析。结果:美国Medicaid调剂费主要偿付方式有按药品分类偿付、按药品所属机构偿付、按药品所在地域偿付、按药品剂量偿付、按药品金额偿付、按治疗时间偿付等。结论:对我国医疗保险机构药事服务费偿付方式的选择有一定的启示。

美国Medicaid项目处方药费用控制措施介绍及对我国的启示

目的:研究美国Medicaid项目处方药费用控制措施,为我国医保药品支出控制改革提供参考。方法:通过研读政策文件、学术论文和新闻报道等,梳理美国Medicaid项目的药品费用控制政策的做法和对医保费用影响,并提出对我国医保药品控费的建议。结果与结论:美国Medicaid项目处方药费用控制措施包括药品利用管理和药品控费新措施,前者包括首选药品清单、事先授权和分步治疗、处方限额,后者包括药品支出增长上限控制、封闭式药品目录管理等。首选药品清单是一系列药品控费措施的基础,为事先授权和分步治疗提供了政策框架;事先授权和分步治疗是控费的具体做法,通过对具体病例的引导鼓励低价药品的使用;处方限额从控制单一患者用药费用入手,从另一个角度节省医保支出;药品支出增长上限控制是从医保支出总费用角度进行的控费,是对传统方法的补充;封闭式药品目录管理是突破首选药品清单局限性的新的政策尝试。Medicaid项目采用的处方药控费措施一定程度上能够有效缩减其药品支出,但也因可干预医师处方权,存在损害患者利益的可能性。我国应通过加强医保在医疗服务体系中的作用,谨慎借鉴美国Mdeicaid药品利用管理措施;健全医保支出费用动态控制机制,针对重点药品采取特别措施;健全药品目录管理机制,抓好准入、退出和动态调整三个环节,引导医疗机构合理用药。

Predictors of hospitalization and institutionalization in Medicaid patient populations with Alzheimer’s Disease

Objectives: Determine predictors of hospitalization and institutionalization in Medicaid populations with Alzheimer’s Disease (AD). Methods: Data were obtained from the Centers for Medicareand Medicaid Services (CMS). Individuals enrolled in Florida,New Jersey, and New York Medicaid programs on January 1, 2004, remained in that program for 1 year and exposed to an AD medication were included. AD diagnosis was based on the ICD-9-CM code 331.0. Outcomes of interest were hospitalization and institutionalization. Multivariate logistic regression models were used to test for the association between outcomes of interest and demographics, resource utilization factors, and type of AD pharmacotherapy exposure. Results: A total of 65,442 individuals qualified for the study. Age was positively and significantly associated with hospitalization (p likely to be hospitalized than Florida residents (OR = 1.30;99% CI: 1.17 - 1.44), where as New Jersey residents were significantly less likely to be hospitalized (OR = 0.75;99% CI: 0.66 - 0.85). Finally, compared toFloridaresidents, residents of New Jerseywere significantly more likely to be institutionalized (OR = 4.61;99% CI: 3.98 - 5.33). Conclusion: Demographics, state of residence and pharmacotherapy exposure weresignificant predictors of health care service utilization. Further pharmacoeconomic studies in AD medication therapy are warranted.

A census tract-level assessment of social determinants of health,traffic exposure,and asthma exacerbations in New York State's Medicaid Population(2005–2015)

This study aims to evaluate the association between social determinants,environmental exposure metrics,and the risk of asthma emergency department(ED)visits in the New York State(NYS)Medicaid population using smallarea analysis.Traffic densities for each census tract in NYS were calculated using the length of road segments within each tract and total area of the tract to produce a measure of average number of vehicles per square meter per day.Data on social determinants of health including internal and external environments and other demographic factors were obtained from various sources.Poisson regression analyses were conducted to identify significant factors associated with asthma ED visits in Medicaid claim and encounter data for years 2005–2015.High traffic density in NYS excluding New York City(NYC)correlated with increased risk of asthma ED visits(RR 1.69;95%CI:1.42,2.00),mitigated by adjusting for environmental and social determinants(RR 1.00;95%CI:0.85,1.19).Similar trends were observed in NYC only(RR 1.19;95%CI:1.00,1.41),with the adjusted risk remaining elevated(RR 1.14;95%CI:0.98,1.33)albeit not statistically significant.Living in census tracts with high concentrated disadvantage index,high proportions of minorities,and less green space predicted higher asthma ED visits.We mapped predicted rates and model residuals to identify areas of high risk.Our results support previous findings that environmental and social risk factors in poor and urban areas contribute to asthma exacerbations in the NYS Medicaid population,even if they may not necessarily contribute to its development.

美国医疗救助计划(Medicaid)控制药物费用增长的措施

介绍了美国医疗救助计划(Medicaid)的药品福利,具体讨论了近年来美国各个州政府为控制医疗救助计划处方药费用迅速增长而采取的各项措施。这些措施对我国控制药品费用具有一定的借鉴作用。

成本-效果分析中药物成本测量的良好研究规范:Medicare和Medicaid计划以及其他美国政府支持者角度——ISPOR药物成本工作组报告之四

目的:公共项目为美国的药物支出提供了大部分的财政支持。截至目前,仍然没有相关指南来估算由美国公共项目资助的药物的成本。本研究的目的是为估算由美国公共项目支持的药物的成本提供标准,以便将其用于药物经济学评价。方法:本报告由国际药物经济学与结果研究协会(ISPOR)的专项计划——成本-效果分析中药物成本测量的良好研究规范工作组中的美国政府角度即美国医疗保险计划(Medicare)和医疗补助计划(Medicaid)以及其他美国政府支付者角度的专门小组撰写。该小组的任务是对研究者在估算由美国公共项目资助药物的成本时所遇到的方法学及实际问题进行评价,以便提出适用于更透明、更准确和更具一致性的成本计算的标准。结果:该小组提出了以下建议:(1)研究者必须考虑会对由公共项目所支付的药物成本产生影响的管理要求;(2)药物成本必须反映真实的购置成本,包括所有的回扣和折扣;(3)必须确保成本投入的相关透明度;(4)推荐包括公共项目的视角;(5)需要特别关注高成本药物,尤其当某一特殊疾病所用药物占卫生保健支出很大比例时;(6)由于公共项目之间的差异,必须对实际购置成本、实际依从性以及仿制药的可获得性进行敏感性分析。此外还对Medicare和Medicaid提出了特别建议。结论:随着对美国公共项目覆盖政策而进行的药物经济学评价越来越多,必须保证药物成本估算的准确性和一致性。以上建议的执行将允许研究者在药物经济学评价当中使用准确、无偏倚的成本估算。

美国医疗救助及启示

美国的医疗救助是一旨在提高低收入人群卫生服务可及性、保障健康公平的项目,它对救助对象的资格条件、救助范围、服务提供的方式和偿付额度都有严格的限定。为了控制医疗费用的过快增长,保障卫生服务供给的公平和效率,美国政府改进了医疗救助支付体系。我国医疗救助的开展应在注重公平的基础上提高效率,注意制度间的衔接配套,加强管理,以保障制度的有效运行。

美国儿童健康保险制度及其改革趋势

美国儿童健康保险主要包括医疗救助计划(Medicaid)和"州儿童健康保险计划(SCHIP,也称CHIP)"两大计划,前者对贫困线以下家庭儿童实行健康保险,限制比较严格;后者对收入高于贫困线的低收入家庭儿童实行健康保险,限制较为宽松,是美国儿童健康保险改革的热点。近年来,出现了Medicaid计划的覆盖范围日益压缩,而SCHIP计划覆盖范围逐渐增大的趋势。从SCHIP计划与WIC等福利计划相捆绑的成功经验看,SCHIP计划逐渐放宽对身份和收入的限制,有利于实现全国儿童广泛覆盖。美国两党很可能在SCHIP计划全国覆盖与私人保险系统上实现妥协,在新一届政府任期内通过新的儿童健康保险制度,实现儿童健康保险全国覆盖。

Barriers and facilitators to mexican-american participation in clinical trials: physician and patient focus group perspectives

Racial/ethnic minority populations are under- represented in clinical trials and Hispanic participation rates are particularly low. This study assessed barriers and facilitators to clinical trials participation by Medicaid eligible Mexican- Americans and their serving physicians. Qualitative data from two focus groups conducted among Mexican-American Medicaid eligible patients and four physician focus groups were analyzed. Mexican-American patients have a basic understanding of clinical trials. While most are open to participating in clinical research, not speaking English, time, and transportation were identified as barriers. Physicians believe that desperation and financial need are the primary patient motivators for participation. Barriers to physician recruitment and referral include: lack of information about clinical trials, concern that study participation may not be in the patient’s best interest, and lack of staffing and time to conduct trials. Ample opportunities exist to engage providers and patients in future efforts to increase Mexican-American patient recruitment into clinical trials.

沈阳市和成都市贫困医疗救助项目实施效果评价

利用家庭入户调查资料,采用比值法评价贫困医疗救助年度实施效果。相对基线调查,低保家庭与普通家庭的患病率比值下降,就诊比例比值及就诊率比值上升,住院率比值有升有降,医疗支出占总收入(或总支出)比重比下降,对社区卫生服务的利用率增加。结论:贫困医疗救助项目实施1年后,贫困人口就医的经济负担减轻,卫生服务利用率增加。

贫困人群医疗救助的若干关键问题

对医疗救助的理论进行了回顾与整理 ,探讨了对贫困人群实施医疗救助的概念与意义 ,讨论了医疗救助中的若干关键问题 ,包括 :医疗救助对象的确定、优先需要的确定、医疗救助中的社会性别问题。

沈阳市和成都市贫困医疗救助项目第一年度运行分析

主要进展和成效:部门合作在救助对象的识别注册、项目宣传与发动方面发挥了重要作用。医疗救助机构有严格的准入机制和健全的管理制度,医疗救助内容和额度符合原方案设计,救助资金的管理日臻完善。主要问题:救助服务利用率低,成都市流动人口救助工作开展得不理想,信息管理系统需要完善。建议:采取综合措施提高救助服务利用率,调整项目区医疗救助资金的总额。

贫困人口的健康服务:人口与发展的一个新领域

较系统地阐述了人口、发展及贫困的关系 ,重点阐述了我国农村地区贫困人口健康服务的状况及问题。应在社会可持续发展框架下全面审视和统筹解决贫困人口健康服务不公平的问题。在目前中国现实国情下 ,对贫困人口应实施医疗救助计划 ,改善其健康服务 ,以促进社会发展 ,实现公平。展望了贫困人口健康问题研究的前景及其与其它学科在医疗救助领域中的合作问题。

中国贫困医疗救助模式的制度缺陷及其改进思路

讨论现行国内医疗救助模式的基本经验与存在的缺陷。现行国内医疗救助模式无论在制度设计还是具体实施中都存在许多缺陷,如在制度设计方面,救助标准与水平总体上部比较低,大病病种的规定大大限制和缩小了贫困医疗救助的范围,而定点医院限制了救助对象选择的空间等。

流动人口孕产妇分娩救助探讨

目的:调查流动人口孕产妇分娩限价救助标准及效果评价,探索流动人口贫困孕产妇分娩救助方法。为政府制定措施提供依据。方法:采用回顾性病历分析研究方法,抽取北京市城乡结合部三所试点医院分娩的流动人口孕产妇的分娩资料,选择接受基本服务项目并且住院阴道分娩费用≤1000元的275例产妇为研究组,选择同期孕期检查正常、阴道分娩费用>1000元的312例产妇为对照组。对两组孕产妇分娩费用进行分析。结果:分娩数2004年比2003年平均增加80.3%。研究组总费用平均为909.15元,对照组平均为2102.56元。研究组主要费用花在必须利用的医疗服务上。对照组费用增加主要是药费、床位费、治疗费。由于实施本研究规定的正常分娩基本服务项目及收费,三家医院产科及相关科室收入减少。结论:本项目实施的分娩服务项目及费用对贫困流动人口是可行的,对她们的经济负担影响不大,是可接受的。但救助对试点医院存在显著影响,而且医疗风险增加。所以要实现现行救助方式的可持续性,政府应予以医院补贴及政策支持。