Gender Surgery Beyond Chest and Genitals: Current Insurance Landscape

2019 ◽  
Vol 40 (4) ◽  
pp. NP202-NP210 ◽  
Author(s):  
Ledibabari M Ngaage ◽  
Katie L McGlone ◽  
Shan Xue ◽  
Brooks J Knighton ◽  
Caroline A Benzel ◽  
...  
Keyword(s):  
Insurance Coverage ◽  
Body Contouring ◽  
International Standards ◽  
Insurance Companies ◽  
Standards Of Care ◽  
Cross Sectional ◽  
Coverage Criteria ◽  
Telephone Interviews ◽  
Facial Surgery ◽  
Wide Variability

Abstract Background Plastic surgery plays an essential role in the treatment of gender dysphoria. International standards of care currently consider genital and chest surgeries to be medically necessary. Ancillary procedures such as facial surgery, chondrolaryngoplasty, hair restoration/removal, and body contouring are considered cosmetic surgeries except in individual circumstances. Objective The authors sought to assess the frequency of coverage provision for ancillary transition-related surgeries through a cross-sectional analysis of US insurance policies. Methods The authors selected insurance companies based on state enrollment data and market share. Policies were identified through web-based search and telephone interviews. A list of eligible procedures was compiled and grouped into 5 categories: body masculinization, body feminization, facial procedures, hair restoration/removal, and chondrolaryngoplasty. Medical necessity criteria from publicly accessible policies were then abstracted. Results Sixty-one insurance companies held an established policy. One-third of these policies offered favorable coverage for at least 1 ancillary procedure. Chondrolaryngoplasty was the most covered category (26%, n = 16), whereas body masculinization was the least covered (8%, n = 5). Almost two-thirds of the companies with favorable policies listed coverage criteria. We identified 4 recurring requirements: age, hormone therapy, continuous living in a congruent gender role, and referral from a mental health professional. Conclusions There is a low prevalence of US insurance coverage for ancillary gender surgeries and wide variability in coverage criteria. Reevaluation of ancillary transition-related procedures from cosmetic to medically necessary based on clinical judgement or establishment of defined coverage criteria may augment coverage and better address the needs of transgender patients.

scholarly journals Effects of SO2 Pollution on Household Insurance Purchasing in China: A Cross-Sectional Study

2021 ◽  
Vol 9 ◽  
Author(s):  
Ren Wang ◽  
Lizhi Zhang ◽  
Ting Tang ◽  
Fei Yan ◽  
Dawei Jiang
Keyword(s):  
Air Pollution ◽  
Health Insurance ◽  
Insurance Coverage ◽  
Household Head ◽  
Positive Association ◽  
Insurance Companies ◽  
Significant Positive Association ◽  
Cross Sectional ◽  
Commercial Health Insurance ◽  
Insurance Purchasing

There have been considerable concerns regarding the effects of air pollution on health and economy over the past decades across the world. As insurance coverage has been closely related to household welfare, we aim to investigate the influence of air pollution, in particular, the sulfur dioxide (SO2) pollution on household purchases of commercial health insurance using data from the 2017 China Household Financial Survey (CHFS). The results show that the rise in SO2 emission has a significant positive association with tendency of residents to participate in commercial health insurance. The possibility of household commercial health insurance purchasing increases by 4% per 1,000 tons of SO2 emission. In addition, the proportion of commercial health insurance expenditure in household annual income increases by 29% per 1,000 tons of SO2 emission. The effects are also found to differ among resident groups. Residents in eastern parts of China are more likely to buy commercial health insurance facing SO2 pollution compared to those in western parts of China; people with higher income are more likely to be affected compared to those with lower income; families with the household head being female are more likely to be affected compared to those with the household head being male. This research provides baseline information on the formulation and implementation of future operation strategy in commercial health insurance companies of China.

PARTICIPATING IN HEALTH INSURANCE AND FACTORS AFFECTING AMONG PERSONS WHOSE ENROLMENT IS VOLUNTARY IN THUA THIEN HUE PROVINCE

2015 ◽  
pp. 89-95
Author(s):  
Thi Hoai Thuong Nguyen ◽  
Hoang Lan Nguyen ◽  
Mau Duyen Nguyen
Keyword(s):  
Health Insurance ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Health Insurance Scheme ◽  
Insurance Scheme ◽  
Cross Sectional ◽  
Factors Affecting ◽  
The People ◽  
Universal Health Insurance Coverage ◽  
The Social

Background:To provide information helps building policy that meets the practical situation and needs of the people with the aim at achieving the goal of universal health insurance coverage, we conducted this study with two objectives (1) To determine the rate of participating health insurance among persons whose enrolment is voluntary in some districts of ThuaThien Hue province; (2) To investigate factor affecting their participation in health insurance. Materials and Methodology:A cross-sectional descriptive study was conducted in three districts / towns / city of ThuaThien Hue in 2014. 480 subjects in the voluntary participation group who were randomly selected from the study settings were directly interviewed to collect information on the social, economic, health insurance participation and knowledge of health insurance. Test χ2 was used to identify factors related to the participation in health insurance of the study subjects. Results:42.5% of respondents were covered by health insurance scheme. Factors related to their participation were the resident location (p = 0.042); gender (p = 0.004), age (p <0.001), chronic disease (p <0.001), economic conditions (p<0.001) and knowledge about health insurance (p <0.001). Conclusion: The rate of participating health insurance among study subjects was low at 42,5%. There was "adverse selection" in health insurance scheme among voluntary participating persons. Providing knowledge about health insurance should be one of solutions to improve effectively these problems. Key words: Health insurance, voluntary, Thua Thien Hue

scholarly journals Reluctance to Accept Palliative Care and Recommendations for Improvement: Findings From Semi-Structured Interviews With Patients and Caregivers

2021 ◽  
pp. 104990912110126
Author(s):  
Valeria Cardenas ◽  
Anna Rahman ◽  
Yujun Zhu ◽  
Susan Enguidanos
Keyword(s):  
Palliative Care ◽  
Controlled Trial ◽  
Insurance Coverage ◽  
Healthcare Providers ◽  
Health Condition ◽  
Insurance Companies ◽  
Structured Interviews ◽  
Care Services ◽  
Home Based ◽  
Palliative Care Services

Background: Despite some insurance plans now paying for home-based palliative care, recent reports have suggested that insurance coverage for palliative care may be insufficient in expanding patient access to home-based palliative care. Aim: To identify patients’ and caregivers’ perceived barriers to home-based palliative care and their recommendations for overcoming these barriers. Design: We conducted a qualitative study using semi-structured individual interviews. Our interview protocol elicited participants’ perspectives on home-based palliative care services; positive and negative aspects of the palliative program explanation; and suggestions for improving messaging around home-based palliative care. Setting/Participants: Twenty-five participants (patients, proxies, and their caregivers) who were eligible for a randomized controlled trial of home-based palliative care were interviewed by telephone. Results: Themes related to home-based palliative care referral barriers included reluctance to have home visits, enrollment timing, lack of palliative care knowledge, misconceptions about palliative care, and patients’ self-perceived health condition. Themes related to recommendations for overcoming these obstacles included ensuring that palliative care referrals come from healthcare providers or insurance companies and presenting palliative care services more clearly. Conclusion: Findings reinforce the need for additional palliative care education among patients with serious illness (and their caregivers) and the importance of delivering palliative care information and referrals from trusted sources.

scholarly journals Women’s perceptions of factors influencing their food shopping choices and how supermarkets can support them to make healthier choices

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Preeti Dhuria ◽  
Wendy Lawrence ◽  
Sarah Crozier ◽  
Cyrus Cooper ◽  
Janis Baird ◽  
...  
Keyword(s):  
Healthy Eating ◽  
Personal Responsibility ◽  
Food Preferences ◽  
Food Choices ◽  
Cross Sectional Study ◽  
Future Research ◽  
Cross Sectional ◽  
Telephone Interviews ◽  
Food Shopping ◽  
Women’S Perceptions

Abstract Objectives To examine women’s perceptions of factors that influence their food shopping choices, particularly in relation to store layout, and their views on ways that supermarkets could support healthier choices. Design This qualitative cross-sectional study used semi-structured telephone interviews to ask participants the reasons for their choice of supermarket and factors in-store that prompted their food selections. The actions supermarkets, governments and customers could take to encourage healthier food choices were explored with women. Thematic analysis was conducted to identify key themes. Setting Six supermarkets across England. Participants Twenty women customers aged 18–45 years. Results Participants had a median age of 39.5 years (IQR: 35.1, 42.3), a median weekly grocery spend of £70 (IQR: 50, 88), and 44% had left school aged 16 years. Women reported that achieving value for money, feeling hungry, tired, or stressed, and meeting family members’ food preferences influenced their food shopping choices. The physical environment was important, including product quality and variety, plus ease of accessing the store or products in-store. Many participants described how they made unintended food selections as a result of prominent placement of unhealthy products in supermarkets, even if they adopted more conscious approaches to food shopping (i.e. written or mental lists). Participants described healthy eating as a personal responsibility, but some stated that governments and supermarkets could be more supportive. Conclusions This study highlighted that in-store environments can undermine intentions to purchase and consume healthy foods. Creating healthier supermarket environments could reduce the burden of personal responsibility for healthy eating, by making healthier choices easier. Future research could explore the interplay of personal, societal and commercial responsibility for food choices and health status.

scholarly journals Changes in Tobacco Use Patterns during COVID-19 and Their Correlates among Older Adults in Bangladesh

2021 ◽  
Vol 18 (4) ◽  
pp. 1779
Author(s):  
Sabuj Kanti Mistry ◽  
Armm Mehrab Ali ◽  
Md. Ashfikur Rahman ◽  
Uday Narayan Yadav ◽  
Bhawna Gupta ◽  
...  
Keyword(s):  
Older Adults ◽  
Tobacco Use ◽  
Rural Areas ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Policy Makers ◽  
Use Patterns ◽  
Telephone Interviews ◽  
Related Information ◽  
Structured Questionnaire

The present study explored the changes in tobacco use patterns during the COVID-19 pandemic and their correlates among older adults in Bangladesh. This cross-sectional study was conducted among 1032 older adults aged ≥60 years in Bangladesh through telephone interviews in October 2020. Participants’ characteristics and COVID-19-related information were gathered using a pretested semi-structured questionnaire. Participants were asked if they noted any change in their tobacco use patterns (smoking or smokeless tobacco) during the COVID-19 pandemic compared to pre-pandemic (6 months prior to the survey). Nearly half of the participants (45.6%) were current tobacco users, of whom 15.9% reported increased tobacco use during the COVID-19 pandemic and all others had no change in their tobacco use patterns. Tobacco use was significantly increased among the participants from rural areas, who had reduced communications during COVID-19 compared to pre-pandemic (OR = 2.76, 95%CI:1.51–5.03). Participants who were aged ≥70 years (OR = 0.33, 95% CI: 0.14–0.77), widowed (OR = 0.36, 95% CI: 0.13–1.00), had pre-existing, non-communicable, and/or chronic conditions (OR = 0.44, 95% CI: 0.25–0.78), and felt themselves at the highest risk of COVID-19 (OR = 0.31, 95% CI: 0.15–0.62), had significantly lower odds of increased tobacco use. Policy makers and practitioners need to focus on strengthening awareness and raising initiatives to avoid tobacco use during such a crisis period.

scholarly journals Pain and Hardship Among Older Men: Examining the Buffering Effect of Medicare Insurance Coverage

2018 ◽  
Vol 12 (5) ◽  
pp. 1439-1449 ◽  
Author(s):  
Gillian L. Marshall ◽  
Tamara A. Baker ◽  
Chiho Song ◽  
David B. Miller
Keyword(s):  
Insurance Coverage ◽  
Interactive Effect ◽  
Later Life ◽  
Older Men ◽  
The United States ◽  
Pain Severity ◽  
Financial Strain ◽  
Cross Sectional ◽  
Retirement Study

To better understand the health status of men in the United States, this study aimed to assess the association of hardship on the presence of and pain severity among men 50 years of age and older. Cross-sectional multivariate logistic regression analyses were conducted using the 2010 wave of the Health and Retirement Study ( N = 3,174) to assess the association between four hardship indicators and the presence of pain and pain severity among this sample of older men. Results suggest that the association between the presence of pain and hardship was statistically significant across all four indicators: ongoing financial hardship (CI [1.05, 1.63], p < .05), difficulty paying bills (CI [1.42, 3.02], p < .001), food insecurity (CI [1.46, 3.15], p < .001), and not taking medication due to cost (CI [1.06, 1.66], p < .05), even after adjusting for all demographic factors. The associations between pain severity and ongoing financial strain (CI [1.23, 2.83], p < .01) and difficulty paying bills (CI [1.02, 3.18], p < .05) were statistically significant. Results also indicate that education was a buffer at all levels. In addition, the interactive effect of hardship and Medicare insurance coverage on pain severity was significant only for ongoing financial strain (CI [1.74, 14.33], p > .001) and difficulty paying bills (CI [1.26, 7.05], p < .05). The evidence is clear that each hardship indicators is associated with the presence of pain and across some of the indicators in pain severity among men aged 50 and older. In addition, these findings stress the importance that Medicare insurance plays in acting as a buffer to alleviate some of the hardships experienced by older men. These findings also highlight the association between the presence of pain and pain severity for the overall quality of life, health outcomes, and financial position of men in later life.

What services are available for the treatment of transsexuals in Great Britain?

2002 ◽  
Vol 26 (6) ◽  
pp. 210-212 ◽  
Author(s):  
S. Murjan ◽  
M. Shepherd ◽  
B. G. Ferguson
Keyword(s):  
Great Britain ◽  
Local Level ◽  
International Standards ◽  
Standards Of Care ◽  
High Court ◽  
Health Authorities ◽  
Legal Situation ◽  
Specialist Services ◽  
Assessment And Treatment ◽  
The Right

AIMS AND METHODWe conducted a questionnaire survey of all 120 health authorities and boards responsible for the commissioning of services for the assessment and treatment of transsexual people in England, Scotland and Wales, in order to identify the nature of the input offered and assess conformity to current international standards of care.RESULTSEighty-two per cent of the commissioning authorities responded and confirmed that most health authorities/boards provide a full service for the treatment of transsexuals, although this would be delivered at a local level in only 20% of cases. However, 11 commissioning authorities gave confused and inaccurate responses and three other health authorities appear to hold views on the commissioning of these specialist services that are not in keeping with the current legal situation and a recent High Court ruling, which establishes the right of transsexual people to NHS assessment and treatment.CLINICAL IMPLICATIONSThere are discrepancies in prioritisation and provision of clinical services for this group that are not standard across Great Britain.

scholarly journals Monitoring of dietary changes by telephone interviews: results from Denmark

2001 ◽  
Vol 4 (6) ◽  
pp. 1287-1295 ◽  
Author(s):  
Jóhanna Haraldsdóttir ◽  
Lotte Holm ◽  
Arne Vernon Astrup ◽  
Jytte Halkjær ◽  
Steen Stender
Keyword(s):  
Food Habits ◽  
Dietary Guidelines ◽  
Computer Assisted ◽  
Cross Sectional ◽  
Use Patterns ◽  
Telephone Interviews ◽  
Frequent Monitoring ◽  
Whole Milk ◽  
Consumption Frequency ◽  
Drinking Milk

AbstractObjectives:To monitor trends in Danish food habits with respect to selected key elements, from 1995 to 1998, and to evaluate the appropriateness of the method developed for that purpose.Design and method:Two cross-sectional population surveys, in 1995 and 1998. Data collection by computer-assisted telephone interviews including 10 food-frequency questions, questions on type of fat used on sandwiches and drinking milk, and check questions on the previous day. Reproducibility was tested in a subgroup (n=222) in the 1998 survey.Setting:The Danish Nutrition Council initiated the survey.Subjects:Men and women aged 15–90 years, 1007 in 1995 and 1024 in 1998. Samples of private telephone numbers were drawn from regional telephone registers, geographically stratified. Participation rates were 62%.Results:Significant differences were observed between 1995 and 1998, some of these in accordance with dietary guidelines (decreased use of whole milk and fat spread on bread, increased use of skimmed milk, salad vegetables, rice/pasta and fish). Other changes were opposite to dietary guidelines (increased use of soft butter, decreased use of soft margarine and low-fat spreads, potatoes, and fresh fruit). Differences in average consumption frequency amounted to 4–13%. Several results were confirmed by comparison with other data, and the reproducibility of the method was acceptable. Data were suitable for analysis of food use patterns, a relevant approach when assessing food habits in a lifestyle context.Conclusions:The changes observed illustrate the dynamics of food habits and the need for frequent monitoring. This simple telephone method may be a valuable tool for that purpose, as a supplement to national dietary surveys, also in a public health context.

scholarly journals Cortisol, DHEAS, their ratio and the metabolic syndrome: evidence from the Vietnam Experience Study

2010 ◽  
Vol 162 (5) ◽  
pp. 919-923 ◽  
Author(s):  
Anna C Phillips ◽  
Douglas Carroll ◽  
Catharine R Gale ◽  
Janet M Lord ◽  
Wiebke Arlt ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Military Service ◽  
Fasting Blood Glucose ◽  
Density Lipoprotein ◽  
Cross Sectional ◽  
Us Army ◽  
Telephone Interviews ◽  
The Metabolic Syndrome ◽  
Increased Risk ◽  
Vietnam Era

ObjectivesThe aim of these analyses was to examine the association of cortisol, DHEAS and the cortisol:DHEAS ratio with the metabolic syndrome (MetS) and its components.DesignThe analyses were cross-sectional.MethodsParticipants were 4255 Vietnam era US army veterans. From military service files, telephone interviews and a medical examination, occupational, socio-demographic and health data were collected. MetS was ascertained from data on body mass index; fasting blood glucose or a diagnosis of diabetes; blood pressure or a diagnosis of hypertension; high-density lipoprotein cholesterol; and triglyceride levels. Contemporary morning fasted cortisol and DHEAS concentrations were determined. The outcomes were MetS and its components. Analysis was by logistic regression, first adjusting for age and then additionally for an array of candidate confounders.ResultsCortisol, although not in the fully adjusted analysis, and DHEAS were both related to MetS. Whereas high cortisol concentrations were associated with an increased risk of MetS, high DHEAS concentrations appeared protective. By far, the strongest associations with MetS were observed for the cortisol:DHEAS ratio; the higher the ratio, the greater the risk of having MetS. The ratio was also significantly related to four of the five MetS components.ConclusionsThe cortisol:DHEAS ratio is positively associated with MetS. Prospective analyses are needed to help untangle direction of causality, but this study suggests that the cortisol:DHEAS ratio is worthy of further study in this and other health contexts.

The Role of Law in Health Services Delivery: Diabetes and State-Mandated Benefits

2003 ◽  
Vol 31 (S4) ◽  
pp. 51-51 ◽  
Author(s):  
DeKeely Hartsfield ◽  
Frank Vinicor
Keyword(s):  
Systemic Disease ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
Lifestyle Changes ◽  
Standards Of Care ◽  
State Laws ◽  
Glucose Levels ◽  
Services Delivery ◽  
Mandated Benefits ◽  
Control And Prevention

Diabetes is a chronic and systemic disease that has reached epidemic proportions. An estimated 17 million Americans have diabetes (5.9 million of which are undiagnosed), and an additional 16 million individuals are considered to have pre-diabetes. Studies have shown that timely screening and referral are necessary to maintain healthy blood glucose levels and slow the progression of diabetes-related complications. Furthermore, lifestyle changes (i.e., altered diet and physical activity) can prevent or delay the onset of Type 2 diabetes for high-risk individuals.The Division of Diabetes Translation at the Centers for Disease Control and Prevention undertook an analysis of diabetes-related legislation across the nation. More specifically, state laws, rules and regulations mandating health insurance coverage for diabetes-related supplies and services were examined according to Sample Purchasing Specifications for Services Related to Diabetes—an evidence-based model of standards of care for persons with diabetes.

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