scholarly journals Trends in high deductible health plan enrolment and spending among commercially insured members with and without chronic conditions: a Natural Experiment for Translation in Diabetes (NEXT-D2) Study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e044198
Author(s):  
Laura F Garabedian ◽  
Fang Zhang ◽  
Robert LeCates ◽  
Jamie Wallace ◽  
Dennis Ross-Degnan ◽  
...  
Keyword(s):  
Health Plan ◽  
Chronic Conditions ◽  
Natural Experiment ◽  
Well Being ◽  
Descriptive Study ◽  
Total Spending ◽  
Healthcare Needs ◽  
Percentage Points ◽  
High Deductible Health Plan ◽  
Insurance Database

ObjectivesTo examine trends in high deductible health plan (HDHP) enrolment among members with diabetes and cardiovascular disease (CVD) compared with healthy members and compare out-of-pocket (OOP) and total spending for members with chronic conditions in HDHPs versus low deductible plans.DesignDescriptive study with time trends.SettingA large national commercial insurance database.Participants1.2 million members with diabetes, 4.5 million members with CVD (without diabetes) and 18 million healthy members (defined by a low comorbidity score) under the age of 65 years and insured between 2005 and 2013.Outcome measuresPercentage of members in an HDHP (ie, annual deductible ≥$1000) by year, annual mean OOP and total spending, adjusted for member sociodemographic and employer characteristics.ResultsEnrolment in HDHPs among members in all disease categories increased by 5 percentage points a year and was over 50% by 2013. On average, over the study period, HDHP enrolment among members with diabetes and CVD was 2.84 (95% CI: 2.78 to 2.90) and 2.02 (95% CI: 1.98 to 2.05) percentage points lower, respectively, than among healthy members. HDHP members with diabetes, CVD and low morbidity had higher annual OOP costs ($636 (95% CI: 630 to 642), $539 (95% CI: 537 to 542) and $113 (95% CI: 112 to 113)) and lower total costs (−$529 (95% CI: −597 to −461), −$364 (95% CI: −385 to −342) and −$79 (95% CI: −81 to −76)), respectively, than corresponding low deductible members when averaged over the study period. Members with chronic diseases had yearly OOP expenditures that were five to seven times higher than healthier members.ConclusionHigh HDHP enrolment coupled with the high OOP costs associated with HDHPs may be particularly detrimental to the financial well-being of people with diabetes and CVD, who have more healthcare needs than healthier populations.

A descriptive study of the prevalence of psychological distress and mental disorders in the Canadian population: comparison between low-income and non-low-income populations

2010 ◽  
Vol 30 (3) ◽  
pp. 148-149 ◽  
Author(s):  
J. Caron ◽  
A. Liu
Keyword(s):  
Mental Health ◽  
Substance Abuse ◽  
Psychological Distress ◽  
Mental Disorders ◽  
Low Income ◽  
Well Being ◽  
Descriptive Study ◽  
Canadian Community Health Survey ◽  
Vulnerable Groups ◽  
High Psychological Distress

Objective This descriptive study compares rates of high psychological distress and mental disorders between low-income and non-low-income populations in Canada. Methods Data were collected through the Canadian Community Health Survey – Mental Health and Well-being (CCHS 1.2), which surveyed 36 984 Canadians aged 15 or over; 17.9% (n = 6620) was classified within the low-income population using the Low Income Measure. The K-10 was used to measure psychological distress and the CIDI for assessing mental disorders. Results One out of 5 Canadians reported high psychological distress, and 1 out of 10 reported at least one of the five mental disorders surveyed or substance abuse. Women, single, separated or divorced respondents, non-immigrants and Aboriginal Canadians were more likely to report suffering from psychological distress or from mental disorders and substance abuse. Rates of reported psychological distress and of mental disorders and substance abuse were much higher in low-income populations, and these differences were statistically consistent in most of the sociodemographic strata. Conclusion This study helps determine the vulnerable groups in mental health for which prevention and promotion programs could be designed.

COVID-19 Epigenetics and Implications for Public Health

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Verda Tunalıgil ◽  
Gülsen Meral ◽  
Ahmet Katı ◽  
Dhrubajyoti Chattopadhyay ◽  
Amit Kumar Mandal
Keyword(s):  
Chronic Conditions ◽  
Empirical Investigation ◽  
Age Groups ◽  
Infectious Agent ◽  
Well Being ◽  
Epigenetic Mechanisms ◽  
Age Group ◽  
Epigenetic Changes ◽  
Patient Groups ◽  
Epigenetic Processes

Abstract:: Epigenetic changes in COVID-19 host, a pandemic-causing infectious agent that globally incapacitated communities in varying complexities and capacities are discussed, proposing an analogy that epigenetic processes contribute to disease severity and elevate the risk for death from infection. Percentages of hospitalization, with and without intensive care, in the presence of diseases with increased ACE2 expression, were compared, based on the best available data. Further analysis compared two different age groups, 19-64 and ≥65 years of age. The COVID-19 disease is observed to be the most severe in the 65-and-higher-age group with preexisting chronic conditions. This observational study is a non-experimental empirical investigation of the outcomes of COVID-19 in different patient groups. Results are promising for conducting clinical trials with intervention groups. To ultimately succeed in disease prevention, researchers and clinicians must integrate epigenetic mechanisms to generate valid prescriptions for global well-being.

Out-of-Pocket Spending Inequity Among High-Deductible Health Plan Members with Bipolar Disorder

2021 ◽  
Author(s):  
J. Frank Wharam ◽  
Jamie Wallace ◽  
Robert F. LeCates ◽  
Jeanne M. Madden ◽  
Fang Zhang ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Health Plan ◽  
High Deductible Health Plan

scholarly journals Affective Vulnerability to Short Sleep Predicts 10-Year Changes in Chronic Health Conditions

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 635-636
Author(s):  
Nancy Sin ◽  
Jonathan Rush ◽  
Orfeu Buxton ◽  
David Almeida
Keyword(s):  
Risk Factor ◽  
Sleep Duration ◽  
Chronic Conditions ◽  
Structural Equation ◽  
Structural Equation Models ◽  
Well Being ◽  
National Study ◽  
Short Sleep ◽  
Telephone Interviews ◽  
Item Checklist

Abstract We examined daily affective vulnerability to short sleep (i.e., individual differences in the extent that sleeping ≤6h predicts next-day affect) as a risk factor for developing chronic conditions 10 years later. Participants (N=1945, ages 35-85, 57% women) from the National Study of Daily Experiences reported sleep duration and affect in daily diary telephone interviews. Chronic conditions were assessed with a 39-item checklist (e.g., arthritis, hypertension, diabetes). Multilevel structural equation models revealed that individuals with heightened negative affect following short sleep had an increased number of chronic conditions after 10 years (Est.=1.20, SE=.48, p<.01). Positive affective vulnerability (i.e., greater declines in positive affect following shorter sleep vs. longer sleep) was marginally associated with 10-year chronic conditions (Est.=-.72, SE=.40, p=.07). Adding to the well-established connections between sleep duration and well-being across adulthood, these findings suggest that affective vulnerability to short sleep represents a unique risk factor for long-term health as people age.

Development, implementation and evaluation of nurse-led integrated, person-centred care with long-term conditions

2017 ◽  
Vol 25 (3) ◽  
pp. 186-195 ◽  
Author(s):  
Clare Lynette Harvey ◽  
Jonathan Sibley ◽  
Janine Palmer ◽  
Andrew Phillips ◽  
Eileen Willis ◽  
...  
Keyword(s):  
Health Services ◽  
Chronic Conditions ◽  
Well Being ◽  
Multiple Chronic Conditions ◽  
Long Term Conditions ◽  
Content Type ◽  
Care Services ◽  
Health Strategy ◽  
Global Increase

Purpose The purpose of this paper is to outline a conceptual plan for innovative, integrated care designed for people living with long-term conditions (LTCs). Design/methodology/approach The conceptual plan delivers a partnership between the health system, the person with LTCs (chronic), their family, and the community. The partnership aims to support people at home with access to effective treatment, consistent with the New Zealand Government Health Strategy. This concept of people-owned care is provided by nurses with advanced practice skills, who coordinate care across services, locations and multiple LTCs. Findings With the global increase in numbers of people with multiple chronic conditions, health services are challenged to deliver good outcomes and experience. This model aims to demonstrate the effective use of healthcare resources by supporting people living with a chronic condition, to increase their self-efficacy and resilience in accordance with personal, cultural and social circumstance. The aim is to have a model of care that is replicable and transferable across a range of health services. Social implications People living with chronic conditions can be empowered to manage their health and well-being, whilst having access to nurse-led care appropriate to individual needs. Originality/value Although there are examples of case management and nurse-led coordination, this model is novel in that it combines a liaison nursing role that works in partnership with patients, whilst ensuring that care across a number of primary and secondary care services is truly integrated and not simply interfaced.

scholarly journals Miserable Migrants? Natural Experiment Evidence on International Migration and Objective and Subjective Well-Being

2015 ◽  
Vol 65 ◽  
pp. 79-93 ◽  
Author(s):  
Steven Stillman ◽  
John Gibson ◽  
David McKenzie ◽  
Halahingano Rohorua
Keyword(s):  
International Migration ◽  
Natural Experiment ◽  
Well Being ◽  
Subjective Well Being

Colorectal Cancer Screening in a Nationwide High-deductible Health Plan Before and After the Affordable Care Act

Medical Care ◽  
2016 ◽  
Vol 54 (5) ◽  
pp. 466-473 ◽  
Author(s):  
J. Frank Wharam ◽  
Fang Zhang ◽  
Bruce E. Landon ◽  
Robert LeCates ◽  
Stephen Soumerai ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Health Plan ◽  
Affordable Care Act ◽  
Before And After ◽  
The Affordable Care Act ◽  
High Deductible Health Plan

scholarly journals Covid-19: Early evening curfews are not effective and may backfire

2021 ◽  
Author(s):  
Sotiris Vandoros ◽  
Alina Velias ◽  
Sotiris Georganas
Keyword(s):  
Natural Experiment ◽  
Relative Difference ◽  
Relative Increase ◽  
Percentage Points ◽  
Early Evening ◽  
Before And After ◽  
Clear Identification ◽  
Econometric Approach ◽  
The Impact ◽  
Indoor Spaces

Background: During the COVID-19 pandemic, some countries have introduced early evening curfews. Several studies try measure the effectiveness of such measures across different countries, but clear identification of effects is elusive. Objective: We examined the impact of an early evening curfew on mobility by studying a shift in curfews from 9pm to 6pm in Greece. Data and Methods: We took advantage of a natural experiment in Greece, where curfews shifted from 9pm to 6pm in one Region, but not in another. We followed a difference-in-difference econometric approach, where we compared trends in mobility in groceries and pharmacies as well as residential spaces before and after the introduction of the 6pm curfew, in the two regions. Results: The relative difference in the time spent in groceries and pharmacies between the two regions before and after the intervention, is statistically insignificant [coeff: -9.95; 95%CI -44.358 to 24.458]. The relative increase in time spent in groceries and pharmacies after the 6pm curfew was only 4.625 percentage points [coeff: 4.625; 95%CI 1.412 to 7.838]. Conclusions: We found that the 6pm instead of 9pm curfew in Athens led to a 4.63 percentage point relative increase in time spent at home and had no effect on time spent in groceries and pharmacies. Considering that this was a result of a 18.75% reduction in hours where people were allowed to leave home, it seems that the early evening curfew led to more crowding in indoor spaces; which may facilitate the spread of disease. Lockdowns and other measures are necessary to tackle Covid-19, but it is important to avoid substitution by activities that contribute further to spreading the virus. Interventions should therefore be based on a thorough analysis of human behaviour.

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