The Prevalence of Immune Thrombocytopenic Purpura (ITP).

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1277-1277 ◽  
Author(s):  
Deirdra Terrell ◽  
Laura A Beebe ◽  
James George ◽  
Barbara R Neas ◽  
Sara K. Vesely ◽  
...  
Keyword(s):  
Primary Care Physicians ◽  
Private Insurance ◽  
The United States ◽  
Geographic Region ◽  
The State ◽  
Prevalence Estimate ◽  
Insurance Status ◽  
Chronic Itp ◽  
Prevalence Estimates ◽  
One Year

Abstract Introduction : Knowing the prevalence of ITP is important to determine the burden of this rare disease. Multiple new thrombopoietin agonists are being developed for the treatment of ITP, despite the paucity of reliable and generalizable estimates of ITP prevalence. Only two studies have previously reported the prevalence of ITP in the United States (US) (the only other prevalence estimate focused on children with chronic ITP in the United Kingdom). Segal et al (J Thromb Haemost2006; 4:2377–2383) report a one-year age adjusted prevalence of 9.5 per 100,000 persons aged 1–64 years; Feudjo-Tepie et al (J Thromb Haemost2008; 6:711–712) report a one-year prevalence of adult chronic ITP of 23.6 per 100,000 adults 318 years of age. Both studies based their estimates on private insurance claims data. The goal of this study was to determine the prevalence of ITP in all patients in the State of Oklahoma, regardless of insurance status and age. Methods : Similar to the previous 2 studies, the ICD-9-CM code of 287.3 was used to identify ITP. Unlike the previous 2 studies, we obtained data directly and entirely from hematologists. In November 2007, there were 93 hematologists in Oklahoma who cared for ITP patients. Our preliminary data documented that hematologists saw 3 92% of all patients with ITP and that primary care physicians in Oklahoma reported they were ‘likely’ to refer 85% of patients with platelet counts <30,000/μL and bleeding symptoms to a hematologist. All hematologists were asked to provide information on all (new and existing) ITP patients seen from 01/01/2003–12/31/2004. Ninety-five percent (88/93) of the hematologists in the state were able to provide these data. One-year prevalence estimates were used to generate an annual average prevalence. Prevalence estimates were calculated separately for children (age <16 years), adults (age > 16 years), and the overall population. The denominator was the Oklahoma population (US Census 2000). Results : The 2003 prevalence estimates were: 8.8 per 100,000 children, 11.6 per 100,000 adults, and 11.0 overall per 100,000 persons. The 2004 prevalence estimates were: 7.4 per 100,000 children, 12.6 per 100,000 adults, and 11.4 overall per 100,000 persons. The average annual prevalence estimates were: 8.1 per 100,000 children (95% CI 6.7, 9.5), 12.1 per 100,000 adults (95%CI 11.1, 13.0), and overall 11.2 per 100,000 persons (95% CI 10.4, 12.0). The children were 51% female, 49% male, and the average age was six years. Adults were 57% female, 43% male, and the average age was 55 years. Conclusion : This is the first population based study to determine the prevalence of ITP for an entire defined geographic region, regardless of insurance status and age. These results represent the most generalizable estimates of prevalence currently available on which to determine the burden of ITP. Results from this study should be generalizable because the demographics of Oklahoma closely resemble the demographics of the US. Additionally, these results confirm and extend the previously published prevalence estimate of Segal et al, 2006. This information is important not only for pharmaceutical companies, regulatory agencies, and heath care authorities, but also for patients with ITP.

Abstract 3023: The Association of Insurance Status, Quality of Care, and In-Hospital Outcomes among Patients Hospitalized with Intracerebral Hemorrhage: Findings from GWTG-Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Michael L James ◽  
Julian P Yand ◽  
Maria Grau-Sepulveda ◽  
DaiWai M Olson ◽  
Deepak L Bhatt ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Length Of Stay ◽  
Intracerebral Hemorrhage ◽  
Reference Group ◽  
Private Insurance ◽  
Quality Measures ◽  
Geographic Region ◽  
Insurance Status ◽  
Hospital Outcomes

Introduction Intracerebral hemorrhage (ICH) can be a devastating condition, requiring intensive intervention. Yet, few studies have examined whether patient insurance status is associated with ICH care or acute outcomes. Methods Using data from 1,711 sites participating in GWTG-Stroke database from April 2003 to April 2011, we identified 156,848 non-transferred subjects with ICH who had known discharge status. Insurance status was categorized as private, Medicaid, Medicare or none. We explored associations between lack of insurance (using private insurance status as the reference group) and in-hospital outcomes (mortality, ambulatory status, & length of stay) and quality of care measures (DVT prophylaxis, smoking cessation, dysphagia screening, stroke education, imaging times, & rehabilitation). We utilized multiple individual (including demographics and medical history) and hospital (including size, geographic region and academic teaching status)lcharacteristics as covariates. Results Subjects without insurance (n=10647) were younger (54.4 v. 71 years), more likely men (60.6 v. 50.8%), more likely black (33.2 v. 17.4%) or Hispanic (15.8 v. 7.9%), from the South (50.6 v. 38.9%), and had fewer vascular risk factors with the exception of smoking when compared with the overall subject population. Further, subjects without insurance were more likely to experience in-hospital mortality (25.9 v. 23.9%; adjusted OR 1.29) and longer length of stay (11.4 v. 7.8 days), but were more likely to receive all quality measures of care, be discharged home (52.1 v. 36.1%), and ambulate independently (47.5 v. 38.5%) at discharge compared with subjects with private insurance (n=40033). Conclusions Among GWTG-Stroke participating hospitals, ICH patients without insurance were more likely to die while in the hospital but experienced higher quality measures of care and were more likely to ambulate independently at discharge should they survive.

Abstract 284: Length Of Stay In Index Hospitalization Of Decompensated Heart Failure With Preserved Ejection Fraction As A Factor For 30-day Readmission And 1-year Mortality

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Sunil Saith ◽  
Ciril Khorolsky ◽  
Anuragh Trikha ◽  
Tamta Chkhikvadze ◽  
Jung-eun Ha ◽  
...  
Keyword(s):  
Heart Failure ◽  
Length Of Stay ◽  
Ejection Fraction ◽  
Primary Care Physicians ◽  
The United States ◽  
P Value ◽  
Preserved Ejection Fraction ◽  
Index Hospitalization ◽  
One Year

Introduction: Heart Failure is one of the leading causes of readmission in the United States. Heart Failure with preserved Ejection Fraction (HFpEF) accounts for a growing proportion of heart failure hospitalizations and accounts for approximately half of hospitalizations today. Unlike Heart Failure with reduced Ejection Fraction (HFrEF), there are no consensus-driven guidelines for the management of HFpEF. Methods: We collected demographic data, co-morbidities, laboratory and echocardiographic data on patients hospitalized with HFpEF throughout our health care system between August 2016 to August 2017. We assessed length of stay (LOS), whether the patient was re-admitted for any cause within 30 days and whether the patient died within 1 year of index hospitalization. We performed a Wilcoxon rank-sum test comparing patients who were both readmitted within 30 days for any reason and died within 1 year, against patients who were readmitted but were verified alive at one-year follow-up. Results: There were 366 patients hospitalized for HFpEF during the study period. Overall 30-day readmission rate was 24.3%, with a one-year mortality of 19.9%. One-year outcomes was verifiable for 359 patients. There were 27 patients who were readmitted within 30 days and died within one year of follow-up. Median LOS was significantly greater in patients during index hospitalization who died within 1 year of follow-up (Median LOS: 8 days, IQR 5-10 days), compared to patients who were readmitted within 30 days, but were alive at 1-year follow-up (Median LOS: 5 days, IQR: 3-8 days; p-value = 0.001). Conclusions: Among patients who were re-hospitalized within 30 days of an index hospitalization for HFpEF, LOS was significantly greater than patients who died within one year, compared to patients who remained alive at one-year follow-up. This may help identify a high-risk subset on index hospitalization and assist care transition teams and primary care physicians at follow-up in regarding discussions on goals of care and life sustaining treatments.

Physician Prescribing Patterns of Innovative Antidepressants in the United States: The Case of MDD Patients 1993–2007

2011 ◽  
Vol 42 (4) ◽  
pp. 353-368 ◽  
Author(s):  
Hsien-Chang Lin ◽  
Steven R. Erickson ◽  
Rajesh Balkrishnan
Keyword(s):  
Logistic Regression ◽  
Multinomial Logistic Regression ◽  
Private Insurance ◽  
Selection Procedure ◽  
The United States ◽  
Prescribing Patterns ◽  
Insurance Status ◽  
Cross Sectional ◽  
Physician Practices ◽  
Sociological Factors

Objective: Innovative antidepressants such as SSRIs and SNRIs have been widely adopted. However, the differences in their adoption across patients' and physicians' characteristics, geographic regions, and insurance status need to be further explored. This study was trying to disentangle the patterns of physician antidepressant prescribing and medication choice for major depressive disorder treatment. Method: A retrospective cross-sectional study was conducted using the 1993–2007 National Ambulatory Medical Care Survey database. A multinomial logistic regression with the Heckman two-step selection procedure was applied to capture the two-step nature of physician prescription decision making. Results: The weighted logistic regression indicated that patients' race/ethnicity and primary source of payment for services, physician ownership status, and physicians' practice regions were associated with differential likelihood of physician' antidepressant prescribing. Non-Hispanic white patients were more likely to be prescribed antidepressants compared to Hispanic patients (OR=1.52, 95% CI 1.24–1.87). Physicians' choice on antidepressant varied across with patient age and health insurance status. Compared to private insurance, patients who were primarily covered by Medicare were less likely to be prescribed only SSRIs/SNRIs or other newer antidepressants (RRRs=0.42 and 0.39; 95% CIs 0.21–0.83 and 0.18–0.84, respectively). Conclusions: We observed strong associations between sociological factors and physicians' antidepressant prescribing patterns. Possible health disparities and gaps between optimal and suboptimal healthcare for patient mental health caused by systematic differences in sociological factors need to be mitigated. We need policy makers to design effective policy interventions to improve physician practice guidelines adherence to eliminate possible variations among physician practices.

scholarly journals Insurance Status Impacts Survival in Burkitt Lymphoma

Blood ◽  
2017 ◽  
Vol 130 (Suppl_1) ◽  
pp. 916-916
Author(s):  
Jordan S. Goldstein ◽  
Jeffrey M. Switchenko ◽  
Madhusmita Behera ◽  
Christopher Flowers ◽  
Jean L. Koff
Keyword(s):  
United States ◽  
Research Funding ◽  
Private Insurance ◽  
The United States ◽  
Insurance Status ◽  
Proportional Hazard ◽  
Comorbidity Score ◽  
Cox Proportional Hazard ◽  
Cox Proportional Hazard Models ◽  
Insured Patients

Abstract Introduction: Burkitt lymphoma (BL) is an aggressive non-Hodgkin lymphoma with an estimated 1480 new cases diagnosed in the United States in 2016. BL is simultaneously one of the most aggressive lymphomas, with a tumor volume doubling time of just 24 hours, and one of the most curable, with several clinical trials showing 3-year survival rates over 80%. However, recent studies have identified a significant discrepancy between clinical trial and "real-world" survival, implying access to care may play an important role in BL outcomes. A patient's insurance status represents a major factor in the utilization of cancer therapies and outcomes in the United States. Underinsured patients are more likely to be diagnosed at an advanced stage, receive substandard therapy, and have worse outcomes. We examined the effect of insurance status on survival in adults with BL and compared the impact of insurance status on BL outcomes to that seen in plasmablastic lymphoma (PBL), an aggressive lymphoma that has poor outcomes regardless of treatment. Methods: We used data from the National Cancer Database (NCDB), a nationwide, hospital-based cancer registry jointly sponsored by the American Cancer Society and American College of Surgeons that contains 34 million historical records and captures 75% of newly diagnosed cancer cases in the United States. Commission on Cancer (CoC)-accredited facilities report patients' vital status and date of death to the NCDB annually. We included patients > 18 years old diagnosed 2004-2014 with BL or PBL as the primary tumor who received all or part of initial course of treatment at the reporting facility. Patients missing information on insurance status or survival were excluded, as were those who had non-Medicare/Medicaid government insurance (VA, Indian Health Services). Chi-square tests were used to compare sociodemographic and clinical characteristics by insurance status. All analyses were performed for both BL and PBL and stratified on age 65, due to changes in eligibility for Medicare at that age. Kaplan-Meier survival curves were stratified by insurance status, and log-rank tests were performed. Univariate Cox proportional hazard models were generated to describe the unadjusted associations for the covariables, and multivariable Cox proportional hazard models were generated to estimate the hazard ratio (HR) associated with insurance status when adjusted for prognostic factors. Results: We identified 7,073 BL patients and 475 PBL patients in the NCDB who met inclusion criteria. Of the 5235 BL patients < 65 years, 65.0% had private insurance, 17.2% had Medicaid, 7.6% had Medicare, and 10.2% had no insurance. Of the 1838 BL patients ≥ 65 years, 12.9% had private insurance, 1.5% had Medicaid, 85% had Medicare, and 0.65% had no insurance. Uninsured and Medicaid-insured patients were more likely to be Hispanic or black, have lower socioeconomic status (SES), have B symptoms, be HIV-positive, and have a Charlson-Deyo comorbidity score ≥ 2 when compared with privately insured patients. Medicare patients were more likely to be female, have ≥1 comorbidity, and not receive chemotherapy treatment when compared to privately insured patients. BL patients without private insurance had significantly worse overall survival compared to those with private insurance, regardless of age group (adjusted HR age <65: uninsured 1.41 [95% confidence interval 1.2,1.7], Medicaid 1.17 [1,1.4], Medicare 1.5 [1.2,1.8]; adjusted HR age ≥ 65: uninsured 6 [2.1,17.3], Medicare 1.33 [1,1.8]; see Figure). Conversely, Cox regression models demonstrated that PBL patients without private insurance experienced no significant differences in overall survival in either age group. For BL patients age <65, low SES, presence of B symptoms, advanced stage, HIV-positive status, comorbidity score ≥ 2, and lack of treatment were significant, independent predictors of worse outcomes and contributed to the disparities in survival by insurance status. For BL age > 65, B symptoms, comorbidity score ≥ 2, and lack of treatment were significant, independent predictors of worse outcomes. Conclusion: We identified insurance status as an important predictor of clinical outcomes for BL. Our findings suggest that expanding access to care may improve survival disparities in BL, for which curative therapy exists, but not PBL, where more effective therapies are needed to improve outcomes. Disclosures Flowers: Celgene: Consultancy, Research Funding; Bayer: Consultancy; V Foundation: Research Funding; Research to Practice: Research Funding; Infinity: Research Funding; Acerta: Research Funding; National Institutes Of Health: Research Funding; Clinical Care Options: Research Funding; Educational Concepts: Research Funding; Abbvie: Consultancy, Research Funding; Pharmacyclics LLC, an AbbVie Company: Research Funding; OptumRx: Consultancy; Spectrum: Consultancy; Genentech/Roche: Consultancy, Research Funding; National Cancer Institute: Research Funding; Eastern Cooperative Oncology Group: Research Funding; Onyx: Research Funding; Burroughs Welcome Fund: Research Funding; TG Therapeutics: Research Funding; Prime Oncology: Research Funding; Millennium/Takeda: Research Funding; Janssen Pharmaceutical: Research Funding; Seattle Genetics: Consultancy; Gilead: Consultancy.

The impact of ethnicity and insurance status on stage of cancer at diagnosis and overall survival of breast cancer.

2011 ◽  
Vol 29 (27_suppl) ◽  
pp. 154-154
Author(s):  
M. Omaira ◽  
M. Mozayen ◽  
R. Mushtaq ◽  
K. Katato
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
African Americans ◽  
Private Insurance ◽  
Ethnic Disparities ◽  
The United States ◽  
Insurance Status ◽  
Advanced Stage ◽  
Stage At Diagnosis ◽  
The Impact

154 Background: Major advances in early diagnosis and treatment of breast cancer (BC) have been achieved with significant declines in mortality. However, not all segments of the United States population have experienced equal benefits from this progress. Though ethnic disparities in BC outcome have been attributed to lack of adequate health insurance, the differences in outcome when insurance and socioeconomic status are similar still exist. We elected to examine the effect of insurance status at diagnosis, and whether race is an independent risk of poor outcome in a population from a community-based cancer database. Methods: A retrospective study on BC among patients aged 18 to 64 years were identified, between 1993 and 2005, using data from the Tumor Registry at Hurley Medical Center in Flint, Michigan. Patient’s characteristics included age, race, stage at diagnosis, and primary payer. Insurance status was classified as uninsured/Medicaid, private insurance, and Medicare disability (Medicare under age 65). The 5-year overall survival (OS) was calculated, in respect to patient ethnicity, and compared between the three insurance groups using Fisher’s exact test. Results: A total of 779 patients have been identified with diagnosis of BC. 147 patients were excluded due to incomplete data. 632 patients were analyzed. African Americans were 228 (36%), Caucasians 391 (62%), and other ethnicities 13 (2%). Mean age at diagnosis was (49.21) for African Americans versus (51.35) for Caucasians (p = 0.002). African Americans were more likely to present at advanced stage (III, IV) than Caucasians (17% versus 10%, p = 0.017). However, this difference was not statistically significant when adjusting for insurance status. Although both ethnicities had similar OS in respect of their insurance group, patients with Medicaid/uninsured had significantly lower OS compared to patients with Medicare disability (p = 0.006) and private insurance (p < 0.0001) respectively. Conclusions: Uninsured/Medicaid patients with breast cancer have worse outcome when compared to patients with Medicare or private insurance. Ethnicity is not an independent risk factor of advanced stage at diagnosis and poorer outcome.

Impact of insurance status on survival in neuroendocrine tumors: A multi-institutional Study from the U.S. Neuroendocrine Study Group.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 371-371
Author(s):  
Paula Marincola Smith ◽  
Alexandra G Lopez-Aguiar ◽  
Mary Dillhoff ◽  
Eliza W Beal ◽  
George A. Poultsides ◽  
...  
Keyword(s):  
Overall Survival ◽  
Surgical Resection ◽  
Neuroendocrine Tumors ◽  
Private Insurance ◽  
The United States ◽  
Study Group ◽  
Insurance Status ◽  
Insured Patients ◽  
The Impact ◽  
The U.S

371 Background: Insurance status predicts access to medical care in the United States. Previous studies show uninsured and government insured patients have worse outcomes than those with private insurance. However, the impact of insurance status on survival in patients with Gastrointestinal Neuroendocrine Tumors (GI-NETs) is unclear. We evaluate the association between insurance status and survival in patients with GI-NETs. Methods: Our analysis includes 2022 patients who had surgical resection of GI-NETs at 8 institutions in the U.S. Neuroendocrine Study Group. Patients were categorized based on insurance as private (PI), government (GovI) or uninsured (UI). Factors associated with insurance status were assessed by uni- and multi-variate analysis. Primary endpoint was overall survival. Results: Patient demographics between the insurance categories were similar in ECOG performance status and tumor size at presentation. GovI patients had a higher median age than PI or UI (66 vs. 54 vs. 56 years respectively; p<0.01). Uninsured patients were more likely African American (21.5%) or Latino (5%) compared to PI (11.5%, 2%) or GovI (15%, 2%) (p<0.01). The UI group had a higher proportion of patients who underwent no surveillance imaging post-operatively (39%) compared to PI (26%) and GovI patients (26%) but this was not statistically significant (p=0.15). There was no difference in operative intent (curative vs. palliative) between groups (p=0.2). Five-year overall survival was 86% for PI, 82% for GovI, and 73% for UI patients (p<0.01). On multivariate regression analysis, being uninsured was independently associated with reduced survival when controlling for ASA Class, ECOG, race, tumor location, neoadjuvant and adjuvant chemotherapy, Somatostatin analog, or radiation therapy (HR 1.39, p = 0.012). Conclusions: This is the first systematic analysis of insurance status’s association with overall survival in GI-NET patients. Our analysis shows uninsured or government insured patients have shortened survival compared to the privately insured. The disparity is likely underrepresented in this study, as we examined only patients who underwent surgical resection.

scholarly journals Mortality of Dandy-Walker syndrome in the United States: Analysis by race, gender, and insurance status

2015 ◽  
Vol 6 (02) ◽  
pp. 182-185 ◽  
Author(s):  
Shearwood McClelland ◽  
Onyinyechi I. Ukwuoma ◽  
Scott Lunos ◽  
Kolawole S. Okuyemi
Keyword(s):  
African American ◽  
Hospital Volume ◽  
Private Insurance ◽  
The United States ◽  
Insurance Status ◽  
Discharge Disposition ◽  
Csf Drainage ◽  
Operative Care ◽  
Admission Type ◽  
African American Race

ABSTRACT Background: Dandy-Walker syndrome (DWS) is a congenital disorder often diagnosed in early childhood. Typically manifesting with signs/symptoms of increased intracranial pressure, DWS is catastrophic unless timely neurosurgical care can be administered via cerebrospinal fluid (CSF) drainage. The rates of mortality, adverse discharge disposition (ADD), and CSF drainage in DWS may not be uniform regardless of race, gender or insurance status; such differences could reflect disparities in access to neurosurgical care. This study examines these issues on a nationwide level. Materials and Methods: The Kids’ Inpatient Database spanning 1997-2003 was used for analysis. Only patients admitted for DWS (ICD-9-CM = 742.3) were included. Multivariate analysis was adjusted for several variables, including patient age, race, sex, admission type, primary payer, income, and hospital volume. Results: More than 14,000 DWS patients were included. Increasing age predicted reduced mortality (OR = 0.87; P < 0.05), ADD (OR = 0.96; P < 0.05), and decreased likelihood of receiving CSF drainage (OR = 0.86; P < 0.0001). Elective admission type predicted reduced mortality (OR = 0.29; P = 0.0008), ADD (OR = 0.68; P < 0.05), and increased CSF drainage (OR = 2.02; P < 0.0001). African-American race (OR = 1.20; P < 0.05) and private insurance (OR = 1.18; P < 0.05) each predicted increased likelihood of receiving CSF drainage, but were not predictors of mortality or ADD. Gender, income, and hospital volume were not significant predictors of DWS outcome. Conclusion: Increasing age and elective admissions each decrease mortality and ADD associated with DWS. African-American race and private insurance status increase access to CSF drainage. These findings contradict previous literature citing African-American race as a risk factor for mortality in DWS, and emphasize the role of private insurance in obtaining access to potentially lifesaving operative care.

scholarly journals Medicaid Health Insurance Status Limits Patient Accessibility to Rehabilitation Services Following ACL Reconstruction Surgery

2018 ◽  
Vol 6 (4) ◽  
pp. 232596711876335 ◽  
Author(s):  
Miranda J. Rogers ◽  
Ian Penvose ◽  
Emily J. Curry ◽  
Anthony DeGiacomo ◽  
Xinning Li
Keyword(s):  
Health Insurance ◽  
Acl Reconstruction ◽  
Metropolitan Area ◽  
Private Insurance ◽  
The United States ◽  
The State ◽  
Median Income ◽  
Insurance Type ◽  
Insured Patients ◽  
Privately Insured

Background: In the senior author’s (X.L.) orthopaedic sports medicine clinic in the United States (US), patients appear to have difficulty finding physical therapy (PT) practices that accept Medicaid insurance for postoperative rehabilitation. Purpose: To determine access to PT services for privately insured patients versus those with Medicaid who underwent anterior cruciate ligament (ACL) reconstruction in the largest metropolitan area in the state of Massachusetts, which underwent Medicaid expansion as part of the Affordable Care Act. Study Design: Cross-sectional study. Methods: Locations offering PT services were identified through Google, Yelp, and Yellow Pages internet searches. Each practice was contacted and queried about health insurance type accepted (Medicaid [public] vs Blue Cross Blue Shield [private]) for postoperative ACL reconstruction rehabilitation. Additional data collection points included time to first appointment, reason for not accepting insurance, and ability to refer to a location accepting insurance type. Median income and percentage of households living in poverty were also noted through US Census data for the town in which the practice was located. Results: Of the 157 PT locations identified, contact was made with 139 to achieve a response rate of 88.5%. Overall, 96.4% of practices took private insurance, while 51.8% accepted Medicaid. Among those locations that did not accept Medicaid, only 29% were able to refer to a clinic that would accept it. “No contract” was the most common reason why Medicaid was not accepted (39.4%). Average time to first appointment was 5.8 days for privately insured patients versus 8.4 days for Medicaid patients ( P = .0001). There was no significant difference between clinic location (town median income or poverty level) and insurance type accepted. Conclusion: The study results reveal that 43% fewer PT clinics accept Medicaid as compared with private insurance for postoperative ACL reconstruction rehabilitation in a large metropolitan area. Furthermore, Medicaid patients must wait significantly longer for an initial appointment. Access to PT care is still limited despite the expansion of Medicaid insurance coverage to all patients in the state.

scholarly journals Functioning of the pension system of Ukraine, United Kingdom and the USA: comparative and legal characteristics

2020 ◽  
pp. 141-147
Author(s):  
V.V. Mirgorod-Karpova ◽  
K.R. Koroshchenko
Keyword(s):  
United Kingdom ◽  
Pension System ◽  
Private Insurance ◽  
The United States ◽  
The State ◽  
Insurance Companies ◽  
Complete Analysis ◽  
Retirement Pension ◽  
Economic Problems ◽  
The Government

The article deals with the problem of the pension system of Ukraine. And also a complete analysis of the pension system that exists in Ukraine, the US and the UK. The possibility of a pension for any country in the world is an opportunity for the full exercise of power by their authorities, as well as the achievement of the goal of the state - full social security for its citizens. In Ukraine, the existence of a solidarity system alone raises a number of problems. One of them is a working population less than people in need of a pension. That is, citizens have earned, but do not receive it in full, because there is a principle of a solidarity system of “heredity of generations”. World experience has shown that the most reliable retirement benefit is the one I have taken care of. Citizens in countries where there are fewer economic problems than in Ukraine have the opportunity to accumulate their retirement pension separately and use it when they reach retirement age. There are various private insurance companies where a person can deduct a portion from their salary. It is up to the individual to decide what part of the pension to accumulate in retirement. Such prudent citizens most often have two state pensions and from such private funds, the quality of life is certainly rising. The purpose of the Ukrainian pension system is to provide Ukrainians with pensions in full, and also to solve economic problems that will allow them to accumulate their old age in addition. The government is trying to make changes to change the existing solidarity system, and is looking for ways to address the situation in which pensioners do not receive the amount of money they donated to the state. The purpose of the article is to investigate the pension system of the countries where the highest pensions are, namely: the United States and the United Kingdom. Using the experience of foreign countries to build a reliable pension in Ukraine.

scholarly journals Temporal distribution of visceral leishmaniasis in Paraíba state, northeastern brazil, by geographic region, 2012-2017

2021 ◽  
Vol 10 (6) ◽  
pp. e9410615575
Author(s):  
Allan Batista Silva ◽  
Hemílio Fernandes Campos Coêlho ◽  
Francisca Inês de Sousa Freitas ◽  
Clélia de Alencar Xavier Mota ◽  
Sérgio Vital da Silva Junior ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Ecological Study ◽  
Temporal Distribution ◽  
Geographic Region ◽  
The State ◽  
Northeastern Brazil ◽  
Central Public Health ◽  
Preventive Actions ◽  
Increasing Trend ◽  
One Year

This study aims to analyze the temporal distribution of human (HVL) and canine visceral leishmaniasis (CVL) in the state of Paraíba between 2012 and 2017, by Intermediate and Immediate Geographic Region (GR). As an ecological study with a quantitative approach, data were collected in the LACEN PB database; Dra. Telma Lobo Central Public Health Laboratory, Paraíba; and refer to positive cases of HVL and CVL presented in the state in the period under study. Poisson Regression Modeling was used to quantify the average number of cases from one year to another. The results revealed that the immediate GRs of Mamanguape - Rio Tinto, Campina Grande, and Cajazeiras present a statistically significant increasing trend in the average number of HVL cases. The immediate GRs of Campina Grande, Patos, Cuité - Nova Floresta, Itaporanga, and João Pessoa revealed a significant increase in the average number of CVL cases during the period analyzed. The need for reorganization of disease control operations and preventive actions was confirmed, especially in those regions identified with growth.

Sign in / Sign up

Export Citation Format

Share Document