scholarly journals Expelled uninsured patients in a less-competitive hospital market in Florida, USA

2016 ◽  
Vol 15 (1) ◽  
Author(s):  
Keon-Hyung Lee ◽  
Seunghoo Lim ◽  
Jungwon Park
Keyword(s):  
Uninsured Patients ◽  
Hospital Market

scholarly journals 623. Self-Administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) in Uninsured Patients

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S371-S371
Author(s):  
Yasir Hamad ◽  
Jaspur Min ◽  
Yvonne Burnett
Keyword(s):  
Antimicrobial Therapy ◽  
Adverse Drug Events ◽  
Hospital Length ◽  
Clinic Visit ◽  
Hospital Length Of Stay ◽  
Uninsured Patients ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Joint Infections ◽  
Insured Patients ◽  
Hospital Days

Abstract Background Uninsured patients requiring long-term intravenous (IV) antimicrobials do not have access to outpatient parenteral antimicrobial therapy (OPAT) and often remain hospitalized for the duration of their treatment, transition to inferior oral antimicrobials, or leave against medical advice. A hospital-supported self-administered OPAT (S-OPAT) program was piloted in uninsured patients to decrease hospital length of stay and improve access to care. Methods Uninsured adult patients requiring IV antimicrobials were enrolled in an S-OPAT pilot study from July 2019 to April 2020. Patients with drug use history or documented non-adherence were excluded. S-OPAT patients attended weekly clinic visits for blood draws, dressing changes, and medication supply. The measured outcomes were hospital days saved, and potential income generated by earlier discharges. The latter was calculated by multiplying the number of hospital days saved by the daily charge for a hospital bed to insured patients. Results Seventeen patients were enrolled in S-OPAT, 14 (82%) were males, 8 (47%) were black, and the mean age was 39 years. The most common indication for OPAT was bone and joint infections in 12 (71%), and most commonly used antibiotic was ceftriaxone in 12 (71%) patients (Table). Early discontinuation occurred in 3 (17%) patients due to clinic visit non-adherence resulted in 2 (12%) and adverse drug events in 1 (6%). Only one (6%) patient had unplanned hospital readmission during OPAT. Transition to S-OPAT resulted in 533 hospital days avoided, and a net saving of approximately $900,000. Conclusion S-OPAT model is safe and can enhance care for uninsured patients while optimizing health-system resources. Table Disclosures All Authors: No reported disclosures

scholarly journals Implementing Telemedicine Visits in an Underserved Ophthalmology Clinic in the COVID-19 Era

2021 ◽  
Vol 12 ◽  
pp. 215013272199627
Author(s):  
Mona Adeli ◽  
William R. Bloom
Keyword(s):  
Latin America ◽  
High Risk ◽  
Vulnerable Populations ◽  
Low Income ◽  
Office Visit ◽  
Medically Underserved ◽  
Uninsured Patients ◽  
Potential Barriers ◽  
Ocular Morbidity

Introduction: Many of the potential barriers to providing telehealth services already disproportionately impact vulnerable populations. The purpose of this study was to assess the incorporation of synchronous ophthalmology telemedicine visits in a tertiary university-based ophthalmology clinic for low-income and uninsured patients in the COVID-19 era. Methods: The records of 18 patients who were due for an in-person visit in the medically underserved patient clinic at our institute were reviewed. Patients considered high risk of ocular morbidity progression were approved to proceed with an in-person visit. Patients with non-urgent visit indications were attempted to be contacted by telephone to be offered a telemedicine telephone visit as an alternative to a postponed in-person office visit. Results: Clinical triage by an attending ophthalmologist determined that 17 patients (94.4%, n = 18) had visit indications appropriate for evaluation by telemedicine. Six patients (35.3%, n = 17) were successfully contacted and offered a telemedicine visit as an alternative to a postponed in-person office visit. All 6 patients accepted, scheduled, and completed a telemedicine visit. Eleven patients (64.7%, n = 17) were not able to be successfully contacted to offer and schedule either a telemedicine visit or a postponed in-person office visit. Patients who were not able to be successfully contacted were on average younger in age and more likely to be female, Hispanic/Latino, from Latin America, with a preferred language of Spanish. Conclusions: Synchronous ophthalmology telemedicine visits can be successfully incorporated in a tertiary university-based setting for low-income and uninsured patients. The primary barrier to providing telemedicine visits in this population was the ability to successfully contact patients to offer and schedule these visits.

Early and Later Onset Type 2 Diabetes in Uninsured Patients: Clinical and Behavioral Differences

2008 ◽  
Vol 19 (4) ◽  
pp. 1119-1135 ◽  
Author(s):  
Tracie L.S. Smith ◽  
Melinda L. Drum ◽  
Jadwiga Miernik ◽  
Leon A. Fogelfeld ◽  
Rebecca B. Lipton
Keyword(s):  
Type 2 Diabetes ◽  
Behavioral Differences ◽  
Uninsured Patients ◽  
Onset Type

scholarly journals Market concentration trends in South Africa’s private healthcare sector

2016 ◽  
Vol 19 (1) ◽  
pp. 53-63 ◽  
Author(s):  
Marine Erasmus ◽  
Nicola Theron
Keyword(s):  
Market Structure ◽  
Private Hospital ◽  
Market Concentration ◽  
Competitive Dynamics ◽  
Healthcare Sector ◽  
Private Hospitals ◽  
Hospital Market ◽  
Private Healthcare ◽  
Structure Changes ◽  
Relative Bargaining Power

The Competition Commission (CC) commenced with an enquiry into South Africa’s private healthcare sector at the beginning of 2014, the outcome of which could have far-reaching consequences for the medical industry in South Africa. The panel appointed to consider competition in the private healthcare sector has indicated that they are interested in understanding increased consolidation in the private hospital market and the effect this may have on competitive dynamics. This article considers historical concentration trends in the private hospital market from 2000 to 2012. In addition it also deals with changes in market structure in the medical scheme and administrator markets. These trends provide a complete picture of market structure changes and the implications for relative bargaining power of the various parties. It finds that whereas the market concentration of private hospitals has remained relatively stable since 2004, the market concentration of medical schemes and administrators has increased over this period.

scholarly journals Treatment biases in traumatic neurosurgical care: a retrospective study of the Nationwide Inpatient Sample from 1998 to 2009

2015 ◽  
Vol 123 (2) ◽  
pp. 406-414 ◽  
Author(s):  
Brandon A. McCutcheon ◽  
David C. Chang ◽  
Logan Marcus ◽  
David D. Gonda ◽  
Abraham Noorbakhsh ◽  
...  
Keyword(s):  
Vertebral Fracture ◽  
Spinal Fusion ◽  
Nationwide Inpatient Sample ◽  
Injury Severity ◽  
Spinal Injury ◽  
Hospital Setting ◽  
Spine Injury ◽  
Intracranial Hematoma ◽  
Uninsured Patients ◽  
Insured Patients

OBJECT This study was designed to assess the relationship between insurance status and likelihood of receiving a neurosurgical procedure following admission for either extraaxial intracranial hemorrhage or spinal vertebral fracture. METHODS A retrospective analysis of the Nationwide Inpatient Sample (NIS; 1998–2009) was performed. Cases of traumatic extraaxial intracranial hematoma and spinal vertebral fracture were identified using International Classification of Diseases, Ninth Revision (ICD-9) diagnosis codes. Within this cohort, those patients receiving a craniotomy or spinal fusion and/or decompression in the context of an admission for traumatic brain or spine injury, respectively, were identified using the appropriate ICD-9 procedure codes. RESULTS A total of 190,412 patients with extraaxial intracranial hematoma were identified between 1998 and 2009. Within this cohort, 37,434 patients (19.7%) received a craniotomy. A total of 477,110 patients with spinal vertebral fracture were identified. Of these, 37,302 (7.8%) received a spinal decompression and/or fusion. On multivariate analysis controlling for patient demographics, severity of injuries, comorbidities, hospital volume, and hospital characteristics, uninsured patients had a reduced likelihood of receiving a craniotomy (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.71–0.82) and spinal fusion (OR 0.67, 95% CI 0.64–0.71) relative to insured patients. This statistically significant trend persisted when uninsured and insured patients were matched on the basis of mortality propensity score. Uninsured patients demonstrated an elevated risk-adjusted mortality rate relative to insured patients in cases of extraaxial intracranial hematoma. Among patients with spinal injury, mortality rates were similar between patients with and without insurance. CONCLUSIONS In this study, uninsured patients were consistently less likely to receive a craniotomy or spinal fusion for traumatic intracranial extraaxial hemorrhage and spinal vertebral fracture, respectively. This difference persisted after accounting for overall injury severity and patient access to high- or low-volume treatment centers, and potentially reflects a resource allocation bias against uninsured patients within the hospital setting. This information adds to the growing literature detailing the benefits of health reform initiatives seeking to expand access for the uninsured.

Hospital prices and market structure in the hospital and insurance industries

2010 ◽  
Vol 5 (4) ◽  
pp. 459-479 ◽  
Author(s):  
Asako S. Moriya ◽  
William B. Vogt ◽  
Martin Gaynor
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Market Concentration ◽  
Insurance Market ◽  
Hospital Services ◽  
Hospital Market ◽  
Market Effects ◽  
Transaction Prices ◽  
Care Services ◽  
The Relationship

AbstractThere has been substantial consolidation among health insurers and hospitals, recently, raising questions about the effects of this consolidation on the exercise of market power. We analyze the relationship between insurer and hospital market concentration and the prices of hospital services. We use a national US dataset containing transaction prices for health care services for over 11 million privately insured Americans. Using three years of panel data, we estimate how insurer and hospital market concentration are related to hospital prices, while controlling for unobserved market effects. We find that increases in insurance market concentration are significantly associated with decreases in hospital prices, whereas increases in hospital concentration are non-significantly associated with increases in prices. A hypothetical merger between two of five equally sized insurers is estimated to decrease hospital prices by 6.7%.

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