scholarly journals Changes in employer-sponsored private health insurance among retirees in Ontario: a cross-sectional study

CMAJ Open ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. E15-E22 ◽  
Author(s):  
Fiona K.I. Chan ◽  
Kimberlyn McGrail ◽  
Sumit R. Majumdar ◽  
Michael R. Law
Keyword(s):  
Health Insurance ◽  
Private Health Insurance ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Is healthy children surveillance being duplicated by family physicians and paediatricians? A cross-sectional study in Portugal

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e015902
Author(s):  
Susana Rebelo ◽  
Sofia Velho Rua ◽  
Joana d’Orey Leça ◽  
Ana Couto ◽  
Rute Teixeira ◽  
...  
Keyword(s):  
Health Insurance ◽  
Educational Level ◽  
Private Health Insurance ◽  
Prevalence Ratio ◽  
Cross Sectional Study ◽  
Healthy Children ◽  
Net Income ◽  
Sectional Study ◽  
Cross Sectional ◽  
Number Of Children

ObjectivesTo determine if children attend the family physician (FP) or the FP/paediatrician for their surveillance medical appointments, as well as analyse the variables associated with the parents’ choice between the two physicians.DesignCross-sectional study.SettingPublic, semiprivate and private kindergartens in the city of Vila Nova de Famalicão (Portugal).ParticipantsParents of children aged 6 years or less without chronic diseases, enrolled in the selected kindergartens.Main outcome measuresProportion of children attending the FP or FP/paediatrician for their surveillance appointments; association between the chosen physician and sociodemographic and household variables (parents’ age, educational level, professional situation and marital status; household net income; number of children; the child’s age; presence of private health insurance), assessment of the parents’ perception of clinical knowledge and accessibility regarding the FP and the paediatrician.ResultsA total of 697 children were included in the analysis: 30.6% attended only the FP and 69.4% attended both the FP and the paediatrician. Using a Poisson regression, the mother’s age (PR=1.02, 95% CI 1.00 to 1.03), higher educational level (prevalence ratio (PR=1.15, 95% CI 1.00 to 1.33), private health insurance (PR=1.30, 95% CI 1.15 to 1.46), number of children (PR=0.86, 95% CI 0.78 to 0.94) and the child’s age (PR=0.95, 95% CI 0.91 to 0.98) were statistically associated with attending both the FP and the paediatrician; parents of children who attended only FP rated the FP with a higher accessibility and knowledge mean score than those who consulted both physicians (2.91vs2.38, P<0.001, and 4.11vs3.85, P<0.001).ConclusionsOur data show that 70% of our sample simultaneously attended an FP and a paediatrician. FPs are equally qualified to provide medical care to healthy children but this information is not properly transmitted to the general population.

scholarly journals Awareness of Heart Disease Among Female College Students

2020 ◽  
Vol 29 (4) ◽  
Author(s):  
Ghadah Alshuwaiyer ◽  
E. Laurette Taylor
Keyword(s):  
Heart Disease ◽  
Health Insurance ◽  
Private Health Insurance ◽  
Cross Sectional Study ◽  
Female Students ◽  
Educational Opportunities ◽  
Female College Students ◽  
Sectional Study ◽  
Cross Sectional ◽  
Preventive Methods

This cross-sectional study assessed the knowledge of female students about heart disease (HD). A sample of 334 students (age=18-64 years) completed a 43-item survey. Students (32%) considered themselves “not informed” about HD. Yet, HD was identified as a main health problem (30.5%) and a leading cause of death (60%; p < .05). Students with private health insurance (54%) visited the doctor regularly versus those without private or known type of insurance (6.4% and 2.1%, respectively; p < .05). Students identified exercise (73.8%) and aromatherapy (14.1%) as preventive methods for HD. To increase HD awareness among female students, educational opportunities should be incorporated into coursework.

scholarly journals Prevalence of gout and asymptomatic hyperuricemia in the pediatric population: a cross-sectional study of a Japanese health insurance database

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Shuichi Ito ◽  
Tomoko Torii ◽  
Akihiro Nakajima ◽  
Takeshi Iijima ◽  
Hiroshi Murano ◽  
...  
Keyword(s):  
Uric Acid ◽  
Health Insurance ◽  
Pediatric Population ◽  
Gouty Arthritis ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Insurance Claims ◽  
Cross Sectional ◽  
Total Prevalence ◽  
Health Insurance Claims

Abstract Background Although gout is rare in children, chronic sustained hyperuricemia can lead to monosodium urate deposits progressing to gout, just as in adults. This study assessed prevalence and characteristics of gout and asymptomatic hyperuricemia, and incidence of gouty arthritis in the pediatric population, using data from Japanese health insurance claims. The diagnosis and treatment of pediatric gout and hyperuricemia were analyzed, and specific characteristics of those patients were assessed. Since Japanese guidelines recommend treatment with uric acid lowering drugs for asymptomatic hyperuricemia as well as for gout, these data were also used to investigate the real-world use of uric acid lowering drugs in a pediatric population. Methods This cross-sectional study was based on a 2016–2017 Japanese health insurance claims database, one of the largest epidemiology claims databases available in Japan, which included 356,790 males and 339,487 females 0–18 years of age. Outcomes were measured for prevalence, patient characteristics, treatment with uric acid lowering drugs for gout and asymptomatic hyperuricemia, and prevalence and incidence of gouty arthritis. Because uric acid can be elevated by some forms of chemotherapy, data from patients under treatment for malignancies were excluded from consideration. Results Total prevalence of gout and asymptomatic hyperuricemia in 0–18 year-olds was 0.040% (276/696,277 patients), with gout prevalence at 0.007% (48/696,277) and asymptomatic hyperuricemia at 0.033% (228/696,277). Prevalence of gout and asymptomatic hyperuricemia was highest in adolescent males, at 0.135% (176/130,823). The most common comorbidities for gout and asymptomatic hyperuricemia were metabolic syndrome at 42.8% (118/276) and kidney disease at 34.8% (96/276). Of the patients diagnosed with gout or asymptomatic hyperuricemia, 35.1% (97/276) were treated with uric acid lowering drugs. Gouty arthritis developed in 43.8% (21/48) of gout patients during the study, at an incidence of 0.65 flares/person-year. Conclusions Even the pediatric population could be affected by asymptomatic hyperuricemia, gout, and gouty arthritis, and uric acid lowering drugs are being used in this population even though those drugs have not been approved for pediatric indications. Such off-label use may indicate a potential need for therapeutic agents in this population. Trial registration UMIN000036029.

scholarly journals Geographical variation in musculoskeletal surgical care in public hospitals in Ireland: a repeated cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e028037 ◽  
Author(s):  
Mary E Walsh ◽  
Fiona Boland ◽  
John M O’Byrne ◽  
Tom Fahey
Keyword(s):  
Hip Fracture ◽  
Hip Replacement ◽  
Geographical Variation ◽  
Private Health Insurance ◽  
Knee Arthroscopy ◽  
Cross Sectional Study ◽  
Public Hospitals ◽  
Sectional Study ◽  
Cross Sectional ◽  
Referral Hospitals

ObjectiveTo examine the extent of geographical variation across musculoskeletal surgical procedures and associated factors in Ireland.DesignRepeated cross-sectional study.Setting36 public hospitals in Ireland.ParticipantsAdult admissions for hip fracture, hip and knee replacement, knee arthroscopy and lumbar spine interventions over 5 years (2012–2016).Primary outcome measureStandardised discharge rate (SDR).AnalysisAge and sex SDRs were calculated for 21 geographical areas. Extremal quotients, coefficients of variation and systematic components of variance were calculated. Linear regression analyses were conducted exploring the relationship between SDRs and year, unemployment, % urban population, number of referral hospitals, % on waiting lists>6 months and % with private health insurance for each procedure.ResultsAcross 36 public hospitals, n=102 756 admissions were included. Hip fracture repair showed very low variation. Elective hip and knee procedures showed high variation in particular years, while variation for lumbar interventions was very high. Knee arthroscopy rates decreased over time. Higher unemployment was associated with knee and hip replacement rates and urban areas had lower hip replacement rates. Spinal procedure rates were associated with a lower number of referral hospitals in a region and spinal injection rates were associated with shorter waiting lists. A higher proportion of patients having private health insurance was associated with higher rates of hip and knee replacement and lumbar spinal procedures.ConclusionsVariation and factors associated with SDRs for publicly funded hip and knee procedures are consistent with similar international research in this field. Further research should explore reasons for high rates of spinal injections and the impact of private practice on musculoskeletal procedure variation.

scholarly journals Degree of regional variation and effects of health insurance-related factors on the utilization of 24 diverse healthcare services - a cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Wenjia Wei ◽  
Agne Ulyte ◽  
Oliver Gruebner ◽  
Viktor von Wyl ◽  
Holger Dressel ◽  
...  
Keyword(s):  
Health Insurance ◽  
Managed Care ◽  
Influencing Factors ◽  
Healthcare Utilization ◽  
Regional Variation ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Related Factors ◽  
Cross Sectional

Abstract Background Regional variation in healthcare utilization could reflect unequal access to care, which may lead to detrimental consequences to quality of care and costs. The aims of this study were to a) describe the degree of regional variation in utilization of 24 diverse healthcare services in eligible populations in Switzerland, and b) identify potential drivers, especially health insurance-related factors, and explore the consistency of their effects across the services. Methods We conducted a cross-sectional study using health insurance claims data for the year of 2014. The studied 24 healthcare services were predominantly outpatient services, ranging from screening to secondary prevention. For each service, a target population was identified based on applicable clinical recommendations, and outcome variable was the use of the service. Possible influencing factors included patients’ socio-demographics, health insurance-related and clinical characteristics. For each service, we performed a comprehensive methodological approach including small area variation analysis, spatial autocorrelation analysis, and multilevel multivariable modelling using 106 mobilité spaciale regions as the higher level. We further calculated the median odds ratio in model residuals to assess the unexplained regional variation. Results Unadjusted utilization rates varied considerably across the 24 healthcare services, ranging from 3.5% (osteoporosis screening) to 76.1% (recommended thyroid disease screening sequence). The effects of health insurance-related characteristics were mostly consistent. A higher annual deductible level was mostly associated with lower utilization. Supplementary insurance, supplementary hospital insurance and having chosen a managed care model were associated with higher utilization of most services. Managed care models showed a tendency towards more recommended care. After adjusting for multiple influencing factors, the unexplained regional variation was generally small across the 24 services, with all MORs below 1.5. Conclusions The observed utilization rates seemed suboptimal for many of the selected services. For all of them, the unexplained regional variation was relatively small. Our findings confirmed the importance and consistency of effects of health insurance-related factors, indicating that healthcare utilization might be further optimized through adjustment of insurance scheme designs. Our comprehensive approach aids in the identification of regional variation and influencing factors of healthcare services use in Switzerland as well as comparable settings worldwide.

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