scholarly journals Medicare for All, One Organ at a Time: How Disease Entitlement Can Work for Diabetes

2020 ◽  
Vol 27 ◽  
Author(s):  
Eli Richman
Keyword(s):  
Financial Burden ◽  
Private Insurance ◽  
Age Groups ◽  
The United States ◽  
Insurance Companies ◽  
Richard Nixon ◽  
Successful Program ◽  
Medicare Coverage ◽  
The Us ◽  
Healthcare Innovation

While Richard Nixon may not spring to mind as a Medicare for All pioneer, his groundbreaking healthcare innovation that expanded Medicare entitlement for renal disease, regardless of a patient's age, demonstrates a viable path for expanding Medicare coverage today. This highly successful program provided dialysis or transplantation to over one million patients with kidney disease and became known as socialized medicine for an organ. In addition to extending patients' lives, the program proved that Medicare can be structured to cover people with specific diagnoses, not just those in distinct age groups. This paper argues that the United States could use the same model to expand Medicare coverage to other expensive diseases, particularly diabetes. Not only would this ease diabetics' financial burden, it would also reduce costs for private insurance companies, potentially allowing them to offer less expensive plans than are currently available. This paper demonstrates the need for such a program by examining the high cost of diabetes treatment and provides a cost estimate for such a program. The paper concludes that diabetes entitlement is a viable option for expanding Medicare and improving the US healthcare system.

scholarly journals All-Payer Rate Setting: A Framework for a More Efficient Health Care System

2017 ◽  
Vol 24 ◽  
pp. 81
Author(s):  
Eric Flanagan
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Services ◽  
Health Care Systems ◽  
Private Insurance ◽  
The United States ◽  
Insurance Companies ◽  
Cost Shifting ◽  
The Us ◽  
Care System

The United States is unique among countries with health care systems that rely primarily on private insurance companies because there are generally no regulations that mandate a standard fee schedule for health care services. The prevalence of multiple private and public insurers is known as a multi-payer system. Other countries that have multiple payers set prices unilaterally, as is the case in Japan, or through negotiations between payers and providers, as is the case in Germany. The outcome is a uniform set of prices that applies to all payers within a single hospital. This framework is known as all-payer rate setting. This paper explains how all-payer rate setting regulation can mitigate several problems plaguing the US health care system. Examples include cost shifting, price discrimination, and provider market leverage. The paper then analyzes how these problems negatively affect the US health care system. Finally, the benefits of all-payer rate setting are explained, followed by the downsides (or tradeoffs) of such a system.

scholarly journals THU0442 GOUT AND HEART FAILURE IN THE US: A NATIONAL PERSPECTIVE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 458.2-458
Author(s):  
G. Singh ◽  
M. Sehgal ◽  
A. Mithal
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Confidence Intervals ◽  
Burden Of Illness ◽  
Average Length ◽  
Private Insurance ◽  
Significant Risk ◽  
Case Fatality ◽  
The United States ◽  
The Us

Background:Heart failure (HF) is the eighth leading cause of death in the US, with a 38% increase in the number of deaths due to HF from 2011 to 2017 (1). Gout and hyperuricemia have previously been recognized as significant risk factors for heart failure (2), but there is little nationwide data on the clinical and economic consequences of these comorbidities.Objectives:To study heart failure hospitalizations in patients with gout in the United States (US) and estimate their clinical and economic impact.Methods:The Nationwide Inpatient Sample (NIS) is a stratified random sample of all US community hospitals. It is the only US national hospital database with information on all patients, regardless of payer, including persons covered by Medicare, Medicaid, private insurance, and the uninsured. We examined all inpatient hospitalizations in the NIS in 2017, the most recent year of available data, with a primary or secondary diagnosis of gout and heart failure. Over 69,800 ICD 10 diagnoses were collapsed into a smaller number of clinically meaningful categories, consistent with the CDC Clinical Classification Software.Results:There were 35.8 million all-cause hospitalizations in patients in the US in 2017. Of these, 351,735 hospitalizations occurred for acute and/or chronic heart failure in patients with gout. These patients had a mean age of 73.3 years (95% confidence intervals 73.1 – 73.5 years) and were more likely to be male (63.4%). The average length of hospitalization was 6.1 days (95% confidence intervals 6.0 to 6.2 days) with a case fatality rate of 3.5% (95% confidence intervals 3.4% – 3.7%). The average cost of each hospitalization was $63,992 (95% confidence intervals $61,908 - $66,075), with a total annual national cost estimate of $22.8 billion (95% confidence intervals $21.7 billion - $24.0 billion).Conclusion:While gout and hyperuricemia have long been recognized as potential risk factors for heart failure, the aging of the US population is projected to significantly increase the burden of illness and costs of care of these comorbidities (1). This calls for an increased awareness and management of serious co-morbid conditions in patients with gout.References:[1]Sidney, S., Go, A. S., Jaffe, M. G., Solomon, M. D., Ambrosy, A. P., & Rana, J. S. (2019). Association Between Aging of the US Population and Heart Disease Mortality From 2011 to 2017. JAMA Cardiology. doi:10.1001/jamacardio.2019.4187[2]Krishnan E. Gout and the risk for incident heart failure and systolic dysfunction. BMJ Open 2012;2:e000282.doi:10.1136/bmjopen-2011-000282Disclosure of Interests: :Gurkirpal Singh Grant/research support from: Horizon Therapeutics, Maanek Sehgal: None declared, Alka Mithal: None declared

Abstract 18272: The Increasing Proportion of Acute Myocardial Infarction Represented by the Uninsured: a Growing Financial Burden in the United States

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Bethany Doran ◽  
Yu Guo ◽  
Jinfeng Xu ◽  
Sripal Bangalore
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Health Insurance ◽  
Financial Burden ◽  
Insurance Coverage ◽  
The United States ◽  
The Us ◽  
Hospital Stays ◽  
Nationally Representative ◽  
The Cost

Introduction: Under the provisions of the Affordable Care Act, insurance coverage will markedly increase with the Congressional Budgetary Office estimating the number of insured to increase by approximately 13 million in 2014 and 25 million in 2016. However, approximately 31 million non-elderly US citizens are expected to remain without health insurance in 2016. Acute myocardial infarction (AMI) remains a source of significant morbidity and mortality, as well as cost to society. No prior studies have examined temporal rates of uninsured among patients presenting with an AMI using a nationally representative database. Hypothesis: We tested the hypothesis that the proportion of uninsured individuals with AMI and cost of uninsured to society will vary by year. Methods: We used the Nationwide Inpatient Sample (NIS), which contains estimates from approximately 8 million hospital visits and information related to number of discharges, aggregate charges, and principal diagnoses of all patients discharged in the US. We calculated the percentage of acute myocardial infarction by insurance status, and the sum of all charges of hospital stays in the US adjusted for inflation. Results: The cost to society due to acute myocardial infarction in the uninsured increased substantially from 1997 to 2012, with total cost in 1997 of $852,596,272 and $3,446,893,954 in 2012 after adjustment for inflation. In addition, although rates of AMI decreased in the general population (from 268.6/100,000 individuals in 1997 to 193.8/100,000 individuals in 2012), the proportion of individuals with AMI who were uninsured increased (from 3.83% in 1997 to 7.37% in 2012). Conclusions: The proportion of those experiencing AMI who are uninsured is rising, as is cost to society. It remains to be seen what the effects of expanding health insurance will have on the rate of AMI as well as proportion of AMI represented by the uninsured.

The Watergate Crisis

2020 ◽  
Author(s):  
Dafydd Townley
Keyword(s):  
United States ◽  
Vietnam War ◽  
The United States ◽  
Public Confidence ◽  
Washington Dc ◽  
Richard Nixon ◽  
The Us ◽  
National Headquarters ◽  
Post War ◽  
The 1960S

The Watergate affair has become synonymous with political corruption and conspiracy. The crisis has, through fact, fiction, and debate, become considerably more than the arrest of five men breaking into the Democratic Party’s national headquarters in the Watergate complex in Washington DC in the early hours of Saturday, June 17, 1972. Instead, the term “Watergate” has since come to represent the burglary, its failed cover-up, the press investigation, the Senate enquiry, and the eventual resignation of the thirty-seventh president of the United States, Richard Nixon. Arguably, Watergate has come to encompass all the illegalities of the Nixon administration. The crisis broke when the Vietnam War had already sunk public confidence in the executive to a low ebb, and in the context of a society already fractured by the turbulence of the 1960s. As such, Watergate is seen as the nadir of American democracy in the 20th century. Perversely, despite contemporaries’ genuine fears for the future of the US democratic system, the scandal highlighted the efficiency of the US governmental machine. The investigations that constituted the Watergate enquiry, which were conducted by the legislative and judicial branches and the fourth estate, exposed corruption in the executive of the United States that stretched to the holder of the highest office. The post-war decades had allowed an imperial presidency to develop, which had threatened the country’s political equilibrium. Watergate disclosed that the presidency had overreached its constitutional powers and responsibilities and had conspired to keep those moves hidden from the electorate. More significantly, however, the forced resignation of Richard Nixon revealed that the checks-and-balances system of government, which was conceived almost 200 years before the Watergate affair, worked as those who devised it had planned. Watergate should illustrate to Americans not just the dangers of consolidating great power in the office of the president, but also the means to counteract such growth.

scholarly journals Folate status in the US population 20 y after the introduction of folic acid fortification

2019 ◽  
Vol 110 (5) ◽  
pp. 1088-1097 ◽  
Author(s):  
Christine M Pfeiffer ◽  
Maya R Sternberg ◽  
Mindy Zhang ◽  
Zia Fazili ◽  
Renee J Storandt ◽  
...  
Keyword(s):  
Folic Acid ◽  
White Women ◽  
Geometric Mean ◽  
Age Groups ◽  
The United States ◽  
Reproductive Age ◽  
Serum Folate ◽  
Folate Status ◽  
Cereal Grain ◽  
The Us

ABSTRACT Background Enriched cereal-grain products have been fortified in the United States for >20 y to improve folate status in women of reproductive age and reduce the risk of folic acid–responsive neural tube birth defects (NTDs). Objectives Our objectives were to assess postfortification changes in folate status in the overall US population and in women aged 12–49 y and to characterize recent folate status by demographic group and use of folic acid–containing supplements. Methods We examined cross-sectional serum and RBC folate data from the NHANES 1999–2016. Results Serum folate geometric means increased from 2007–2010 to 2011–2016 in persons aged ≥1 y (38.7 compared with 40.6 nmol/L) and in women (35.3 compared with 37.0 nmol/L), whereas RBC folate showed no significant change. Younger age groups, men, and Hispanic persons showed increased serum and RBC folate concentrations, whereas non-Hispanic black persons and supplement nonusers showed increased serum folate concentrations. The folate insufficiency prevalence (RBC folate <748 nmol/L; NTD risk) in women decreased from 2007–2010 (23.2%) to 2011–2016 (18.6%) overall and in some subgroups (e.g., women aged 20–39 y, Hispanic and non-Hispanic black women, and supplement nonusers). After covariate adjustment, RBC folate was significantly lower in all age groups (by ∼10–20%) compared with persons aged ≥60 y and in Hispanic (by 8.2%), non-Hispanic Asian (by 12.1%), and non-Hispanic black (by 20.5%) compared with non-Hispanic white women (2011–2016). The 90th percentile for serum (∼70 nmol/L) and RBC (∼1800 nmol/L) folate in supplement nonusers aged ≥60 y was similar to the geometric mean in users (2011–2014). Conclusions Blood folate concentrations in the US population overall and in women have not decreased recently, and folate insufficiency rates are ∼20%. Continued monitoring of all age groups is advisable given the high folate status particularly in older supplement users.

Health insurance literacy, financial hardship and financial sacrifices among cancer survivors in the United States.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 1560-1560
Author(s):  
Jingxuan Zhao ◽  
Xuesong Han ◽  
Zhiyuan Zheng ◽  
Matthew P. Banegas ◽  
Donatus U. Ekwueme ◽  
...  
Keyword(s):  
United States ◽  
Health Insurance ◽  
Cancer Survivors ◽  
Financial Burden ◽  
Age Groups ◽  
The United States ◽  
Financial Hardship ◽  
Adult Cancer Survivors ◽  
Health Insurance Literacy ◽  
Medical Bills

1560 Background: Rising costs of cancer care have imposed substantial financial burden on cancer survivors. To date, little is known about the associations between potentially modifiable patient characteristics, including health insurance literacy (HIL), on financial burden among cancer survivors. This study aimed to evaluate the associations between HIL and financial hardship and financial sacrifices among adult cancer survivors in the United States. Methods: We identified 914 adult cancer survivors from the 2016 Medical Expenditure Panel Survey Experiences with Cancer Questionnaire. HIL was measured based on the question “Did you ever have a problem understanding health insurance or medical bills related to your cancer, its treatment, or the lasting effects of that treatment?” Medical financial hardship was measured in three domains—1) material (e.g. problems paying medical bills); 2) psychological (e.g. worry about large medical bills); and 3) behavioral (e.g. delay or forego healthcare because of cost). Financial sacrifices were based on questions related to changes in spending on vacation or leisure activities. We used multivariable logistic regression modeling to separately evaluate the associations between HIL problems and 1) financial hardship and 2) financial sacrifices. Results: 18.9% cancer survivors aged 18-64 years and 14.6% survivors ≥65 years reported HIL problems. Regardless of age groups, cancer survivors with HIL problems were more likely to report any material (OR =3.2; 95% CI:1.9-5.2) or psychological (OR=7.2; 95% CI: 4.1-12.7) financial hardship than those without the problems, as well as more likely to delay or forgo multiple medical care due to cost, including prescription medicine (OR=3.6; 95% CI: 1.8-7.1), specialist visit (OR=2.6; 95% CI: 1.2-5.8), and follow-up care (OR=2.1, 95% CI 1.2-4.0). Higher likelihood of reporting all measures of financial sacrifices were observed among those with HIL problems in both age groups (all p<0.05). Conclusions: Cancer survivors with HIL problems were more likely to report financial hardship and financial sacrifices than those without the problems. Improving HIL may help mitigate financial hardship.

Intergenerational Transfers and Public Expenditure on the Elderly in Modern Britain

1988 ◽  
Vol 8 (2) ◽  
pp. 129-146 ◽  
Author(s):  
Paul Johnson ◽  
Jane Falkingham
Keyword(s):  
Social Services ◽  
Elderly Population ◽  
Public Expenditure ◽  
Age Groups ◽  
The Elderly ◽  
The United States ◽  
Generational Conflict ◽  
The Us ◽  
Families With Children ◽  
Poor Children

ABSTRACTIn the United States, much attention has recently been directed to the issue of whether the welfare system has become over-generous to the retired population, at the expense of families with children. The proportion of the US elderly population living in poverty has fallen significantly in the last fifteen years while the number of poor children has increased rapidly, and it has been suggested that this lack of investment in the next generation of workers may have disastrous longterm consequences for the U.S. economy. This paper considers whether similar trends are evident in Britain. It reviews data on the poverty and income of the elderly population, and finds little unequivocal evidence of relative economic gain over the last two decades, although it is clear that many children have suffered from the recent rise in unemployment-induced poverty. It also looks at direct public expenditure on the elderly through both the pension and the health and personal social services systems, and finds no evidence of a transfer of public resources away from children and towards the elderly population. The paper concludes that the British welfare state has been remarkably neutral in its allocation of resources between generations, and that, in the British context, any discussion of inter-generational conflict for welfare resources establishes a false dichotomy, because economic inequality within broad age groups is much greater than inequality between age groups.

scholarly journals Obesity trends in populations of the Russian Federation and the United States of America. Thirty-year long dynamics

2018 ◽  
Vol 17 (4) ◽  
pp. 67-73 ◽  
Author(s):  
V. G. Vilkov ◽  
S. A. Shalnova ◽  
A. D. Deev ◽  
Yu. A. Balanova ◽  
S. E. Efstifeeva ◽  
...  
Keyword(s):  
Russian Federation ◽  
Age Groups ◽  
The United States ◽  
Men And Women ◽  
The Us ◽  
Obesity Trends ◽  
Prevalence Of Obesity ◽  
The Mean ◽  
And Gender ◽  
Gender Categories

Aim. To evaluate the dynamics of obesity and mean body mass index (BMI) in Russia and USA in various age and gender categories during 1975-2014.Material and methods. By a repeat analysis of one-moment studies of Russian and US population in 1975-1982 and 2007-2014, the values of obesity and BMI were assessed in men and women age 25-64 y. o. Into analysis, the data was included from Russian part of the Lipid Clinics study and multicenter ESSE-RF study (Epidemiology of cardiovascular diseases and risk factors in various regions of Russian Federation). American data acquired from the studies NHANES (National Health And Nutrition Examination Survey), open access. Total number of observations 48974.Results. In the 80s of XX century in all age groups of women the mean BMI levels were lower in USA comparing to Russia, in men there were no significant differences. For the following 30 years in Russia the situation improved for men and women <45 y. o. — differences with USA changed modality, and currently BMI in Russia is lower than in USA.Conclusion. Russia was below the US 30 years ago by the mean BMI in females of all ages, with no differences for males. For the following 30 years in the US there was significant increase of BMI in all age strata of men and women, and in Russia dynamics was the same, but lesser. Comparison of the prevalence of obesity in men 30 years ago showed some predominance of obesity in American males, especially young, but not statistically significant. Russian women had higher prevalence of obesity regardless of age. Currently, obesity in young age is more prevalent in men and women of USA, and >45 years old — in Russia.

scholarly journals Prevalence of hypotension in populations of the Russian Federation and the United States of America according to 30-year follow-up

2020 ◽  
Vol 19 (3) ◽  
pp. 2497
Author(s):  
V. G. Vilkov ◽  
S. A. Shalnova ◽  
Yu. A. Balanova ◽  
S. E. Evstifeeva ◽  
A. E. Imaeva ◽  
...  
Keyword(s):  
United States ◽  
Adult Population ◽  
Age Groups ◽  
The United States ◽  
Cross Sectional ◽  
Men And Women ◽  
National Medical ◽  
Health And Nutrition ◽  
The Us ◽  
The Usa

Aim. To study the prevalence of hypotension according to several criteria in the Russia and the USA.Material and methods. We used data of Russian population studies performed in 1975-1982 and ESSE-RF study performed in 2012-2014 at the National Medical Research Center for Therapy and Preventive Medicine. A comparison was made with the data of cross-sectional stu - dies of the US population — National Health and Nutrition Examination Survey (NHANES): NHANES II (1976-1980) and Continuous NHANES (2007-2012). We analyzed age, sex, and systolic and diastolic blood pressure. The prevalence of individuals with hypotension was calculated in men and women of five age groups using four different criteria for hypertension.Results. The prevalence of hypotension in studies of different years according to different criteria was as follows: in the Russia — 0,3-9,0% in men and 2-15% in women; in the USA — 5-30% in men and 8-45% in women. In age group >30 years, the prevalence of hypotension in Russia, by most criteria, decreased approximately by 50% in men and did not change in women. In the United States, according to all criteria, the prevalence in men and women has increased 2-3 times.Conclusion. The prevalence of hypotension in the adult population ranges from decimal percentages to 45% and varies many times depending on the selected criterion.

scholarly journals Trends and Risk Factors for Leishmaniasis among Reproductive Aged Women in the United States

2021 ◽  
Vol 10 (2) ◽  
pp. 166-173
Author(s):  
Chioma Ikedionwu ◽  
Deepa Dongarwar ◽  
Courtney Williams ◽  
Evelyn Odeh ◽  
Maylis Nkeng Peh ◽  
...  
Keyword(s):  
United States ◽  
Risk Factors ◽  
Global Health ◽  
Protective Factor ◽  
Private Insurance ◽  
The United States ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
The Us ◽  
Clinical Awareness

Background and Objective: Leishmaniasis, a neglected tropical disease, is endemic in several regions globally, but commonly regarded as a disease of travelers in the United States (US). The literature on leishmaniasis among hospitalized women in the US is very limited. The aim of this study was to explore trends and risk factors for leishmaniasis among hospitalized women of reproductive age within the US. Methods: We analyzed hospital admissions data from the 2002-2017 Nationwide Inpatient Sample among women aged 15-49 years. We conducted descriptive statistics and bivariate analyses for factors associated with leishmaniasis. Utilizing logistic regression, we assessed the association between sociodemographic and hospital characteristics with leishmaniasis disease among hospitalized women of reproductive age in the US. Joinpoint regression was used to examine trends over time. Results: We analyzed 131,529,239 hospitalizations; among these, 207 cases of leishmaniasis hospitalizations were identified, equivalent to an overall prevalence of 1.57 cases per million during the study period. The prevalence of leishmaniasis was greatest among older women of reproductive age (35-49 years), Hispanics, those with Medicare, and inpatient stay in large teaching hospitals in the Northeast of the US. Hispanic women experienced a statistically significant increased odds of leishmaniasis diagnosis (OR, 1.80; 95% CI, 1.19-4.06), compared to Non-Hispanic (NH) White women. Medicaid and Private Insurance appeared to serve as a protective factor in both unadjusted and adjusted models. We did not observe a statistically significant change in leishmaniasis rates over the study period. Conclusion and Global Health Implications: Although the prevalence of leishmaniasis among women of reproductive age appears to be low in the US, some risk remains. Thus, appropriate educational, public health and policy initiatives are needed to increase clinical awareness and timely diagnosis/treatment of the disease.   Copyright © 2021 Ikedionwu, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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