Search Results (159)

Introduction: Musculoskeletal conditions impose a substantial economic burden on the United States (U.S.) healthcare system, but contemporary national estimates of condition-specific spending for common orthopaedic conditions remain limited. This study utilized the 2023 Medical Expenditure Panel Survey (MEPS) to estimate the national prevalence, condition-specific expenditures, and payer distribution for treated knee injuries and shoulder disorders. Methods: Adults with treated knee injuries or shoulder disorders were identified using ICD-10-CM codes from the MEPS Medical Conditions File. Condition-specific expenditures were estimated by linking diagnoses to medical events and payments using the MEPS Condition–Event Link File. Expenditures were aggregated across inpatient, outpatient, office-based, emergency, home health, and prescribed medicine categories. Survey-weighted analyses were used to estimate national prevalence, mean expenditures, service-level spending patterns, and payer distributions. Survey-weighted Gamma generalized linear models with log link were used to examine patient characteristics associated with expenditures among the U.S. civilian noninstitutionalized population with positive condition-specific spending. Results: The analysis identified 2.55 million adults with treated knee injuries and 2.58 million adults with treated shoulder disorders. Mean annual condition-specific expenditures per person were higher for knee injuries ($10,552; 95% CI: $6128–$14,975) than for shoulder disorders ($4310; 95% CI: $3337–$5283). Knee injury expenditures were concentrated in inpatient and home health care, whereas shoulder disorder expenditures were concentrated in outpatient and office-based care. Private insurance, Medicare, out-of-pocket payments, and Worker’s Compensation each contributed to the financial burden, with payer distributions varying by condition. In adjusted models, fair/poor self-rated health and female sex were associated with higher knee injury expenditures, while no covariates were statistically significant for shoulder disorder expenditures. Conclusions: Treated knee injuries and shoulder disorders showed distinct condition-specific expenditure profiles across care settings and payer sources. These findings provide contemporary national benchmarks for orthopaedic spending and may support future research, utilization monitoring, and value-based reimbursement planning. Full article

Persistent challenges in cervical cancer (CC) control highlight the need for stage-specific cost estimates to refine prevention strategies. Structural integration of National Health Insurance (NHI) administrative claims, the Taiwan Cancer Registry (TCR), and the National Cause of Death Registry (NCDR) provided the empirical basis for this population-based research. The final analytical sample encompassed 6055 women with cervical intraepithelial neoplasia (CIN) identified in 2016 as well as 9318 patients diagnosed with stage I to IV invasive CC during the 2008 to 2015 period. Reimbursed direct medical costs were estimated for CIN within 6 months after diagnosis and for CC over 5 years after diagnosis. Across CIN grades, no consistent cost gradient was observed, although inpatient utilization was highest in CIN3. Among women with CC, healthcare utilization and expenditures were concentrated in the first year after diagnosis, accounting for 52–65% of the total 5-year costs. After age adjustment, the mean first-year costs increased from NT$256,095 (US$8413) in stage I to NT$474,724 (US$15,595) in stage IV, while 5-year survival declined from 85.3% to 19.5%. These findings show that cervical disease imposes substantial direct medical costs on Taiwan’s healthcare system and provide updated evidence to inform human papillomavirus (HPV) vaccination and CC screening policy. Full article

Background/Objectives: Guidelines for obstructive hypertrophic cardiomyopathy (HCM) recommend treatment with disopyramide as an add-on to beta-blockers or calcium-channel blockers when symptoms persist. Data pertaining to effective disopyramide use in practice beyond single-center experience are very limited. This study aimed to quantify disopyramide use in patients with obstructive HCM in England, France and Germany, before the availability of cardiac myosin inhibitors. Methods: This retrospective study used nationally representative databases from England (Clinical Practice Research Datalink and Hospital Episode Statistics, 2010–2019), France (National Healthcare Data System, 2012–2019) and Germany (German statutory health insurance, 2011–2019). Adults (18+) with obstructive HCM were included, based on diagnostic codes for obstructive HCM or any HCM with septal reduction therapy. Disopyramide usage was defined as ≥1 prescription for a patient in a calendar year. Results: Overall, 3730, 6823 and 1141 patients diagnosed with obstructive HCM were identified in the English, French and German databases, respectively. In England, disopyramide use ranged from 4.7% to 5.6% per year with use generally stable over time. The equivalent usage for France was 1.7% to 2.6% per year. As expected, no recorded reimbursed use was reported in Germany during the study period. Conclusions: Disopyramide use is very low in patients with obstructive HCM, possibly due to treatment-related issues, availability or lack of reimbursement. These barriers may drive the uptake of alternative guideline recommended therapies for obstructive HCM treatment. Full article

Background: Breast cancer (BC) survivors frequently experience depression, which is associated with poorer quality of life (QoL), increased healthcare utilization, and worse prognosis. Although traditional Chinese medicine (TCM) is commonly used as an adjunctive therapy among Chinese populations for cancer-related symptom relief and supportive care, population-based evidence remains limited regarding whether integrated Chinese and Western medicine (ICWM) confers measurable benefits over Western medicine (WM) alone in terms of healthcare utilization and survival. Taiwan’s National Health Insurance (NHI) system offers a unique nationwide setting to address this gap because it reimburses patients for both WM and TCM services and captures care from a large number of TCM clinics across Taiwan, allowing evaluation of adjunctive TCM use in routine clinical practice at a scale rarely possible in prior studies. We used emergency department visits, hospitalization, and length of stay as pragmatic proxy indicators of patients’ daily functioning and disease burden. Leveraging a 10-year enrollment window (2004–2013) and up to 17 years of follow-up, we hypothesized that ICWM would be associated with a reduced risk of acute care events and lower healthcare expenditures compared with WM alone. This hypothesis was examined in a large cohort of breast cancer patients treated across nearly 4000 medical facilities nationwide, encompassing the entire Taiwanese population. Methods: A retrospective cohort study was performed to analyze Taiwan’s National Health Insurance Research Database and Cancer Registry. Women newly diagnosed with breast cancer between 2004 and 2013 who subsequently developed depression (≥3 outpatient diagnoses or 1 hospitalization) were followed until death or 31 December 2021. Patients receiving ≥30 cumulative days of TCM after diagnosis were classified as the ICWM group, whereas those receiving <30 days were classified as the WM group. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) for all-cause mortality. Healthcare utilization, including emergency department visits, hospitalization, and medical expenditures, was analyzed on a per-person-year basis. Results: A total of 1193 patients were included, with 488 in the WM group and 705 in the ICWM group. Compared with WM users, ICWM users were younger, had lower body mass index, and were more likely to have stage 0–II disease. ICWM was associated with lower total, inpatient, and emergency healthcare expenditures per person-year, as well as fewer emergency visits per person-year, although outpatient and overall visits were higher. In stage-stratified multivariable analyses, ICWM was associated with lower all-cause mortality in both stage 0–II disease (aHR = 0.61, 95% CI: 0.39–0.94) and stage III–IV disease (aHR = 0.38, 95% CI: 0.21–0.67). Kaplan–Meier analyses likewise showed significantly better overall survival in the ICWM group in both early-stage and advanced-stage disease. Conclusions: In this nationwide retrospective cohort of breast cancer patients with depression, adjunctive ICWM was associated with better survival, lower acute care utilization, and lower healthcare expenditures compared with WM alone. However, because quality of life was not directly measured and the study was based on observational data, QoL-related interpretations should be made cautiously, with healthcare utilization outcomes viewed as indirect proxy indicators rather than direct evidence of improved daily QoL. Full article

The Therapeutic Shoe Benefit (TSB) allows Medicare insurance beneficiaries to reduce their diabetic foot ulcer risk by providing offloading shoes. Anecdotal evidence suggests that the process is cumbersome and that not all providers are aware of this benefit. This study evaluated TSB awareness across multiple healthcare disciplines and documented barriers to utilization. An online study surveyed healthcare providers practicing in the United States to determine familiarity with TSB and barriers to prescribing therapeutic shoes. The project was IRB-reviewed and received exempt status. The survey was sent to a wide variety of healthcare practitioners including: podiatrists, primary care providers, physical therapists, orthotist/prosthetists, specialty providers, and diabetes educators. This was done through targeted emails from professional organizations, word-of-mouth messaging through private practice groups, and marketing on LinkedIn. The survey was administered via Qualtrics with embedded branching logic used to gather data from the TSB’s three classifications of healthcare specialists: certifying physicians, prescribing practitioners, and suppliers. A total of 580 valid completions of the survey were analyzed. Irrespective of the TSB, podiatric physicians and medical professionals providing direct patient care recommend supportive shoes for patients with diabetes 98.2% (336/342) of the time. When asked about knowledge of the TSB, 522 or 90% of respondents indicated awareness of this Medicare benefit. Knowledge by specialty was hard to differentiate due to low responses by some specialties; however, prescribing podiatrists and prosthetic providers both responded with a familiarity rate above 92%. Common obstacles to providers prescribing shoes were: complexity of documentation (67.8%), challenges communicating with other providers (55.0%), and financial reasons/labor-to-reimbursement ratio (38.4%). TSB has the potential to reduce amputations and wound care costs. However, therapeutic shoes are underutilized with less than 20% of potential beneficiaries accessing this benefit. This research strengthens the argument that streamlining the process may increase access to therapeutic shoes. Full article

Background: Chronic Obstructive Pulmonary Disease (COPD) poses a substantial public health challenge in China owing to its increasing prevalence and substantial economic burden. In response, the diagnosis–intervention packet (DIP) payment reform was implemented to control healthcare costs and enhance service efficiency. Methods: To evaluate the effect of the DIP reform on medical costs, hospitalization days, and individual out-of-pocket payments for COPD inpatients in M City, a pilot city in central China, we conducted an interrupted time series (ITS) analysis using monthly reimbursement records from January 2020 to December 2023. The study included 84,410 hospitalized patients from a city-wide database of 3,241,233 inpatient records with COPD who met the inclusion criteria. The analysis focused on the total healthcare costs, length of stay, and individual out-of-pocket costs. Results: The DIP reform resulted in a 3.7% reduction (95% CI: 0.9% to 6.5%) in the total hospitalization costs in the first month post-reform, with a sustained monthly decline of 0.8% (95% CI: 0.5% to 1.1%). The length of stay decreased from 9.53 (95% CI: 9.31 to 9.75) to 8.74 days (95% CI: 8.62 to 8.86). Conversely, the proportion of out-of-pocket payments relative to total costs increased. Conclusions: While the DIP reform effectively reduced hospitalization costs and days, it led to an increase in individual out-of-pocket payments. Future research should focus on optimizing payment rules, enhancing the supervision of medical services, and refining health insurance policies to achieve the reform’s objectives better and alleviate the financial burden on patients. Full article

Introduction: Recurrent inguinal hernia remains a clinically relevant outcome that is difficult to quantify in the absence of national prospective registries. In Romania, structural differences between public and private hospitals may further influence recurrence-related care, access to minimally invasive surgery, and resource utilization. This study aimed to assess recurrence patterns after inguinal hernia repair at a national level, with emphasis on reinterventions, patient-related risk factors, and health system disparities. Methods: A nationwide retrospective cohort study was conducted using administrative DRG data from the Romanian National Health Insurance House. All adult patients undergoing inguinal hernia repair in 2019 were identified and followed for five years (2019–2023). Reintervention was used as a proxy for recurrence. Surgical approach, hospital sector, length of stay, reimbursement, patient migration, geographic distribution, and comorbidities were analyzed using descriptive statistics and multivariable logistic regression to explore factors associated with laparoscopic approach and reintervention. Results: Among the 18,185 patients who underwent inguinal hernia repair in 2019, reintervention rates during follow-up ranged from 0.58% to 4.88%, a variability that reflects inherent limitations of administrative coding. Most reinterventions occurred in the year of the index surgery, suggesting early technical failure. Public hospitals managed the majority of cases and disproportionately absorbed recurrent and clinically complex patients. Access to laparoscopic repair was uneven and concentrated in large academic centers. Length of hospital stay declined gradually in public hospitals but remained consistently shorter in private institutions, reflecting differences in patient selection and care pathways. Reimbursement by The National Health Insurance House was similar for open and laparoscopic procedures. Conclusions: Recurrent inguinal hernia care in Romania is shaped by system-level disparities extending beyond surgical technique. Further progress requires reimbursement reform, establishment of a national hernia registry, and expansion of laparoscopic training to ensure equitable access to high-quality hernia care. Full article

Liquid biopsy (LB) offers a minimally invasive approach to characterizing and monitoring glioblastoma (GB), a tumor marked by extensive heterogeneity, limited surgical accessibility and rapid molecular evolution. By analyzing circulating tumor-derived components such as circulating tumor DNA (ctDNA), extracellular vesicles (EVs), circulating RNA species and circulating tumor cells (CTC), LB provides dynamic molecular information that cannot be captured by neuroimaging or single-site tissue sampling. Cerebrospinal fluid (CSF) currently yields the highest sensitivity for detecting tumor-specific alterations, while plasma enables repeat monitoring despite lower biomarker abundance. EVs have gained particular prominence due to their ability to preserve DNA, RNA, and protein cargo that reflects key genomic changes, treatment resistance mechanisms, and immune evasion. Although advances are substantial, clinical implementation remains constrained by low analyte concentrations, methodological variability, limited standardization and the high cost of testing, which is rarely reimbursed by insurers. This review summarizes current evidence on circulating biomarkers in GB and highlights research priorities essential for integrating LB into future diagnostic and therapeutic workflows. Full article

Pet health insurance can reduce the financial burden of veterinary care and ensure adequate treatment for companion animals. In France, where 67% of households own at least one pet and 68% of owners consider them family members, awareness of pet insurance reaches 94%, yet only around 5–6% of pets are insured. This review aims to provide an overview of the French pet health insurance market, analysing its structure, coverage options, and potential implications for veterinary practice. A literature review was conducted using French and English sources, complemented by simulated price quotes from major insurance companies for four virtual pets (two dogs and two cats). The analysis compared 11 major French pet insurance providers across criteria such as species covered, waiting periods, age limits, coverage rates, reimbursement mechanisms, and preventive care benefits. The results reveal significant variability in coverage options, preventive care allowances, and reimbursement procedures. Across providers, simulated annual premiums for the virtual pets ranged from EUR 71.76 to EUR 1426.44, with reimbursement rates of 50–100% and annual caps of EUR 763–2500. It can be concluded that pet insurance may help owners manage unexpected veterinary costs and encourage preventive care. However, subscription rates remain low due to limited understanding of insurance plans and perceived high costs. Wider adoption of pet insurance could improve access to care and ensure fair remuneration for veterinarians. Full article

Background/Objectives: Under the urban–rural dual structure, rural children’s health security faces multiple challenges. These stem from geographical disadvantages, inadequate resources, and systemic flaws in medical insurance design. The outpatient cost-sharing policy is a key design to address these issues. Methods: Using data from the 2018 China Household Income Project (CHIP), this study employs Propensity Score Matching, Ordered Probit, Logit, and a Two-Part Model to examine the association between the policy and the health and economic outcomes of rural children. Conclusions: The results show that the policy is significantly associated with better child health scores and a higher probability of reimbursement. These positive associations appear to be connected to three potential factors: higher use of outpatient services, better mother’s health, and greater school-related food and accommodation expenses. In contrast to adult populations, no significant substitution between outpatient and inpatient services was observed for children, suggesting the non-discretionary and rigid nature of pediatric hospitalization decisions. This research provides robust empirical evidence for the policy’s potential benefits, offering important implications for optimizing the child medical security system. Full article

Background: Obesity, gastrointestinal disorders, and mental health conditions are major drivers of employer healthcare expenditures, yet nutrition-focused interventions are infrequently reimbursed by health insurance. Precision nutrition, which integrates genetic, gut microbiome, biometric, and behavioral data to guide personalized dietary and lifestyle changes, may offer a scalable approach to reducing costs associated with diet-responsive conditions. Objectives: To evaluate the impact of a precision nutrition digital therapeutic on employer medical spending for diet-responsive conditions in self-insured U.S. health plans. Methods: We conducted a retrospective cohort study of medical claims from January 2022 to December 2024 across seven U.S. self-insured employers. Employees enrolled in a precision nutrition digital therapeutic (n = 258) were compared with never-enrolled peers (n = 8268). We estimated treatment effects using a two-stage difference-in-differences model with member and calendar-month fixed effects and clustered standard errors, focusing on per-member-per-year (PMPY) employer-paid medical spending overall and for predefined diet-responsive condition categories. PMPY estimates were defined conditional on months with positive employer-paid spending and therefore reflect changes in the intensity of spending among members generating claims rather than unconditional per-capita costs. Results: Enrollment in the precision nutrition digital therapeutic was associated with a −$3012 PMPY reduction in diet-responsive medical spending (p = 0.021) relative to non-enrolled peers on this conditional basis. The largest relative reductions were observed for digestive disorders (−$9240 PMPY; p = 0.029) and obesity (−$4884 PMPY; p = 0.007), with a smaller reduction for anxiety-related conditions (−$1356 PMPY; p = 0.043). Total medical spending decreased by −$4044 PMPY but this change did not reach statistical significance (p = 0.09). Conclusions: In this multi-employer claims analysis, participation in a precision nutrition digital therapeutic was associated with lower employer-paid medical expenditures for diet-responsive conditions, particularly digestive disorders and obesity. These findings suggest that precision nutrition digital therapeutics may represent a scalable strategy for employers to address the economic burden of chronic disease within self-insured health plans by reducing the intensity of medical spending among members. Full article

Limb amputation is a growing health concern worldwide, driven largely by the rising incidence of vascular and metabolic diseases and military conflicts. In the past two decades, remarkable advancements in surgical techniques, prosthetic technologies, and rehabilitation strategies have made a profound impact on outcomes for individuals with limb loss. In this article, we explore the evolving landscape of limb care in the United States, highlighting innovations in prosthetic technology and amputation surgery including osseointegration, neuromuscular surgeries and interfaces, artificial intelligence, sensory feedback, and the importance of prosthetic embodiment. We discuss limb care systems and the continuum of limb loss rehabilitation, focusing on the need for coordinated models of patient-centered care. We present the demographic biases and healthcare disparities related to insurance coverage and reimbursement in the United States and the explore ethics and equitability considerations pertaining to prosthetic standard of care and advanced treatments for limb loss. Finally, we lay out the systemic reform, policy advocacy, and future research needed to ensure that everyone with limb loss has equitable access to the benefits of modern amputee care. Full article

Background: Budget Impact Analysis is an integral part of the Health Technology Assessment in Bulgaria, informing reimbursement decisions of the National Health Insurance Fund. Inaccurate projections risk both fiscal unsustainability and restricted patient access to innovation. Yet projection accuracy methods remains uncertain, particularly given limited epidemiologic data and evolving clinical use. Objectives: This study aimed to assess the empirical validity of Health Technology Assessment budget-impact projections for medicines approved in 2019 by comparing projected patient volumes and expenditures with real-world National Health Insurance Fund reimbursements through 2025, and to identify drivers of divergence across therapeutic areas and reimbursement channels. Methods: We conducted a retrospective cohort analysis linking 2019 Health Technology Assessment submissions with monthly National Health Insurance Fund claims for both hospital and outpatient reimbursement channels. Actual utilization was calculated as the annualized median number of treated patients per month. Projected costs were derived by multiplying HTA-projected patient volumes by the observed unit cost per patient-month. We quantified deviations using observed-to-projected ratios and absolute gaps and assessed the relationship between projected and actual expenditures using a log–log regression model. Results: By September 2025, realized volumes typically exceeded projections (median ratio 1.6; range 0.02–21.3). Large overshoots were observed for Avelumab, Risankizumab, and Guselkumab; Cobimetinib and Abemaciclib remained below forecast. Expenditure deviations were driven predominantly by volume: immunology (+€17.4 million) and oncology (+€5.0 million) accounted for the largest absolute gaps. Elasticity was near proportional overall (β = 1.002; standard error = 0.24; R² = 0.50), lower in hospitals (β = 0.79; p = 0.055) and higher in outpatient care (β = 1.30; p = 0.003). Conclusions: Health Technology Assessment Budget Impact Analyses captured broad cost scaling but systematically missed product-specific uptake, with deviations largely volume-driven. Strengthening national registries and real-world data pipelines, and adopting dynamic, indication-responsive contracting and forecasting, could materially improve budget predictability while preserving access to innovation. Full article

Background/Objectives: Unpaid medical expenses incurred by foreign nationals represent a growing concern for healthcare systems amid increasing international mobility. Japan, which lacks mandatory public insurance coverage for non-resident visitors, faces particular vulnerability in terms of uncompensated hospital care. This study aims to identify factors contributing to unpaid medical charges among uninsured, non-resident foreign patients hospitalized at a tertiary care facility in Tokyo. Methods: This retrospective observational analysis was conducted using medical and administrative data from patients admitted between January 2023 and February 2025. Patients who received elective medical tourism care were excluded. Data on demographics, length of hospital stay, care intensity, payment status, and third-party financial assistance were analyzed. Logistic regression models were applied to assess predictors of nonpayment. Results: Among 153 eligible cases, 9 patients (5.9%) had outstanding hospital bills upon discharge. Compared with those with completed payments, the unpaid group experienced longer admissions, more intensive care utilization, and higher total charges. Notably, the absence of third-party financial support (primarily travel insurance) was significantly associated with unpaid charges. Multivariate analysis identified this factor as the main independent predictor (adjusted odds ratio [OR]: 0.12; 95% confidence interval [CI]: 0.02–0.915; p = 0.040). Total amount of billing was also statistically significant (adjusted odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00–1.01; p = 0.039). Conclusions: These findings highlight the importance of private insurance in mitigating financial risk in hospitals. Implementing policy measures to promote or require insurance enrollment, along with streamlined reimbursement systems, may contribute to sustainable care delivery for international patients. Full article

Background: Preventing and reducing acute exacerbations is a key objective in chronic obstructive pulmonary disease (COPD) management. Therefore, vaccination against influenza and pneumococcal disease is particularly important for this population. Under self-funded vaccination policies, the coverage rates for both vaccines among COPD patients in China are critically low. Since 2013, Shanghai has implemented a program providing one free dose of the 23-valent pneumococcal polysaccharide vaccine (PPV23) to residents aged 60 and above, whereas influenza vaccination remains self-funded. Few studies have compared influenza and pneumococcal vaccination coverage among COPD patients in China under these distinct funding strategies. Methods: This study used a stratified cluster sampling method to select COPD patients registered in the “Shanghai Community Chronic Disease Health Management System” from both urban (Xuhui) and suburban (Fengxian) districts of Shanghai. Data on demographic characteristics, medical history, physical examination results, behavioral risk factors, and vaccination records were extracted from the system. Vaccination records were verified using the “Shanghai Immunization Information System”. Descriptive analysis was conducted to assess influenza vaccine (self-funded, InfV) coverage during the 2023/2024 influenza season and cumulative PPV23 (government-funded) vaccination coverage among COPD patients. Logistic regression analysis was further employed to identify potential factors associated with InfV and PPV23 vaccination uptake in this population. Results: During the 2023/2024 influenza season, the influenza vaccination coverage under a self-funded policy was 5.87% among 1601 COPD patients in Shanghai, while the cumulative coverage of PPV23 under the government-funded program reached 52.15%. The willingness to receive PPV23 (60.40% vs. 27.55%; χ² = 350.73, p < 0.001) and the uptake among willing individuals (86.35% vs. 21.32%; χ² = 570.69, p < 0.001) were significantly higher under the free strategy compared to the self-funded InfV. For both vaccines, the primary reason for vaccine hesitancy was concern about adverse reactions, cited by over 50% of unwilling COPD patients. Multivariate analysis identified urban residence (aOR = 4.47, 95%CI: 2.86–6.98), prior PPV23 vaccination (aOR = 6.00, 95%CI: 3.43–10.49) and prior COVID-19 vaccination (aOR = 3.18, 95%CI: 1.79–5.66) as positive predictors of self-funded influenza vaccination. For PPV23 vaccination under the government-funded policy, significant factors included prior influenza vaccination (aOR = 6.89, 95%CI: 4.68–10.12), advanced age (aOR = 4.73, 95%CI: 3.68–6.09), and suburban residence (aOR = 0.37, 95%CI: 0.29–0.47). Conclusions: Influenza vaccination coverage among COPD patients in Shanghai remains critically low compared to the government-funded PPV23, highlighting the pivotal role of public funding. To address this disparity, urgent policy measures, including incorporating the influenza vaccine into publicly funded or health insurance reimbursement schemes, are essential. Full article