This paper examines factors associated with the cesarean birth rate, including medical condition and method of payment, in the largest maternity hospital of Fortaleza, Brazil. Data were collected on 5996 women who delivered at the Maternidade Escola Assis Chateaubriand from October 1980 to July 1981. All women were classified according to how they paid for their care: private (financed at least part of their care with own funds), insured (federal or state), or indigent. Private patients were found to be far more likely than patients in the other two groups to have cesarean deliveries, due primarily to the high percentage of private patients recorded as having prolonged or obstructed labor, combined with a high rate of prior cesarean sections. From this data, it appears likely that financial incentives did play a role in physician decisions on whether to perform cesarean deliveries.
To assess health care resource utilization (HRU) and costs associated with comorbid obesity in patients with type 2 diabetes mellitus (T2DM) from a nationally representative US sample. METHODS: The 2009 Medical Expenditure Panel Survey was analyzed to identify adults (≥20 years) with diabetes (ICD-9-CM: 250). T2DM was identified if one of the following criteria was met: 1) evidence of ≥1 oral or non-insulin injectable anti-diabetic medication; 2) diagnosis of diabetes after age 30; 3) diagnosis before age 30 and not on insulin monotherapy. Pregnant women were excluded. Annual HRU and costs were compared for individuals with T2DM based on the presence of comorbid obesity (BMI≥30 kg/m 2 ). A generalized linear regression model adjusting for patient demographic and clinical characteristics was performed to assess the association between comorbid obesity and total health care costs. Population weights were applied to account for the multi-stage sampling design to produce nationally representative estimates. RESULTS: Of the 2,269 T2DM patients (representing 19.2 million individuals in the US), 54.5% were obese. Obese T2DM patients were more likely to be younger (59 vs. 65 years; p<0.01) than non-obese T2DM patients. Obese T2DM patients had similar inpatient hospital (17.8% vs. 17.9%; p=0.99) and emergency room (21.7% vs. 19.5%; p=0.33) utilization but utilized more outpatient hospital visits (33.3% vs. 27.9%; p=0.03), had more prescription medication fills (48.0 vs. 37.1, p<0.01) and higher total health care costs ($12,009 vs. $10,081, p=0.02) than non-obese T2DM patients. After controlling for age, gender, race, income, insured status and comorbidities, obese T2DM patients had total health care costs of 1.19 times those of the non-obese T2DM patients (p=0.04). CONCLUSIONS: Obesity appears to be associated with higher health care costs in T2DM patients. Effective weight management in T2DM patients may be costeffective and should be considered in diabetes treatment plans.
and implementation results. RESULTS: Outpatient hemophilia treatment is covered by health insurance schemes in more than 80% of the selected cities, yet with reimbursement caps and patient co-pay requirements. While there is significant variation by city, the average co-pay requirement is more than 50% and annual reimbursement is usually capped below USD16k (100k CNY). However, some cities have pioneered innovative policies to provide better coverage for hemophilia patients: Guangzhou health insurance bureau has decreased hemophilia co-payments to less than 10% after their extensive review of the economics of hemophilia treatment. The local health insurance bureau in Qingdao has decided to joint-fund prophylaxis treatment for pediatric patients together with a FVIII manufacturer. CONCLUSIONS: Hemophilia treatment reimbursement in China is still at a low level overall despite a few pioneer cities which have identified unique approaches to reducing the economic burden of patients living with hemophilia. There is significant room to increase reimbursement ratio and cap to reduce patients' economic burden, and meanwhile we expect tailored public-private partnerships to be a promising supplementing solution.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.