The Patient Protection and Affordable Care Act: opportunities for prevention and public health

Shaw, Frederic E.; Asomugha, Chisara N.; Conway, Patrick H.; Rein, Andrew S.

doi:10.1016/s0140-6736(14)60259-2

Cited by 95 publications

(63 citation statements)

References 15 publications

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“…15 Based on the findings in this study, the anesthetic choice and surgical approach utilized for CTR represents a Note. The y-axis on the left is for general or regional anesthesia while the y-axis on the right is for local anesthesia.…”

Section: Discussionmentioning

confidence: 97%

Surgical Approach and Anesthetic Modality for Carpal Tunnel Release

Foster

Sivasundaram

Heckmann

et al. 2016

Hand (New York, N,Y.)

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Background: Carpal tunnel release (CTR) is commonly performed for carpal tunnel syndrome once conservative treatment has failed. Operative technique and anesthetic modality vary by surgeon preference and patient factors. However, CTR practices and anesthetic trends have, to date, not been described on a nationwide scale in the United States. Methods: The PearlDiver Patient Records Database was used to search Current Procedural Terminology codes for elective CTR from 2007 to 2011. Anesthetic modality (eg, general and regional anesthesia vs local anesthesia) and surgical approach (eg, endoscopic vs open) were recorded for this patient population. Cost analysis, patient demographics, regional variation, and annual changes in CTR surgery were evaluated. Results: We identified 86 687 patients who underwent carpal tunnel surgery during this 5-year time period. In this patient sample, 80.5% of CTR procedures were performed using general or regional anesthesia, compared with 19.5% of procedures performed using local anesthesia; 83.9% of all CTR were performed in an open fashion, and 16.1% were performed using an endoscopic technique. Endoscopic surgery was on average $794 more expensive than open surgery, and general or regional anesthesia was $654 more costly than local anesthesia. Conclusions: In the United States, open CTR under local anesthesia is the most cost-effective way to perform a CTR. However, only a small fraction of elective CTR procedures are performed with this technique, representing a potential area for significant health care cost savings. In addition, regional and age variations exist in procedure and anesthetic type utilized.

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Section: Discussionmentioning

confidence: 97%

Surgical Approach and Anesthetic Modality for Carpal Tunnel Release

Foster

Sivasundaram

Heckmann

et al. 2016

Hand (New York, N,Y.)

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“…14,79 The ACA instituted measures to increase access and funding for preventative health services including mandated insurance coverage of ACIP-recommended vaccinations when delivered by in-network providers. 80,81 However, pharmacies are still largely considered outof-network providers and the ACA did not change the terms of Medicare Part D coverage, which create additional challenges for both patients and pharmacists pursuing insurance coverage and reimbursement. Higher rates of insured adults and a greater emphasis on providing services through patient-centered medical homes will likely influence the utilization and sustainability of PBIS.…”

Section: Discussionmentioning

confidence: 99%

Community pharmacies as sites of adult vaccination: A systematic review

Burson

Buttenheim

Armstrong

et al. 2016

Human Vaccines & Immunotherapeutics

142

118

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Vaccine-preventable deaths among adults remain a major public health concern, despite continued efforts to increase vaccination rates in this population. Alternative approaches to immunization delivery may help address under-vaccination among adults. This systematic review assesses the feasibility, acceptability, and effectiveness of community pharmacies as sites for adult vaccination. We searched 5 electronic databases (PubMed, EMBASE, Scopus, Cochrane, LILACS) for studies published prior to June 2016 and identified 47 relevant articles. We found that pharmacy-based immunization services (PBIS) have been facilitated by state regulatory changes and training programs that allow pharmacists to directly provide vaccinations. These services are widely accepted by both patients and pharmacy staff, and are capable of improving access and increasing vaccination rates. However, political and organizational barriers limit the feasibility and effectiveness of vaccine delivery in pharmacies. These studies provide evidence to inform policy and organizational efforts that promote the efficacy and sustainability of PBIS.

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“…In 2014, the ACA extended health insurance coverage to low-income Americans through expansion of Medicaid eligibility in states that choose to participate. 8,9,12,25,26 The health insurance coverage gains realized through Medicaid expansion, the Health Insurance Marketplace, and the individual market coverage may have helped reduce the percentage of uninsured working-aged adults. 27 In a recent analysis, researchers estimated that the ACA increased the number of insured workingaged adults by an estimated 16.9 million compared with the number who would have been insured had the law not been enacted.…”

Section: Discussionmentioning

confidence: 99%

Trends of lack of health insurance among US adults aged 18–64 years: findings from the Behavioral Risk Factor Surveillance System, 1993–2014

et al. 2017

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a b s t r a c tObjective: To examine the prevalence of lack of health insurance and its changes over time among adult residents (aged 18e64 years) in 50 states and the District of Columbia (DC).Study design: Cross-sectional surveys. Methods:We aggregated annual state-based Behavioral Risk Factor Surveillance System (BRFSS) data from 1993 through 2014 to provide nationwide and state-based prevalence estimates for lack of insurance among adults aged 18e64 years. The adjusted prevalence was estimated using log-linear regression analyses with a robust variance estimator after controlling for demographic variables. The trend was assessed separately for the periods 1993e2010 and 2011e2014 due to methodologic changes in the BRFSS.Results: From 1993 through 2010, the adjusted prevalence of lack of health insurance increased by 0.54% (P < 0.0001) annually (range: 16.3% in 1995 to 19.1% in 2005); this prevalence decreased significantly in 2014 (15.1%). In 2014, Georgia, Mississippi, and Texas had the highest adjusted prevalences (range: 23.0e24.6%) of lack of health insurance, and DC, Massachusetts, and Rhode Island had the lowest (range: 6.2e10.1%). The changes in the prevalence of lack of insurance over time varied significantly by state. Conclusions:The nationwide prevalence of lack of health insurance decreased significantly in the past few years, especially in 2014 when about one-seventh of Americans aged 18e64 years reported lack of health insurance coverage. The huge variations in the prevalence of lack of health insurance and its changes over time among states suggest continuing efforts to ensure healthcare access for all Americans are needed to improve the overall health of the population.

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The Patient Protection and Affordable Care Act: opportunities for prevention and public health

Cited by 95 publications

References 15 publications

Surgical Approach and Anesthetic Modality for Carpal Tunnel Release

Surgical Approach and Anesthetic Modality for Carpal Tunnel Release

Community pharmacies as sites of adult vaccination: A systematic review

Trends of lack of health insurance among US adults aged 18–64 years: findings from the Behavioral Risk Factor Surveillance System, 1993–2014

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