Quantifying delay in access to new medical treatment: an application of risk advancement period methodology

BACKGROUND: We present a novel application of the concept of risk or rate advancement to compute the extent of delay in adoption of an effective new drug in 2 German health insurance systems. METHODS: We identified individuals with migraines, age 18 to 65 years, in 371 primary care practices in Germany in 1994 (MediPlus, IMS Health database). These included 8173 persons covered under the statutory health insurance system and 503 persons covered by private health insurance. We derived risk and population risk advancement periods for sumatriptan compared with nonserotoninergic acute migraine therapy using multiplicative risk regression and generalized estimating equations, adjusted for patient, physician, and practice cofactors. RESULTS: For patients at the mean age of the cohort, 43 years of age, sumatriptan was prescribed 1.2 (95% confidence interval [CI] = 0.3-2.0) years later among those in the statutory health insurance system compared with those who had private insurance. The lag increased by 0.6 (-0.1 to 1.3) years for every 10 years of patient age. In the age-mix of our sample, access to the health benefits of sumatriptan therapy lagged nearly 1.5 years behind in the statutory health insurance system and for Germany as a whole. CONCLUSIONS: Migraine patients' access to sumatriptan therapy lagged substantially in the statutory health insurance system and in the country as a whole. Risk advancement periods provide a useful methodology for communicating major healthcare issues in a meaningful way to society and policymakers.     

Managing the behavior of the medically insured in Germany: the acceptance of cost-sharing and risk premiums by members of the statutory health insurance

In the course of the conflicts over the reform of statutory health insurance in Germany complaints about moral hazard-behavior on the part of the insured were repeatedly raised and linked to the demand for expanding managerial incentives aimed at reducing the consumption of health care benefits (copayments). However, critics and supporters of managerial incentives mostly neglect the perceptions and dispositions of the insured. In contrast, the article examines how members of the statutory health insurance scheme assess managerial intervention, namely cost-sharing and risk premiums.     

市场经济与卫生改革对不同性别人群卫生服务可及性的影响

该文采用定性研究方法,描述和分析了南通、淄博两市在市场经济条件下医疗保健制度改革对不同性别人群卫生服务可及性的影响.研究发现不同性别人群的卫生服务可及性与疾病种类、个人与家庭的经济实力、可享有的社会福利、以及社会地位/关系等直接相关;性别差异对卫生服务可及性无直接影响;在职女工的妇女保健服务基本可及.但个人与家庭抗慢性重大疾病风险的能力不足;非在职职工的医疗保险和保健工作需要大,但落实难;社会政策的制定还应为女性劳动者创造公平的竞争条件,并为其生儿育女的再生产过程提供风险保障.     

Who is giving up the free lunch? The insured patients’ decision to access health insurance benefits and its determinants: Evidence from a low-income country

ObjectivesThis paper examines the determinants of the insured's decision to use their health insurance card when seeking outpatient and inpatient health care in Vietnam.MethodsUses Vietnam's latest Household Living Standard Survey data and random-intercept logistic regression to assess the influence of the observed individual, household and commune/ward factors on the insured's decision to access health insurance benefits while controlling for the unobserved commune/ward-specific factors.ResultsCompared to the compulsory enrollees, the voluntary enrollees and the beneficiaries of the Health Care Fund for the Poor are less likely to use their card when seeking inpatient care. An individual's likelihood of accessing insurance benefits varies inversely with income and the level of education, suggesting that the outpatient care provided to the insured is of inferior quality.ConclusionsAlthough health insurance has the potential of increasing access and reducing the financial burden of health care utilization, Vietnam's experience clearly suggests that these benefits may not be fully realized as long as the quality of care remains low and the high opportunity costs of accessing insurance benefits deter the insured from accessing benefits.     

Urban and Rural Differences in Health Insurance and Access to Care

This study considers differences in access to health care and insurance characteristics between residents of urban and rural areas. Data were collected from a telephone survey of 10,310 randomly selected households in Minnesota. Sub-samples of 400 group-insured, individually insured, intermittently insured, and uninsured people, were asked about access to health care. Those with group or individual insurance were also asked about the costs and characteristics of their insurance policies.
Rural areas had a higher proportion of uninsured and individually insured respondents than urban areas. Among those who purchased insurance through an employer, rural residents had fewer covered benefits than urban residents (5.1 vs 5.7, P < 0.01) and were more likely to have a deductible (80% versus 40%, P < 0.01). In spite of this, rural uninsured residents were more likely to have a regular source of care than urban residents (69% versus 51%, P < 0.01), and were less likely to have delayed care when they thought it was necessary (21% versus 32%, P<0.01). These differences were confirmed by multivariate analysis.
Rural residents with group insurance have higher out-of-pocket costs and fewer benefits. Uninsured rural residents may have better access to health care than their urban counterparts. Attempts to expand access to health care need to consider how the current structure of employment-based insurance creates inequities for individuals in rural areas as well as the burdens this structure may place on rural providers.     

Les politiques publiques affectant négativement les familles demandeuses d’asile avec des jeunes de 0 à 5 ans au Québec

In 2019, 30,615 asylum claims were made in Quebec, representing almost half of the claims made in Canada. Asylum-seeking families with young children (0 to 5 years) represent a significant proportion of this population. Canada, as well as Quebec, have a responsibility to protect asylum seekers and to ensure that public policies promote health and well-being, especially among children. However, certain existing public policies exclude asylum seekers and are negatively affecting families. This commentary seeks to raise awareness among all those involved in policymaking, especially decision-makers, regarding asylum-seekers and three policy domains that are contributing to poverty, social isolation, and reduced access to care among asylum-seeking families with young children. These include the lack of eligibility for child benefits, the limited access to affordable daycare, and barriers to accessing family doctors. Consequently, both parents and children suffer impacts to their health and well-being. We are calling on our governments to assume their responsibilities and eliminate these inequities, and to ensure that the health of asylum seekers is considered in all policies.     

Impfempfehlungen der Ständigen Impfkommission beim Robert Koch-Institut

The promotion of immunisation in Germany is regulated under Federal and Land (state) law. The Protection against Infection Act (Infektionsschutzgesetz) provides the framework for immunisations as a means of public health protection from vaccine-preventable diseases. Book Five of the Social Code (SGB V) regulates the claim of statutory health insurance members to receive protective vaccinations. Both federal laws stipulate that the health administration and the self-administration organs proceed on the basis of the recommendations issued by the Standing Committee on Vaccination (STIKO) at the Robert Koch Institute. This ensures homogeneous, evidence-based and comprehensive preventive immunisation coverage and the provision of the corresponding benefits by the statutory health insurance. In the Laender (states), the tasks and possibilities of the public health services vary with respect to preventive immunisations. A future task will be to further intensify cooperation among the institutions of self-administration in the health care system and the authorities at the local, Land (state) and Federal levels. Concerted action can achieve an increase in immunisation participation by the population, especially in regions where levels are moderate.     

医疗保险设计如何影响卫生服务的成本和可及性——根据11个国家不同收入人群的调查

2010年的调查研究了澳大利亚、加拿大、法国、德国、荷兰、新西兰、挪威、瑞典、瑞士、美国和英国成人的医保相关经历。这些国家的医保有不同的覆盖范围,体现在既有公共的又有公私合营的保险体系,并且具有不同的费用报销比例。总的来说,本次研究发现医疗保险设计导致不同保险的可及性、成本分担和问题等方面存在显著差异。即使在有保险的情况下,美国的成年人承担的医疗费用最高,需要花费大量时间填写保险书面材料和处理争议并且有可能被拒绝支付。德国人和美国人在填写书面材料上花费的时间差不多,但是不需要自付费用;瑞士人的自付费用虽然很高,但是在获得医保或者费用支付上没有任何障碍。对于美国成年人,全面的医疗改革可以在很多方面改进,包括减少本次研究中发现的因收入不同而产生的差别。     

Patients' rights to care under Clinton's Health Security Act: the structure of reform.

Like most reform proposals, President Clinton's proposed Health Security Act offers universal access to care but does not significantly alter the nature of patients' legal rights to services. The act would create a system of delegated federal regulation in which the states would act like federal administrative agencies to carry out reform. To achieve uniform, universal coverage, the act would establish a form of mandatory health insurance, with federal law controlling the minimum services to which everyone would be entitled. Because there is no constitutionally protected right to health care and no independent constitutional standard for judging what insurance benefits are appropriate, the federal government would retain considerable freedom to decide what services would and would not be covered. If specific benefits are necessary for patients, they will have to be stated in the legislation that produces reform.     

Economic burden of multiple sclerosis to the social insurance system in Germany

Aim

This study aims to calculate the cost of illness concerning multiple sclerosis (MS) from the perspective of the German social insurance system.

Subjects and methods

Expenditures for MS (ICD-10 GM: G35) were evaluated retrospectively for the year 2012 from the perspective of the social insurance system. Expenditures from the German statutory health insurance, the Federal statutory pension fund, and statutory long-term care insurances were calculated based on administrative claims of a large nationwide health insurance and statistics from the Federal statutory pension fund. Additionally, expenditures of the long-term care insurances were requested by standardized questionnaire. Costs were extrapolated for all health and statutory long-term care insurances.

Results

In the base case, extrapolated expenditures for German statutory health insurance amount to 1.062 billion €. German statutory pension funds expenses for MS were around 258.700 million € on medical rehabilitation and early retirement. Extrapolated for the whole population insured expenditures of the statutory long-term care insurances on persons with MS were approximately 372.200 million €.

Conclusion

This study delivered important information regarding the economic burden of MS for the social insurance system in Germany. The top-down process of data collection yielded population-based results on the cost of illness.

     

Current research perspectives of health system research and health economics in Germany

The German statutory health insurance scheme is confronted with a steadily rapid progress of medical sciences and increasing difficulties to mobilize the financial resources necessary for applying the new scientific knowledge in health care. Therefore it is absolutely imperative to intensify the efforts to improve the effectiveness and efficiency of health care. Health policies based on health targets, the development of patterns requiring integrated care, redefining the bunch of health insurance benefits, and a more regular use of methods of economic evaluation have been proposed as promising approaches towards optimizing resource allocation in health care. However, an analysis of these approaches demonstrates that a valid appraisal of their potential to improve the effectiveness and efficiency of health care requires further research. In addition, European integration may produce tendencies towards a convergence of the national health care systems; this makes it rather difficult to assess how the room for autonomous national health policies will develop in the future.     

Gesundheits?konomische Evaluation auf Grundlage von GKV-Routinedaten

Although the quality of administrative data of German health insurance is relatively good, administrative data are rarely used for the purpose of health economic evaluations in Germany. Health economic evaluations in Germany have so far mainly been performed based on primary data while in other countries the use of secondary data is quite common. The objective of the article is to give an introduction into the possibilities of performing health economic evaluations based on administrative data. First, we show that German health insurance have data sets that allow the follow-up of patients across all sectors of health care. Subsequently, characteristics of primary data and administrative data of health insurance for the purpose of health economic evaluations are compared. Finally we present an overview of recently performed health economic evaluations based on administrative data in Germany and conclude with lessons from other countries on the use of administrative data and implications for Germany.     

Erstattungsf?higkeit neuartiger Arzneimitteltherapien

Medical progress poses a new financial challenge for the German statutory health insurance. In order to assure the stability of the German statutory health insurance all services have to be economical, but on the other hand the health care system allows access to new therapy in the ambulant and in-patient sector. This article describes in detail how new therapies are reimbursed.     

Health economic evaluation based on administrative data from German health insurance

Although the quality of administrative data of German health insurance is relatively good, administrative data are rarely used for the purpose of health economic evaluations in Germany. Health economic evaluations in Germany have so far mainly been performed based on primary data while in other countries the use of secondary data is quite common. The objective of the article is to give an introduction into the possibilities of performing health economic evaluations based on administrative data. First, we show that German health insurance have data sets that allow the follow-up of patients across all sectors of health care. Subsequently, characteristics of primary data and administrative data of health insurance for the purpose of health economic evaluations are compared. Finally we present an overview of recently performed health economic evaluations based on administrative data in Germany and conclude with lessons from other countries on the use of administrative data and implications for Germany.     

Reimbursement of new medical therapy

Medical progress poses a new financial challenge for the German statutory health insurance. In order to assure the stability of the German statutory health insurance all services have to be economical, but on the other hand the health care system allows access to new therapy in the ambulant and in-patient sector. This article describes in detail how new therapies are reimbursed.     

Do individuals respond to cost-sharing subsidies in their selections of marketplace health insurance plans?

The Affordable Care Act (ACA) provides assistance to low-income consumers through both premium subsidies and cost-sharing reductions (CSRs). Low-income consumers’ lack of health insurance literacy or information regarding CSRs may lead them to not take-up CSR benefits for which they are eligible. We use administrative data from 2014 to 2016 on roughly 22 million health insurance plan choices of low-income individuals enrolled in ACA Marketplace coverage to assess whether they behave in a manner consistent with being aware of the availability of CSRs. We take advantage of discontinuous changes in the schedule of CSR benefits to show that consumers are highly sensitive to the value of CSRs when selecting insurance plans and that a very low percentage select dominated plans. These findings suggest that CSR subsidies are salient to consumers and that the program is well designed to account for any lack of health insurance literacy among the low-income population it serves.     

Determinants of Regional Variation in Health Expenditures in Germany

Health care expenditure in Germany shows clear regional differences. Such geographic variations are often seen as an indicator for inefficiency. With its homogeneous health care system, low co‐payments and uniform prices, Germany is a particularly suited example to analyse regional variations. We use data for the year 2011 on expenditure, utilization of health services and state of health in Germany's statutory health insurance system. This data, which originate from a variety of administrative sources and cover about 90% of the population, are enriched with a wealth of socio‐economic variables, data on pollutants, prices and individual preferences. State of health and demography explains 55% of the differences as measured by the standard deviation while all control variables account for a total of 72% of the differences at county level. With other measures of variation, we can account for an even greater proportion. A higher proportion of variation than usually supposed can thus be explained. Whilst this study cannot quantify inefficiencies, our results contradict the thesis that regional variations reflect inefficiency. Copyright © 2015 John Wiley & Sons, Ltd.     

浅析医院信息系统中医保接口的实现方案

本文介绍了医院信息系统与医保系统接口的实现方案,重点研究了文件导出导入、嵌入式DLL和WEB服务接口三种接入模式,详细描述了我院门诊和住院的医保业务流程。