Base de dados : MEDLINE
Pesquisa : N03.219.521.576 [Categoria DeCS]
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[PMID]:29191895
[Au] Autor:Eisenberg R; Varmus H
[Ad] Endereço:University of Michigan Law School, Ann Arbor, MI 48109, USA. rse@umich.edu varmus@med.cornell.edu.
[Ti] Título:Insurance for broad genomic tests in oncology.
[So] Source:Science;358(6367):1133-1134, 2017 12 01.
[Is] ISSN:1095-9203
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Análise Mutacional de DNA/economia
Testes Genéticos/economia
Seguro
Neoplasias/genética
[Mh] Termos MeSH secundário: Análise Custo-Benefício
Genes erbB-1
Genômica/economia
Seres Humanos
Oncologia/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171202
[St] Status:MEDLINE
[do] DOI:10.1126/science.aao6708


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[PMID]:29298337
[Au] Autor:Zhang W; Su Y; Ke R; Chen X
[Ad] Endereço:School of Traffic and Transportation, Northeast Forestry University, Harbin, China.
[Ti] Título:Evaluating the influential priority of the factors on insurance loss of public transit.
[So] Source:PLoS One;13(1):e0190103, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Understanding correlation between influential factors and insurance losses is beneficial for insurers to accurately price and modify the bonus-malus system. Although there have been a certain number of achievements in insurance losses and claims modeling, limited efforts focus on exploring the relative role of accidents characteristics in insurance losses. The primary objective of this study is to evaluate the influential priority of transit accidents attributes, such as the time, location and type of accidents. Based on the dataset from Washington State Transit Insurance Pool (WSTIP) in USA, we implement several key algorithms to achieve the objectives. First, K-means algorithm contributes to cluster the insurance loss data into 6 intervals; second, Grey Relational Analysis (GCA) model is applied to calculate grey relational grades of the influential factors in each interval; in addition, we implement Naive Bayes model to compute the posterior probability of factors values falling in each interval. The results show that the time, location and type of accidents significantly influence the insurance loss in the first five intervals, but their grey relational grades show no significantly difference. In the last interval which represents the highest insurance loss, the grey relational grade of the time is significant higher than that of the location and type of accidents. For each value of the time and location, the insurance loss most likely falls in the first and second intervals which refers to the lower loss. However, for accidents between buses and non-motorized road users, the probability of insurance loss falling in the interval 6 tends to be highest.
[Mh] Termos MeSH primário: Acidentes de Trânsito
Seguro
Setor Público
Transportes
[Mh] Termos MeSH secundário: Algoritmos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180104
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190103


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[PMID]:28991426
[Au] Autor:Rothstein J; Valletta RG
[Ti] Título:Scraping by: Income and Program Participation After the Loss of Extended Unemployment Benefits.
[So] Source:J Policy Anal Manage;36(4):880-908, 2017.
[Is] ISSN:0276-8739
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Many Unemployment Insurance (UI) recipients do not find new jobs before exhausting their benefits, even when benefits are extended during recessions. Using Survey of Income and Program Participation (SIPP) panel data covering the 2001 and 2007 to 2009 recessions and their aftermaths, we identify individuals whose jobless spells outlasted their UI benefits (exhaustees) and examine household income, program participation, and health-related outcomes during the six months following UI exhaustion. For the average exhaustee, the loss of UI benefits is only slightly offset by increased participation in other safety net programs (e.g., food stamps), and family poverty rates rise substantially. Self-reported disability also rises following UI exhaustion. These patterns do not vary dramatically across household demographic groups, broad income level prior to job loss, or the two business cycles. The results highlight the unique, important role of UI in the U.S. social safety net.
[Mh] Termos MeSH primário: Nível de Saúde
Assistência Pública/utilização
Desemprego/estatística & dados numéricos
[Mh] Termos MeSH secundário: Recessão Econômica
Previsões
Seres Humanos
Renda
Seguro
Pobreza
Assistência Pública/estatística & dados numéricos
Assistência Pública/tendências
Previdência Social/tendências
Previdência Social/utilização
Desemprego/tendências
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:T
[Da] Data de entrada para processamento:171011
[St] Status:MEDLINE


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[PMID]:28708677
[Au] Autor:Edwards JD; Lucas AR; Boscardin WJ; Dudley RA
[Ad] Endereço:1Division of Pediatric Critical Care, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY.2Department of Statistics, University of California, Berkeley, CA.3Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA.4Department of Medicine, University of California, San Francisco, San Francisco, CA.5Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, San Francisco, CA.6Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA.
[Ti] Título:Repeated Critical Illness and Unplanned Readmissions Within 1 Year to PICUs.
[So] Source:Crit Care Med;45(8):1276-1284, 2017 Aug.
[Is] ISSN:1530-0293
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: To determine the occurrence rate of unplanned readmissions to PICUs within 1 year and examine risk factors associated with repeated readmission. DESIGN: Retrospective cohort analysis. SETTING: Seventy-six North American PICUs that participated in the Virtual Pediatric Systems, LLC (VPS, LLC, Los Angeles, CA). PATIENTS: Ninety-three thousand three hundred seventy-nine PICU patients discharged between 2009 and 2010. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Index admissions and unplanned readmissions were characterized and their outcomes compared. Time-to-event analyses were performed to examine factors associated with readmission within 1 year. Eleven percent (10,233) of patients had 15,625 unplanned readmissions within 1 year to the same PICU; 3.4% had two or more readmissions. Readmissions had significantly higher PICU mortality and longer PICU length of stay, compared with index admissions (4.0% vs 2.5% and 2.5 vs 1.6 d; all p < 0.001). Median time to readmission was 30 days for all readmissions, 3.5 days for readmissions during the same hospitalization, and 66 days for different hospitalizations. Having more complex chronic conditions was associated with earlier readmission (adjusted hazard ratio, 2.9 for one complex chronic condition; hazard ratio, 4.8 for two complex chronic conditions; hazard ratio, 9.6 for three or more complex chronic conditions; all p < 0.001 compared no complex chronic condition). Most specific complex chronic condition conferred a greater risk of readmission, and some had considerably higher risk than others. CONCLUSIONS: Unplanned readmissions occurred in a sizable minority of PICU patients. Patients with complex chronic conditions and particular conditions were at much higher risk for readmission.
[Mh] Termos MeSH primário: Estado Terminal/terapia
Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos
Readmissão do Paciente/estatística & dados numéricos
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Doença Crônica
Grupos de Populações Continentais
Feminino
Número de Leitos em Hospital
Seres Humanos
Lactente
Seguro
Tempo de Internação
Masculino
Estudos Retrospectivos
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170816
[Lr] Data última revisão:
170816
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170715
[St] Status:MEDLINE
[do] DOI:10.1097/CCM.0000000000002439


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[PMID]:28700736
[Au] Autor:Strom JB; Kramer DB; Wang Y; Shen C; Wasfy JH; Landon BE; Wilker EH; Yeh RW
[Ad] Endereço:Richard A. and Susan F. Smith Center for Cardiovascular Outcomes Research, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
[Ti] Título:Short-term rehospitalization across the spectrum of age and insurance types in the United States.
[So] Source:PLoS One;12(7):e0180767, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Few studies have examined rates and causes of short-term readmissions among adults across age and insurance types. We compared rates, characteristics, and costs of 30-day readmission after all-cause hospitalizations across insurance types in the US. We retrospectively evaluated alive patients ≥18 years old, discharged for any cause, 1/1/13-11/31/13, 2006 non-federal hospitals in 21 states in the Nationwide Readmissions Database. The primary stratification variable of interest was primary insurance. Comorbid conditions were assessed based on Elixhauser comorbidities, as defined by administrative billing codes. Additional measures included diagnoses for index hospitalizations leading to rehospitalization. Hierarchical multivariable logistic regression models, with hospital site as a random effect, were used to calculate the adjusted odds of 30-day readmissions by age group and insurance categories. Cost and discharge estimates were weighted per NRD procedures to reflect a nationally representative sample. Diagnoses for index hospitalizations leading to rehospitalization were determined. Among 12,533,551 discharges, 1,818,093 (14.5%) resulted in readmission within 30 days. Medicaid insurance was associated with the highest adjusted odds ratio (AOR) for readmission both in those ≥65 years old (AOR 1.12, 95%CI 1.10-1.14; p <0.001), and 45-64 (AOR 1.67, 95% CI 1.66-1.69; p < 0.001), and Medicare in the 18-44 group (Medicare vs. private insurance: AOR 1.99, 95% CI 1.96-2.01; p <0.001). Discharges for psychiatric or substance abuse disorders, septicemia, and heart failure accounted for the largest numbers of readmissions, with readmission rates of 24.0%, 17.9%, 22.9% respectively. Total costs for readmissions were 50.7 billion USD, highest for Medicare (29.6 billion USD), with non-Medicare costs exceeding 21 billion USD. While Medicare readmissions account for more than half of the total burden of readmissions, costs of non-Medicare readmissions are nonetheless substantial. Medicaid patients have the highest odds of readmission in individuals older than age 44, commonly due to hospitalizations for psychiatric illness and substance abuse disorders. Medicaid patients represent a population at uniquely high risk for readmission.
[Mh] Termos MeSH primário: Readmissão do Paciente/economia
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Seres Humanos
Seguro/economia
Seguro/estatística & dados numéricos
Masculino
Medicaid/economia
Medicare/economia
Medicare/estatística & dados numéricos
Meia-Idade
Alta do Paciente/economia
Alta do Paciente/estatística & dados numéricos
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170925
[Lr] Data última revisão:
170925
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170713
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0180767


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[PMID]:28636481
[Au] Autor:Aaron HJ; Fiedler M; Ginsburg PB; Adler L; Rivlin AM
[Ad] Endereço:From the Brookings Institution, Washington, DC.
[Ti] Título:Turmoil in the Individual Insurance Market - Where It Came From and How to Fix It.
[So] Source:N Engl J Med;377(4):314-315, 2017 Jul 27.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Cobertura do Seguro/economia
Seguro Saúde/organização & administração
Patient Protection and Affordable Care Act/organização & administração
Política
[Mh] Termos MeSH secundário: Custo Compartilhado de Seguro
Seguro
Seguro Saúde/economia
Seguro Saúde/legislação & jurisprudência
Patient Protection and Affordable Care Act/economia
Patient Protection and Affordable Care Act/legislação & jurisprudência
Governo Estadual
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170801
[Lr] Data última revisão:
170801
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170622
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMp1707593


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[PMID]:28384693
[Au] Autor:Skinner JS; Volpp KG
[Ad] Endereço:The Dartmouth Institute for Health Policy and Clinical Practice, DHMC, Hanover, New Hampshire.
[Ti] Título:Replacing the Affordable Care Act: Lessons From Behavioral Economics.
[So] Source:JAMA;317(19):1951-1952, 2017 May 16.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Redução de Custos
Economia Comportamental
Reforma dos Serviços de Saúde/legislação & jurisprudência
Cobertura do Seguro/legislação & jurisprudência
Patient Protection and Affordable Care Act/legislação & jurisprudência
[Mh] Termos MeSH secundário: Comportamento de Escolha
Honorários e Preços/legislação & jurisprudência
Reforma dos Serviços de Saúde/economia
Gastos em Saúde
Disparidades nos Níveis de Saúde
Seres Humanos
Seguro
Cobertura do Seguro/economia
Cobertura do Seguro/estatística & dados numéricos
Medicare Part A/economia
Medicare Part B/economia
Política
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170922
[Lr] Data última revisão:
170922
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170407
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.4084


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[PMID]:28306486
[Au] Autor:Kipperman BS; Kass PH; Rishniw M
[Ti] Título:Factors that influence small animal veterinarians' opinions and actions regarding cost of care and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout.
[So] Source:J Am Vet Med Assoc;250(7):785-794, 2017 Apr 01.
[Is] ISSN:1943-569X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE To determine small animal veterinarians' opinions and actions regarding costs of care, obstacles to client education about veterinary care costs, and effects of economic limitations on patient care and outcome and professional career satisfaction and burnout. DESIGN Cross-sectional survey. SAMPLE 1,122 small animal practitioners in the United States and Canada. PROCEDURES An online survey was sent to 37,036 veterinarians. Respondents provided information regarding perceived effects of client awareness of costs and pet health insurance coverage on various aspects of practice, the influence of client economic limitations on professional satisfaction and burnout, and proposals for addressing those effects. RESULTS The majority (620/1,088 [57%]) of respondents indicated that client economic limitations affected their ability to provide the desired care for their patients on a daily basis. Approximately half (527/1,071 [49%]) of respondents reported a moderate-to-substantial level of burnout, and many cited client economic limitations as an important contributing factor to burnout. Only 31% and 23% of respondents routinely discussed veterinary costs and pet insurance, respectively, with clients before pets became ill, and lack of time was cited as a reason for forgoing those discussions. Most respondents felt improved client awareness of veterinary costs and pet health insurance would positively affect patient care and client and veterinarian satisfaction. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested most small animal practitioners believe the veterinary profession needs to take action at educational and organizational levels to inform pet owners and educate and train veterinary students and veterinarians about the costs of veterinary care.
[Mh] Termos MeSH primário: Esgotamento Profissional
Satisfação no Emprego
Médicos Veterinários/psicologia
Medicina Veterinária/economia
[Mh] Termos MeSH secundário: Bem-Estar do Animal/economia
Animais
Estudos Transversais
Coleta de Dados
Seres Humanos
Seguro/economia
Animais de Estimação
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170808
[Lr] Data última revisão:
170808
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170318
[St] Status:MEDLINE
[do] DOI:10.2460/javma.250.7.785


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[PMID]:28238528
[Au] Autor:Smith AL; Kulhari A; Wolfram JA; Furlan A
[Ad] Endereço:Department of Neurology, University Hospitals Case Medical Center, Cleveland, Ohio.
[Ti] Título:Impact of Insurance Precertification on Discharge of Stroke Patients to Acute Rehabilitation or Skilled Nursing Facility.
[So] Source:J Stroke Cerebrovasc Dis;26(4):711-716, 2017 Apr.
[Is] ISSN:1532-8511
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: The purpose of this study is to determine if the common insurance practice of requiring precertification before a medically ready stroke patient can be discharged to a skilled nursing facility (SNF) or inpatient rehabilitation facility (IRF) causes a delay in discharge. Eliminating delays in discharge of stroke patients is important given the increasing demands for health-care efficiency after the passage of the Affordable Health Care Act. METHODS: A retrospective chart review of 1007 patients who were admitted to our comprehensive stroke center with the primary diagnosis of stroke over a 12-month period was performed. Out of the patient pool, 289 patients met the inclusion criterion of a primary diagnosis of stroke that required discharge to a SNF or IRF. All 289 patients were medically cleared for discharge to a SNF or IRF by a board-certified vascular neurologist. RESULTS: Of the 289 patients who met the inclusion criteria, 118 required insurance precertification and 171 did not require precertification before being discharged to a SNF or IRF. All 118 patients who required precertification had private health insurance. The patients who required insurance precertification had an average delay of discharge (DOD) of 1.5 days, and those patients who did not require precertification had an average DOD of .8 days (P value <.0001). After removing the outliers, the difference in the length of stay (LOS) between the 2 groups became statistically significant (P value < .04). CONCLUSION: The results of this study demonstrate that insurance precertification leads to delay in discharge, increased LOS, and increased hospital costs for stroke patients.
[Mh] Termos MeSH primário: Seguro
Alta do Paciente/estatística & dados numéricos
Centros de Reabilitação
Instituições de Cuidados Especializados de Enfermagem
Reabilitação do Acidente Vascular Cerebral/métodos
Acidente Vascular Cerebral/enfermagem
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Certificação
Feminino
Seres Humanos
Seguro/estatística & dados numéricos
Tempo de Internação
Masculino
Meia-Idade
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170703
[Lr] Data última revisão:
170703
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170228
[St] Status:MEDLINE


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[PMID]:28238476
[Au] Autor:Guthmann JP; Pelat C; Célant N; Parent du Chatelet I; Duport N; Rochereau T; Lévy-Bruhl D
[Ad] Endereço:Santé publique France, 12, rue du Val d'Osne, 94415 Saint-Maurice Cedex, France. Electronic address: jean-paul.guthmann@santepubliquefrance.fr.
[Ti] Título:Socioeconomic inequalities to accessing vaccination against human papillomavirus in France: Results of the Health, Health Care and Insurance Survey, 2012.
[So] Source:Rev Epidemiol Sante Publique;65(2):109-117, 2017 Apr.
[Is] ISSN:0398-7620
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In France, human papillomavirus (HPV) vaccination coverage among adolescents and young women is low and decreasing. We analysed data from the 2012 Health, Health Care and Insurance Survey with the aim of identifying factors associated with this vaccination. We also compared the socioeconomic profile of unvaccinated young women to that of women who do not undergo cervical cancer screening (CCS). METHODS: Data were collected through interviews and self-administered questionnaires completed by a randomised sample of Health insurance beneficiaries. Two analyses were performed using Poisson regression: one to investigate the determinants of CCS uptake in women aged 25-65 years old (n=4508), the other to investigate the determinants of HPV vaccination in young women aged 16-24 years old (n=899). A sub-analysis was performed in 685 "daughter-mother" couples from the same household in order to analyse the association between participation to CCS in mothers and HPV vaccination in daughters. RESULTS: Factors significantly associated both to a lower CCS uptake and to an insufficient HPV vaccination were the lack of a complementary private health insurance (P=0.023 and P=0.037, respectively) and living in a family with a low household income (P<0.001 and P=0.005, respectively). A low education level was associated to a lower CCS uptake (P<0.001). The absence of CCS uptake in the last three years in mothers was associated to a lower level of HPV vaccination in their daughter (P=0.014). CONCLUSION: Women who do not undergo CCS and HPV unvaccinated young women tend to be of modest socioeconomic status. Unvaccinated young females tend to have mothers who do not undergo CCS and are therefore at risk of benefiting from none of the two cervical cancer preventive measures. The current implementation strategy concerning HPV vaccination in France may therefore increase inequalities regarding cervical cancer prevention.
[Mh] Termos MeSH primário: Infecções por Papillomavirus/epidemiologia
Infecções por Papillomavirus/prevenção & controle
Vacinas contra Papillomavirus/uso terapêutico
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
Vacinação/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Feminino
França/epidemiologia
Seres Humanos
Seguro/estatística & dados numéricos
Masculino
Meia-Idade
Papillomaviridae/imunologia
Fatores Socioeconômicos
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Papillomavirus Vaccines)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170929
[Lr] Data última revisão:
170929
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170228
[St] Status:MEDLINE



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