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[PMID]:28453715
[Au] Autor:Pan B; Towne SD; Chen Y; Yuan Z
[Ad] Endereço:Department of Health Statistics, School of Public Health, Nanchang University, Nanchang, People' Republic of China.
[Ti] Título:The inequity of inpatient services in rural areas and the New-Type Rural Cooperative Medical System (NRCMS) in China: repeated cross sectional analysis.
[So] Source:Health Policy Plan;32(5):634-646, 2017 Jun 01.
[Is] ISSN:1460-2237
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Objective : The main aim of the New-type Rural Cooperative Medical System (NRCMS) put into effect in 2003 was to reduce financial barriers in accessing health care services among vulnerable populations. The aim of this study was to assess the association between NRCMS and income related inequality in hospital utilization among rural inhabitants in Jiangxi Province, China. Methods : A multistage stratified random cluster sampling method was adopted to select 1838, 1879, and 1890 households as participants in 2003/2004, 2008 and 2014, respectively. The Erreygers Concentration index (EI) of two measures of hospital inpatient care including admission to hospital and hospital avoidance, were calculated to measure income-related inequality. The decomposition of the EI was performed to characterize the contributions of socioeconomic and need factors to the measured inequality. Results : An affluent-focused (pro-rich) inequity was observed for hospital admission adjusting for need factors over time. The level of inequity for hospital admission decreased dramatically, while hospital avoidance decreased marginally, and with a high value (EI, -0.0176) in 2008. The implementation of the NRCMS was associated with decreased inequity in 2008 and in 2014, but the associations were limited. Income contributed the most to the inequality of hospital utilization each year. Conclusion : The coverage of the NRCMS expanded to cover nearly all rural inhabitants in Jiangxi province by 2014 and was associated with a very small reduction in inequalities in admission to hospital. In order to increase equitable access to health care, additional financial protections for vulnerable populations are needed. Improving the relatively low level of medical services in township hospitals, and low rate of reimbursement and financial assistance with the NRCMS is recommended.
[Mh] Termos MeSH primário: Disparidades em Assistência à Saúde/estatística & dados numéricos
Hospitais/utilização
Serviços de Saúde Rural/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
China/epidemiologia
Estudos Transversais
Disparidades em Assistência à Saúde/economia
Seres Humanos
Seguro Saúde
Serviços de Saúde Rural/economia
População Rural/estatística & dados numéricos
Fatores Socioeconômicos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1093/heapol/czw175


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[PMID]:28452692
[Au] Autor:An R; Sturm R
[Ad] Endereço:Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
[Ti] Título:A Cash-back Rebate Program for Healthy Food Purchases in South Africa: Selection and Program Effects in Self-reported Diet Patterns.
[So] Source:Am J Health Behav;41(2):152-162, 2017 Mar 01.
[Is] ISSN:1945-7359
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: A South African insurer launched a rebate program for healthy food purchases for its members, but only available in program-designated supermarkets. To eliminate selection bias in program enrollment, we estimated the impact of subsidies in nudging the population towards a healthier diet using an instrumental variable approach. METHODS: Data came from a health behavior questionnaire administered among members in the health promotion program. Individual and supermarket addresses were geocoded and differential distances from home to program-designated supermarkets versus competing supermarkets were calculated. Bivariate probit and linear instrumental variable models were performed to control for likely unobserved selection biases, employing differential distances as a predictor of program enrollment. RESULTS: For regular fast-food, processed meat, and salty food consumption, approximately two-thirds of the difference between participants and nonparticipants was attributable to the intervention and one-third to selection effects. For fruit/ vegetable and fried food consumption, merely one-eighth of the difference was selection. The rebate reduced regular consumption of fast food by 15% and foods high in salt/sugar and fried foods by 22%- 26%, and increased fruit/vegetable consumption by 21% (0.66 serving/day). CONCLUSIONS: Large population interventions are an essential complement to laboratory experiments, but selection biases require explicit attention in evaluation studies conducted in naturalistic settings.
[Mh] Termos MeSH primário: Comportamentos Relacionados com a Saúde
Promoção da Saúde/métodos
Dieta Saudável
Seguro Saúde
Motivação
Recompensa
[Mh] Termos MeSH secundário: Adulto
Feminino
Seres Humanos
Seleção Tendenciosa de Seguro
Masculino
Meia-Idade
África do Sul
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.5993/AJHB.41.2.6


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[PMID]:29339366
[Au] Autor:Steinbrook R
[Ad] Endereço:JAMA Internal Medicine, San Francisco, CA, USA.
[Ti] Título:Healthcare in Trump's first year.
[So] Source:BMJ;360:k173, 2018 01 16.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Assistência à Saúde/legislação & jurisprudência
Governo
Acesso aos Serviços de Saúde/legislação & jurisprudência
Política
[Mh] Termos MeSH secundário: Assistência à Saúde/economia
Seres Humanos
Seguro Saúde/economia
Seguro Saúde/legislação & jurisprudência
Patient Protection and Affordable Care Act/legislação & jurisprudência
Estados Unidos
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180118
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k173


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[PMID]:29480830
[Au] Autor:Conte C; Palmaro A; Grosclaude P; Daubisse-Marliac L; Despas F; Lapeyre-Mestre M
[Ad] Endereço:LEASP-UMR 1027, Inserm-University of Toulouse.
[Ti] Título:A novel approach for medical research on lymphomas: A study validation of claims-based algorithms to identify incident cases.
[So] Source:Medicine (Baltimore);97(2):e9418, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The use of claims database to study lymphomas in real-life conditions is a crucial issue in the future. In this way, it is essential to develop validated algorithms for the identification of lymphomas in these databases. The aim of this study was to assess the validity of diagnosis codes in the French health insurance database to identify incident cases of lymphomas according to results of a regional cancer registry, as the gold standard.Between 2010 and 2013, incident lymphomas were identified in hospital data through 2 algorithms of selection. The results of the identification process and characteristics of incident lymphomas cases were compared with data from the Tarn Cancer Registry. Each algorithm's performance was assessed by estimating sensitivity, predictive positive value, specificity (SPE), and negative predictive value.During the period, the registry recorded 476 incident cases of lymphomas, of which 52 were Hodgkin lymphomas and 424 non-Hodgkin lymphomas. For corresponding area and period, algorithm 1 provides a number of incident cases close to the Registry, whereas algorithm 2 overestimated the number of incident cases by approximately 30%. Both algorithms were highly specific (SPE = 99.9%) but moderately sensitive. The comparative analysis illustrates that similar distribution and characteristics are observed in both sources.Given these findings, the use of claims database can be consider as a pertinent and powerful tool to conduct medico-economic or pharmacoepidemiological studies in lymphomas.
[Mh] Termos MeSH primário: Algoritmos
Bases de Dados Factuais
Seguro Saúde
Linfoma/diagnóstico
Sistema de Registros
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Pesquisa Biomédica/métodos
Feminino
Seres Humanos
Linfoma/terapia
Masculino
Meia-Idade
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; VALIDATION STUDIES
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009418


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[PMID]:29466590
[Au] Autor:Tseng P; Kaplan RS; Richman BD; Shah MA; Schulman KA
[Ad] Endereço:Duke University School of Medicine, Durham, North Carolina.
[Ti] Título:Administrative Costs Associated With Physician Billing and Insurance-Related Activities at an Academic Health Care System.
[So] Source:JAMA;319(7):691-697, 2018 02 20.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Administrative costs in the US health care system are an important component of total health care spending, and a substantial proportion of these costs are attributable to billing and insurance-related activities. Objective: To examine and estimate the administrative costs associated with physician billing activities in a large academic health care system with a certified electronic health record system. Design, Setting, and Participants: This study used time-driven activity-based costing. Interviews were conducted with 27 health system administrators and 34 physicians in 2016 and 2017 to construct a process map charting the path of an insurance claim through the revenue cycle management process. These data were used to calculate the cost for each major billing and insurance-related activity and were aggregated to estimate the health system's total cost of processing an insurance claim. Exposures: Estimated time required to perform billing and insurance-related activities, based on interviews with management personnel and physicians. Main Outcomes and Measures: Estimated billing and insurance-related costs for 5 types of patient encounters: primary care visits, discharged emergency department visits, general medicine inpatient stays, ambulatory surgical procedures, and inpatient surgical procedures. Results: Estimated processing time and total costs for billing and insurance-related activities were 13 minutes and $20.49 for a primary care visit, 32 minutes and $61.54 for a discharged emergency department visit, 73 minutes and $124.26 for a general inpatient stay, 75 minutes and $170.40 for an ambulatory surgical procedure, and 100 minutes and $215.10 for an inpatient surgical procedure. Of these totals, time and costs for activities carried out by physicians were estimated at a median of 3 minutes or $6.36 for a primary care visit, 3 minutes or $10.97 for an emergency department visit, 5 minutes or $13.29 for a general inpatient stay, 15 minutes or $51.20 for an ambulatory surgical procedure, and 15 minutes or $51.20 for an inpatient surgical procedure. Of professional revenue, professional billing costs were estimated to represent 14.5% for primary care visits, 25.2% for emergency department visits, 8.0% for general medicine inpatient stays, 13.4% for ambulatory surgical procedures, and 3.1% for inpatient surgical procedures. Conclusions and Relevance: In a time-driven activity-based costing study in a large academic health care system with a certified electronic health record system, the estimated costs of billing and insurance-related activities ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure. Knowledge of how specific billing and insurance-related activities contribute to administrative costs may help inform policy solutions to reduce these expenses.
[Mh] Termos MeSH primário: Centros Médicos Acadêmicos/economia
Custos de Cuidados de Saúde/estatística & dados numéricos
Seguro Saúde/organização & administração
Administração da Prática Médica/economia
[Mh] Termos MeSH secundário: Centros Médicos Acadêmicos/organização & administração
Custos e Análise de Custo
Seguro Saúde/economia
Sistemas Computadorizados de Registros Médicos/economia
Modelos Organizacionais
Análise e Desempenho de Tarefas
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180222
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.19148


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[PMID]:29450525
[Au] Autor:Daw JR; Sommers BD
[Ad] Endereço:Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Association of the Affordable Care Act Dependent Coverage Provision With Prenatal Care Use and Birth Outcomes.
[So] Source:JAMA;319(6):579-587, 2018 02 13.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: The effect of the Affordable Care Act (ACA) dependent coverage provision on pregnancy-related health care and health outcomes is unknown. Objective: To determine whether the dependent coverage provision was associated with changes in payment for birth, prenatal care, and birth outcomes. Design, Setting, and Participants: Retrospective cohort study, using a differences-in-differences analysis of individual-level birth certificate data comparing live births among US women aged 24 to 25 years (exposure group) and women aged 27 to 28 years (control group) before (2009) and after (2011-2013) enactment of the dependent coverage provision. Results were stratified by marital status. Main Exposures: The dependent coverage provision of the ACA, which allowed young adults to stay on their parent's health insurance until age 26 years. Main Outcomes and Measures: Primary outcomes were payment source for birth, early prenatal care (first visit in first trimester), and adequate prenatal care (a first trimester visit and 80% of expected visits). Secondary outcomes were cesarean delivery, premature birth, low birth weight, and infant neonatal intensive care unit (NICU) admission. Results: The study population included 1 379 005 births among women aged 24-25 years (exposure group; 299 024 in 2009; 1 079 981 in 2011-2013), and 1 551 192 births among women aged 27-28 years (control group; 325 564 in 2009; 1 225 628 in 2011-2013). From 2011-2013, compared with 2009, private insurance payment for births increased in the exposure group (36.9% to 35.9% [difference, -1.0%]) compared with the control group (52.4% to 51.1% [difference, -1.3%]), adjusted difference-in-differences, 1.9 percentage points (95% CI, 1.6 to 2.1). Medicaid payment decreased in the exposure group (51.6% to 53.6% [difference, 2.0%]) compared with the control group (37.4% to 39.4% [difference, 1.9%]), adjusted difference-in-differences, -1.4 percentage points (95% CI, -1.7 to -1.2). Self-payment for births decreased in the exposure group (5.2% to 4.3% [difference, -0.9%]) compared with the control group (4.9% to 4.3% [difference, -0.5%]), adjusted difference-in-differences, -0.3 percentage points (95% CI, -0.4 to -0.1). Early prenatal care increased from 70% to 71.6% (difference, 1.6%) in the exposure group and from 75.7% to 76.8% (difference, 0.6%) in the control group (adjusted difference-in-differences, 0.6 percentage points [95% CI, 0.3 to 0.8]). Adequate prenatal care increased from 73.5% to 74.8% (difference, 1.3%) in the exposure group and from 77.5% to 78.8% (difference, 1.3%) in the control group (adjusted difference-in-differences, 0.4 percentage points [95% CI, 0.2 to 0.6]). Preterm birth decreased from 9.4% to 9.1% in the exposure group (difference, -0.3%) and from 9.1% to 8.9% in the control group (difference, -0.2%) (adjusted difference-in-differences, -0.2 percentage points (95% CI, -0.3 to -0.03). Overall, there were no significant changes in low birth weight, NICU admission, or cesarean delivery. In stratified analyses, changes in payment for birth, prenatal care, and preterm birth were concentrated among unmarried women. Conclusions and Relevance: In this study of nearly 3 million births among women aged 24 to 25 years vs those aged 27 to 28 years, the Affordable Care Act dependent coverage provision was associated with increased private insurance payment for birth, increased use of prenatal care, and modest reduction in preterm births, but was not associated with changes in cesarean delivery rates, low birth weight, or NICU admission.
[Mh] Termos MeSH primário: Cobertura do Seguro
Reembolso de Seguro de Saúde/estatística & dados numéricos
Patient Protection and Affordable Care Act
Resultado da Gravidez
Cuidado Pré-Natal/utilização
[Mh] Termos MeSH secundário: Adulto
Fatores Etários
Cesárea/estatística & dados numéricos
Feminino
Seres Humanos
Recém-Nascido de Baixo Peso
Cobertura do Seguro/estatística & dados numéricos
Seguro Saúde
Unidades de Terapia Intensiva Neonatal
Modelos Lineares
Medicaid/estatística & dados numéricos
Gravidez
Nascimento Prematuro/epidemiologia
Cuidado Pré-Natal/economia
Estudos Retrospectivos
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180217
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2018.0030


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[PMID]:29394486
[Au] Autor:Rollins JA
[Ti] Título:Healthcare: It's 'So Complicated'.
[So] Source:Pediatr Nurs;43(2):58, 102, 2017 Mar-Apr.
[Is] ISSN:0097-9805
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Reforma dos Serviços de Saúde/economia
Cobertura do Seguro/economia
Seguro Saúde/economia
Patient Protection and Affordable Care Act
[Mh] Termos MeSH secundário: Seres Humanos
Sociedades Médicas
Sociedades de Enfermagem
Estados Unidos
[Pt] Tipo de publicação:EDITORIAL
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE


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[PMID]:29368471
[Au] Autor:Bonasso FS
[Ti] Título:The scope, purpose, and reasoning behind Senate Bill 602.
[So] Source:W V Med J;112(5):8-10, 2016 Sep-Oct.
[Is] ISSN:0043-3284
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Orçamentos/legislação & jurisprudência
Financiamento Governamental/legislação & jurisprudência
Legislação como Assunto
Política
[Mh] Termos MeSH secundário: Administração Financeira/legislação & jurisprudência
Programas Governamentais/legislação & jurisprudência
Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência
Seres Humanos
Seguro Saúde/legislação & jurisprudência
Estados Unidos
West Virginia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180126
[St] Status:MEDLINE


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[PMID]:27771817
[Au] Autor:Cooley LA; Hoots B; Wejnert C; Lewis R; Paz-Bailey G; NHBS Study Group
[Ad] Endereço:Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, MS-E46, Atlanta, GA, 30329, USA. LCooley@cdc.gov.
[Ti] Título:Policy Changes and Improvements in Health Insurance Coverage Among MSM: 20 U.S. Cities, 2008-2014.
[So] Source:AIDS Behav;21(3):615-618, 2017 Mar.
[Is] ISSN:1573-3254
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Recent policy changes have improved the ability of gay, bisexual, and other men who have sex with men (MSM) to secure health insurance. We wanted to assess changes over time in self-reported health insurance status among MSM participating in CDC's National HIV Behavioral Surveillance (NHBS) in 2008, 2011, and 2014. We analyzed NHBS data from sexually active MSM interviewed at venues in 20 U.S. cities. To determine if interview year was associated with health insurance status, we used a Poisson model with robust standard errors. Among included MSM, the overall percentage of MSM with health insurance rose 16 % from 2008 (68 %) to 2014 (79 %) (p value for trend < 0.001). The change in coverage over time was greatest in key demographic segments with lower health insurance coverage all three interview years, by age, education, and income. Corresponding with recent policy changes, health insurance improved among MSM participating in NHBS, with greater improvements in historically underinsured demographic segments. Despite these increases, improved coverage is still needed. Improved access to health insurance could lead to a reduction in health disparities among MSM over time.
[Mh] Termos MeSH primário: Infecções por HIV/prevenção & controle
Política de Saúde
Disparidades nos Níveis de Saúde
Homossexualidade Masculina
Cobertura do Seguro/tendências
Seguro Saúde
[Mh] Termos MeSH secundário: Adolescente
Adulto
Cidades
Infecções por HIV/diagnóstico
Infecções por HIV/economia
Infecções por HIV/epidemiologia
Inquéritos Epidemiológicos
Seres Humanos
Masculino
Assunção de Riscos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1712
[Cu] Atualização por classe:180302
[Lr] Data última revisão:
180302
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161025
[St] Status:MEDLINE
[do] DOI:10.1007/s10461-016-1567-7


  10 / 29797 MEDLINE  
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[PMID]:29390313
[Au] Autor:Parikh-Patel A; Morris CR; Kizer KW
[Ad] Endereço:California Cancer Reporting and Epidemiologic Surveillance (CalCARES) Program, Institute for Population Health Improvement, University of California Davis Health.
[Ti] Título:Disparities in quality of cancer care: The role of health insurance and population demographics.
[So] Source:Medicine (Baltimore);96(50):e9125, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Escalating costs and concerns about quality of cancer care have increased calls for quality measurement and performance accountability for providers and health plans. The purpose of the present cross-sectional study was to assess variability in the quality of cancer care by health insurance type in California.Persons with breast, ovary, endometrium, cervix, colon, lung, or gastric cancer during the period 2004 to 2014 were identified in the California Cancer Registry. Individuals were stratified into 5 health insurance categories: private insurance, Medicare, Medicaid, dual Medicare and Medicaid eligible, and uninsured. Quality of care was evaluated using Commission on Cancer quality measures. Logistic regression models were generated to assess the independent effect of health insurance type on stage at diagnosis, quality of care and survival after adjusting for age, sex, race/ethnicity, and socioeconomic status (SES).A total of 763,884 cancer cases were evaluated. Individuals with Medicaid or Medicare-Medicaid dual-eligible coverage and the uninsured had significantly lower odds of receiving recommended radiation and/or chemotherapy after diagnosis or surgery for breast, endometrial, and colon cancer, relative to those with private insurance. Dual eligible patients with gastric cancer had 21% lower odds of having the recommended number of lymph nodes removed and examined compared to privately insured patients.After adjusting for known demographic confounders, substantial and consistent disparities in quality of cancer care exist according to type of health insurance in California. Further study is needed to identify particular factors and mechanisms underlying the identified treatment disparities across sources of health insurance.
[Mh] Termos MeSH primário: Demografia
Disparidades em Assistência à Saúde
Cobertura do Seguro
Seguro Saúde
Neoplasias/economia
Neoplasias/terapia
Qualidade da Assistência à Saúde
[Mh] Termos MeSH secundário: California
Estudos Transversais
Feminino
Seres Humanos
Masculino
Sistema de Registros
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009125



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