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Ethics of access to newly approved expensive medical treatments: multi-stakeholder dialogues in a publicly funded healthcare system
Conclusion: Policies for access to non-reimbursed treatments should address stakeholders’ concerns regarding transparency, equal access and solidarity, and loss of potential health benefits for patients. Multi-stakeholder dialogues are an important tool to help inform policy-making on access to newly approved (too) expensive treatments in countries facing challenges to the sustainability of healthcare systems. (Source: Frontiers in Pharmacology)
Source: Frontiers in Pharmacology - January 29, 2024 Category: Drugs & Pharmacology Source Type: research

Challenges and Potential of Artificial Intelligence in Neuroradiology
ConclusionTranslating AI methods from the research to the clinical domain is complicated by challenges related to model design and validation studies, medical product regulations, and healthcare providers ’ reservations regarding AI’s efficacy and affordability. However, each of these limitations is also an opportunity for high-impact research that will help to accelerate the clinical adoption of state-of-the-art medical AI. In all cases, establishing and adhering to appropriate reporting standar ds is an important responsibility that is shared by all of the parties involved in the life cycle of a prospective AI softw...
Source: Klinische Neuroradiologie - January 29, 2024 Category: Radiology Source Type: research

Insurance denials and delays in care for pediatric patients with inflammatory bowel disease
Biologics are effective medications used for induction and maintenance of remission in pediatric patients with inflammatory bowel disease (IBD). Insurance companies often require clinicians to obtain prior authorization (PA) prior to administration of biologics. Recent data determined that PA was associated with delays in care in pediatric IBD patients and an increased risk of subsequent healthcare utilization. Our study aim was to assess the effect of the PA process and its impact on care delivery for pediatric patients with IBD. (Source: Gastroenterology)
Source: Gastroenterology - January 25, 2024 Category: Gastroenterology Authors: Pareenaz Behbahani-Nejad, Michael Finkler, Hasina Momotaz, Sharon Perry, Denise Young, Thomas Sferra, Jonathan Moses Source Type: research

Insurer-mandated medication utilization barriers are associated with decreased insurance satisfaction and adverse clinical outcomes: an ibd partners survey
Insurer-mandated barriers to timely initiation of advanced therapies used to treat inflammatory bowel disease (IBD) have been shown to worsen clinical outcomes and increase healthcare utilization, yet rarely alter the medication ultimately prescribed. Using the IBD Partners research network, we analyzed patient-reported impacts of these barriers on insurance satisfaction and clinical outcomes. (Source: Gastroenterology)
Source: Gastroenterology - January 25, 2024 Category: Gastroenterology Authors: Brad Constant, Millie Long, Frank Scott, Peter Higgins Source Type: research

New CMS Rule Helps Bring Care to People Living on the Streets
Am J Nurs. 2024 Feb 1;124(2):14. doi: 10.1097/01.NAJ.0001006660.84615.d1.ABSTRACTBilling codes for services apply to government and private insurers.PMID:38270412 | DOI:10.1097/01.NAJ.0001006660.84615.d1 (Source: The American Journal of Nursing)
Source: The American Journal of Nursing - January 25, 2024 Category: Nursing Authors: Karen Roush Source Type: research

Novice driver crashes: The relation between putative causal factors, countermeasures, real world implementations, and policy - A case study in simple, scalable solutions
This article is a case study in the United States of how a better understanding of the causes of novice driver crashes led to training countermeasures targeting teen driving behaviors with known associations with crashes. These effects on behaviors were large enough and long-lasting enough to convince insurance companies to develop training programs that they offered around the country to teen drivers. The success of the training programs at reducing the frequency of behaviors linked to crashes also led to several large-scale evaluations of the effect of the training programs on actual crashes. A reduction in crashes was o...
Source: Accident; Analysis and Prevention. - January 25, 2024 Category: Accident Prevention Authors: Donald L Fisher Ravi Agrawal Gautam Divekar Malek Abdul Hamid Akhilesh Krishnan Hasmik Mehranian Jeff Muttart Anuj Pradhan Shannon Roberts Matthew Romoser Siby Samuel Willem Vlakveld Yusuke Yamani Jared Young Tracy Zafian Lisa Zhang Source Type: research

Managed competition in Colombia: convergence of public and private insurance and delivery
Health Econ Policy Law. 2024 Jan 22:1-15. doi: 10.1017/S1744133123000348. Online ahead of print.ABSTRACTThe Colombian health system has made a deep transition into managed competition since a major reform in 1993. A market for insurers was created, the consumer has free choice of insurer and a national-level equalisation fund distributes revenues via a per-capita payment. Fully subsidised insurance for the poor and informal, and a comprehensive standardised benefit package for subsidised and contributory schemes (both schemes covering 98 per cent of the population), has led to a low level of out-of-pocket expenses and high...
Source: Health Economics, Policy, and Law - January 22, 2024 Category: Health Management Authors: Ramon Castano Sergio I Prada Norman Maldonado Victoria Soto Source Type: research

Clinical and Socioeconomic Effects of Misdiagnosed Wrist Ligament Injuries
J Wrist Surg DOI: 10.1055/s-0043-1776342 Purpose Misdiagnosed and maltreated wrist ligament injuries (scapholunate [SL], lunotriquetral, and triangular fibrocartilage complex [TFCC]) filed to the Swedish National Patient Insurance Company (LÖF [“regionernas ömsesidiga försäkringsbolag”]) 2011 to 2018 were analyzed in terms of complications and costs for society. Methods All filed claims are database registered. The database was assessed in June 2019 through injury International Classification of Diseases 10th Revision-SWE diagnoses. Demographics, reasons for avoidance, type of complication, and costs ...
Source: Journal of Wrist Surgery - January 22, 2024 Category: Orthopaedics Authors: Rosvall, Felicia Hagert, Elisabet Gustafson, Pelle Andersson, Jonny K. Tags: Survey or Meta-Analysis Source Type: research

Effectiveness of an 11-week exercise intervention for patients with hip or knee osteoarthritis: results of a quasi-experimental pragmatic trial
ConclusionsThis trial demonstrated short-, mid- and long-term superiority of exercise versus control. However, differences were smaller than those reported in previous efficacy trials, raising questions regarding clinical importance. Responder analysis will follow to identify possible predictors for patient responsiveness on an individual level. Further studies should investigate the frequency and reasons for joint replacement following exercise therapy.Trial registrationGerman Clinical Trial Register (DRKS00009251). Registered 10 September 2015. (Source: BMC Sports Science, Medicine and Rehabilitation)
Source: BMC Sports Science, Medicine and Rehabilitation - January 20, 2024 Category: Sports Medicine Source Type: research

IMPAACT: IMproving the PArticipAtion of older people in policy decision-making on common health CondiTions - a study protocol
This study aims to elicit the values and preferences of evidence-informed older people living in the community on early screening for common health conditions (cardiovascular disease, diabetes, dementia and frailty). The study will proceed in three Phases: (1) generating recommendations of older people through a series of Citizens’ Juries; (2) obtaining feedback from a diverse range of stakeholder groups on the jury findings; and (3) co-designing a set of Knowledge Translation resources to facilitate implementation into research, policy and practice. Conditions were chosen to reflect common health conditions characte...
Source: BMJ Open - January 12, 2024 Category: General Medicine Authors: Ambagtsheer, R. C., Hurley, C. J., Lawless, M., Braunack-Mayer, A., Visvanathan, R., Beilby, J., Stewart, S., Cornell, V., Leach, M. J., Taylor, D., Thompson, M., Dent, E., Whiteway, L., Archibald, M., O'Rourke, H. M., Williams, K., Chudecka, A. Tags: Open access, Geriatric medicine Source Type: research