Search Results (171)

Background: Alcohol-associated liver disease (AALD) represents significant health burdens worldwide. This study aims to provide a comprehensive overview of the AALD outcomes that were incompletely understood. Methods: The current study utilizes data from the National Health and Nutrition and Examination Survey (NHANES) from 2011–2020, using a stratified, multistage probability cluster design. AALD in the NHANES was defined using clinical laboratory data and self-reported alcohol use, among which fibrosis-4 score of >2.67. Analysis is conducted using weighted, logistic, and Cox linear regression. Results: The initial sample included 23,206 participants aged 20 and older, with recorded cardiovascular status and AST/ALT levels. Participants reporting AALD had a higher percentage of college degrees (p < 0.001) and were more likely to be daily smokers. Asians exhibited the highest rates of AALD compared to other demographics (p < 0.001). The prevalence in private insurance is significantly greater than Medicaid, but the usage trends have been increasing in Medicaid. The trends of advanced fibrosis have been increasing in blacks and Asians, while they have been decreasing among whites and Mexicans. Those with AALD also had higher mean systolic and diastolic blood pressure, as well as elevated fasting glucose levels (p < 0.001). The mortality rate among AALD participants with heart diseases was 25%, compared to 3% among those without (p < 0.001). After adjusting for potential confounding variables, no statistically significant associations were found between AALD status and HF or CAD. However, a clinically significant increase in the odds of stroke was observed within the AALD group (p < 0.001). Conclusions: Our findings indicate Asians have the highest rates of AALD. The trends of advanced fibrosis have been increasing in blacks and Asians. There is an increased prevalence of AALD with heart diseases and a significant increase in mortality with stroke. Full article

The continued migration of physicians from independent practice to affiliation with larger entities has garnered significant scrutiny. These affiliation models include hospitals and health systems, payers and corporate entities, and management services organizations, which may or may not be private equity (PE)-backed. Data on the impact of different physician affiliation models on cost of care is limited. We examined the relationship between provider affiliation model, site of care (SOC), and cost of care for certain high-volume procedures in procedure-intensive specialties for both Medicare and commercial insurance. We found that hospital-affiliated physicians are least likely—and PE-affiliated physicians are most likely—to provide care in lower-cost settings. For both Medicare and commercial insurance, SOC contributes meaningfully to procedure unit price, which is consistently greater in hospital-based settings. These findings suggest that the physician affiliation model and associated SOC cost differentials contribute materially to healthcare expenditures. As the Medicare cost differentials are set by statute and regulations, strategies such as site-neutral payments are needed to mitigate the monetary impact of historical and future physician practice migration. Full article

Healthcare cost acceleration and resource allocation issues have worsened across European health systems, where a small group of patients drives excessive healthcare spending. The prediction of high-cost utilization patterns is important for the sustainable management of healthcare and focused intervention measures. The aim of our study was to derive and validate machine learning algorithms for high-cost healthcare utilization prediction based on detailed administrative data and by comparing three algorithmic methods for the best risk stratification performance. The research analyzed extensive insurance beneficiary records which compile data from health group collective funds operated by non-life insurers across EU countries, across multiple service classes. The definition of high utilization was equivalent to the upper quintile of overall health expenditure using a moderate cost threshold. The research applied three machine learning algorithms, namely logistic regression using elastic net regularization, the random forest, and support vector machines. The models used a comprehensive set of predictor variables including demographics, policy profiles, and patterns of service utilization across multiple domains of healthcare. The performance of the models was evaluated using the standard train–test methodology and rigorous cross-validation procedures. All three models demonstrated outstanding discriminative ability by achieving area under the curve values at near-perfect levels. The random forest achieved the best test performance with exceptional metrics, closely followed by logistic regression with comparable exceptional performance. Service diversity proved to be the strongest predictor across all models, while dentistry services produced an extraordinarily high odds ratio with robust confidence intervals. The group of high utilizers comprised approximately one-fifth of the sample but demonstrated significantly higher utilization across all service classes. Machine learning algorithms are capable of classifying patients eligible for the high utilization of healthcare services with nearly perfect discriminative ability. The findings justify the application of predictive analytics for proactive case management, resource planning, and focused intervention measures across private group health insurance providers in EU countries. Full article

Background/Objectives: The urine sodium/potassium (Na/K) ratio can potentially be used to detect dietary habits that contribute to hypertension. In this prospective cohort interventional trial, we aimed to verify whether private insurance sales staff can help clients change their lifestyle habits based on their urinalysis results. Methods: Clients of the life insurance company (20–65 years old) who were considered to have “high risk” lifestyle factors, which was defined as having high values for two or more of the following indicators: body mass index, blood pressure, triglycerides, liver enzymes, and glucose metabolism, were included. The clients were randomly assigned to three groups: a face-to-face (FF) intervention by sales staff (n = 83), non-FF (Non-FF) intervention via a social networking service (n = 87), and no intervention (Control) (n = 58). Urinalysis and surveys about diet and exercise habits were conducted before and after a 3-month interventional period in all groups. Three interventions were performed for the FF and Non-FF groups, including dietary advice based on urinalysis results, education encouraging reduced salt intake and increased locomotor activity, and viewing an educational video. The Control group only received their urinalysis results by mail. Results: The participants’ mean age was 44.0 years old. Significant improvements in estimated potassium intake were observed in the Non-FF group, and significant reductions in urine Na/K ratios were noted in both the FF and Non-FF groups. Multiple logistic regression analysis indicated that watching the video was the most effective factor for decreasing the urine Na/K ratio (odds ratio = 1.869). The total points for dietary behavior, based on the questionnaire, significantly improved among the individuals who watched the video. Conclusions: This study demonstrates the potential for private health insurance companies to contribute to health promotion and introduces a novel strategy for improving lifestyle habits among individuals at high risk of lifestyle-related diseases. Full article

The Brazilian population in the United States is growing, and many Brazilian workers are employed in settings that may lack occupational health and safety (OHS) protections. In this study, we examined two domains of OHS (measured by the Occupational Health and Safety Vulnerability Survey), namely, Workplace Hazards (potential dangers that may result in injury or illness) and Workplace Vulnerability (inadequate occupational health and safety resources), and described health and demographic characteristics associated with these conditions. Eligible participants were women aged 18 and over, born in Brazil, currently residing in the United States, and employed. A cross-sectional online survey was conducted between July and August 2020. Recruitment occurred through community partnerships and social media. Multivariable models among n = 191 women revealed that greater exposure to Workplace Hazards was associated with employment in private household settings, including childcare and housecleaning (p < 0.001). The association between Workplace Vulnerability and jobs in private household services approached statistical significance (p = 0.07). Both Workplace Hazards and Workplace Vulnerability were associated with lower incomes and educational attainment, as well as having public insurance. Our findings suggest the need for stronger OHS protections and policies, particularly among those working in private household services, to ensure safer working conditions for Brazilian immigrant women. Full article

Background and Objectives: Breast reconstruction following mastectomy improves quality of life and psychosocial outcomes, yet it is not consistently performed despite multiple federal mandates. Current data shows decreased reconstruction in minority races, those with a low socioeconomic status, and those holding public health insurance. Many barriers remain misunderstood or unstudied. This study examines barriers to post-mastectomy breast reconstruction to promote a supportive clinical climate by addressing multifactorial obstacles to equitable access to care. Materials and Methods: The California Cancer Registry Data Surveillance, Epidemiology, and End Results (SEER) database and California Health and Human Services Agency Cancer Surgeries Database (2013–2021 and 2000–2021, respectively) were used in this retrospective observational study on mastectomy with immediate breast reconstruction (IBR), delayed breast reconstruction (DBR), or mastectomy only (MO) rates. Data were collected on age, sex, race, insurance type, hospital type, socioeconomic status, and residence. Pearson’s chi-square analysis was performed. Results: We found that 168,494 mastectomy and reconstruction surgeries were performed (82.36% MO, 7% IBR, 10.6% DBR). The 40–49 age group received significantly less MO (38.1%) compared to the 70–74 age group (94.8%, (p = <0.001). Significantly more reconstruction was carried out in patients with private, HMO, or PPO insurance (IBR 75.86%, DBR 75.32%, p = <0.001). Almost all breast surgeries were in urban areas as opposed to rural/isolated rural areas (96.02% vs. 1.55%, p = <0.001). There was no significant difference between races. Of all surgeries, 7.46% were completed in a cancer center with significantly higher rates of IBR. LA County, San Luis Obispo/Ventura County, and Northern CA had significantly more MO than other regions (p = <0.001). Conclusions: Reconstruction rates after mastectomy are low, with only 17.64% of patients undergoing reconstruction. Nationally, 70.5% of patients received MO, with 29.6% undergoing reconstruction. Significant factors positively contributing to reconstruction were private insurance, high SES, cancer center care, and urban residency. Identified barriers include public health insurance enrollment, rural or non-urban residence, older age, low SES, and non-white race/ethnicity, indicating potential monetary influences on care. Full article

Objectives: This study investigates the presence of crowding-in or crowding-out effects of long-term care insurance (LTCI) on older adults’ care in Korea. Additionally, it examines the influence of old-age income security and private systems, including private transfer income and private health insurance, on these effects. The analysis focuses on three aspects: family-provided care, private non-family care, and total care expenses. Methods: This study conducted logistic and linear regression. Logistic regression was used to examine the likelihood of receiving family-provided and private non-family care, while linear regression analyzed factors associated with total care expenditures. Results: The results reveal a crowding-in effect for family care, as greater utilization of public LTCI is positively associated with family-provided care. However, the relationship between public LTCI and private non-family care was not statistically significant, suggesting that the crowding-in effect on private care systems remains limited. Lastly, LTCI utilization was significantly associated with higher care expenditures. It is noteworthy that the current public LTCI in Korea has low coverage, resulting in insufficient care provision. Consequently, there is growing activity in the private care sector. Conclusions: These findings highlight the need for a more integrated approach to long-term care in Korea, balancing public, private, and family care resources. To achieve quality integrated long-term care for older people, policymakers should focus on expanding public LTCI coverage while fostering coordination between family caregivers and professional care services, ensuring a comprehensive and high-quality care system that meets the diverse needs of Korea’s aging population. Full article

Background/Objectives: High-flux online hemodiafiltration (OL-HDF) appears to be associated with better survival than hemodialysis (HD). In Brazil, OL-HDF is only affordable for patients with private health insurance. Although observational studies have shown a survival advantage with OL-HDF, even in Brazil, it is unclear whether this benefit applies to patients without private health insurance. We compared overall and cardiovascular mortality between OL-HDF and HD in patients treated exclusively through the public health care system. We hypothesized that patients on OL-HDF would have a higher survival rate than those on HD. Methods: This is an observational cohort study. Adult patients on maintenance hemodialysis or OL-HDF for at least one month during the period between 1 September 2022 and 1 December 2024 were enrolled into the study. The primary outcome was all-cause mortality. The secondary outcome was cardiovascular mortality. Fine-Gray sub-distribution hazard models were used to evaluate survival in the presence of competing events (kidney transplant and recovery of renal function). Results: Patients on HD (N = 321) and OL-HDF (N = 48) were similar in age, race, sex, and vascular access. Patients on HD were more likely to have diabetes (54.0% vs. 29.2%, p = 0.001) and spent more hours per week on dialysis (11.2 ± 1.8 vs. 10.5 ± 1.6 h, p = 0.006). In an adjusted Fine-Gray model, the hazard of death for patients on OL-HDF was 68% lower than that for patients on HD, and the risk of death for patients with an arteriovenous fistula was 55% lower compared to those with a catheter. Cardiovascular mortality did not differ between the groups. Conclusions: These findings suggest that OL-HDF is associated with an overall higher survival rate compared to HD, even for patients without private health insurance. Full article

Background/Objectives: In 2022, over 200 million outpatient antibiotic prescriptions were written in the U.S., with 30% deemed unnecessary. Previous studies have shown that demographic factors, such as age, gender, and race, influence antibiotic prescribing patterns. However, few studies have examined how social determinants of health contribute to health inequities in antibiotic prescribing. This study aims to explore these disparities in Tennessee using IQVIA data. Methods: The Tennessee Department of Health conducted a cross-sectional study using the IQVIA LRx and Dx databases, linking prescription data to diagnoses from 2022. Antibiotic prescriptions were categorized into three tiers based on appropriateness. A multivariable logistic regression model assessed factors such as age, gender, insurance type, and social vulnerability index (SVI) on antibiotic prescribing patterns. Results: Of 2,874,505 prescriptions analyzed, 59.3% were classified as inappropriate (Tier 3). Female patients and children were less likely to receive inappropriate antibiotics. Patients in lower SVI areas, indicating less social disadvantage, had lower odds of receiving unnecessary prescriptions. Medicaid and Medicare Part D beneficiaries had higher odds of receiving inappropriate antibiotics compared to those with private insurance. Conclusions: This study highlights significant health disparities in outpatient antibiotic prescribing in Tennessee. Male patients, older adults, and individuals in socioeconomically vulnerable areas are more likely to receive inappropriate prescriptions. These findings stress the need for targeted public health interventions to reduce unnecessary antibiotic use and address underlying health inequities, ultimately improving healthcare outcomes and reducing antimicrobial resistance. Full article

Background: Structural inequalities in healthcare access may influence how individuals experience the psychological effects of psychedelic substances, potentially limiting positive outcomes among vulnerable populations. Objectives: This study uses data from the National Survey on Drug Use and Health (2008–2019; N = 484,732) to examine how public and private health insurance moderate the association between psychedelic use and psychological distress. Methods: Ordinary least squares (OLS) regression models indicate that private health insurance is associated with lower psychological distress, while public insurance is associated with higher distress. Results: Psychedelic use moderates these associations, reinforcing the protective pattern linked to private insurance and intensifying distress among those with public coverage. These patterns vary by gender: among men, psychedelic use does not significantly alter the association between insurance type and distress; among women, however, psilocybin and lysergic acid diethylamide (LSD) use are associated with lower distress among those with private insurance, but with higher distress among those with public insurance. Conclusions: These findings indicate that while psychedelics may interact with existing healthcare conditions, they do not mitigate structural inequalities and may, in some cases, exacerbate them. Full article

Public buildings are crucial to creating healthy and sustainable cities. These buildings promote social cohesion and enrich urban life by transforming existing facilities into hybrid models that integrate medical content. Historical developments highlight shifts in residential, economic, and healthcare infrastructure. The healthcare system aims to enhance public health while ensuring financial equity. Reforms in healthcare privatization, governed by public health and insurance policies, involve liberalizing service provision and are supported by the Ministry of Health and Finance. This study examines how public buildings can adapt to enhance health and social sustainability. Through case studies, it assesses architectural adaptability in analyzing spatial, economic, and social impacts. Diagrams illustrate spatial dynamics, while surveys compare efficiency, sustainability, and user experience. Statistical analysis highlights the role of spatial adaptability in fostering sustainable urban environments. The results, which express significant differences between means for different locations and citizens’ satisfaction, suggest that the hypothesis offers substantial results in every area. Besides commercial programs in commercial buildings, healthcare also gives satisfactory results. This study advocates for adaptive architecture as a key strategy, aligning with evolving societal and health demands. Hybridizing healthcare facilities and commercial spaces transforms shopping centers into sustainable models, enhancing social cohesion and economic viability. Full article

Background/Objectives: Primary healthcare (PHC) plays a central role in the promotion of universal healthcare coverage within the Brazilian health system. Nevertheless, inequalities across municipalities represent substantial barriers to achieving equity in access to health, particularly due to disparities in the quality of healthcare delivered to patients. Thus, the study aimed to investigate factors associated with perception of PHC quality among adult individuals using private and public facilities within the Brazilian health system. Methods: The empirical approach was based on quantitative analysis of cross-sectional data from five nationally representative surveys conducted by the Brazilian Institute for Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE) in 1998, 2003, 2008, 2013, and 2019. Pairwise comparisons and marginal analyses allowed for the assessment of differences in patients’ perception of healthcare quality according to source of funding and type of healthcare quality. A logistic regression model was estimated to identify factors associated with the perception of good quality of care. Model discrimination, calibration, and goodness-of-fit were assessed to ensure the robustness of analyses. Results: The results indicate that patients’ satisfaction was positively associated with level of implementation of the national program based on payment for performance in public healthcare facilities, PMAQ-AB (OR = 3.376; p < 0.001), self-assessment of good health status (OR = 3.209; p < 0.001), and healthcare financed through health insurance (OR = 2.344; p < 0.001). Contrarily, receiving healthcare in a public facility (OR = 0.358; p < 0.001) was negatively associated with the evaluation of good quality. Conclusions: The findings showed that patients’ perception of quality of care presents significant associations with patients’ health characteristics, healthcare funding source, and implementation of the PMAQ-AB. Furthermore, patients generally perceived lower healthcare quality in public facilities. The study indicates the need for evidence-based decision-making in public policies of health, particularly regarding further advances in payment for performance programs designed to foster improvements in quality of care within public PHC facilities in Brazil. Full article

This study focuses on the psychological state and economic preparedness of socially isolated older individuals in China’s rapidly aging society. Both a simple model and an extended model were developed and tested to explore the impact of social isolation on the subjective well-being of older adults by analyzing how social isolation, self-assessment of health, and anxiety about old age affect subjective well-being. The results indicated that both social isolation and self-assessment of health have a strong influence on subjective well-being, and that social isolation significantly alters older individuals’ perception of caregiving responsibility. While private insurance participation had a significant impact on the well-being of younger individuals, its effect on older adults was limited. These findings provide valuable insights for improving support systems for older people. Full article

Background and Objectives: Mental health disorders, including major depressive disorder and adjustment disorder with mixed anxiety and depressed mood, present a significant global burden, with early onset and progression leading to substantial individual and social impacts. While pharmacotherapy remains the standard treatment, many patients experience inadequate symptom relief or intolerable side effects. In this context, transcranial magnetic stimulation (TMS) has emerged as a non-invasive, well-tolerated neuromodulation technique offering an alternative treatment option. Although its clinical efficacy is well-documented, limited research exists on patient perceptions, decision-making processes and barriers to TMS utilization in private healthcare settings, particularly in Romania. This study explores patients’ experiences with TMS, factors influencing their treatment choices and comparative views on its acceptability relative to pharmacological interventions. Materials and Methods: A qualitative research design was employed, using semi-structured interviews with 20 patients diagnosed with MDD or AD who had undergone TMS therapy as part of two pilot studies which were non-randomized in Romanian private practices. Data were collected via interviews and analyzed thematically to identify patterns in patient perceptions, decision-making factors and treatment experiences. Results: Participants reported predominantly positive perceptions of TMS, citing improvements in mood, anxiety reduction, and enhanced daily functioning. The most common motivations for seeking TMS included dissatisfaction with pharmacotherapy, recommendations from physicians or peers and information obtained via online sources. TMS was perceived as a safer and more tolerable alternative to medication, particularly due to its lack of systemic side effects. However, barriers such as high treatment costs, limited insurance coverage and logistical challenges in accessing TMS services were noted as significant deterrents. Conclusions: The study highlights the strong preference for TMS among patients who seek alternatives to pharmacotherapy, with key motivators including efficacy, tolerability and non-invasiveness. However, systemic barriers to access remain a critical challenge in private healthcare settings. Future research should focus on expanding accessibility, improving patient education and integrating TMS into broader mental healthcare frameworks to optimize treatment outcomes. Full article

Introduction: The rise in youth sports participation has led to an increase in pediatric sports-related injuries in the United States, contributing to growing healthcare costs and exacerbating socioeconomic disparities. Insurance payor status is a critical factor influencing access to care, treatment delays, and health outcomes. This study examines the association between insurance payor status and outcomes in pediatric sports-related injuries. Methods: A systematic review of the Medline database was conducted. Included studies reported insurance payor status and pediatric sports orthopedic patient outcomes following surgery. Outcomes included time to be seen by a provider, treatment access, complication and revision rates, postoperative Emergency Department (ED)/Urgent Care utilization, readmission rates, hospital length of stay, pain, functional scores, discharge destinations, return to activity, and follow-up. Results: A total of 35 studies comprising 535,891 pediatric patients were included. Publicly insured or uninsured patients consistently experienced significant delays in accessing care, with average wait times for clinic visits, imaging, and surgery up to six times longer compared to privately insured patients. These delays were associated with worsened injury severity, higher rates of postoperative complications, and poorer functional outcomes. Publicly insured patients were less likely to receive advanced treatments such as bracing or physical therapy, further compounding disparities. Minority groups faced delays even when controlling for insurance status. Conclusions: Public and uninsured pediatric patients face systemic barriers to timely and equitable care, resulting in worse outcomes following sports-related injuries. Future research should explore targeted solutions to ensure equitable care for this vulnerable population. Full article