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Medicaid: Medicaid: eligibility--2005. End of Year Issue Brief.

Medicaid, a joint federal-state program started in 1965 as Title XIX of the Social Security Act, provides health insurance coverage to low-income children, parents meeting specific income thresholds, pregnant women, the elderly and people with disabilities. In 2003, Medicaid provided health care insurance to approximately 40.2 million low-income Americans. That same year, 45 million Americans had no health insurance at all. In order to reduce the number of uninsured people in the United States, state legislators have introduced hundreds of bills over the past decade to expand health insurance coverage to low-income citizens. Health insurance has been extended for low-income children through Medicaid expansions, the State Children's Health Insurance Program (SCHIP) and other medical assistance programs. States, in partnership with the federal government, have also made it easier for disabled individuals to qualify for Medicaid through Ticket-to-Work legislation (which allows individuals with disabilities to remain in the workforce and keep their Medicaid coverage). They also have expanded coverage for senior citizens, especially for their prescription drug needs through Medicaid Pharmacy Plus waivers. In fact, from 1997 to 2003, monthly Medicaid enrollment rose from 31.2 million to 40.6 million recipients.

Adult↗

Affiliations with medical care providers.

Two analytical techniques are applied to a household survey of Rhode Island residents to develop the concept of an affiliation with medical care provider. A modification of a deviant case analysis is used to examine those people who are extreme in terms of the numbers of affiliations that they have with medical care providers. Overall, 4.1% of the sample have no affiliations and 7.3% have four or more affiliations. One of the most important variables in distinguishing those people with an unusual number of affiliations is a subjective variable of health status--whether they worry about their health. Nonparticipants rarely worry about their health and are generally in good health, while those with a high number of affiliations worry a great deal, regardless of their actual health status. A multiple regression analysis reveals that the variables of number of health conditions, sex, insurance, worry about health, income, disability days, and family structure are significantly related to mean number of affiliations with an R2 of 19.5%. Discussion includes the study's implications both for greater understanding of how and why people seek care and for application in the further development of a social psychological model of health behavior.

Adolescent↗

[Medical and non-medical risk factor criteria for disability pension].

BACKGROUND: Non-medical factors may contribute substantially to the risk of becoming disabled, despite the common medically based criteria for disability pension. This study seeks to identify medical and non-medical determinants for the national medically-based disability pension in a Norwegian total population. MATERIAL AND METHODS: The baseline data were obtained through a comprehensive health screening programme, the Nord-Trøndelag Health Study in 1984-86 (HUNT I). Participants were people without disability pension, 20-66 years old in 1984-86. Information on disability pensioning was obtained from the National Insurance Administration database in 1995. Data analysis was performed by life table and Cox regression analysis. RESULTS: The incidence of disability pension showed great variations by age and gender; there was an increase over the follow-up period, especially among people below 50. We found a consistent pattern of increasing risk of disability pension with decreasing socio-economic status and education. Low educational level, low perceived health, occupational related factors, and any long-standing health problem were found to be the strongest independent risk factors for disability pension. INTERPRETATION: Non-medical factors are strong risk factors for disability pension. These factors are usually not addressed by individually based health or rehabilitation programmes. Thus, when it comes to addressing the causes of incidence of disability pension in the population, the results suggest a population approach.

Adult↗

[Analysis of work absenteeism due to illness in the provinces].

Sickness absenteeism in individual regions (voivodships) depends on various factors involved in temporary work disability, such as industrial advancement, industrial structure, socio-economic development, and recently also unemployment in individual regions as well as changes in the social insurance system. Certificates recording temporary work disability served as a reference material for the analysis. The material under study was derived from the nation-wide database covering a 15% random sample of those cards. Sickness absenteeism was expressed by the rate lost time which defined the percentage of work disability in days in relation to the product of calendar days and the mean number of the employed. In 1994 lost time rate in Poland accounted for 6.69 and it was very much diversified depending on individual regions. The lowest rates were registered in the region of Warsaw (3.17), Lomza (4.23), Suwałki (4.48), Koszalin (4.55) and Olsztyn (4.58), whereas the highest ones occurred in Sieradz (12.07), Nowy Sacz (11.10), Premyśl (10.08), Tarnŏw (9.98) and Tarnobrzeg (9.89) regions. Over a twofold increase in sick absenteeism in comparison with 1990 was noted in Siedlce, Tarnobrzeg, Tarnów, Ostrołeka, Sieradz and Zamość regions. The Sieradz region shows the highest rate of sick absenteeism due to diseases of the musculoskeletal system (2.87), gynecological diseases and complications of pregnancy (1.52), the Nowy Sacz region due to diseases of the respiratory (1.82) and the circulatory (1.90) systems, and the Przemyśl region due to neuroses, psychoses and other mental disorders (0.85). A considerable increase in sickness absenteeism in low industrialised regions (Siedlce, Ostrołeka, Chełm, Zamość and Sieradz) observed during the last five years applies mostly to chronic diseases and it related with the right to sickness benefits which discloses poor health of workers employed in agriculture. Industrial restructuring and establishment of small-scale enterprises have also contributed to essential changes in regional diversification of sickness absenteeism. These changes confirm the need verifying the discussed relationship through an in-depth study.

Absenteeism↗

A cost-utility analysis of mitoxantrone hydrochloride and interferon beta-1b in the treatment of patients with secondary progressive or progressive relapsing multiple sclerosis.

BACKGROUND: Information on the cost utility of interferon beta-1b and mitoxantrone hydrochloride, 2 disease-modifying agents approved by the US Food and Drug Administration for the treatment of secondary progressive (SP) multiple sclerosis (MS), is limited. OBJECTIVE: The aim of this study was to compare the cost utility of i.v. mitoxantrone hydrochloride administered every 3 months, s.c. interferon beta-1b administered every other day, and routine supportive care from the perspectives of both the insurer and society. METHODS: We used a Markov model with health states based on the Kurtzke Expanded Disability Status Scale (EDSS) scores from both an insurer's and a societal perspective (including direct and total costs, respectively). Theoretical patients entered the model with an EDSS score of 3; their progression was followed for 10 years. Transition probabilities were derived from clinical trial data. Cost and utility inputs were taken from the literature. Sensitivity analyses were conducted on all variables. RESULTS: From the insurer's perspective, the incremental cost-utility ratio of mitoxantrone hydrochloride therapy compared with routine supportive care was 58,272 dollars per quality-adjusted life year (QALY) gained. From a societal perspective, mitoxantrone hydrochloride was more effective and less costly than supportive care. From the perspectives of insurers and society, the cost-utility ratios of interferon beta-1b compared with routine supportive care were 338,738 dollars and 245,700 dollars per QALY gained, respectively. When compared with mitoxantrone hydrochloride, interferon beta-1b had an incremental cost-utility ratio of 741,331 dollars and 658,402 dollars per QALY from the insurer's and society's perspectives, respectively. Cost-utility ratios for mitoxantrone hydrochloride were sensitive to acquisition and administration costs of therapy and to effectiveness at slowing disease progression. Cost-utility ratios for interferon beta-1b were not sensitive to any of the variables included in the model. CONCLUSIONS: Mitoxantrone hydrochloride is likely to be a cost-effective treatment for patients with SPMS or progressive relapsing MS from an insurer' perspective and is cost saving from a societal perspective. Interferon beta-1b is not likely an efficient treatment using conventional comparisons for cost-effectiveness. This analysis has potentially important implications for policy implementation; however, decisions about which agent to use for each patient should consider the treatment's adverse-event profile, the method of administration, and the patient's preferences for these factors.

Adjuvants, Immunologic↗

[Self-inflicted finger-amputation: insurance fraud or accidental injury?].

A 50-year-old surgeon was working with his electrical circle saw as a do-it-yourselfer. He was alone, nobody witnessed his mishap when he amputated his left index finger. He claimed high financial compensation from two accident insurance companies because of his disability. A long series of medical expertises followed. The juridical procedures took 12 years in total. All higher authorities had to deal with the forensic medical implications. Finally, the high court (Bundesgerichtshof) decided that the complainant would receive no compensation because he gave two very different descriptions. Concerning the reconstruction of the accident, the first version was unlikely from a biomechanical point of view. The decision of the court was solely based on the violation of the obligation to give a clear presentation of the course of events (Obliegenheitsverletzung).

Accidents↗

Cost and determinants of morbidity from work related disabling injuries in Taiwan.

OBJECTIVES: To estimate the cost and determinants of morbidity from work related disabilities. METHODS: 114 people who lived in metropolitan Taipei and who had received disability compensation from the Labor Insurance Bureau from March to June, 1991 were randomly selected. There were 77 workers interviewed through a questionnaire that inquired about possible loss of productivity including the duration of morbidity, the ability to return to work, and any change in monthly income upon returning to work. RESULTS: The mean (SD) duration of a stay in hospital was 29 (39) days, median: 15 days. The average duration between discharge from the hospital and returning to work was 111 (146) days, median: 45 days. The main determinants of the duration of the stay in hospital were the number of stays in hospital and the severity of the injury. A multivariate linear analysis showed that old age and the severity of injury determine the durations of morbidity. An ordinal logistic regression analysis showed that the severity of injury, size of the factory, and age determined the magnitude of future productivity loss. Based on these models, it was estimated that the total duration of morbidity (in hospital and at home) due to occupational disability was 660,000 person-days each year. When the percentage of the decrease in income because of permanent disability was converted into a loss of work days, the annual morbidity costs were about 19,000-26,000 person-years between 1985-1990. CONCLUSION: The morbidity cost was about five times as high as the lump sum payment that a worker usually received for disability compensation. We conclude that morbidity cost should be evaluated carefully in the future for the establishment of accurate and fair disability compensation payments.

Accidents, Occupational↗