Envisioning a Better U.S. Health Care System for All: Coverage and Cost of Care

Crowley, Ryan; Daniel, Hilary; Cooney, Thomas G.; Engel, Lee S.

doi:10.7326/m19-2415

Cited by 93 publications

(71 citation statements)

References 94 publications

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“…One type of shared cost is the copayment, or "copay," which is a fixed amount an individual pays for a specific service or prescription medication. 2 Since the advent of direct-acting antiviral (DAA) treatment, 3 there has been an increase in the use of HCV-V organs for transplant, [4][5][6][7][8] mostly within the clinical trial setting but also as part of real-world clinical practice protocols in which patients are responsible for the cost of DAA therapy, 9,10 which can be considerable. 11 Recent reports suggest excellent short-term outcomes with use of HCV-V organ transplantation.…”

Section: Backg Rou N Dmentioning

confidence: 99%

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Post‐transplant survey to assess patient experiences with donor‐derived HCV infection

Prakash

Ramirez‐Sanchez

Ramirez

et al. 2020

Transplant Infectious Dis

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Background: Despite increased utilization of hepatitis C virus-infected (HCV+) organs for transplantation into HCV-uninfected recipients, there is lack of standardization in HCV-related patient education/consent and limited data on financial and social impact on patients. Methods: We conducted a survey on patients with donor-derived HCV infection at our center transplanted between 4/1/2017 and 11/1/2019 to assess: why patients chose to accept HCV+ organ(s), the adequacy of their pre-transplant HCV education and informed consent process, financial issues related to copays after discharge, and social challenges they faced. Results: Among 49 patients surveyed, transplanted organs included heart (n = 19), lung (n = 9), kidney (n = 11), liver (n = 4), heart/kidney (n = 4), and liver/kidney (n = 2). Many recipients accepted an HCV-viremic (HCV-V) organ due to perceived reduction in waitlist time (n = 33) and/or trust in their physician's recommendation (n = 29). Almost all (n = 47) felt that pre-transplant education and consent was appropriate. Thirty patients had no copay for direct-acting antivirals (DAA) for HCV, including 21 with household income <$20 000; seven had copays of <$100 and one had a copay >$1000. Two patients reported feeling isolated due to HCV infection and eight reported higher than anticipated medication costs. Patients' biggest concern was potential HCV transmission to partners (n = 18) and family/friends (n = 15). Overall almost all (n = 47) patients reported a positive experience with HCV-V organ transplantation. Conclusion: We demonstrate that real-world patient experiences surrounding HCV-V organ transplantation have been favorable. Almost all patients report comprehensive HCV-related pre-transplant consent and education. Additionally, medication costs and social isolation/exclusion were not barriers to the use of these organs.

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Section: Backg Rou N Dmentioning

confidence: 99%

“…The share incurred by the individual varies greatly by type of insurance, policy, and even by state. One type of shared cost is the copayment, or “copay,” which is a fixed amount an individual pays for a specific service or prescription medication 2 …”

Section: Introductionmentioning

confidence: 99%

Post‐transplant survey to assess patient experiences with donor‐derived HCV infection

Prakash

Ramirez‐Sanchez

Ramirez

et al. 2020

Transplant Infectious Dis

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“…Another critique is that the US healthcare system (if it can be called a system) is vastly complex with no coordination between healthcare receivers, providers and financers (Moses et al, 2013). Similarly, Crowley et al (2020) summarise that this country’s healthcare system is unaffordable, unsustainable and inaccessible. Besides, 29 million Americans (8.9% of the population) did not have health insurance at any point in 2018 (Census, 2020).…”

Section: Introductionmentioning

confidence: 99%

How Do Various Health Insurance Coverages Affect COVID-19-related Stay-at-Home-Tendencies of People Across US States?

Ongan

Göçer

2020

Journal of Health Management

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This study investigates the relations between COVID-19-related stay-at-home-tendencies and various health insurance coverages of people across US states. To this aim, the K-means clustering and panel regression analysis with cross-sectional dependence are applied. The main empirical finding reveals that various health insurance coverages have different level impacts on COVID-19-related stay-at-home-tendencies. People who are uninsured tend to stay at home the most as compared with people with private, Medicaid, Medicare and military health insurance coverages. As a result, it may be interpreted that uninsured people have serious concerns about affording healthcare costs associated with COVID-19 and, thereby, stay at home. However, people with private health insurance coverages tend to stay at home the least. This may also lead to the interpretation that people with private health insurance coverages feel safer and better protected against the rising risks of this pandemic outside their homes.

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“…Today, national health insurance is a central dividing issue in the Democratic presidential primary election, which will produce President Trump’s challenger, and potentially his successor. Meanwhile, in January, the nation’s largest medical specialty society took the historic step of endorsing national health insurance (Medicare for All) as one road to universal coverage 13. There is, then, some burgeoning hope that the US may yet join other nations in realizing a right to healthcare.…”

mentioning

confidence: 99%