The effect of prescription drug insurance on the incidence of potentially inappropriate prescribing: evidence from Medicare Part D

The Medicare Part D program has been documented to increase the affordability and accessibility of drugs and improve the quality of prescription drug use; however, less is known about the equity impact of the Part D program on potentially inappropriate prescribing—specifically, incidences of polypharmacy and potentially inappropriate medication (PIM) use based on different racial/ethnic groups. Using a difference in the regression discontinuity design, we found that among Whites, Part D was associated with increases in polypharmacy and “broadly defined” PIM use, while the use of “always avoid” PIM remained unchanged. Conversely, Blacks and Hispanics reported no changes in such drug utilization patterns

Prescription Patterns and Burden of Pediatric Asthma in Korea

PURPOSE: This study aimed to estimate the prevalence, prescription pattern and burden of pediatric asthma in Korea by analyzing the National Health Insurance (NHI) claims data. METHODS: We retrospectively analyzed the insurance claim records from the Korean NHI claims database from January 2010 to December 2014. Asthmatic patients were defined as children younger than 18 years, with appropriate 10th Revision of the International Classification of Diseases codes (J45 or J46) and a prescription for 1 or more asthma maintenance medications at the same date. Hospitalization and emergency department visits for asthma were defined as use of short-acting beta₂-agonists during hospital visits among asthmatic patients. RESULTS: There were 1,172,807 asthmatic children in 2010, which increased steadily to 1,590,228 in 2014 in Korea. The prevalence showed an increasing trend annually for all ages. The mean prevalence by age in those older than 2 years decreased during the study period (from 39.4% in the 2-3 year age group to 2.6% in the 15-18 year age group). In an outpatient prescription, leukotriene receptor antagonists were the most commonly prescribed medication for all ages. Patients older than 6 years for whom inhaled corticosteroids were prescribed comprised less than 15% of asthmatic patients. The total direct medical cost for asthma between 2010 and 2014 ranged from $376 to$483 million. Asthma-related medical cost per person reached its peak in $366 in 2011 and decreased to$275 in 2014. CONCLUSIONS: The prevalence of pediatric asthma increased annually and decreased with age. Individual cost of asthma showed a decreasing trend in Korean children.ope

Can diabetes patients seeking a second hospital get better care? Results from nested case-control study

This study investigates the effects of the number of medical institutions visited on risk of death. This study conducted a nested case-control design using the National Health Insurance Service-Senior database from 2002 to 2013. Cases were defined as those with death among outpatients who had first diagnosis of diabetes mellitus (E10-E14) after entry into the base cohort and controls were selected by incidence density sampling and matched to cases based on age, and sex. Our main results were presented by conditional logistic regression for nested case-controls design. Of total 55,558 final study samples, there were 9,313 (16.8%) cases and 46,245 (83.2%) controls. With an increase by one point in the number of hospitals per medical utilization, risk of death significantly increased by 4.1% (odds ratio (OR): 1.041, 95% confidence interval [CI]: 1.039-1.043). In both medical utilization and number of hospitals, those with high medical utilization (OR: 1.065, 95% CI: 1.059-1.070) and number of hospitals (OR: 1.049, 95% CI: 1.041-1.058) for risk of death were significantly higher than those with low medical utilization (OR: 1.040, 95% CI: 1.037-1.043) and number of hospitals (OR: 1.029, 95% CI: 1.027-1.032), respectively. The number of medical institution visited was significantly associated with risk of death. Therefore, diabetics should be warned about the potential of risk of death incurred from excessive access to medical utilizations.ope

Voter Education: The Key to Election Reform Success Lessons from Florida

Over a dozen national task forces and commissions have analyzed the 2000 presidential election and concluded that electoral system reforms are imperative not just in Florida, but nationwide. Among the common recommendations are elimination of punch card ballots, enhancement of registration procedures and outreach, provision of more accurate voter lists, clear delineation of appeals processes, establishment of voter rights and responsibilities, clarification of recount rules and procedures, securing of accessible polling places, better facilitation of voting and proper counting of absentee ballots, and ensuring provisional ballots available at each precinct. For these reforms to be most effective, the reports say, better voter education is needed, and elections officials and poll workers must receive better training. Florida has passed laws mandating better voter education, along with many other electoral reforms, in both the 2001 and 2002 legislative sessions. The sweeping Florida Election Reform Act of 2001 requires all 67 county supervisors of elections to file voter education plans with the Division of Elections in the Florida Department of State in order to qualify for state funds. (The Act appropriated nearly $6 million for voter education in fiscal year 2001-2002 in addition to$24 million for purchase of new voting equipment, fiscal years 2001-2003.) Laws passed in the 2002 session broaden the scope of voter education responsibilities, more definitively spell out voter rights, and ensure that Florida\u27s electoral system conforms with the Americans with Disabilities Act of 1990. This Article details the content and thrust of Florida s voter education efforts and examines the creative educational efforts underway at the local level that other states\u27 communities would do well to follow, lest they become the objects of major litigation, the sites of political furor, and the objects of unwanted national attention

The Ground on Which We All Stand: A Conversation About Menstrual Equity Law and Activism

This essay grows out of a panel discussion among five lawyers on the subject of menstrual equity activism. Each of the authors is a scholar, activist or organizer involved in some form of menstrual equity work. The overall project is both enriched and complicated by an intersectional analysis. This essay increases awareness of existing menstrual equity and menstrual justice work; it also identifies avenues for further inquiry, next steps for legal action, and opportunities that lie ahead. After describing prior and current work at the junction of law and menstruation, the contributors evaluate the successes and limitations of recent legal changes. The authors then turn to conceptual issues about the relationship between menstrual equity and gender justice, as well as the difference between equity and equality. The essay concludes with consideration of the future of menstrual equity and menstrual justice work. The authors envision an expanded, inclusive group of individuals working for greater gender justice

Robotic Surgery for Rectal Cancer and Cost-Effectiveness

Robotic surgery is considered as one of the advanced treatment modality of minimally invasive surgery for rectal cancer. Robotic rectal surgery has been performed for three decades and its application is gradually expanding along with technology development. It has several technical advantages which include magnified three-dimensional vision, better ergonomics, multiple articulated robotic instruments, and the opportunity to perform remote surgery. The technical benefits of robotic system can help to manipulate more meticulously during technical challenging procedures including total mesorectal excision in narrow pelvis, lateral pelvic node dissection, and intersphincteric resection. It is also reported that robotic rectal surgery have been shown more favorable postoperative functional outcomes. Despite its technical benefits, a majority of studies have been reported that there is rarely clinical or oncologic superiority of robotic surgery for rectal cancer compared to conventional laparoscopic surgery. In addition, robotic rectal surgery showed significantly higher costs than the standard method. Hence, the cost-effectiveness of robotic rectal surgery is still questionable. In order for robotic rectal surgery to further develop in the field of minimally invasive surgery, there should be an obvious cost-effective advantages over laparoscopic surgery, and it is crucial that large-scale prospective randomized trials are required. Positive competition of industries in correlation with technological development may gradually reduce the price of the robotic system, and it will be helpful to increase the cost-effectiveness of robotic rectal surgery.ope

Chinese Experience with Global G3 Standard-Setting

China’s growth strategy as set out in the 11th 5-year plan in 2005 called for upgrading of product quality, the development of an innovation society, and reduced reliance on foreign intellectual property with high license fees. Consistent with this policy, China has been involved in recent years with the development of a Chinese standard in third generation (3G) mobile phone technology, both in negotiating the standard and seeing it through to commercialization. This is the first case of a developing country both originating and successfully negotiating a telecommunications standard and this experience raises issues for China’s future development strategy based on product and process upgrading in manufacturing. We argue that while precedent setting from an international negotiating point of view, the experience has thus far is unproven commercially. But the lessons learned will benefit future related efforts in follow-on technologies if similar Chinese efforts are made.This paper documents Chinese standard-setting efforts from proposal submission to ITU to the current large-scale trial network deployment in China and overseas trial networks deployment. We discuss the underlying objectives for this initiative, evaluate its effectiveness, and assess its broader implications for Chinese development policy.