Is Health Insurance Affordable for the Uninsured?

In this paper, we investigate the meaning of affordability' in the context of health insurance. Assessing the relationship between the affordability of coverage and the large number of uninsured in the U.S. is important for understanding the barriers to purchasing coverage for the uninsured and evaluating the role of policy in reducing this number. We propose several definitions of affordability and examine the implications of alternative definitions on estimates of the proportion of currently uninsured who are unable to afford coverage. We find that, depending on the definition, health insurance was affordable to between one-quarter and three-quarters of the uninsured in 2000.

From Hospital to Drugstore: Insurance and the Shift to Outpatient Care

As policymakers consider whether and how to add prescription drug coverage to Medicare, they need to understand the relationship between insurance coverage and the adoption of new medical technologies, including drugs. Even the direction of these relationships is not always so clear. In this Issue Brief, Drs. Danzon and Pauly examine the shift from inpatient to outpatient care in the last 20 years, and ask two broad questions: to what extent was this shift encouraged by changes in insurance, and to what extent was insurance coverage influenced by this shift

Health Insurance and the Growth in Pharmaceutical Expenditures*

This paper examines the contribution of insurance coverage to the recent unprecedented growth in spending on pharmaceuticals. Trends in drug spending over time closely paralleled the growth in drug coverage. Most of the coverage growth reflects an increase in the number of people with coverage, 65 percent from 1987 to 1996, rather than increased depth of coverage. The direct moral hazard effect of this insurance growth accounts for between one‐fourth and one‐half of the increase in drug spending. Technological change contributed to these changes, because both the flow of new drugs increased the demand for insurance and information technologies enabled the development of pharmacy benefit management, which reduced the real price of drug coverage. It is plausible that insurance growth also stimulated drug promotion. The only obvious source of inefficiency is the tax subsidy, which may lead to excessive insurance and promotion. This applies to all health care, not just pharmaceuticals

Is Health Insurance Affordable for the Uninsured?

In this paper, we investigate the meaning of “affordability” in the context of health insurance. Assessing the relationship between the affordability of coverage and the large number of uninsured in the U.S. is important for understanding the barriers to purchasing coverage and evaluating the role of policy in reducing the number of uninsured. We propose several definitions of affordability and examine the implications of alternative definitions for estimates of the proportion of uninsured who are unable to afford coverage. We find that, depending on the definition, health insurance was affordable to between one-quarter and three-quarters of the uninsured in the United States in 2000

Tableau-based decision procedure for the multi-agent epistemic logic with all coalitional operators for common and distributed knowledge

We develop a conceptually clear, intuitive, and feasible decision procedure for testing satisfiability in the full multi-agent epistemic logic CMAEL(CD) with operators for common and distributed knowledge for all coalitions of agents mentioned in the language. To that end, we introduce Hintikka structures for CMAEL(CD) and prove that satisfiability in such structures is equivalent to satisfiability in standard models. Using that result, we design an incremental tableau-building procedure that eventually constructs a satisfying Hintikka structure for every satisfiable input set of formulae of CMAEL(CD) and closes for every unsatisfiable input set of formulae.Comment: Substantially extended and corrected version of arXiv:0902.2125. To appear in: Logic Journal of the IGPL, special issue on Formal Aspects of Multi-Agent System

Identification of patients at high risk for hypocalcemia after total thyroidectomy with serial calcium estimation and intact parathyroid hormone levels-a comparative study

Background: In recent years, multiple retrospective and prospective studies have emerged, which support the use of postoperative serum intact parathyroid hormone (iPTH) levels can also predict hypocalcaemia in postoperative thyroidectomy patients. Therefore, the present study was designed to determine the incidence of hypocalcaemia after total thyroidectomy.Methods: 146 patients who underwent total thyroidectomy were recruited. The incidence of hypocalcaemia was analyzed with serial calcium estimation results with 6 hours, 24 hours, 48 hours and 2 weeks post-operative calcium level estimations. The incidence of hypocalcaemia with regards to the number of parathyroid glands was determined and the results between the three groups were compared.Results: The incidence of transient hypocalcaemia at 24hr postoperative period and intact parathyroid hormone (iPTH) level showed a significant difference (p<0.001). 49% of the patients were with calcium levels <8 mg/dl in first 24hrs of serial calcium estimation in comparison with the 51% parathormone level with <15pg/dl was also showed a significant difference (p<0.001). Calcium levels lessthan 8 mg/dl. The serial calcium level after 2wks with features of hypocalcemia (<8mg/dl) were 18% and was more predictable and coast effective than intact parathyroid hormone (i PTH) estimation which require Rs.1000-1200 in comparison with the serial calcium estimation of around Rs. 400.Conclusions: The serial calcium level estimations are more predictable and coast effective than intact parathyroid hormone (i PTH) estimation in predicting long term post-operative hypocalcaemia after total/near total thyroidectomy

A retrospective study on the incidence of hypocalcemia and number of parathyroid glands identified and preserved during thyroid surgeries

Background: Hypocalcaemia remains a major post-operative complication of total thyroidectomy causing potentially severe symptoms and anxiety in affected patients and increasing hospitalization time. Therefore the present study was designed to evaluate the incidence of hypocalcaemia and the number of parathyroid gland.Methods: 146 patients who underwent total/near total thyroidectomy were recruited. The incidence of hypocalcaemia was analyzed with serial calcium estimation results with 6 hours, 24 hours, 48 hours and 2weeks post-operative calcium level estimations. The incidence of hypocalcaemia with regards to the number of parathyroid glands was determined and the results between the three groups were compared.Results: The overall incidence of hypocalcaemia decreases with increase in the number of parathyroid glands per operatively. In Group-3, 16% of patients had hypocalcaemia in first 6 hours and 96% of patients had calcium value more than 8 mg/dl after 2 weeks without the features of hypocalcaemia. It was 84% and 77% in Group-1, 33% and 23% in Group-2.The difference was found to be statistically significant (p&lt;0.001).Conclusions: The incidence of hypocalcaemia decreases with increase in the number of parathyroid glands peroperativly in thyroid surgeries. The post-operative hypocalcaemia is predictable with the number of parathyroid glands and it gives a platform for an early discharge of the thyroidectomy patients without the fear of post-operative hypocalcaemia

Nanotrench for nano and microparticle electrical interconnects

We present a simple and versatile patterning procedure for the reliable and reproducible fabrication of high aspect ratio (10 4 ) electrical interconnects that have separation distances down to 20 nm and lengths of several hundreds of microns. The process uses standard optical lithography techniques and allows parallel processing of many junctions, making it easily scalable and industrially relevant. We demonstrate the suitability of these nanotrenches as electrical interconnects for addressing micro and nanoparticles by realizing several circuits with integrated species. Furthermore, low impedance metal-metal low contacts are shown to be obtained when trapping a single metal-coated microsphere in the gap, emphasizing the intrinsic good electrical conductivity of the interconnects, even though a wet process is used. Highly resistive magnetite-based nanoparticles networks also demonstrate the advantage of the high aspect ratio of the nanotrenches for providing access to electrical properties of highly resistive materials, with leakage current levels below 1 pA. © 2010 IOP Publishing Ltd

Function and quality of life following medial unicompartmental knee arthroplasty in patients 60years of age or younger

SummaryIntroductionUKA is an appropriate bone-sparing solution for focal advanced knee osteoarthritis in young patients. As the expectations of patients younger than 60 years of age are different from those in an older population, we aimed to evaluate quality of life and the quality of sports activity after UKA in this population.Patients and methodsSixty-five UKAs in 62 patients younger than 60 (mean age: 54.7 years; mean BMI: 28kg/m2) performed between 1989 and 2006 were included. At last follow-up (minimum 2 years), before the objective evaluation, patients were asked to fill in a KOOS questionnaire and a specific sports questionnaire including the UCLA score and questions from the Mohtadi score.ResultsWith a mean follow-up of 11.2±5 years (range, 2–19 years), the KOOS score was higher than 75 points in 90% of the patients for the quality-of-life categories but also for the score's four other categories: 83.4% of the patients had resumed their sports activities and the mean UCLA score was 6.8 (range, 4–9); 90% of the patients reported no or slight limitation during sports activities. The function KSS improved from 52±4 to 95±3 points postoperatively and the Knee KSS from 50±4 to 94±4 points. With three patients undergoing revision for an isolated insert exchange, one for septic loosening and three for osteoarthritis in the external compartment, the 12-year Kaplan-Meier survivorship was 94%.Discussion and conclusionThese results confirmed that UKA can provide good patient-rated outcomes, which is very important in this demanding population. As for TKA, wear remains a problem in this active population.Level of evidenceTherapeutic study, level IV