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Bleck R, Marquez E, Gold MA, Westhoff CL. A scoping review of acupuncture insurance coverage in the United States. Acupunct Med 2020; 39:461-470. [PMID: 33307728 DOI: 10.1177/0964528420964214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Increasing access to non-pharmacologic pain management modalities, including acupuncture, has the potential to reduce opioid overuse. A lack of insurance coverage for acupuncture could present a barrier for both patients and providers. The objective of this scoping review was to assess the existing literature on acupuncture insurance coverage in the United States and to identify knowledge gaps and research priorities. METHODS We utilized the Arksey and O'Malley framework to guide our scoping review methodology. We followed a pre-determined study protocol for the level-one abstract and level-two full text screenings. We synthesized information into subject-area domains and identified knowledge gaps. RESULTS We found a lack of published data on acupuncture coverage in 44 states, especially in the Midwest and the South. Where data were available, a large proportion of acupuncture users did not have insurance coverage. Consumer demand, state mandates, and efforts to reduce opioid use were motivations to cover acupuncture. Licensed acupuncturists were less likely to be reimbursed and were reimbursed at lower rates compared to physicians. Reported barriers encountered when implementing coverage included a lack of providers, challenges determining when to offer non-pharmacologic treatments, and a lack of evidence for clinical efficacy and cost-effectiveness. CONCLUSION We found a lack of recent publications and data comparing regional coverage in the United States. A key challenge is that commercial insurance plan data are not in the public domain. Further research should assess insurance coverage implementation for acupuncture and measure the impact of policy changes on acupuncture utilization and rates of opioid overuse.
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Affiliation(s)
- Roselle Bleck
- Columbia University Mailman School of Public Health, New York, NY, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Emma Marquez
- Columbia University Mailman School of Public Health, New York, NY, USA.,Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Melanie A Gold
- Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Pediatrics, Columbia University Irving Medical Center, Now York, NY, USA
| | - Carolyn L Westhoff
- Columbia University Mailman School of Public Health, New York, NY, USA.,Department of Obstetrics & Gynecology, Columbia University Irving Medical Center, New York, NY, USA
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Findley PA, Wiener RC, Shen C, Dwibedi N, Sambamoorthi U. Health reform under the patient protection and Affordable Care Act: characteristics of exchange-based health insurance enrollees. SOCIAL WORK IN HEALTH CARE 2019; 58:685-702. [PMID: 31215849 PMCID: PMC7203640 DOI: 10.1080/00981389.2019.1619116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 09/27/2018] [Accepted: 05/11/2019] [Indexed: 06/09/2023]
Abstract
The Affordable Care Act (ACA) reformed and expanded healthcare coverage with an exchange-based health insurance program. While millions of Americans have benefited from enrollment in ACA marketplace insurance plans, many individuals are likely to be affected by potential future policy changes. Since few studies on the features of marketplace enrollees exist, we adopted a retrospective, cross-sectional study design using 2016 National Health Interview data to identify sociodemographic and health characteristics of enrollees, comparing them to those without insurance. Chi-square tests and logistic regression examined factors associated with enrollees. Adults with multiple chronic diseases (AOR = 1.90, 95% CI = 1.44, 2.50), a history of smoking (AOR = 2.44, 95% CI = 1.82, 3.26), females, married, age 50-64 years, higher educational attainment, and retirees (AOR = 1.86, 95% CI = 1.06, 3.27) were more likely to be enrollees. Since enrollees are largely higher risk individuals with greater healthcare needs, policies that modify the ACA should take these factors into account to reduce potential adverse impacts on enrollees.
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Affiliation(s)
| | - R. Constance Wiener
- Department of Dental Practice and Rural Health, School of Dentistry, West Virginia University, Morgantown, WV, USA
| | - Chan Shen
- Departments of Health Services Research and Biostatistics, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nilanjana Dwibedi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA
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Charles SA, Ponce N, Ritley D, Guendelman S, Kempster J, Lewis J, Melnikow J. Health Benefits Mandates and Their Potential Impacts on Racial/Ethnic Group Disparities in Insurance Markets. J Immigr Minor Health 2016; 19:921-928. [PMID: 27225252 DOI: 10.1007/s10903-016-0436-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Addressing racial/ethnic group disparities in health insurance benefits through legislative mandates requires attention to the different proportions of racial/ethnic groups among insurance markets. This necessary baseline data, however, has proven difficult to measure. We applied racial/ethnic data from the 2009 California Health Interview Survey to the 2012 California Health Benefits Review Program Cost and Coverage Model to determine the racial/ethnic composition of ten health insurance market segments. We found disproportional representation of racial/ethnic groups by segment, thus affecting the health insurance impacts of benefit mandates. California's Medicaid program is disproportionately Latino (60 % in Medi-Cal, compared to 39 % for the entire population), and the individual insurance market is disproportionately non-Latino white. Gender differences also exist. Mandates could unintentionally increase insurance coverage racial/ethnic disparities. Policymakers should consider the distribution of existing racial/ethnic disparities as criteria for legislative action on benefit mandates across health insurance markets.
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Affiliation(s)
- Shana Alex Charles
- Department of Health Science, California State University Fullerton, 800 N. State College Boulevard, Fullerton, CA, 92831, USA.
| | - Ninez Ponce
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Dominique Ritley
- Department of Family and Community Medicine, UC Davis, Davis, CA, USA
| | | | | | - John Lewis
- California Health Benefits Review Program, Oakland, CA, USA
| | - Joy Melnikow
- Department of Family and Community Medicine, UC Davis, Davis, CA, USA
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Fabian CJ, Meyskens FL, Bajorin DF, George TJ, Jeter JM, Khan S, Tyne CA, William WN. Barriers to a Career Focus in Cancer Prevention: A Report and Initial Recommendations From the American Society of Clinical Oncology Cancer Prevention Workforce Pipeline Work Group. J Clin Oncol 2016; 34:186-93. [PMID: 26527778 PMCID: PMC5070551 DOI: 10.1200/jco.2015.63.5979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assist in determining barriers to an oncology career incorporating cancer prevention, the American Society of Clinical Oncology (ASCO) Cancer Prevention Workforce Pipeline Work Group sponsored surveys of training program directors and oncology fellows. METHODS Separate surveys with parallel questions were administered to training program directors at their fall 2013 retreat and to oncology fellows as part of their February 2014 in-training examination survey. Forty-seven (67%) of 70 training directors and 1,306 (80%) of 1,634 oncology fellows taking the in-training examination survey answered questions. RESULTS Training directors estimated that ≤ 10% of fellows starting an academic career or entering private practice would have a career focus in cancer prevention. Only 15% of fellows indicated they would likely be interested in cancer prevention as a career focus, although only 12% thought prevention was unimportant relative to treatment. Top fellow-listed barriers to an academic career were difficulty in obtaining funding and lower compensation. Additional barriers to an academic career with a prevention focus included unclear career model, lack of clinical mentors, lack of clinical training opportunities, and concerns about reimbursement. CONCLUSION Reluctance to incorporate cancer prevention into an oncology career seems to stem from lack of mentors and exposure during training, unclear career path, and uncertainty regarding reimbursement. Suggested approaches to begin to remedy this problem include: 1) more ASCO-led and other prevention educational resources for fellows, training directors, and practicing oncologists; 2) an increase in funded training and clinical research opportunities, including reintroduction of the R25T award; 3) an increase in the prevention content of accrediting examinations for clinical oncologists; and 4) interaction with policymakers to broaden the scope and depth of reimbursement for prevention counseling and intervention services.
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Affiliation(s)
- Carol J Fabian
- Carol J. Fabian, University of Kansas Medical Center, Kansas City, KS; Frank L. Meyskens Jr, University of California at Irvine, Irvine, CA; Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY; Thomas J. George Jr, University of Florida, Gainesville, FL; Joanne M. Jeter, University of Arizona, Tucson, AZ; Shakila Khan, Mayo Clinic, Rochester, MN; Courtney A. Tyne, Feinstein Kean Healthcare, Washington, DC; and William N. William Jr, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Frank L Meyskens
- Carol J. Fabian, University of Kansas Medical Center, Kansas City, KS; Frank L. Meyskens Jr, University of California at Irvine, Irvine, CA; Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY; Thomas J. George Jr, University of Florida, Gainesville, FL; Joanne M. Jeter, University of Arizona, Tucson, AZ; Shakila Khan, Mayo Clinic, Rochester, MN; Courtney A. Tyne, Feinstein Kean Healthcare, Washington, DC; and William N. William Jr, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Dean F Bajorin
- Carol J. Fabian, University of Kansas Medical Center, Kansas City, KS; Frank L. Meyskens Jr, University of California at Irvine, Irvine, CA; Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY; Thomas J. George Jr, University of Florida, Gainesville, FL; Joanne M. Jeter, University of Arizona, Tucson, AZ; Shakila Khan, Mayo Clinic, Rochester, MN; Courtney A. Tyne, Feinstein Kean Healthcare, Washington, DC; and William N. William Jr, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas J George
- Carol J. Fabian, University of Kansas Medical Center, Kansas City, KS; Frank L. Meyskens Jr, University of California at Irvine, Irvine, CA; Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY; Thomas J. George Jr, University of Florida, Gainesville, FL; Joanne M. Jeter, University of Arizona, Tucson, AZ; Shakila Khan, Mayo Clinic, Rochester, MN; Courtney A. Tyne, Feinstein Kean Healthcare, Washington, DC; and William N. William Jr, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Joanne M Jeter
- Carol J. Fabian, University of Kansas Medical Center, Kansas City, KS; Frank L. Meyskens Jr, University of California at Irvine, Irvine, CA; Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY; Thomas J. George Jr, University of Florida, Gainesville, FL; Joanne M. Jeter, University of Arizona, Tucson, AZ; Shakila Khan, Mayo Clinic, Rochester, MN; Courtney A. Tyne, Feinstein Kean Healthcare, Washington, DC; and William N. William Jr, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shakila Khan
- Carol J. Fabian, University of Kansas Medical Center, Kansas City, KS; Frank L. Meyskens Jr, University of California at Irvine, Irvine, CA; Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY; Thomas J. George Jr, University of Florida, Gainesville, FL; Joanne M. Jeter, University of Arizona, Tucson, AZ; Shakila Khan, Mayo Clinic, Rochester, MN; Courtney A. Tyne, Feinstein Kean Healthcare, Washington, DC; and William N. William Jr, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Courtney A Tyne
- Carol J. Fabian, University of Kansas Medical Center, Kansas City, KS; Frank L. Meyskens Jr, University of California at Irvine, Irvine, CA; Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY; Thomas J. George Jr, University of Florida, Gainesville, FL; Joanne M. Jeter, University of Arizona, Tucson, AZ; Shakila Khan, Mayo Clinic, Rochester, MN; Courtney A. Tyne, Feinstein Kean Healthcare, Washington, DC; and William N. William Jr, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William N William
- Carol J. Fabian, University of Kansas Medical Center, Kansas City, KS; Frank L. Meyskens Jr, University of California at Irvine, Irvine, CA; Dean F. Bajorin, Memorial Sloan Kettering Cancer Center, New York, NY; Thomas J. George Jr, University of Florida, Gainesville, FL; Joanne M. Jeter, University of Arizona, Tucson, AZ; Shakila Khan, Mayo Clinic, Rochester, MN; Courtney A. Tyne, Feinstein Kean Healthcare, Washington, DC; and William N. William Jr, The University of Texas MD Anderson Cancer Center, Houston, TX
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