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Barr J, Mackie A, Gorelik D, Buckingham H, Clark D, Brissett AE. Health Disparities Research in Facial Plastic and Reconstructive Surgery: A Scoping Review. Otolaryngol Head Neck Surg 2024. [PMID: 38796736 DOI: 10.1002/ohn.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/09/2024] [Accepted: 05/04/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Health disparities contribute significantly to disease, health outcomes, and access to care. Little is known about the state of health disparities in facial plastic and reconstructive surgery (FPRS). This scoping review aims to synthesize the existing disparities research in FPRS and guide future disparities-related efforts. DATA SOURCES PubMed, Embase, Web of Science. REVIEW METHODS We conducted a scoping review in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Our search included all years through March 03, 2023. All peer-reviewed primary literature of any design related to disparities in FPRS was eligible for inclusion. RESULTS Of the 12283 unique abstracts identified, 215 studies underwent full-text review, and 108 remained for final review. The most frequently examined topics were cleft lip and palate (40.7%), facial trauma (29.6%), and gender affirmation (9.3%). There was limited coverage of other areas. Consideration of race/ethnicity (68.5%), socioeconomic status (65.7%), and gender/sex (40.7%) were most common. Social capital (0%), religion, occupation, and features of relationships were least discussed (0.01% each). The majority of studies were published after 2018 (59.2%) and were of nonprospective designs (95.4%). Most studies focused on disparity detection (80.6%) and few focused on understanding (13.9%) or reducing disparities (0.06%). CONCLUSION This study captures the existing literature on health disparities in FPRS. Studies are concentrated in a few areas of FPRS and are primarily in the detecting phase of public health research. Our review highlights several gaps and opportunities for future disparities-related focus.
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Affiliation(s)
- Jeremy Barr
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Aaron Mackie
- School of Medicine, Texas A&M University, Bryan, Texas, USA
| | - Daniel Gorelik
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
| | - Hannah Buckingham
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Delaney Clark
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Anthony E Brissett
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
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Wagner CS, Hitchner MK, Plana NM, Morales CZ, Salinero LK, Barrero CE, Pontell ME, Bartlett SP, Taylor JA, Swanson JW. Incomes to Outcomes: A Global Assessment of Disparities in Cleft and Craniofacial Treatment. Cleft Palate Craniofac J 2024:10556656241249821. [PMID: 38700320 DOI: 10.1177/10556656241249821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024] Open
Abstract
OBJECTIVE Recent investigations focused on health equity have enumerated widespread disparities in cleft and craniofacial care. This review introduces a structured framework to aggregate findings and direct future research. DESIGN Systematic review was performed to identify studies assessing health disparities based on race/ethnicity, payor type, income, geography, and education in cleft and craniofacial surgery in high-income countries (HICs) and low/middle-income countries (LMICs). Case reports and systematic reviews were excluded. Meta-analysis was conducted using fixed-effect models for disparities described in three or more studies. SETTING N/A. PATIENTS Patients with cleft lip/palate, craniosynostosis, craniofacial syndromes, and craniofacial trauma. INTERVENTIONS N/A. RESULTS One hundred forty-seven articles were included (80% cleft, 20% craniofacial; 48% HIC-based). Studies in HICs predominantly described disparities (77%,) and in LMICs focused on reducing disparities (42%). Level II-IV evidence replicated delays in cleft repair, alveolar bone grafting, and cranial vault remodeling for non-White and publicly insured patients in HICs (Grades A-B). Grade B-D evidence from LMICs suggested efficacy of community-based speech therapy and remote patient navigation programs. Meta-analysis demonstrated that Black patients underwent craniosynostosis surgery 2.8 months later than White patients (P < .001) and were less likely to undergo minimally-invasive surgery (OR 0.36, P = .002). CONCLUSIONS Delays in cleft and craniofacial surgical treatment are consistently identified with high-level evidence among non-White and publicly-insured families in HICs. Multiple tactics to facilitate patient access and adapt multi-disciplinary case in austere settings are reported from LMICs. Future efforts including those sharing tactics among HICs and LMICs hold promise to help mitigate barriers to care.
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Affiliation(s)
- Connor S Wagner
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA
| | - Michaela K Hitchner
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA
| | - Natalie M Plana
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA
| | - Carrie Z Morales
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA
- Center for Surgical Health, Department of Surgery, Penn Medicine, USA
| | - Lauren K Salinero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA
| | - Carlos E Barrero
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA
| | - Matthew E Pontell
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA
| | - Scott P Bartlett
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA
| | - Jesse A Taylor
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA
| | - Jordan W Swanson
- Division of Plastic, Reconstructive, and Oral Surgery, Children's Hospital of Philadelphia, USA
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Rochlin DH, Rizk NM, Flores RL, Matros E, Sheckter CC. The Reality of Commercial Payer-Negotiated Rates in Cleft Lip and Palate Repair. Plast Reconstr Surg 2023; 152:476e-487e. [PMID: 36847669 DOI: 10.1097/prs.0000000000010329] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Commercial payer-negotiated rates for cleft lip and palate surgery have not been evaluated on a national scale. The aim of this study was to characterize commercial rates for cleft care, both in terms of nationwide variation and in relation to Medicaid rates. METHODS A cross-sectional analysis was performed of 2021 hospital pricing data from Turquoise Health, a data service platform that aggregates hospital price disclosures. The data were queried by CPT code to identify 20 cleft surgical services. Within- and across-hospital ratios were calculated per CPT code to quantify commercial rate variation. Generalized linear models were used to assess the relationship between median commercial rate and facility-level variables and between commercial and Medicaid rates. RESULTS There were 80,710 unique commercial rates from 792 hospitals. Within-hospital ratios for commercial rates ranged from 2.0 to 2.9 and across-hospital ratios ranged from 5.4 to 13.7. Median commercial rates per facility were higher than Medicaid rates for primary cleft lip and palate repair ($5492.20 versus $1739.00), secondary cleft lip and palate repair ($5429.10 versus $1917.00), and cleft rhinoplasty ($6001.00 versus $1917.00; P < 0.001). Lower commercial rates were associated with hospitals that were smaller ( P < 0.001), safety-net ( P < 0.001), and nonprofit ( P < 0.001). Medicaid rate was positively associated with commercial rate ( P < 0.001). CONCLUSIONS Commercial rates for cleft surgical care demonstrated marked variation within and across hospitals, and were lower for small, safety-net, or nonprofit hospitals. Lower Medicaid rates were not associated with higher commercial rates, suggesting that hospitals did not use cost-shifting to compensate for budget shortfalls resulting from poor Medicaid reimbursement.
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Affiliation(s)
- Danielle H Rochlin
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Nada M Rizk
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine
| | - Evan Matros
- From the Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center
| | - Clifford C Sheckter
- Division of Plastic and Reconstructive Surgery, Stanford University Medical Center
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Ullrich PJ, Ramsey MD. Global Plastic Surgery: A Review of the Field and a Call for Virtual Training in Low- and Middle-Income Countries. Plast Surg (Oakv) 2023; 31:118-125. [PMID: 37188140 PMCID: PMC10170637 DOI: 10.1177/22925503211034833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
Lack of surgical access severely harms countless populations in many low- and middle-income countries (LMICs). Many types of surgery could be fulfilled by the plastic surgeon, as populations in these areas often experience trauma, burns, cleft lip and palate, and other relevant medical issues. Plastic surgeons continue to contribute significant time and energy to global health, primarily by participating in short mission trips intended to provide many surgeries in a short time frame. These trips, while cost-effective for lack of long-term commitments, are not sustainable as they require high initial costs, often neglect to educate local physicians, and can interfere with regional systems. Education of local plastic surgeons is a key step toward creating sustainable plastic surgery interventions worldwide. Virtual platforms have grown popular and effective-particularly due to the coronavirus disease 2019 pandemic-and have shown to be beneficial in the field of plastic surgery for both diagnosis and teaching. However, there remains a large potential to create more extensive and effective virtual platforms in high-income nations geared to educate plastic surgeons in LMICs to lower costs and more sustainably provide capacity to physicians in low access areas of the world.
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Affiliation(s)
- Peter J. Ullrich
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew D. Ramsey
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Bennett KG, Patterson AK, Schafer K, Haase M, Ranganathan K, Carlozzi N, Vercler CJ, Kasten SJ, Buchman SR, Waljee JF. Decision-Making in Cleft-Related Surgery: A Qualitative Analysis of Patients and Caregivers. Cleft Palate Craniofac J 2019; 57:161-168. [PMID: 31382774 DOI: 10.1177/1055665619866552] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Preference-sensitive surgical decisions merit shared decision-making, as decision engagement can reduce decisional conflict and regret. Elective cleft-related procedures are often preference sensitive, and therefore, we sought to better understand decision-making in this population. DESIGN Semistructured interviews were conducted to elicit qualitative data. A hierarchical codebook was developed through an iterative process in preparation for thematic analysis. Thematic analysis was performed to examine differences between patients and caregivers. SETTING Multidisciplinary cleft clinic at a tertiary care center. PARTICIPANTS Patients with cleft lip aged 8 and older (n = 31) and their caregivers (n = 31) were purposively sampled. Inability to converse in English, intellectual disability, or syndromic diagnoses resulted in exclusion. MAIN OUTCOME MEASURES Preferences surrounding surgical decision-making identified during thematic analysis. RESULTS Mean patient age was 12.7 (standard deviation: 3.1). Most had unilateral cleft lip and palate (43.8%). Three themes emerged: Insufficient Understanding of Facial Difference and Treatment, Diversity of Surgical Indications, and Barriers to Patient Autonomy. Almost half of caregivers believed their children understood their clefts, but most of these children failed to provide information about their cleft. Although many patients and caregivers acknowledged that surgery addressed function and/or appearance, patients and caregivers exhibited differences regarding the necessity of surgery. Furthermore, a large proportion of patients believed their opinions mattered in decisions, but less than half of caregivers agreed. CONCLUSIONS Patients with clefts desire to participate in surgical decisions but have limited understanding of their facial difference and surgical indications. Cleft surgeons must educate patients and facilitate shared decision-making.
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Affiliation(s)
- Katelyn G Bennett
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Annie K Patterson
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kylie Schafer
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Madeleine Haase
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Noelle Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | | | - Steven J Kasten
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Steven R Buchman
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer F Waljee
- Section of Plastic Surgery, University of Michigan, Ann Arbor, MI, USA
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Sheriff S, Zawahrah HJ, Chang LV, Beyatli S, Elhadi Babiker HM, Roach AL, Biskup N, van Aalst JA. What is the Cost of Free Cleft Surgery in the Middle East? World J Surg 2017; 42:1239-1247. [DOI: 10.1007/s00268-017-4309-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Big data in facial plastic and reconstructive surgery: from large databases to registries. Curr Opin Otolaryngol Head Neck Surg 2017; 25:273-279. [PMID: 28525400 DOI: 10.1097/moo.0000000000000377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW There are many limitations to performing clinical research with high levels of evidence in facial plastic and reconstructive surgery (FPRS), such as randomization into surgical groups and sample size recruitment. Therefore, additional avenues for exploring research should be explored using big data, from databases to registries. Other organizations have developed these tools in the evolving landscape of outcomes measurement and value in healthcare, which may serve as models for our specialty. RECENT FINDINGS Over the last 5 years, FPRS literature of large-scale outcomes research, utilizing several administrative databases, has steadily grown. Our objectives are to describe key administrative databases, strengths and weaknesses of each, and identify recent FPRS publications utilizing big data. A registry with FPRS defined outcomes has the most potential. SUMMARY Although FPRS research has trended to a more evidence-based approach in the modern healthcare era, gaps persist. Several large administrative databases or registries can address voids in outcomes research within FPRS.
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Sitzman TJ, Hossain M, Carle AC, Heaton PC, Britto MT. Variation among cleft centres in the use of secondary surgery for children with cleft palate: a retrospective cohort study. BMJ Paediatr Open 2017; 1:e000063. [PMID: 29479567 PMCID: PMC5823530 DOI: 10.1136/bmjpo-2017-000063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To test whether cleft centres vary in their use of secondary cleft palate surgery, also known as revision palate surgery, and if so to identify modifiable hospital- and surgeon-factors that are associated with use of secondary surgery. DESIGN Retrospective cohort study. SETTING Forty-three paediatric hospitals across the United States. PATIENTS Children with cleft lip and palate who underwent primary cleft palate repair from 1999 to 2013. MAIN OUTCOME MEASURES Time from primary cleft palate repair to secondary palate surgery. RESULTS We identified 4,939 children who underwent primary cleft palate repair. At ten years after primary palate repair, 44% of children had undergone secondary palate surgery. Significant variation existed among hospitals (p<0.001); the proportion of children undergoing secondary surgery by 10 years ranged from 9% to 77% across hospitals. After adjusting for patient demographics, primary palate repair before nine months of age was associated with an increased hazard of secondary palate surgery (initial hazard ratio 6.74, 95% CI 5.30-8.73). Postoperative antibiotics, surgeon procedure volume, and hospital procedure volume were not associated with time to secondary surgery (p>0.05). Of the outcome variation attributable to hospitals and surgeons, between-hospital differences accounted for 59% (p<0.001), while between-surgeon differences accounted for 41% (p<0.001). CONCLUSIONS Substantial variation in the hazard of secondary palate surgery exists depending on a child's age at primary palate repair and the hospital and surgeon performing their repair. Performing primary palate repair before nine months of age substantially increases the hazard of secondary surgery. Further research is needed to identify other factors contributing to variation in palate surgery outcomes among hospitals and surgeons.
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Affiliation(s)
- Thomas J Sitzman
- Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,James M. Anderson for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Monir Hossain
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Adam C Carle
- James M. Anderson for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Pamela C Heaton
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio, USA
| | - Maria T Britto
- James M. Anderson for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Thompson JA, Heaton PC, Kelton CM, Sitzman TJ. National Estimates of and Risk Factors for Inpatient Revision Surgeries for Orofacial Clefts. Cleft Palate Craniofac J 2017; 54:60-69. [DOI: 10.1597/15-206] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To provide national estimates of the number and cost of primary and revision cleft lip and palate surgeries in the U.S. and to determine patient and hospital characteristics associated with disproportionate use of revision surgery. Design Retrospective cross-sectional study using data obtained from the 2003, 2006, and 2009 Kids’ Inpatient Database. Setting Inpatient. Patients Children with CL, CP, or CLP undergoing inpatient cleft lip and/or palate surgery. Interventions Inpatient cleft lip and/or palate surgery. Main Outcome Measures Orofacial cleft surgery estimates, estimates of primary versus revision surgeries, and estimated inflation-adjusted hospitalization costs. Results In 2009, there were a total of 2824 and 5431 hospitalizations for cleft lip and palate surgeries, respectively. Revision surgery accounted for 24.2% of cleft lip surgeries and 36.8% of cleft palate surgeries. Children with CLP (OR 1.87, 95% CI 1.48-2.38), a syndromic diagnosis (OR 1.47, 95% CI: 1.16-1.87), or private insurance (OR 1.71, 95% CI: 1.41-2.09) were more likely to undergo cleft lip revision surgery. Similar risk factors were found for children undergoing cleft palate revision. Mean cost per hospitalization ranged from $7564 to $8393 in 2009, depending on surgery type, and did not change significantly (in 2009 U.S. $) between 2003 and 2009. Conclusions Interventions to reduce revision surgery by improving results of primary surgery should be targeted in the population of identified high-risk (e.g., syndromic) patients. In addition, the association of health insurance status with revision surgery highlights the need to understand and address the impact of economic disparities on cleft care delivery.
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Affiliation(s)
- Jeffrey A. Thompson
- James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Pamela C. Heaton
- Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center, Cincinnati, Ohio
| | - Christina M.L. Kelton
- Carl H. Lindner College of Business, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, Ohio
| | - Thomas J. Sitzman
- Division of Plastic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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An Investigation Into the Disease Profile and Healthcare Costs of Inpatients Treated at a Major Oral and Maxillofacial Surgical Center. J Craniofac Surg 2016; 27:e589-e595. [PMID: 27438443 DOI: 10.1097/scs.0000000000002895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE This study is a retrospective review which reported on the treatment records of oral and maxillofacial inpatients treated at a medical institution with the largest scale of oral and maxillofacial specialist services in China, to reflect on disease profile, healthcare model characteristics and the medical status of oral and maxillofacial surgery in China. PATIENTS AND METHODS Information on 25,825 patients hospitalized between 2008 and 2013 was collected to analyze the mean length of stay (LOS) and preoperative LOS, expenditure patterns, and payment status. RESULTS The overall mean LOS and preoperative LOS were 10.0 ± 4.9 days and 4.3 ± 2.1 days, respectively. The main costs composed of surgery charges and material costs (47.4%). The proportion of nonlocal patients was 76.34% and the majority of patients used their basic medical insurance (57.74%), and the proportion of patients self-paying showed the largest increase over time. Rising charges for inpatients in this institution did not cause an aggravation of medical cost burden of residents. Cost burden of oral and maxillofacial malignancy surgery patients was higher than in developed countries. CONCLUSIONS The overall mean LOS and preoperative LOS were higher than that of similar patients globally. Compared with medicine and material costs, medical income is lower and the value of medical personnel labor is not fully appreciated. The proportion of patients who actually enjoy the benefits of the basic medical insurance in China is lower than the coverage.
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Moffitt KB, Case AP, Farag NH, Canfield MA. Hospitalization charges for children with birth defects in Texas, 2001 to 2010. ACTA ACUST UNITED AC 2015; 106:155-63. [DOI: 10.1002/bdra.23470] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Karen B. Moffitt
- Texas Department of State Health Services; Birth Defects Epidemiology and Surveillance Branch; Austin Texas
| | - Amy P. Case
- Texas Department of State Health Services; Birth Defects Epidemiology and Surveillance Branch; Austin Texas
| | - Noha H. Farag
- Epidemic Intelligence Service; Centers for Disease Control and Prevention; Atlanta Georgia
| | - Mark A. Canfield
- Texas Department of State Health Services; Birth Defects Epidemiology and Surveillance Branch; Austin Texas
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Evaluating the Need for Routine Admission following Primary Cleft Palate Repair. Plast Reconstr Surg 2015; 136:502e-510e. [DOI: 10.1097/prs.0000000000001583] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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