Impact of the 2014 coinsurance rate revision for the elderly on healthcare resource utilization in Japan

An epidemic of cataract surgery in Korea: the effects of private health insurance on the National Health Insurance Service

OBJECTIVES

In Korea, the National Health Insurance Service (NHIS) covers essential healthcare expenses, including cataract surgery. To address concerns that private health insurance (PHI) might have inflated the need for such procedures, we investigated the extent of the PHI-attributable increase in cataract surgery and its impact on NHIS-reimbursed expenses.

METHODS

This retrospective, observational study uses nationwide claims data for cataract surgery from 2016 to 2020. We examined trends in utilization and cost, and we estimated the excess numbers of (1) cataract operations attributable to PHI and (2) types of intraocular lenses used for cataract surgery in 2020.

RESULTS

Between 2016 and 2020, a 36.8% increase occurred in the number of cataract operations, with increases of 63.5% and 731.8% in the total healthcare costs reimbursed by NHIS and PHI, respectively. Over a 5-year period, the surgical rate per 100,000 people doubled for patients aged <65 years (from 328 in 2016 to 664 in 2020). Among the 619,771 cases in 2020 of cataract surgery reimbursed by the Korean diagnosis-related group system, more non-NHIS-covered intraocular lenses were used for patients aged <65 years than ≥65 years (68.1 vs. 14.2%). In 2020 alone, an estimated 129,311 excess operations occurred, accounting for an excess cost of US$115 million.

CONCLUSIONS

A dramatic increase in the number and cost of cataract operations has occurred over the last 5 years. The PHI-related increase in operations resulted in increased costs to NHIS. Measures to curtail the non-indicated use of cataract surgery should be implemented regarding PHI.

Pioglitazone use in Australia and the United Kingdom following drug safety advisories on bladder cancer risk: an interrupted time series study

PURPOSE

National regulators in Australia and the United Kingdom (UK) issued safety advisories on the association between pioglitazone use and bladder cancer in July 2011. The Australian advisory noted that males were at higher risk of bladder cancer than females, while the UK advisory highlighted a new recommendation, suggest careful consideration in the elderly due to increasing risk with age. This study examined whether these differences in the advisories had different age- and sex-based impacts in each country.

METHODS

Interrupted time series analysis was used to compare pioglitazone use (prescriptions/100,000 population) in Australia and the UK for the 24 months before and 11 months after the July 2011 safety advisories (study period July 2009-June 2012). Separate models were used to compare use by sex and age group (≥65 years vs. <65 years) in each country.

RESULTS

Pioglitazone use fell in Australia (17%) and the UK (24%) following the safety advisories. Use of pioglitazone fell more for males (18%) than females (16%) in Australia, and more for females (25%) than males (23%) in the UK; however neither difference was statistically significant (Australia P=0.445, UK P=0.462). Pioglitazone use fell to a similar extent among older people than younger people in the UK (23% vs. 26%, P=0.354), and did not differ between age groups in Australia (both 18%, P=0.772).

CONCLUSIONS

The results indicate that differences in the Australian and UK safety advisories resulted in substantial reductions in pioglitazone use at the population level in both countries, however, differences by sub-groups were not observed. This article is protected by copyright. All rights reserved.