Financial barrier against access to diagnostic procedures among enteric fever suspects in highly-endemic areas of China

Typhoid and paratyphoid fever epidemiological indicators and spatiotemporal analysis in China from 2004 to 2019

Typhoid and paratyphoid fever are systemic infections caused by Salmonella Typhi and Salmonella Paratyphi. These diseases are endemic in many parts of China, occurring periodically throughout the year. Epidemiological features, temporal trends, and spatial distribution of these fevers were analyzed using GraphPad Prism 9 with data collected by China's Public Health Science Data Center from 2004 to 2019. Charts were generated to depict their incidence across provinces, years, age groups, and occupations. Spatial clustering was assessed using ArcGIS 10.5 and Moran's I index. SaTScan 9.5 was employed to analyze their spatiotemporal distribution. From 2004 to 2019, China reported 197,623 cases of typhoid fever, resulting in 72 deaths, and 84,583 cases of paratyphoid fever, with 17 fatalities, showing a yearly reduction. Epidemic zones for these diseases are primarily in Yunnan, Guangxi, Guizhou, and other southwestern regions, affecting predominantly peasants and students. Children and adolescents are particularly vulnerable. Due to the epidemic nature of these diseases, they can occur year-round, with peaks in the summer months. This study provides a comprehensive understanding of their epidemiological characteristics and geographic distribution in China, emphasizing the need for authorities to improve living conditions, implement preventive measures, and develop effective treatments and vaccines in these high-risk areas.

Expanding utilization and regional coverage of diagnostic CT colonography: early Medicare claims experience

PURPOSE

The aim of this study was to assess national and regional trends in utilization and Medicare coverage of diagnostic CT colonography (CTC).

METHODS

Medicare claims for diagnostic CTC were identified for the first 4 complete years for which Current Procedural Terminology® tracking codes existed (2005-2008). The frequencies of billed and denied services were extracted on a national and regional basis, along with physician provider specialty and site of service.

RESULTS

Total annual claims for diagnostic CTC for Medicare fee-for-service beneficiaries increased from 3,660 to 10,802 (+195%) between 2005 and 2008. Overall, 50.1% (14,051 of 28,048) of all claims were denied, with annual national denial rate decreasing from 70.0% to 43.4% (2,562 of 3,660 to 4,692 of 10,802, P < .001). Annual regional denial rates ranged from 16.5% to 98.3%. Of all 28,048 CTC claims, 25,893 (92.3%) were submitted by radiologists, 286 (1.0%) by gastroenterologists, and 369 (1.3%) by other specialists (specialties were indeterminate for 1,550). Most services were performed in office (n = 13,764 [49.1%]) and outpatient hospital (n = 12,110 [43.2%]) settings, with only a small number in the inpatient hospital (n = 1,768 [6.3%]) and other miscellaneous (n = 406 [1.4%]) settings.

CONCLUSIONS

Diagnostic CTC is performed predominantly by radiologists in private office and outpatient hospital settings. Since the advent of Current Procedural Terminology tracking codes, the utilization of diagnostic CTC by Medicare fee-for-service beneficiaries has tripled. Despite perceptions that new technology tracking codes are not payable, more than half of all examinations are now reimbursed by Medicare. Coverage varies regionally but overall is improving annually, setting the stage for expanded patient access.