在医疗保险优势计划中不适当地拒绝放射治疗
Jared Pasetsky1, Kishan Bhatt2, Lisa A Kachnic1
1Department of Radiation Oncology, Columbia University Irving Medical Center, New York, New York; Department of Radiation Oncology, Herbert Irving Comprehensive Cancer Center, New York, New York.
International journal of radiation oncology, biology, physics
|November 17, 2024
概括
医疗保险优势计划不适当地拒绝放射治疗 (RT) 服务比其他医疗服务更多. 这些拒绝影响患者获得癌症治疗的机会,迫切需要政策改革.
科学领域:
- 在瘤学瘤学.
- 卫生政策 卫生政策
- 医疗保健服务研究 医疗服务研究
背景情况:
- 放射性瘤学家因事先授权和保险拒绝而面临重大负担.
- 医学专业之间拒绝率的差异越来越令人担忧.
研究的目的:
- 为了确定医疗保险优势计划是否不适当地拒绝放射治疗 (RT) 服务,其费用比其他医疗服务更高.
- 分析特定RT模式和癌症诊断的拒绝趋势.
主要方法:
- 从医疗保险和医疗补助服务中心公开数据的分析上诉决策搜索 (2022年至2024年6月).
- 对RT和所有卫生服务的不适当拒绝百分比的计算.
- 使用千平方测试和根据治疗方式和诊断关键词进行过的统计比较.
主要成果:
- 与2022-2024年所有卫生服务 (4.66%) 相比,RT服务的不适当拒绝率显著更高 (17.39%).
- 具体的RT疗法显示出不同的拒绝率,强度调节RT为41.06%和质子疗法为13.02%.
- 接受强度调节RT的乳腺癌患者经历了非常高的不适当的拒绝率 (82.14%).
结论:
- 医疗保险优势计划显示,比其他医疗保健服务更频繁地不适当地拒绝放射治疗服务.
- 迫切需要改变政策,以确保医疗保险受益者能够适当地获得必要的癌症治疗.
- 对高风险模式和诊断的具体拒绝驱动因素进行进一步的调查是有必要的.
相关概念视频
Nursing Ethical Principles II
922
Ethical principles are essential in guiding nurses to fulfill their responsibilities, focusing on the quality of nursing care and decision-making. These principles, including autonomy, beneficence, non-maleficence, justice, and fidelity, shape the ethical framework within healthcare settings.
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
Consider the following scenario, which illustrates how these principles are applied in the care of Mr. John, a fifty-year-old teacher diagnosed with metastatic liver cancer.
Initially, Mr. John's...
922
Ethical Issues
856
Nurses are essential in patient care, upholding the ethical principles of their profession and effectively navigating ethical dilemmas. Neglecting ethical issues can lead to inadequate patient care, compromised therapeutic relationships, and moral distress among healthcare workers.
Ethical Concerns in Healthcare:
Ethical Concerns in Healthcare:
856
Targeted Cancer Therapies
7.5K
The targeted cancer therapies, also known as “molecular targeted therapies,” take advantage of the molecular and genetic differences between the cancer cells and the normal cells. It needs a thorough understanding of the cancer cells to develop drugs that can target specific molecular aspects that drive the growth, progression, and spread of cancer cells without affecting the growth and survival of other normal cells in the body.
There are several types of targeted therapies against...
There are several types of targeted therapies against...
7.5K
Treatment Resistant Cancers
3.3K
Cancer is the second leading cause of death in the United States. A cancer cell is genetically unstable and hence can mutate faster. They can also modify their microenvironment and escape immune surveillance. The difficulties in treating cancer are further compounded by the emergence of rapid resistance to anticancer drugs. The most common ways to attain resistance in cancer cells include alteration in drug transport and metabolism, modification of drug target, elevated DNA damage response, or...
3.3K
Standards of Care II
635
Nurses bear specific legal responsibilities under several federal statutes, including:
635
Radiological Investigation III: Pulmonary Angiogram and PET Scan
86
Radiological investigations are paramount in the diagnosis and management of various pulmonary diseases. Two essential investigations are the Pulmonary Angiogram and the Positron Emission Tomography (PET) Scan.
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
86


