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As the United States' population grows via migration and immigration, with this rise in diverse identities, there has been increasing concern regarding disparities for undocumented immigrants living in the U.S. with limited access to the health system. Given the various constraints involving communication and social structures that undocumented immigrants face, a culture-centered approach is drawn on to investigating how this group goes about navigating a dominant health system given their restricted access. I explore co-constructed themes that emerged through conversations with undocumented immigrants, (people without papers as I call them in this work) living in the United States to gain an understanding as to the structural and cultural limitations faced by this group. By doing qualitative semi-structured interviews with local participants living in the South Florida region, I describe the various features of a complex U.S. health system that undocumented immigrants (people without papers) deemed as important obstacles that limit their willingness to interact with official medical spaces. This work draws on narratives and accounts to shed light on the intersection of disparities this group has to overcome in order to consider entering a medical space to receive the treatment they might need. The findings of this article highlighted the structural violence that certain subaltern groups, such as people without papers experience due to their limited access to foundational systems in their environment. [ABSTRACT FROM AUTHOR]

Haze pollution not only affects the quality of economic growth and the image of the government, but also seriously affects public health. With the improvement of climate risk perception, the public is actively seeking all kinds of risk management measures to combat the hazards of haze pollution. The study of the relationship between haze pollution, climate risk perception and the development of commercial health insurance is of great significance to the formulation of haze control policies and the improvement of social security system. This paper attempts to explore the relationship between haze pollution, climate risk perception and commercial health insurance demand by establishing static and dynamic models based on panel data from 31 provinces in China from 2005 to 2022. Also, the spatial spillover effects of haze pollution in different regions on the development of commercial health insurance in other regions are investigated by establishing a spatial Durbin model. It is found that (1) haze pollution has a lagged positive effect on the demand for commercial health insurance; (2) haze pollution has a significant spatial spillover effect on the development of commercial health insurance; (3) this study used Python technology to construct a climate risk perception index, and found that the moderating effect of the residents' perception of climate risk existed significantly, and that the residents might take other measures to manage the risk in the short term, but in the long term, the climate risk perception showed a positive correlation with the level of education. This paper provides implications for government departments and social media to strengthen education and publicity, improve residents' awareness of risk diversification, and deepen the concept of commercial health protection. [ABSTRACT FROM AUTHOR]

Introduction: Since non‐directed (altruistic) kidney donors do not stand to benefit from the lengthening and strengthening of a relationship that they intrinsically value, their donations are considered to constitute the most altruistic variety of living kidney donation. Methodology: This paper uses publicly‐available data to assess the expected value that accrues to the donor of altruistic kidney donation. Findings: Compared to healthy non‐donors, living kidney donors experience only marginally increased absolute risks of poor physical health outcomes, and no difference in important psychosocial health outcomes. Crucially, the chance of requiring a kidney donation is only marginally increased by becoming a living kidney donor. In the United Kingdom, previous living kidney donors that subsequently become in need of any organ donation (not only kidneys) themselves are considered priority patients for these donations. They consequently experience shorter waiting times for these organs and reduced exposure to the inherently harmful effects of dialysis therapy (if a kidney donation is required) compared to non‐donors in need of organ donation. As such, while key data points required to compute an accurate and complete expected value calculation are unavailable, it is likely that the additional risk incurred by becoming a living kidney donor is outweighed by the benefit of being considered a priority patient for the donation of any type of organ in the event that this is needed. Conclusion: Accordingly, the expected value of becoming a living kidney donor is likely to be positive, meaning the act of doing so may be considered akin to the taking out of an insurance policy. In the context of non‐directed (altruistic) kidney donation, this may diminish the extent to which such a donation is considered altruistic. [ABSTRACT FROM AUTHOR]

Over 70% of Medicaid beneficiaries are enrolled in Medicaid managed care (MMC). MMC provider networks therefore represent a critical determinant of access to the Medicaid program. Many MMC insurers also participate in commercial insurance markets where prices are high, and some insurers exercise considerable market power. In this paper, we examined the relationship between commercial insurer market power and MMC physician network breadth using linked national enrollment data and provider directory data. Insurers with more commercial market power had broader Medicaid physician networks. Insurers with over 30% market share had 37.3% broader Medicaid networks than insurers in the same county that had no commercial market share. These differences were driven by greater breadth among primary care providers, as well as other specialists including OB/GYNs, surgeons, neurologists, and cardiologists. Commercial insurance market power may have spillovers on access to care for MMC beneficiaries. [ABSTRACT FROM AUTHOR]

Amid the increasing global internet penetration, understanding the impact of internet use on residents' health is crucial. This aids in formulating more effective health policies and provides empirical evidence for promoting health equity and improving overall public health. Drawing on the China Health and Retirement Longitudinal Study (CHARLS), this paper employs the Propensity Score Matching-Difference in Differences (PSM-DID) method to examine the impact of the internet on individual health and further explores the pathways through which the internet affects health. We introduce the research background and significance in the introduction. Then, in the theoretical analysis, it incorporates internet variables into the Becker health demand model to analyze changes in health demand and impact pathways. The empirical analysis tests the theoretical findings, leading to empirical results. Finally, the study discusses the results and provides relevant recommendations. The findings indicate significant positive effects of the internet on both physical and psychological health. These effects are realized through reducing health information asymmetry, lowering health costs, and increasing exposure to health-promoting environments. In the heterogeneity analysis, economic-related internet content shows a significant positive impact on resident health. Intensive internet use adversely affects psychological health. The beneficial effects of the internet on health are more pronounced among older individuals, those covered by medical insurance, and regions with higher levels of digital economy. Based on these findings, the study offers policy recommendations concerning individuals' internet use patterns, the digital evolution of the healthcare industry, and government infrastructure development. [ABSTRACT FROM AUTHOR]

Within growing marketisation of publicly funded services, the internet has provided new opportunities for marketing, delivery, and coordination of those services. Using web scraping and hyperlink network analysis techniques, this paper examines the ways in which organisations operating in Australia's evolving National Disability Insurance Scheme (NDIS) system inter-connect online. Social media plays the most important role in the online network. Government agencies also play a central role, with many disability service organisations linking their web users to them. Government agency websites do not hyperlink to disability service providers, suggesting that governments do not see their role as assisting access to such services. Advocacy and peak disability organisations are important in online connections between the websites of government and service organisations. Innovative uses of the internet for online brokerage of disability services are evident. The implications of these findings for service delivery are discussed. [ABSTRACT FROM AUTHOR]

In health insurance markets with regulated competition, regulators face the challenge of preventing risk selection. This paper provides a framework for analyzing the scope (i.e., potential actions by insurers and consumers) and incentives for risk selection in such markets. Our approach consists of three steps. First, we describe four types of risk selection: (a) selection by consumers in and out of the market, (b) selection by consumers between high- and low-value plans, (c) selection by insurers via plan design, and (d) selection by insurers via other channels such as marketing, customer service, and supplementary insurance. In a second step, we develop a conceptual framework of how regulation and features of health insurance markets affect the scope and incentives for risk selection along these four dimensions. In a third step, we use this framework to compare nine health insurance markets with regulated competition in Australia, Europe, Israel, and the United States. [ABSTRACT FROM AUTHOR]

Background: The Women's Health Needs Study (WHNS) collected information on the health characteristics, needs, and experiences, including female genital mutilation (FGM) experiences, attitudes, and beliefs, of women aged 18 to 49 years who were born, or whose mothers were born, in a country where FGM is prevalent living in the US. The purpose of this paper is to describe the WHNS design, methods, strengths and limitations, as well as select demographic and health-related characteristics of participants. Methods: We conducted a cross-sectional survey from November 2020 –June 2021 in four US metropolitan areas, using a hybrid venue-based sampling (VBS) and respondent-driven sampling (RDS) approach to identify women for recruitment. Results: Of 1,132 participants, 395 were recruited via VBS and 737 RDS. Most were born, or their mothers were born, in either a West African country (Burkina Faso, Guinea, Mali, Mauritania, Sierra Leone, The Gambia) (39.0%) or Ethiopia (30.7%). More than a third were aged 30–39 years (37.5%) with a majority who immigrated at ages ≥13 years (86.6%) and had lived in the United States for ≥5 years (68.9%). Medicaid was the top health insurer (52.5%), followed by private health insurance (30.5%); 17% of participants had no insurance. Nearly half of women reported 1–2 healthcare visits within the past 12 months (47.7%). One in seven did not get needed health care due to cost (14.8%). Over half have ever used contraception (52.1%) to delay or avoid pregnancy and 76.9% had their last pelvic and/or Papanicolaou (pap) exam within the past 3 years. More than half experienced FGM (55.0%). Nearly all women believed that FGM should be stopped (92.0%). Conclusion: The VBS/RDS approach enabled recruitment of a diverse study population. WHNS advances research related to the health characteristics, needs, and experiences of women living in the US from countries where FGM is prevalent. [ABSTRACT FROM AUTHOR]

Prescription drug cost-sharing is a barrier to medication adherence, particularly for low-income and minority populations. In this systematic review, we examined the impact of prescription drug cost-sharing and policies to reduce cost-sharing on racial/ethnic and income disparities in medication utilization. We screened 2,145 titles and abstracts and identified 19 peer-reviewed papers that examined the interaction between cost-sharing and racial/ethnic and income disparities in medication adherence or utilization. We found weak but inconsistent evidence that lower cost-sharing is associated with reduced disparities in adherence and utilization, but studies consistently found that significant disparities remained even after adjusting for differences in cost-sharing across individuals. Study designs varied in their ability to measure the causal effect of policy or cost-sharing changes on disparities, and a wide range of policies were examined across studies. Further research is needed to identify the types of policies that are best suited to reduce disparities in medication adherence. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to quantify the out-of-pocket (OOP) costs and perceived financial burden among Australian men with localised prostate cancer in the first 6 months after diagnosis, by primary management option. Methods: This cost-analysis quantified OOP costs using administrative claims data and self-reported survey data. Financial burden was assessed using the COmprehensive Score for financial Toxicity–Functional Assessment of Chronic Illness Therapy (COST-FACIT) tool. Participants were recruited into a randomised control trial from public or private treatment centres in Victoria and Queensland. Generalised linear models were used to predict OOP costs and COST-FACIT scores. Results: Median total OOP costs within 6 months of diagnosis for 256 Australian patients with localised prostate cancer was A$1172 (A$343–2548). Up to 50% of the sample reported A$0 costs for most medical services. Compared with those managed with active surveillance, men having active treatment had 6.4 (95% CI: 3.2–12.7) times greater total OOP costs. Management option, higher Gleason score at diagnosis and having multiple comorbidities were significant predictors of higher OOP costs. Overall high scores on the COST-FACIT indicated low levels of financial burden for the entire sample. Conclusion: Largely attributable to being managed with active surveillance, Australian men diagnosed with localised prostate cancer reported relatively low OOP costs and financial burden in the first 6 months post-diagnosis. Together with clinical outcomes, clinicians can use this up to date evidence on costs and perceived financial burdens to assist localised prostate cancer patients and their families make informed decisions about their preferred management option. What is known about the topic? International evidence suggests that men with low-risk prostate cancer managed with active surveillance initially incur lower out-of-pocket costs than those managed with active treatment. What does this paper add? Australian men with low-risk prostate cancer report low out-of-pocket costs and financial burden in the first 6 months post-diagnosis. Compared with those managed with active surveillance, men having active treatment had 6–7 times greater out-of-pocket expenses. What are the implications for practitioners? Being managed by active surveillance as the primary management option for low-risk prostate cancer reduces the financial burdens associated with a cancer diagnosis. [ABSTRACT FROM AUTHOR]

Background: With the increasing number of people affected by multiple chronic conditions, it is essential for public-health professionals to promote strategies addressing patient needs for coordinated care. We aim to explore preference heterogeneity for better-coordinated care delivery models in Swiss older adults, and identify profiles of individuals more open to healthcare reforms. Methods: A DCE (discrete choice experiment) survey was developed online and on paper for the Swiss adults aged 50þ, following best practice. To elicit preferences, we estimated a latent class model allowing grouping individuals with similar preferences into distinct classes, and examined what background characteristics contributed to specific class membership. Results: The optimal model identified three classes with different openness to reforms. Class 1 (49%) members were concerned with premium increases and were in favour of integrated care structures with care managed by interprofessional teams. Individuals in class 2 (19%) were younger, open to reforms, and expressed the needs for radical changes within the Swiss healthcare system. Class 3 respondents (32%) were strongly reluctant to changes. Conclusions: Our study goes beyond average preferences and identifies three distinct population profiles, a majority open to reforms on specific aspects of care delivery, a smallest group in favour radical changes, and a third strongly against changes. Therefore, tailored approaches around healthcare reforms are needed, e.g. explaining the role of interprofessional teams in coordinating care, electronic health records and insurance premium variation. [ABSTRACT FROM AUTHOR]

Based on the unbalanced panel data of Chinese professional health insurance companies from 2011 to 2021, the paper constructs "PW+PCSE" model to empirically investigate the main factors affecting the commercial health insurance surrender in China from the company level. The results show that asset-liability ratio has a significant positive effect on health insurance surrender rate. The value preservation and appreciation rate of capital and R&D expenditure rate both have significant negative effects on health insurance surrender rate. These studies bring important enlightenment for domestic health insurance companies to avoid surrender risk. [ABSTRACT FROM AUTHOR]

There is increasing use of machine learning for the health financing functions (revenue raising, pooling and purchasing), yet evidence lacks for its effects on the universal health coverage (UHC) objectives. This paper provides a synopsis of the use cases of machine learning and their potential benefits and risks. The assessment reveals that the various use cases of machine learning for health financing have the potential to affect all the UHC intermediate objectives -- the equitable distribution of resources (both positively and negatively); efficiency (primarily positively); and transparency (both positively and negatively). There are also both positive and negative effects on all three UHC final goals, that is, utilization of health services in line with need, financial protection and quality care. When the use of machine learning facilitates or simplifies health financing tasks that are counterproductive to UHC objectives, there are various risks -- for instance risk selection, cost reductions at the expense of quality care, reduced financial protection or over-surveillance. Whether the effects of using machine learning are positive or negative depends on how and for which purpose the technology is applied. Therefore, specific health financing guidance and regulations, particularly for (voluntary) health insurance, are needed. To inform the development of specific health financing guidance and regulation, we propose several key policy and research questions. To gain a better understanding of how machine learning affects health financing for UHC objectives, more systematic and rigorous research should accompany the application of machine learning. [ABSTRACT FROM AUTHOR]

Background: Adults with traumatic brain injuries (TBI) frequently experience cognitive, emotional, physical and communication deficits that require long‐term rehabilitation and community support. Although access to rehabilitation services is linked to positive outcomes, there can be barriers to accessing community rehabilitation related to system navigation, referral processes, funding, resource allocation and communications required to ensure access. Aims: This study aimed to identify barriers to accessing insurer funding for rehabilitation and healthcare services, for adults with TBI injured in motor vehicle collisions (MVCs). Methods: We used a co‐design approach to collaborate with persons with lived experience to design a survey of adults who sustained a TBI in an MVC. The survey examined access to insurer funding for rehabilitation services and was disseminated through brain injury networks in Ontario, Canada. Results: Respondents (n = 148) identified multiple barriers to accessing rehabilitation services through insurer funding, including delays of more than 2 years (49%), mandatory duplicative assessments (64%) and invasion of privacy (55%). Speech‐language therapy and neuropsychological services were denied most frequently. Negative experiences included insurers' poor understanding of TBI symptoms, denials of services despite medical evidence demonstrating need and unsupportive insurer interactions. Although 70% of respondents reported cognitive‐communication difficulties, accommodations were rarely provided. Respondents identified supports that would improve insurer and healthcare communications and rehabilitation access. Conclusion & Implications: The insurance claims process had many barriers for adults with TBI, limiting their access to rehabilitation services. Barriers were exacerbated by communication deficits. These findings indicate a role for Speech‐language therapists in education, advocacy and communication supports during the insurance process specifically as well as rehabilitation access processes in general. WHAT THIS PAPER ADDS: What is already known on this subject: There is extensive documentation of the long‐term rehabilitation needs of individuals with traumatic brain injury (TBI) and their challenges in accessing rehabilitation services over the long term. It is also well known that many individuals with TBI have cognitive and communication deficits that affect their interactions in the community, including with healthcare providers, and that SLTs can train communication partners to provide communication supports to individuals with TBI in these communication contexts. What this study adds: This study adds important information about barriers to accessing rehabilitation, including barriers to accessing SLT services in the community. We asked individuals with TBI about challenges to accessing auto insurance funding for private community services, and their responses illustrate the broader challenges individuals with TBI face in communicating their deficits, conveying service needs, educating and convincing service administrators and self‐advocating. The results also highlight the critical role that communication plays in healthcare access interactions, from completing forms to reviewing reports and funding decisions, to managing telephone calls, writing emails and explaining to assessors. What are the clinical implications of this work?: This study shows the lived experience of individuals with TBI in overcoming barriers to accessing community rehabilitation. The results show that best practices in intervention should include evaluating rehabilitation access, which is a critical step in patient‐centred care. Evaluation of rehabilitation access includes evaluating referral and navigation, resource allocation and healthcare communications, and ensuring accountability at each step, regardless of model of service delivery or funding source. Finally, these findings show the critical role of speech‐language therapists in educating, advocating and supporting communications with funding sources, administrators and other healthcare providers. [ABSTRACT FROM AUTHOR]

Widespread livelihood shocks and vulnerability in rural areas highlight the critical need to extend the provision of social protection interventions, as targeted to reduce vulnerabilities and poverty. Evaluating the real effects of social protection instruments on rural communities is an important concern for governments and policymakers. Hence, the objectives of this review were to examine the effects and challenges of social protection in rural Ethiopia. The review was conducted by synthesizing peerreviewed journals, books, working papers, and organization reports, which were obtained through internet searches from Google Scholar, AgEcon, Science Direct, Taylor, and Francis. Interestingly, among the documents retrieved, 45 were included using eligibility criteria. Finally, the data were presented and narrated in texts. The review outcome indicated that Idir, Zakat in Afar, communitybased health insurance and productive safety net program were important to reducing risk vulnerability, poverty, and food insecurity in the rural community. Moreover, a productive safety net program has both positive and negative effects on beneficiaries' social, economic, and environmental development. In a nutshell, social protection services play a vital role in addressing poverty, hazardous events, and vulnerabilities that affect livelihood. Therefore, concerned bodies should be focused on targeting rural communities to achieve food security and health services through social protection. [ABSTRACT FROM AUTHOR]

Legislations for persons with disabilities emerged in the 1990s in India, providing them with rights and entitlements. Aligned with the UNCRPD, the Rights of Persons with Disabilities Act (2016) supports improved programmes and services. There are no exclusive policies for those with intellectual and developmental disabilities. Different government departments and non‐government organisations provide services including centrally sponsored programmes to persons with disabilities and enable them to exercise their rights. For example, rehabilitation and provision of aids and appliances lie with the Ministry of Social Justice and Empowerment, right to education is with the Ministry of Education, and, early intervention and health services and related supports are with the Ministry of Health. In India, non‐government organisations also play a vital role in health care services. In this paper, we discuss the existing health care systems including medical services in India for persons with disabilities with a specific focus on persons with intellectual and developmental disabilities. The discussion include how the system was evolved and what is in place today, the coverage, strengths, and limitations in the system. We have tried to provide a comprehensive description of existing policies, and practices of health care as well as the cultural influences with regard to health care for people with intellectual and developmental disabilities in India. [ABSTRACT FROM AUTHOR]

An unsettling issue for people worldwide has been the rise in medicine prices. The news routinely reports on surprising drug price increases; however, the general public isless informed about the real reason for increasing medicine prices. Although there are a number of parties involved in the drug price increase, it is unclear to whom the increase can be directly attributed. This study used the scoping review method, to map the literature on the topic. It answers a research question concerning stakeholder responsibility for increased drug prices. To do so, the authors conducted a literature survey of different scientific research databases between 2018 to 2022, using two key phrases: "unfair drug price" and "drug price stakeholders." In the study, a total of 26 papers were full-text reviewed out of 323 papers that were initially identified. The cost-effectiveness of new medications that must go through the pricing and reimbursement procedure is routinely assessed by the pharmaceutical industry. However, because there is a data gap, it is impossible to assess the relationship between drug costs and demand over a longer time period, to identify the drugs that are not covered by health insurance, or to determine the role of health insurance in rising drug prices. Even so, the scoping review reveals more evidence that pharmaceutical corporations have the ability to determine prices, undermining the idea that the health insurance industry is the primary cause of price increases. [ABSTRACT FROM AUTHOR]

Physician medical directors working for health care insurance companies conduct utilization reviews, participate in quality-of-care reviews, and adjudicate appeals. As a result, they have access to substantial and important clinical information. The medical director may have both current and historical information that can assist the treatment team in providing care. Sharing this information with a patient's current health care provider(s) is problematic due to concerns about patient privacy and the insurer's goal of not assuming legal liability for patient care. While this paper considers legal issues, it predominantly addresses the ethical responsibilities of medical directors who have valuable information unavailable to or unrecognized by the treatment team. Although it is important to consider sharing general medical information, this paper emphasizes the sharing of behavioral health information, which can be highly sensitive but also pertinent to psychiatric and other medical treatment choices. We suggest that clinical information should flow from insurer to provider when the insurer has information that will benefit the patient or prove crucial to optimal care rather than just flow from provider to insurer for the purposes of claims payments. To support and secure that flow, the paper outlines procedures for determining the need to share information, the means of providing that information, ways to separate liability, and processes for protecting privacy. [ABSTRACT FROM AUTHOR]

Background: Barriers exist for the provision of surgery for permanent contraception in the postpartum period. Prenatal counseling has been associated with increased rates of fulfillment of desired postpartum contraception in general, although it is unclear if there is impact on permanent contraception specifically. Thus, we aimed to investigate the association between initial timing for prenatal documentation of a contraceptive plan for permanent contraception and fulfillment of postpartum contraception for those receiving counseling. Methods: This is a planned secondary analysis of a multi-site cohort study of patients with documented desire for permanent contraception at the time of delivery at four hospitals located in Alabama, California, Illinois, and Ohio over a two-year study period. Our primary exposure was initial timing of documented plan for contraception (first, second, or third trimester, or during delivery hospitalization). We used univariate and multivariable logistic regression to analyze fulfillment of permanent contraception before hospital discharge, within 42 days of delivery, and within 365 days of delivery between patients with a documented plan for permanent contraception in the first or second trimester compared to the third trimester. Covariates included insurance status, age, parity, gestational age, mode of delivery, adequacy of prenatal care, race, ethnicity, marital status, and body mass index. Results: Of the 3103 patients with a documented expressed desire for permanent contraception at the time of delivery, 2083 (69.1%) had a documented plan for postpartum permanent contraception prenatally. After adjusting for covariates, patients with initial documented plan for permanent contraception in the first or second trimester had a higher odds of fulfillment by discharge (aOR 1.57, 95% C.I 1.24–2.00), 42 days (aOR 1.51, 95% C.I 1.20–1.91), and 365 days (aOR 1.40, 95% C.I 1.11–1.75), compared to patients who had their first documented plan in the third trimester. Conclusions: Patients who had a documented prenatal plan for permanent contraception in trimester one and two experienced higher likelihood of permanent contraception fulfillment compared to those with documentation in trimester three. Given the barriers to accessing permanent contraception, it is imperative that comprehensive, patient-centered counseling and documentation regarding future reproductive goals begin early prenatally. Plain language summary: Permanent contraception is a highly desired form of postpartum contraception in the United States, however there are several barriers to accessing it. In this paper, we investigate whether the timing of when a patient has a documented plan for postpartum contraception has an impact on if they achieve postpartum contraception. This is a cohort study from four hospitals in Illinois, Ohio, California, and Alabama for patients with a desire for postpartum permanent contraception documented in their medical record. We specifically investigated the trimester (first, second, or third) where a patient had a plan for permanent contraception first documented. We then used univariate and multivariate models to determine the relationship between the timing of a plan for permanent contraception and if a patient achieved the procedure at three time-points: hospital discharge, 42-days, and 365-days. Our findings showed that of the 3103 patients in our cohort, only 69.1% of them had a documented plan for postpartum contraception at any point before going to the hospital for their delivery admission. We additionally found that patients who had a documented plan for permanent contraception in the first or second trimester had a higher odds of receiving their postpartum contraception procedure compared to people who had their first documented plan in the third trimester. This showed us the importance of earlier counseling regarding contraception for pregnant patients. There are many barriers to accessing postpartum contraception, so having patient focused counseling about future goals around reproductive health early on in pregnancy is critical. [ABSTRACT FROM AUTHOR]

This paper addresses the challenges and solutions in developing a holistic prevention mobile health application (mHealth app) for Germany's healthcare sector. Despite Germany's lag in healthcare digitalization, the app aims to enhance primary prevention in physical activity, nutrition, and stress management. A significant focus is on user participation and usability to counter the prevalent issue of user attrition in mHealth applications, as described by Eysenbach's 'law of attrition'. The development process, conducted in a scientific and university context, faces constraints like limited budgets and external service providers. The study firstly presents the structure and functionality of the app for people with statutory health insurance in Germany and secondly the implementation of user participation through a usability study. User participation is executed via usability tests, particularly the think-aloud method, where users verbalize their thoughts while using the app. This approach has proven effective in identifying and resolving usability issues, although some user feedback could not be implemented due to cost-benefit considerations. The implementation of this study into the development process was able to show that user participation, facilitated by methods like think-aloud, is vital for developing mHealth apps. Especially in health prevention, where long-term engagement is a challenge. The findings highlight the importance of allocating time and resources for user participation in the development of mHealth applications. [ABSTRACT FROM AUTHOR]

Previous research focuses on the question of whether international standards have prompted any improvement of labor and social standards by law or in practice. This paper complements the literature by showing that the way that international standards are translated and implemented at the national level matters as well. Using a novel historical database on paid maternity leave policies in 160 countries with a time series from 1883 to 2018, I document how informal sector workers in low- and middle-income countries (LMICs) fell by the wayside in the widespread adoption of the International Labour Organization (ILO) maternity protection standards. First, the analysis shows that while the adoption of the ILO Maternity Protection Conventions triggered the introduction and extension of maternity leave policies throughout the world, LMICs ignored the provision of social assistance benefits. Second, even when LMICs extended the coverage of maternity leave policies to the informal sector, the implementation constraints further hindered the access of women workers in the informal sector to maternity benefits. [ABSTRACT FROM AUTHOR]

Background: Publicly Funded Health Insurance Schemes (PFHIS) are intended to play a role in achieving Universal Health Coverage (UHC). In countries like India, PFHISs have low penetrance and provide limited coverage of services and of family members within households, which can mean that women lose out. Gender inequities in relation to financial risk protection are understudied. Given the emphasis being placed on achieving UHC for all in India, this paper examined intersecting gender inequalities and changes in PFHIS coverage in southern India, where its penetrance is greater and of longer duration. Data and methods: This study used the fourth (NFHS-4, 2015–16) and fifth (NFHS-5, 2019–21) rounds of India's National Family Health Survey for five southern states: namely, Andhra Pradesh, Karnataka, Kerala, Tamil Nadu, and Telangana. The World Health Organization's Health Equity Assessment Toolkit (HEAT) Plus and Stata were used to analyse PFHIS coverage disaggregated by seven dimensions of inequality. Ratios and differences for binary dimensions; Between Group Variance and Theil Index for unordered dimensions; Absolute and Relative Concentration Index (RCI) for ordered dimensions were computed separately for women and men. Results: Overall, PFHIS coverage increased significantly (p < 0.001) among women and men in Andhra Pradesh, and Kerala from NFHS-4 to NFHS-5. Overall, men had higher PFHIS coverage than women, especially in Andhra Pradesh, Tamil Nadu, and Telangana in both surveys. In both absolute and relative terms, PFHIS coverage was concentrated among older women and men across all states; age-related inequalities were higher among women than men in both surveys in Andhra Pradesh, Kerala, and Telengana. The magnitude of education-related inequalities was twice as high as among women in Telangana (RCINFHS-4: -12.23; RCINFHS-5: -9.98) and Andhra Pradesh (RCINFHS-4: -8.05; RCINFHS-5: -7.84) as compared to men in Telangana (RCINFHS-4: -5.58; RCINFHS-5: -2.30) and Andhra Pradesh (RCINFHS-4: -4.40; RCINFHS-5: -3.12) and these inequalities remained in NFHS-5, suggesting that lower education level women had greater coverage. In the latter survey, a high magnitude of wealth-related inequality was observed in women (RCINFHS-4: -15.78; RCINFHS-5: -14.36) and men (RCINFHS-4: -20.42; RCINFHS-5: -13.84) belonging to Kerala, whereas this inequality has decreased from NFHS-4 to NFHS-5., again suggestive of greater coverage among poorer populations. Caste-related inequalities were higher in women than men in both surveys, the magnitude of inequalities decreased between 2015–16 and 2019–20. Conclusions: We found gender inequalities in self-reported enrolment in southern states with long-standing PFHIS. Inequalities favoured the poor, uneducated and elderly, which is to some extend desirable when rolling out a PFHIS intended for harder to reach populations. However, religion and caste-based inequalities, while reducing, were still prevalent among women. If PFHIS are to truly offer financial risk protection, they must address the intersecting marginalization faced by women and men, while meeting eventual goals of risk pooling, indicated by high coverage and low inequality across population sub-groups. [ABSTRACT FROM AUTHOR]

Diverse manifestations of biological aging often reflect disparities in socioeconomic status (SES). In this paper, we examine associations between indicators of SES and an mRNA-based aging signature during young adulthood, before clinical indications of aging are common. We use data from wave V (2016–2018) of the National Longitudinal Study of Adolescent to Adult Health, a nationally representative study of adults aged 33–43 years, with transcriptomic data from a subset of 2,491 participants. Biological aging is measured using 1) a composite transcriptomic aging signature previously identified by Peters et al.'s out-of-sample meta-analysis (Nat Commun. 2015;6:8570) and 2) 9 subsets that represent functional pathways of coexpressed genes. SES refers to income, education, occupation, subjective social status, and a composite measure combining these 4 dimensions. We examine hypothesized mechanisms through which SES could affect aging: body mass index, smoking, health insurance status, difficulty paying bills, and psychosocial stress. We find that SES—especially the composite measure and income—is associated with transcriptomic aging and immune, mitochondrial, ribosomal, lysosomal, and proteomal pathways. Counterfactual mediational models suggest that the mediators partially account for these associations. The results thus reveal that numerous biological pathways associated with aging are already linked to SES in young adulthood. [ABSTRACT FROM AUTHOR]

What is known about the topic? The health workforce and health tasks are highly contested and largely controlled by regulation. Since the introduction of medical regulation in the mid-19th century, the practice of surgery has been largely dominated by medically trained surgeons. A small group of Australian podiatrists have defied these historic boundaries by creating their own colleges of training and convincing government and regulators of their safety and efficacy in surgical practice. The Podiatry Board of Australia commissioned an independent review of the regulation and regulatory practices of podiatric surgeons in Australia. What does this paper add? This paper discusses the implications of a regulatory review of the role of podiatric surgeons for professional role boundaries. What are the implications for practitioners? Despite historic role boundaries and definitions, with appropriate training, regulation, and financing, the health workforce can be mobilised in different ways to meet population needs, overcoming a professional monopoly over roles. [ABSTRACT FROM AUTHOR]

What is known about this topic? We discuss a recently published paper that alleges clinicians are causal agents of non-compliant billing of Medicare. What does this paper add? The paper's arguments are partially supported by unreferenced assertions, potential logical fallacies, inaccurate reporting of referenced material and unsubstantiated rhetoric. What are the implications for practitioners? Due to the lack of substantive evidence, it cannot be concluded that clinicians are the causal agents of non-compliant billing of Medicare. [ABSTRACT FROM AUTHOR]

In terms of number of beneficiaries, Medicaid is the single largest health insurance program in the US. Along with the Children's Health Insurance Program (CHIP), Medicaid covers nearly half of all births and provides health insurance to nearly half of the children in the country. This article provides a broad introduction to Medicaid and CHIP for the pediatric radiologist with a special focus on topics relevant to pediatric imaging and population health. This includes an overview of Medicaid's structure and eligibility criteria and how it differs from Medicare. The paper examines the means-tested programs within the context of pediatric radiology, reviewing pertinent topics such as the rise of Medicaid managed care plans, Medicaid expansion, the effects of Medicaid on child health, and COVID-19. Beyond the basics of benefits coverage, pediatric radiologists should understand how Medicaid and CHIP financing and reimbursement affect the ability of pediatric practices, radiology groups, and hospitals to provide services for children in a sustainable manner. The paper concludes with an analysis of future opportunities for Medicaid and CHIP. [ABSTRACT FROM AUTHOR]

There is little research on the relationship between welfare policies and immigrant entrepreneurship. Accordingly, this paper examines changes in three welfare domains: child‐care, health/medical insurance, and unemployment insurance in the context of France since roughly the 1980s, but with a focus on the 21st century. Given changes in French welfare policy, I show that immigrants' greater access to fluctuating, sometimes declining, but overall increasing spending in the three domains, can be positively correlated with slowly increasing immigrant entrepreneurship since the early 2000s. However, I also argue that welfare policies do not seem to have a significant effect on the levels and survival of immigrant‐owned firms in France. The findings of this paper should nonetheless be taken with extreme caution in light of the obstacles to analyzing this relationship. As a consequence, I provide an assessment of three possible research designs as a route towards better understanding this relationship. [ABSTRACT FROM AUTHOR]

This paper discusses the Topp-Leone-G power series class of distributions. The greatest attention is paid to the investigation of intrinsic characteristic "saturation" to the horizontal asymptote in the Hausdorff sense. Some estimates for the value of the Hausdorff distance are obtained. We present a new family of recurrence generated adaptive functions with corresponding applications. The usefulness of the obtained results is demonstrated in a simulation study of some real data sets from the medical sector and insurance. Some suitable software modules within the programming environment CAS MATHEMATICA are proposed. [ABSTRACT FROM AUTHOR]

Aims: To identify the barriers and facilitators to healthcare for people without documentation status. Design: We conducted a systematic integrative literature review following the Whittemore and Knafl methodology. Methods: Literature search was conducted to identify studies addressing barriers or facilitators to healthcare for people without documentation status in the United States between 2012 and 2022. Studies were critiqued for quality, with results analysed thematically using the social‐ecological model. Data Sources: Searches were conducted in PubMed, PAIS, Web of Science, CINAHL and Psych Info in October 2022. Results: The review incorporated 30 studies (19 qualitative and 11 quantitative). People without documentation status encountered numerous healthcare barriers such as intrapersonal (lack of financial resources and health insurance, fear), interpersonal (language and cultural discrepancies, discrimination), community (bureaucratic requirements, anti‐immigrant rhetoric) and policy‐related barriers. Conversely, linguistically and culturally competent care, empathetic and representative staff, health navigators, safety‐net clinics and supportive federal policies emerged as key facilitators. Conclusion: These findings illuminate the complex healthcare disparities experienced by people without documentation status and underscore facilitators enhancing care accessibility. Future research is needed to explore interventions to increase access to care for this population. Impact: This paper provides a comprehensive examination of the complex barriers and facilitators to healthcare for people without documentation status in the United States. The findings support the value of universal healthcare access, a priority of the World Health Organization, and can inform healthcare policies and practices worldwide. Reporting Method: The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses framework. Patient or Public Contribution: No patient or public contribution was needed. Trial and Protocol Registration: The study protocol was registered with the PROSPERO database (registration number: CRD42022366289). [ABSTRACT FROM AUTHOR]

Background: The transformation from the quantity of labor supply to the quality of labor supply is an important measure to improve the self-development of migrant workers. Method: Based on the 2018 China Floating Population Dynamic Monitoring Survey data, this paper uses the 2SLS model based on instrumental variable estimation to analyze the impact of urban and rural integrated medical insurance on the quality of migrant workers' labor supply. Results: The study found that: First, urban and rural integrated medical insurance can significantly improve the quality of labor supply for migrant workers. Even with different instrumental variables and the use of propensity score matching for counterfactual inferences, the findings remain robust. Second, the impact of urban–rural integrated medical insurance on the quality of labor supply for migrant workers has nonlinear characteristics. At the low quantile, the impact of urban–rural integrated medical insurance on the quality of labor supply for migrant workers showed a downward trend, but with the increase of the quantile, the impact of urban and rural integrated medical insurance continued to increase, showing a U-shaped trend. Conclusion: Urban–rural integrated medical insurance can not only directly reduce the labor time of migrant workers and ease the labor burden of migrant workers, but also indirectly improve the quality of labor supply for migrant workers through the intermediary role of promoting the availability of public services such as family contracted doctor services and health education. [ABSTRACT FROM AUTHOR]

Applying the behavioral model of health services utilization to data from the United States, this study examined immigrant children's use of physician and dentist visits, hospital care, and prescribed medication. We employed data describing 9759 immigrant parents and children who participated in 2021's National Survey of Children's Health. Logistic regression results negatively linked physician visits to child health, child age, Asian children, fathers, lower parent education, lower family income, uninsured children, and parent's U.S. residence under 5 years. Dentist visits were positively associated with child age, girls, Hispanic children, parent education, family income, public/private health insurance coverage, and U.S.-born children, but such use was associated negatively with Asian children. Hospital use was positively associated with poor child health, Black children, children of "other" race/ethnicity, younger parent age, enrolled in health insurance, and parent's U.S. residence under 5 years. The use of prescribed medication was negatively associated with Asian children, younger child age, lower parent education, uninsured child, and lack of English proficiency. The paper's conclusion suggests policymakers expand Medicaid and CHIP eligibility among immigrant children and suggests community education to foster awareness of children's physical and oral health needs and of Medicaid, CHIP, and prescription assistance programs. The conclusion calls for healthcare providers and social workers to accommodate and respect immigrants' traditional health-related beliefs, showing cultural competence. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic in 2020 enhanced the need for commercial health insurance to address the sudden and overwhelming healthcare costs faced by families. This also led to an increase in the demand for health insurance services requiring insurance companies to innovate and develop suitable services. However, in the context of China, despite the huge potential for growth, health insurance market faces numerous challenges such as inadequate availability of tailored services, educational issues, income limitations, and emphasis on social insurance. To examine the issues and consider areas for improvements, this research investigated the impacts and effects of commercial health insurance from a macro perspective and considered potential recommendations to enhance the effective demand. This paper performed an empirical investigation by using the short panel data for regression analysis. The data was collected over ten years (2010 to 2019) involving 31 provinces in China to establish a fixed effect model. It employed FE and FGLS method to compare and analyze the impact of 9 factors while the health insurance premium was set as the dependent variable. Results showed that domestic economic development led to increasing residents' wealth and consumption levels has increased, including healthcare investments. Elevating the awareness of people through education can promote the development of the commercial health insurance demand, but the influence of urbanization level and the aging of the population remain to be demonstrated. [ABSTRACT FROM AUTHOR]

Ending poverty in all its forms is the first of the 17 Sustainable Development Goals of the 2030 Agenda for Sustainable Development. Therefore, it is of great significance to study poverty in the context of sustainable development. After eradicating absolute poverty, constructing a long-term mechanism to solve relative poverty is an inevitable requirement for achieving common prosperity in China. Therefore, it is extremely important that relative poverty is accurately identified and quantitatively decomposed. This paper adjusts the Foster–Greer–Thorbecke poverty index to propose a new methodology for relative poverty decomposition comprising growth, dispersion, heterogeneity, and identification effect. Based on China Family Panel Studies data from 2014 to 2018, the empirical analysis reveals the contributions to relative poverty made by growth, dispersion, heterogeneity, and identification effects. Specifically, the growth effect reduces the incidence of relative poverty; dispersion effect worsens relative poverty by affecting the depth of poverty; the heterogeneity effect depends on the heterogeneous characteristics of the population; the identification effect aggregates relative poverty by acting mainly on poverty incidence. We also compare the four relative poverty effects in urban versus rural areas. The findings show that dispersion effect and heterogeneity effect are keys to the differences. In particular, dispersion effect differences arise from income disparities, while heterogeneity effect differences depend on heterogeneous characteristics such as education, health insurance, and migrant work. [ABSTRACT FROM AUTHOR]

With the gradual intensification of aging in China, the issue of elderly care has become the primary issue that needs to be urgently solved in society. The construction of a reasonable and scientific integrated medical and care service system can not only efficiently allocate medical resources and services, but also better meet the needs of the elderly. Due to the involvement of multiple disciplines such as architecture, sociology, psychology, and behavioral science in the construction of the system, as well as the restriction of various objective factors such as medical capacity, spatial scale, and operating costs, the government and elderly care institutions have always been unable to find the best solution for how to scientifically and reasonably construct an integrated medical and care service system. This paper is based on Anshan City, Liaoning Province, which has prominent aging issues and distinct characteristics of the elderly population. Through extensive field research in elderly care institutions, and face-to-face communication with personnel from relevant government departments such as the Municipal Commission on Aging, the Civil Affairs Bureau, the Health Commission, the Medical Insurance Bureau, and the Human Resources and Social Security Bureau, it truly understands the problems that arise in the construction of the urban integrated medical and care service system. From three aspects: urban situation, institutional situation and the needs of the elderly, it is proposed to establish a clear departmental linkage mechanism with clear rights and responsibilities, a policy guarantee mechanism tailored to local conditions, a multi-measure operation mechanism, a technology first intelligent response mechanism, a warm and efficient service mechanism for the people, an overall layout mechanism, an evaluation and supervision mechanism for full process control, and a talent supply mechanism of external introduction and internal training. It aims to provide reference for the construction of an integrated medical and care service system in similar cities. [ABSTRACT FROM AUTHOR]

Objective: To estimate the effects of prenatal public health insurance targeting noncitizens on the health of U.S.‐born children of noncitizen mothers beyond birth outcomes. Data Sources and Study Setting: This paper uses the restricted version of the 1998–2014 National Health Interview Survey with state‐level geographic identifiers. Study Design: The empirical strategy compares outcomes in states that adopted the Children's Health Insurance Plan (CHIP) Unborn Child Option with states that never adopted or adopted it at different times, controlling for differences in the pre‐treatment period. I use a flexible event‐study analysis to quantify the effects of the Unborn Child Option on noncitizen women's health insurance coverage, health care utilization, and their children's health. Data Collection/Extraction Methods: All data are derived from pre‐existing sources. Principal Findings: The study finds that the impact of the Unborn Child Option is a 4.7%‐point increase in public health insurance coverage (p < 0.01) and 0.48 more doctor's office visits (p < 0.1) annually among noncitizens of childbearing ages. Subsequently, the reform leads to a 7%‐point rise in the rate of parents reporting their 4–6‐year‐old children are in "excellent" or "very good" health (p < 0.01). While no improvements are evident at birth and at younger ages, observed health improvements begin to appear by preschool age. Conclusions: The study contributes to the literature by providing evidence that certain benefits of in‐utero public health insurance targeting noncitizens may appear several years after birth, specifically around preschool age. [ABSTRACT FROM AUTHOR]

Background: This document describes two qualitative programmatic case studies documenting experiences implementing digital financial services (DFS) for health with a focus on expanding access to universal health coverage (UHC). The CBHI 3MS system in Rwanda and the i-PUSH and Medical Credit Fund programs in Kenya were selected because they represent innovative use of digital financing technologies to support UHC programs at scale. Methods: These studies were conducted from April-August 2021 as part of a broader digital financial services landscape assessment that used a mixed methods process evaluation to answer three questions: 1) what was the experience implementing the program, 2) how was it perceived to influence health systems performance, and 3) what was the client/beneficiary experience? Qualitative interviews involved a range of engaged stakeholders, including implementers, developers, and clients/users from the examined programs in both countries. Secondary data were used to describe key program trends. Results: Respondents agreed that DFS contributed to health system performance by making systems more responsive, enabling programs to implement changes to digital services based on new laws or client-proposed features, and improving access to quality data for better management and improved quality of services. Key informants and secondary data confirmed that both implementations likely contributed to increasing health insurance coverage; however, other changes in market dynamics were also likely to influence these changes. Program managers and some beneficiaries praised the utility of digital functions, compared to paper-based systems, and noted their effect on individual savings behavior to contribute to household resilience. Discussion/Conclusions: Several implementation considerations emerged as facilitators or barriers to successful implementation of DFS for health, including the importance of multisectoral investments in general ICT infrastructure, the value of leveraging existing community resources (CHWs and mobile money agents) to boost enrollment and help overcome the digital divide, and the significance of developing trust across government and private sector organizations. The studies led to the development of five main recommendations for the design and implementation of health programs incorporating DFS. [ABSTRACT FROM AUTHOR]

The average annual budgetary allocation for health in Nigeria is about the lowest in Africa at 5.7% as the total health expenditure is only 0.7% of GDP against the WHO recommended 4%-5%. The out-ofpocket spending by Nigerians is more than 60% of total health expenditure instead of WHO recommended 30-40%, while the national coverage of the National Health Insurance is below 5% which poses a serious problem to health care service utilization. In Nigeria, the ever rising socioeconomic costs of healthcare and the limited or complete lack of supportive public financing is a major challenge to the attainment of the sustainable development goals (SDGs) recently adopted to reduce poverty and improve the wellbeing of all citizens of the world. This paper examined health care financing in Cross River State and determined the extent to which it poses problems to services utilization. The paper reviewed literature relevant to the study while the Marxist conflict theory of healthcare utilization was employed. The design for the paper was Expost facto which relied on secondary data from Cross River State Ministry of Health. The study reviewed various sources of health care financing in Cross River State and the impact of these sources on health care system strengthening or quality health care provision. From the study or discourse and review of health expenditure and its related challenges, it was found out that, out-of -pocket expenditure or user-fee charges, community-based financing, private donor agencies financing and tax-based public health financing sources in the state have not significantly impacted on good services provision to individuals. From these findings, it was recommended among others that government should encourage the establishment of village/ward development committees whose responsibilities should include taking initiative to assist government in building health post (in communities where such do not exist), Government should maintain existing health facilities and provide proper logistics during health campaigns and monitoring of health workers activities at the health facilities. [ABSTRACT FROM AUTHOR]

Objective: Unequal utilization of medical services will have a significant impact on the consumption of resources entitled through health insurance claims of patients. With the proposal of the goal of Healthy China, it is essential to achieve the equity of medical service utilization of patients with rare diseases to further promote social equity and justice. To analyze the consumption of medical resources of rare disease patients, so as to explore how different medical insurance types impact patients' medical resources consumption. This study pioneeringly used medical data from Peking Union Medical College Hospital. By analyzing the consumption data, this paper fills the research gap of existing studies on the analysis of medical service utilization inequality based on the perspective of insurance participation by examining the effects of different types of insurance coverage on medical resource consumption of hemophiliacs. At the same time, rare disease patients as a minority group have long been neglected in the analysis of medical resource consumption, and this paper fills the research gap of medical service utilization of this group to a certain extent by taking hemophiliacs as the object of analysis. Methods: Based on the medical data of hemophilia patients in Peking Union Medical College Hospital from 2010 to 2020, we analyze the consumption of medical resources of the patients, and use a multiple regression model to explore how different medical insurance types impact patients' medical resources consumption. Results: The study has three main findings. Firstly, the disparity in medical expenditure among different hemophilia patients is quite obvious, and the drug expense accounts for a large proportion of the total cost. Secondly, the ratio of reimbursement is generally low, and there is a wide difference in the amount of reimbursement for different types of medical insurance. Thirdly, the resource consumption of patients with different medical insurance types differs a lot. Conclusion: In order to improve the current medical insurance system and mechanism for providing orphan drugs, we put forward the following suggestions. First of all, the medical security system should expand its coverage to eliminate the medical expenditure gap between different hemophilia patients, therefore better promoting equity under the same insurance type. At the same time, the reimbursement level of medical expenses for patients with rare diseases should be appropriately improved, so as to reduce the financial burden of patients with rare diseases, and promote the realization of economic equity. In addition, society should pay special attention to the disadvantaged groups, reduce the differences between various medical insurance, and improve the level of health and equity of the whole society. [ABSTRACT FROM AUTHOR]

The paper investigates the influence of policy ideas from the World Bank and the International Monetary Fund (IMF) on healthcare financing policy in Croatia during the 2002 reform. It contributes to the global social policy literature by providing evidence that the influence of international organisations primarily stems from non-coercive instruments to control the policy agenda, for example, dissemination of ideas, technical assistance and consultations with the recipient government. Even though Croatia was facing economic and political difficulties which weakened its bargaining position vis a vis IOs, the paper shows that impact of coercion and conditionalities attached to international aid was limited. It explains the lenient stance of international organisations by their mission to aid and adjust to a country's needs as well as their self-interest to lend money, to stay in the reform game and to prolong their influence in the future. Consequently, international organisations are willing to bargain and make trade-offs with the recipient government. [ABSTRACT FROM AUTHOR]

Background: Over 150 million people, mostly from low and middle-income countries (LMICs) suffer from catastrophic health expenditure (CHE) every year because of high out-of-pocket (OOP) payments. In Tanzania, OOP payments account for about a quarter of the total health expenditure. This paper compares healthcare utilization and the incidence of CHE among improved Community Health Fund (iCHF) members and non-members in central Tanzania. Methods: A survey was conducted in 722 households in Bahi and Chamwino districts in Dodoma region. CHE was defined as a household health expenditure exceeding 40% of total non-food expenditure (capacity to pay). Concentration index (CI) and logistic regression were used to assess the socioeconomic inequalities in the distribution of healthcare utilization and the association between CHE and iCHF enrollment status, respectively. Results: 50% of the members and 29% of the non-members utilized outpatient care in the previous month, while 19% (members) and 15% (non-members) utilized inpatient care in the previous twelve months. The degree of inequality for utilization of inpatient care was higher (insured, CI = 0.38; noninsured CI = 0.29) than for outpatient care (insured, CI = 0.09; noninsured CI = 0.16). Overall, 15% of the households experienced CHE, however, when disaggregated by enrollment status, the incidence of CHE was 13% and 15% among members and non-members, respectively. The odds of iCHF-members incurring CHE were 0.4 times less compared to non-members (OR = 0.41, 95%CI: 0.27–0.63). The key determinants of CHE were iCHF enrollment status, health status, socioeconomic status, chronic illness, and the utilization of inpatient and outpatient care. Conclusion: The utilization of healthcare services was higher while the incidence of CHE was lower among households enrolled in the iCHF insurance scheme relative to those not enrolled. More studies are needed to establish the reasons for the relatively high incidence of CHE among iCHF members and the low degree of healthcare utilization among households with low socioeconomic status. [ABSTRACT FROM AUTHOR]

Out-of-pocket payments are expenditures borne directly by an individual/household for health services that are not reimbursed by any third-party. Households can experience financial hardship when the burden of such out-of-pocket payments is significant. This financial hardship is commonly measured using the "catastrophic health expenditure" (CHE) metric. CHE has been applied as an indicator in several health sectors and health policies. However, despite its importance, the methods used to measure the incidence of CHE vary across different studies and the terminology used can be inconsistent. In this paper, we introduce and raise awareness of the main approaches used to calculate CHE and discuss critical areas of methodological variation in a global health context. We outline the key features, foundation and differences between the two main methods used for estimating CHE: the budget share and the capacity-to-pay approach. We discuss key sources of variation within CHE calculation and using data from Ethiopia as a case study, illustrate how different approaches can lead to notably different CHE estimates. This variation could lead to challenges when decisionmakers and policymakers need to compare different studies' CHE estimates. This overview is intended to better understand how to interpret and compare CHE estimates and the potential variation across different studies. [ABSTRACT FROM AUTHOR]

Auditing -- in all its forms -- is of particular importance to ensure efficient, transparent and accountable management of health funds and to ensure the provision of quality medical services to patients. The authors, through the present work, reveal - based on the study of specialized literature and reports issued by some specialized institutions - that both internal and external public audit is intended to prevent fraud, thus protecting resources and ensuring the provision of medical services of quality for patients, but also to help identify errors in the funds management process, so that they can be properly corrected and thus ensure an efficient management of resources intended for health insurance in Romania. Equally important is the fact that the audit contributes to increasing transparency in the use of health funds, improving the performance of the health system and ensuring compliance with the rules and regulations in force regarding the management of health funds, so as to avoid unnecessary expenses and ensure the provision of quality medical services. The structure of this paper includes, following this introductory part (1): Management of health insurance funds and ensuring the financing of medical services in Romania (2); Findings of the external public audit regarding the management of health insurance funds (3) and Conclusions (4). [ABSTRACT FROM AUTHOR]

In Canada, public insurance for physician and hospital services, without cost-sharing, is provided to all residents. Outpatient prescription drug coverage, however, is provided through a patchwork system of public and private plans, often with substantial cost-sharing, which leaves many underinsured or uninsured. We conducted a systematic review to examine the association of drug insurance and cost-sharing with drug use, health services use, and health in Canada. We searched 4 electronic databases, 2 grey literature databases, 5 specialty journals, and 2 working paper repositories. At least 2 reviewers independently screened articles for inclusion, extracted characteristics, and assessed risk of bias. The expansion of drug insurance was associated with increases in drug use, individuals who reported drug insurance generally reported higher drug use, and increases in and higher levels of drug cost-sharing were associated with lower drug use. Although a number of studies found statistically significant associations between drug insurance or cost-sharing and health services use, the magnitudes of these associations were generally fairly small. Among 5 studies that examined the association of drug insurance and cost-sharing with health outcomes, 1 found a statistically significant and clinically meaningful association. We did not find that socioeconomic status or sex were effect modifiers; there was some evidence that health modified the association between drug insurance and cost-sharing and drug use. Increased cost-sharing is likely to reduce drug use. Universal pharmacare without cost-sharing may reduce inequities because it would likely increase drug use among lower-income populations relative to higher-income populations. • There is a gap in the literature pertaining to the effects of drug insurance and cost-sharing in a Canadian context. • We conducted a systematic review of Canadian studies and found that there was consistent evidence that the expansion of drug insurance was associated with meaningful increases in drug use, that individuals who reported drug insurance coverage generally reported higher drug use relative to those who reported no coverage, and that increases in and higher levels of drug cost-sharing were associated with lower use. • Universal pharmacare without cost-sharing may reduce inequities in access to essential drugs. [ABSTRACT FROM AUTHOR]

Background and Objectives: There is increasing focus on physician burnout, psychiatric problems, and substance use disorders. Costs of recovery for physicians enrolled in Physician Health Programs (PHPs) remain unexamined with little known regarding funding resources. We sought to elucidate perceived costs of recovery from impairing conditions and highlight resources for financial strain. Methods: This survey study was distributed by the Federation of State Physician Health Organizations via e‐mail to 50 PHPs in 2021. Questions assessed perceptions of costs and ability to pay for recommended evaluation, treatment, and monitoring. Questions also assessed limitation of engagement due to financial concerns, and availability of financial resources. Results: Complete responses were received from 40 of 50 eligible PHPs. The majority (78%) of responding PHPs assessed ability to pay at initial intake evaluation. There is notable financial strain on physicians, particularly those earliest in training, to pay for services. Discussion and Conclusions: PHPs are vital to physicians, especially physicians‐in‐training, as "safe haven programs." Methods to financially assist through PHPs included fee deferrals, sliding scale fees, and fee forgiveness. Health insurance, medical schools, and hospitals were able to provide additional assistance. Scientific Significance: Because burnout, mental health, and substance use disorders are high stakes amongst physicians, it is critical that access to PHPs is available, destigmatized, and affordable. Our paper focuses specifically on the financial cost of recovery, the financial burden placed on PHP participants, a topic lacking in the literature, and highlights remedies and vulnerable populations. [ABSTRACT FROM AUTHOR]

Public healthcare systems are increasingly refusing (temporarily) to reimburse newly approved medical treatments of insufficient or uncertain cost-effectiveness. As both patient demand for these treatments and their list prices increase, a market might arise for voluntary additional health insurance (VHI) that covers effective but (very) expensive medical treatments. In this paper, we evaluate such potential future practices of VHI in public healthcare systems from a justice perspective. We find that direct (telic) egalitarian objections to unequal access to expensive treatments based on different ability to afford VHI do not stand up to scrutiny. However, such unequal access might lead to loss of self-respect among individuals, or loss of fraternity within society, rendering it more difficult for citizens to interact on equal moral footing. This would be problematic from a relational egalitarian perspective. Moreover, the introduction of VHI might turn out to have negative consequences for the comprehensiveness and/or the quality of the public healthcare services that are offered to all patients equally through basic health insurance. These consequences must be weighed against potential health gains and the value of liberty. We conclude that governments should be careful when considering the introduction of VHI in public healthcare systems. [ABSTRACT FROM AUTHOR]

Background: To systematically evaluate the empirical evidence on the impact of community-based health insurance (CBHI) on healthcare utilization and financial risk protection in low- and middle-income countries (LMIC). Methods: We searched PubMed, CINAHL, Cochrane CENTRAL, CNKI, PsycINFO, Scopus, WHO Global Index Medicus, and Web of Science including grey literature, Google Scholar®, and citation tracking for randomized controlled trials (RCTs), non-RCTs, and quasi-experimental studies that evaluated the impact of CBHI schemes on healthcare utilization and financial risk protection in LMICs. We assessed the risk of bias using Cochrane's Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions tools for RCTs and quasi/non-RCTs, respectively. We also performed a narrative synthesis of all included studies and meta-analyses of comparable studies using random-effects models. We pre-registered our study protocol on PROSPERO: CRD42022362796. Results: We identified 61 articles: 49 peer-reviewed publications, 10 working papers, 1 preprint, and 1 graduate dissertation covering a total of 221,568 households (1,012,542 persons) across 20 LMICs. Overall, CBHI schemes in LMICs substantially improved healthcare utilization, especially outpatient services, and improved financial risk protection in 24 out of 43 studies. Pooled estimates showed that insured households had higher odds of healthcare utilization (AOR = 1.60, 95% CI: 1.04–2.47), use of outpatient health services (AOR = 1.58, 95% CI: 1.22–2.05), and health facility delivery (AOR = 2.21, 95% CI: 1.61–3.02), but insignificant increase in inpatient hospitalization (AOR = 1.53, 95% CI: 0.74–3.14). The insured households had lower out-of-pocket health expenditure (AOR = 0.94, 95% CI: 0.92–0.97), lower incidence of catastrophic health expenditure at 10% total household expenditure (AOR = 0.69, 95% CI: 0.54–0.88), and 40% non-food expenditure (AOR = 0.72, 95% CI: 0.54–0.96). The main limitations of our study are the limited data available for meta-analyses and high heterogeneity persisted in subgroup and sensitivity analyses. Conclusions: Our study shows that CBHI generally improves healthcare utilization but inconsistently delivers financial protection from health expenditure shocks. With pragmatic context-specific policies and operational modifications, CBHI could be a promising mechanism for achieving universal health coverage (UHC) in LMICs. [ABSTRACT FROM AUTHOR]

The Genetic Information Nondiscrimination Act of 2008 (GINA) represents a significant legislative step in protecting U.S. citizens from genetic discrimination in health insurance and employment. However, despite its broad preventive measures, GINA has limitations in scope and enforcement. Notably, it does not extend protections to life insurance, disability, and long-term care insurance, leaving U.S. citizens susceptible to genetic discrimination. State-level legislative efforts have tried to reconcile these vulnerabilities. Many state-level legislative efforts vary in effectiveness, with some states like Florida and Illinois enacting more robust laws. The future of genetic information protection requires an amendment to GINA or new federal legislation, drawing from successful state models to ensure adequate protections. This paper advocates for such national legislation, highlighting the minimal impact on the life insurance market and the importance of safeguarding genetic privacy to foster trust in genetic testing and scientific progress. [ABSTRACT FROM AUTHOR]

Background: Although Ghana is lauded for its National Health Insurance Scheme (NHIS), concerns exist about the scheme's functioning and sustainability. An often-cited issue—contributing to the scheme's decreasing membership, long-standing financial deficit, and frequent out-of-pocket payments among members—is the large benefits package (BP). While, on paper, the BP covers over 95% of the conditions occurring in Ghana, its design was not informed by any budget analysis, nor any systematic prioritization of interventions. This paper aims to provide evidence-based input into ongoing discussions regarding a review of the NHIS benefits package. Methods: An existing analytic framework is used to calculate net health benefit (NHB) for a range of interventions in order to assess their cost-effectiveness and enable the prioritization of 'best buys'. The framework is expanded upon by incorporating concerns for financial protection, and practical feasibility, as well as the political economy challenges of disinvesting in currently funded activities. Five different options for the benefits package, each based on policy discourse in Ghana's health sector, are presented and evaluated. Results: Implementing all interventions for which data was available to 100% of the population in need was estimated to cost GH₵4323 million (US$994 million), while the available NHIS budget was only GH₵970 million (US$223 million). Options for the benefits package that focussed on cost-effectiveness and primary care provision achieved the best health outcomes, while options reflecting the status quo and allowing for co-payments included a higher number of healthcare interventions. Apart from the package option focussing on primary care, all packages were faced with physician shortages. Conclusions: Current funding to the NHIS is insufficient to provide the historical benefits package, which promises to cover over 95% of disease conditions occurring in Ghana, to the total population. Shifting the NHIS focus from intervention coverage to population coverage is likely to lead to better health outcomes. A primary care package may be most feasible in the short-term, though additional physicians should be trained to provide higher-level care that is highly cost-effective, such as emergency neonatal care. [ABSTRACT FROM AUTHOR]