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The Indian economy is categorized into two sectors, namely: organized and unorganized sectors. The unorganized sector consists of a pivotal part of the Indian economy. Ragpickers are that class of employees who can be considered as an organized-unorganized labor class. Ragpicking business entails collecting, sorting, and selling various waste materials, mainly plastics or metals. After doing all this work, they sell recyclable material to the junkyard dealers at very petty prices, making them economically poor. Ragpickers are a major contributor to the Indian economy, as they are involved in recycling. Ragpickers mostly work without being equipped with any protective gear and are exposed to many health hazards while doing their role. They suffer from occupational risks and are often found hospitalized paying their bills from their pockets. There are times when they even do not go to hospitals because of hospital expenses. The paper primarily focuses on analyzing the different health insurance schemes, which are provided as social security by the Maharashtra Government and tries to find out the possible loopholes in health insurance policies because of which the ragpickers are not able to utilize or avail the benefits of the policies for which they are eligible. For developing a better understanding of the subject, the researcher has conducted an empirical survey on the ragpickers of Pune. Based on this, the researcher has recommended some policy changes, which can prove beneficial for the welfare of the Ragpickers.

Cardiac surgery utilization has increased after passage of the Affordable Care Act. This multistate study examined whether changes in access after Medicaid expansion (ME) have led to improved outcomes, overall and particularly among ethnoracial minorities.State Inpatient Databases were used to identify nonelderly adults (ages 18-64 years) who underwent coronary artery bypass grafting, aortic valve replacement, mitral valve replacement, or mitral valve repair in 3 expansion (Kentucky, New Jersey, Maryland) vs 2 nonexpansion states (North Carolina, Florida) from 2012 to 2015. Linear and logistic interrupted time series were used with 2-way interactions and adjusted for patient-level, hospital-level, and county-level factors to compare trends and instantaneous changes at the point of ME implementation (quarter 1 of 2014) for mortality, length of stay, and elective status. Interrupted time series models estimated expansion effect, overall and by race-ethnicity.Analysis included 22 038 cardiac surgery patients from expansion states and 33 190 from nonexpansion states. In expansion states, no significant trend changes were observed for mortality (odds ratio, 1.01; P = .83) or length of stay (β = -0.05, P = .20), or for elective surgery (odds ratio, 1.00; P = .91). There were similar changes seen in nonexpansion states. Among ethnoracial minorities, ME did not impact outcomes or elective status.Despite an increase in cardiac surgery utilization after ME, outcomes remained unchanged in the early period after implementation, overall and among ethnoracial minorities. Future research is needed to confirm long-term trends and examine reasons behind this lack of improved outcomes.

Health insurance enrollment in many Sub-Saharan African countries is low, even with highly subsidized premiums and exemptions for vulnerable populations. One possible explanation is low service quality, which results in a low valuation of health insurance. Using a randomized control trial in 64 primary health care facilities in Ghana, this study assesses the impact of a community engagement intervention designed to improve the quality of healthcare and health insurance services on households living nearby the facilities. Although the intervention improved the medical-technical quality of health services, our results show that households' subjective perceptions of the quality of healthcare and insurance services did not increase. Nevertheless, the likelihood of illness and concomitant healthcare utilization reduced, and especially households who were not insured at baseline were more likely to enroll in health insurance. The results show that solely increasing the technical quality of care is not sufficient to increase households' subjective assessments of healthcare quality. Still, improving technical quality can directly contribute to health outcomes and further increase health insurance coverage, especially among the previously uninsured.

The first states began implementing the Medicaid expansion provisions of the Patient Protection and Affordable Care Act (ACA) in 2014. Studies have yet to address its impact on burn patients.Burn patients in geographic regions that expanded Medicaid coverage were compared to patients in regions that did not expand Medicaid before and after implementation of the ACA using bivariate statistics and a difference-in-differences model. A multivariable logistic regression was used to identify factors associated with having Medicaid insurance. The primary outcome of this study was the rate of Medicaid insurance.Of 25,331 discharges, we found greater increases in Medicaid coverage after the ACA in the Medicaid expander regions (23.4-40.2%) compared to the non-expander regions (18.5-20.1%). The difference-in-differences estimate between the expander and non-expander regions was 0.15 (95% CI: 0.11-0.18, p 0.001). Patients admitted in expander regions were more likely to be insured by Medicaid (OR 1.57 [95%CI 1.21-2.05]), as were patients of Black race (OR 1.25 [95%CI 1.19-1.32), Hispanic ethnicity (OR 1.29 [95%CI 1.14-1.46]), and female sex (OR 1.59 [95%CI 1.11-2.27]). We also found a significant interaction between time period (pre-ACA/post-ACA) and expander region location (OR 2.10 [95%CI 1.67-2.62]).The Medicaid expansion provision of the ACA led to increased Medicaid coverage among burn patients which was significantly higher in areas with widespread implementation of the expansion.

BackgroundAnalyzing real-world data, including health insurance claims, may help provide insights into preventing and treating various diseases. We developed a database covering Shizuoka Prefecture (Shizuoka Kokuho Database [SKDB]) in Japan, which included individual-level linked data on health- and care-insurance claims and health checkup results.MethodsAnonymized claims data on health insurance (National Health Insurance [age

Health technology assessment (HTA) has been growing in use over the past 40 years, especially in its impact on decisions regarding the reimbursement, adoption, and use of new drugs, devices, and procedures. In countries or jurisdictions with "pluralistic" healthcare systems, there are multiple payers or sectors, each of which could potentially benefit from HTA. Nevertheless, a single HTA, conducted centrally, may not meet the needs of these different actors, who may have different budgets, current standards of care, populations to serve, or decision-making processes. This article reports on the research conducted by an ISPOR Health Technology Assessment Council Working Group established to examine the specific challenges of conducting and using HTA in countries with pluralistic healthcare systems. The Group used its own knowledge and expertise, supplemented by a narrative literature review and survey of US payers, to identify existing challenges and any initiatives taken to address them. We recommend that countries with pluralistic healthcare systems establish a national focus for HTA, develop a uniform set of HTA methods guidelines, ensure that HTAs are produced in a timely fashion, facilitate the use of HTA in the local setting, and develop a framework to encourage transparency in HTA. These efforts can be enhanced by the development of good practice guidance from ISPOR or similar groups and increased training to facilitate local use of HTA.

Gender minority (GM) (people whose gender does not align with the sex assigned at birth) people have historically been insured at lower rates than the general population. The purpose of this review is to (1) assess the prevalence of health insurance among GM adults in the United States, (2) examine prevalence by gender, and (3) examine trends in prevalence before and after implementation of the Affordable Care Act.Published articles from PubMed, EMBASE, and Web of Science databases before April 26th, 2019, were included. This review is registered on PROSPERO (CRD42019133627). Analysis was guided by a random-effects model to obtain a meta-prevalence estimate for all GM people and stratified by gender subgroup. Heterogeneity was assessed using aOf 55 included articles, a random pooled estimate showed that 75% GM people were insured (95% confidence interval [CI]: 0.71-0.79;The pooled prevalence of health insurance among GM people found in this review is considerably lower than the general population. Standardized collection of gender across research and health care will improve identification of vulnerable individuals who experience this barrier to preventative and acute care services.

Nina Grotenhuis,1 Miranda C Schreuder,1 Tine WL van den Bos,2 Henk van der Worp,1 Marco H Blanker1 1Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 2Foundation Bekkenbodem4All, Tiel, the NetherlandsCorrespondence: Miranda C Schreuder, Department of General Practice and Elderly Care medicine, University Medical Center Groningen, University of Groningen, FA21, PO Box 196, Groningen, 9700AD, the Netherlands, Tel +31 625647144, Email m.c.schreuder@umcg.nlPurpose: We aimed to examine how supply source affects satisfaction with continence products and care among individuals with urinary incontinence (UI). Supply source was compared among pharmacies, national suppliers, and shops. The secondary aim was to compare participant characteristics between the three groups.Patients and Methods: A survey questionnaire was distributed via social media between April and June 2020. This included the international consultation on incontinence questionnaire (ICIQ) UI short form (ICIQ-UI-SF), the ICIQ-PadPROM, and the ICIQ-LUTSqol, together with questions about respondent characteristics and satisfaction with continence products.Results: Of the 1045 respondents, 706 fully completed and 339 partially completed the survey. Among these, 322 (45.6%), 199 (28.1%), and 185 (26.2%) made purchases from shops, national suppliers, and pharmacies, respectively. The mean ICIQ-UI-SF sum scores were comparable for the pharmacy (13.3 ± 3.7) and national supplier (13.8 ± 3.5) groups, but were significantly lower for the shop group (12.0 ± 3.3). Mean sum scores for satisfaction with continence products and satisfaction with continence care were also significantly lower in the shop group (7.9 ± 2.6 and 6.4 ± 2.7, respectively) compared with the pharmacy (9.1 ± 2.7 and 7.9 ± 2.6, respectively) and national supplier (9.3 ± 2.6 and 8.1 ± 3.0, respectively) groups. There were no statistically significant differences in the ICIQ-PadPROM and ICIQ-LUTSqol scores. Respondents’ characteristics were similar, apart from the significantly lower number of males in the shop group.Conclusion: Satisfaction with continence products and continence care is lower for people with UI who purchase materials from a shop than from a pharmacy or national supplier.Keywords: incontinence care, health insurance, incontinence pads, urinary loss

Purpose: The purpose of this research study is to investigate the relationship between technology adoption and workforce productivity within the manufacturing industry. The study aims to identify the role of Intermediaries in assisting choice of channel. Theoretical Framework: The study adopts a qualitative strategy and utilizes content analysis to analyze a significant amount of secondary data from theoretical and empirical reviews. Additionally, interviews with members of the relevant community were conducted to gather specific data for an unstructured questionnaire. Exploratory factor analysis and confirmatory factor analysis were performed to validate the proposed theoretical framework. Design/Methodology/Approach: Data was collected from 384 software employees in Hyderabad, selected due to their likelihood of using both digital and traditional channels for purchasing insurance. The study employed a Likert scale questionnaire to measure respondents' perceptions of various factors influencing channel selection. SPSS 26 and AMOS were used for data analysis, including exploratory factor analysis and confirmatory factor analysis. Findings: The exploratory factor analysis revealed a six-factor channel selection model that explained 77.443% of the variance. All factors demonstrated high reliability (Cronbach's α > 0.883), and the final model consisted of 39 items. The confirmatory factor analysis confirmed the suitability of the model, as all fit indices met the criteria for absolute and incremental fitness. Research, Practical & Social Implications: The study provides insights into the factors influencing channel selection in the context of health insurance purchases. It highlights the importance of intermediaries in the decision-making process and their role in moderating the relationship between various factors and channel selection. These findings have practical implications for insurance providers and intermediaries in developing effective marketing strategies and improving customer experience. Socially, the study contributes to a better understanding of the dynamics between digital and traditional channels in the insurance industry. Originality/Value: This study contributes to the existing literature by examining the moderation effect of intermediaries on the relationship between factors influencing channel selection in the context of health insurance. The research extends the theoretical understanding of channel selection and provides empirical evidence in a specific geographical setting. The findings have practical implications for insurers, intermediaries, and policymakers, enhancing the value of this research in the insurance industry.

U ovom radu posebna pozornost se posvećuje razvoju pojma osiguranja i njegovu utjecaju na društvo općenito od daleke povijesti do novijeg doba. Objasnit će se posebno utjecaj na generaciju Z i zastupljenost osiguranja u današnjem društvu. Osiguranje na radu kao jedno od najvažnijih je ujedno i sinonim za sam pojam osiguranja, pored ostalih ni malo manje važnih vrsta osiguranja. Razvojem i ostalih vrsta uvelike se povećala kvaliteta života i zadovoljstvo društva. Spriječili su se neki negativni utjecaji i smanjile stope kriminala i prevara. Poseban naglasak će biti kako društvo doživljava osiguranje. Zbog određenih skandala u prošlosti, slika osiguranja se na neki način podijelila, te danas imamo sukobljena shvaćanja osiguranja. Također, jedan od naglasaka će biti usporedba osiguranja u Republici Hrvatskoj, EU općenito s osiguranjem u Sjedinjenim Američkim Državama. Govorit će se isto tako o izrazito bitnom pojmu za ekonomski svijet, kako je to osiguranje pospješilo ekonomski razvoj u Europskoj Uniji. In this worksheet special attention would be about insurance development and its impact on society through history until today. The main focus will be about generation Z and insurance presence in todays society. Workers compensation as one of the most important types of insurance and also synonym for insurance world will be explained next to other types, but not less important ones. Development of the whole insurance market led us to better life quality as also society living pleasure. Negative influences have been stopped as criminal ratio also. Due to several scandals in the past, insurance picture was little bit ruined and splitted so today we have confronted thoughts of insurance. Also, one of the focuses would be comparassion between Croatian, EU and USA insurance market. Word is gonna be also about economic world and how did it changed due to insurance development.

Background Workplace absenteeism increases significantly during influenza epidemics. Sick leave records may facilitate more timely detection of influenza outbreaks, as trends in increased sick leave may precede alerts issued by sentinel surveillance systems by days or weeks. Sick leave data have not been comprehensively evaluated in comparison to traditional surveillance methods. The aim of this paper is to study the performance and the feasibility of using a detection system based on sick leave data to detect influenza outbreaks. Methods Sick leave records were extracted from private French health insurance data, covering on average 209,932 companies per year across a wide range of sizes and sectors. We used linear regression to estimate the weekly number of new sick leave spells between 2016 and 2017 in 12 French regions, adjusting for trend, seasonality and worker leaves on historical data from 2010 to 2015. Outbreaks were detected using a 95%-prediction interval. This method was compared to results from the French Sentinelles network, a gold-standard primary care surveillance system currently in place. Results Using sick leave data, we detected 92% of reported influenza outbreaks between 2016 and 2017, on average 5.88 weeks prior to outbreak peaks. Compared to the existing Sentinelles model, our method had high sensitivity (89%) and positive predictive value (86%), and detected outbreaks on average 2.5 weeks earlier. Conclusion Sick leave surveillance could be a sensitive, specific and timely tool for detection of influenza outbreaks.

Research Summary We provide a theory of when relatedness will encourage both diversifying entry and post-entry exit. Our formal model reveals two channels through which resource sharing in combination with firm capabilities affects diversifying entry and post-entry exit. Facing business opportunities in a new segment, low capability firms from a more related segment expect to benefit from more synergies and are therefore more likely to enter than firms with similar capability but from less related segments. Post entry, unfavorable shocks in the new segment tighten the survival criteria and drive some more related but low capability firms out. These predictions are supported using data on U.S. health insurance firms' entry into and exit from the Affordable Care Act market from 2013 to 2017. Managerial Summary When would factors that favor related diversifiers' entry into a new business segment also encourage their exit post-entry? Using data on U.S. health insurance firms' entry into and exit from the Affordable Care Act (ACA) market from 2013 to 2017, we find that more related diversifiers (i.e., insurers offering Medicaid), especially the low capability ones, are more likely to enter ACA. However, facing cost shocks in the new segment, more related diversifiers, especially the low capability ones, are more likely to exit than less related diversifiers (i.e., insurers offering no Medicaid). This is consistent with our formal model that predicts a selection at entry that favors related diversifiers due to expected synergies and an adverse selection post-entry against low capability related diversifiers.

Exploiting the 2001 universal health insurance reform in Thailand as a source of identification, we estimate the effects of health insurance coverage on agricultural production decisions and welfare. Our estimates suggest that the reform led to long-run increases in total cultivation investments and output, and that households shifted their cultivation portfolio towards riskier crops. We explain these findings using a model of agricultural investment, highlighting the important roles of health insurance in terms of mitigating background medical expenditure risk and improving health. We also find that the reform improved households’ welfare by reducing debts and defaults on loans.

Država ima pomembno vlogo pri organiziranosti zdravstva, saj odloča o vzpostavitvi zdravstvenega sistema. Zdravstveni sistem je učinkovit takrat, ko temelji na zanesljivem sistemu financiranja zdravstvenega varstva. Ker Slovenija v primerjavi z drugimi državami EU financiranju zdravstva namenja večji delež zasebnih in manjši delež javnih virov, je v diplomskem delu narejena primerjava ureditve zdravstva z izbranima državama EU, Avstrijo in Hrvaško. Namen diplomskega dela je predstaviti zdravstvo v izbranih državah z vidika ureditve zdravstvenih sistemov, sistemov zdravstvenega zavarovanja in izdatkov za zdravstveno varstvo ter slovensko zdravstvo primerjati z zdravstvom v Avstriji in na Hrvaškem. V diplomskem delu sta uporabljeni metoda deskripcije in komparativna metoda. Na podlagi slednje je ugotovljeno, da ima Hrvaška izmed izbranih držav največji delež javnih virov financiranja zdravstvenega varstva, Slovenija pa najmanjšega. Avstrija ima največje izdatke za zdravstvo v BDP, Hrvaška pa najmanjše. To prav tako velja za javno in zasebno porabo ter zasebne izdatke iz žepa za zdravstvo. Medtem ko je vključenost prebivalstva v obvezno zdravstveno zavarovanje v vseh izbranih državah skoraj celovita, se vključenost v prostovoljno zdravstveno zavarovanje med državami razlikuje. V Sloveniji je prostovoljno zdravstveno zavarovano skoraj vso prebivalstvo, na Hrvaškem nekoliko manj, v Avstriji pa več kot polovico manj kot v Sloveniji. Primerjava zdravstva v Sloveniji z zdravstvom v Avstriji in na Hrvaškem omogoča boljši vpogled v to, kako se ureditev zdravstva med državami razlikuje. Ob tem so prepoznane dobre in slabe prakse ureditve izbranih zdravstvenih sistemov in podani morebitni predlogi za izboljšave zdravstva v Sloveniji. The state plays an important role in the organization of healthcare, as it decides on the establishment of the healthcare system. A health system is effective when it is based on a reliable system of financing healthcare. As Slovenia, compared to other EU countries, allocates a larger share of private and a smaller share of public sources to health financing, the thesis compares the regulation of healthcare with the selected EU countries, Austria and Croatia. The aim of the thesis is to present healthcare in selected countries from the point of view of general regulation of the health systems, the health insurance systems and healthcare expenditure, and to compare Slovenian healthcare with healthcare in Austria and Croatia. In the thesis are used the descriptive method and the comparative method. On the basis of the latter, it is established that Croatia has the largest share of public sources of health care financing among the selected countries, while Slovenia has the smallest. Austria has the largest healthcare expenditure in GDP, while Croatia has the smallest. The same applies to public and private spending and private out-ofpocket expenses on health care. While the participation of the population in compulsory health insurance is almost complete in all selected countries, participation in voluntary health insurance varies between countries. In Slovenia, almost the entire population has voluntary health insurance, in Croatia slightly less, and in Austria more than half as much as in Slovenia. Comparing healthcare in Slovenia with healthcare in Austria and Croatia gives a better insight into how healthcare regulation differs between countries. At the same time, good and bad practices in the regulation of selected health systems are recognized and possible suggestions for improvements in the field of health care in Slovenia are given.

Health insurance is a form of coverage that provides financial protection against the cost of medical expenses and healthcare services. It is typically offered by private insurance companies and can also be provided by government programs in some countries. The abstract of health insurance can be summarized as follows: Health insurance aims to help individuals and families manage the expenses related to medical care and healthcare services. It operates on the principle of risk pooling, where many individuals pay premiums into a collective fund that is then used to cover the healthcare costs of those who require medical treatment. Health insurance plans vary in terms of coverage, cost, and benefits. They typically include provisions for hospitalization, doctor visits, prescription medications, preventive care, and other healthcare services. Some plans may also offer additional benefits such as dental and vision coverage. To access healthcare services covered by health insurance, individuals usually pay a monthly or annual premium. In addition, they may be responsible for deductibles, co-payments, and co-insurance, which are the portion of the medical expenses they must pay out of pocket. Health insurance provides individuals with financial security by reducing the burden of medical costs. It can help protect against high medical bills resulting from unexpected illnesses, accidents, or chronic conditions. Additionally, having health insurance often allows individuals to access a broader range of healthcare providers and facilities. It is important to note that health insurance policies often have limitations, exclusions, and pre-existing condition clauses. These factors can impact coverage and may require individuals to meet certain criteria or wait for a specified period before receiving full benefits.

Theoretical literature predicts that asymmetric information in insurance markets generate inefficient outcomes and literature have mostly focus on adverse selection and moral hazard caused by information advantage in insurance market. Adverse selection is the likelihood of those who anticipate more need of health care due to enhanced health risk to purchase health insurance. Therefore, this study investigates adverse selection in health insurance in Nigeria. Contract theory provided the framework for the study. The insurance-demand equation was derived from the solution to the optimality condition of insurance decision equation which gives the Marshallian insurance-demand equation. The model to measure the determinants of the demand for health insurance was a linear probability demand model. Health insurance model captured adverse selection and was estimated with probit and instrumental variable probit regressions. A positive coefficient for health status and health insurance status indicate the presence of adverse selection. Adverse selection was evident in health insurance, social and private health insurance with coefficients of 0.44, 0.25 and 0.24 respectively. Insurance income elasticity was also positive in health insurance, social health insurance and private health insurance with coefficients of 0.15, 0.23 and 0.05. There is a need for mechanisms of optimal mix of people with poor and good health status that may require working out different premium for different set of people based on the type and nature of their work and regulating the behaviour of the insured, HMO’s and health provider as health insurance market grows in Nigeria.

Nepal’s Primary Health Care (PHC) is aligned vertically with disease control programs at the core and a vast network of community health workers at the periphery. Aligning with the globalization of health and the factors affecting global burden of diseases, Nepal echoes the progressive increase in life expectancy, changes in diseases patterns, including the current impact of COVID-19. Nepal’s health system is also accommodating recent federalization, and thus it is critical to explore how the primary health care system is grappling the challenges amidst these changes. In this review, we conducted a narrative synthesis of literature to explore the challenges related to transformation of Nepal’s primary health care delivery system to meet the demands incurred by impact of globalization and recent federalization, covering following database: PubMED, Embase and Google Scholar. Of the 49 articles abstracted for full text review, 37 were included in the analyses. Existing theories were used for constructing the conceptual framework to explain the study findings. The results are divided into four themes. Additional searches were conducted to further support the narrative synthesis: a total of 46 articles were further included in the articulation of main findings. Transforming Nepal’s primary health care system requires a clear focus on following priority areas that include i) Revised efforts towards strengthening of community based primary health care units; ii) Adapting vertical programs to federal governance; iii) Reinforcing the health insurance scheme; and iv) Strengthening an existing network of community health workers and health human resources. This review discusses how these broad goals bear challenges and opportunities. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-022-00798-5.

The present study explores district-level data associated with health insurance coverage (%) and the prevalence of hypertension (mildly, moderately, and severely elevated) observed across men and women as per NFHS 5. Coastal districts in the peninsular region of India and districts in parts of northeastern India have the highest prevalence of elevated blood pressure. Jammu and Kashmir, parts of Gujarat and parts of Rajasthan have a lower prevalence of elevated blood pressure. Intrastate heterogeneity in spatial patterns of elevated blood pressure is mainly seen in central India. The highest burden of elevated blood pressure is in the state of Kerala. Rajasthan is among the states with higher health insurance coverage and a lower prevalence of elevated blood pressure. There is a relatively low positive relationship between health insurance coverage and the prevalence of elevated blood pressure. Health insurance in India generally covers the cost of inpatient care to the exclusion of outpatient care. This might mean that health insurance has limited impact in improving the diagnosis of hypertension. Access to public health centers raises the probability of adults with hypertension receiving treatment with antihypertensives. Access to public health centers has been seen to be especially significant at the poorer end of the economic spectrum. The health and wellness center initiative under Ayushman Bharat will play a crucial role in hypertension control in India.

The present study explores district-level data associated with health insurance coverage (%) and the prevalence of hypertension (mildly, moderately, and severely elevated) observed across men and women as per NFHS 5. Coastal districts in the peninsular region of India and districts in parts of northeastern India have the highest prevalence of elevated blood pressure. Jammu and Kashmir, parts of Gujarat and parts of Rajasthan have a lower prevalence of elevated blood pressure. Intrastate heterogeneity in spatial patterns of elevated blood pressure is mainly seen in central India. The highest burden of elevated blood pressure is in the state of Kerala. Rajasthan is among the states with higher health insurance coverage and a lower prevalence of elevated blood pressure. There is a relatively low positive relationship between health insurance coverage and the prevalence of elevated blood pressure. Health insurance in India generally covers the cost of inpatient care to the exclusion of outpatient care. This might mean that health insurance has limited impact in improving the diagnosis of hypertension. Access to public health centers raises the probability of adults with hypertension receiving treatment with antihypertensives. Access to public health centers has been seen to be especially significant at the poorer end of the economic spectrum. The health and wellness center initiative under Ayushman Bharat will play a crucial role in hypertension control in India.

How are improvements in healthcare being pursued? How can a textile-based soft exoskeleton be used to maintain the activities of daily living (ADL) of patients with amyotrophic lateral sclerosis (ALS)? The creation of fully soft, upper-limb exoskeletons for rehabilitation of patients with neuromuscular disorders, such as ALS, is an emerging field of study and industry. Of the millions debilitated by these diseases, few can use such robots due to insufficient research. The research team designed a fully soft wearable robotic device that will be able to assist patients with ALS. With IMU and EMG sensors, a cable actuator, and computer programming, the team developed such a device. How do interest groups, advocacies, and others strive to lessen the racial disparities in healthcare in the United States? Public health agencies report health data and fund health services. To fight for health equity, advocacies in health, civil rights and racial justice have established community health centers, free clinics, and demonstration projects. Insurance companies, hospitals and professional associations have influenced such efforts, in part to protect their own interests. In the US, racial disparities in healthcare reflect systemic inequalities that contribute to comparable disparities in education, housing, and criminal justice. Despite improvements in some communities within the US there are still millions without the necessary healthcare they need.

We examine the impact of life and health insurance spending on subjective well-being. Taking advantage of insurance spending and subjective well-being data on more than 700,000 individuals in Japan, we examine whether insurance spending can buffer declines in subjective well-being due to exposure to mass disaster. We find that insurance spending can buffer drops in subjective well-being by approximately 3–6% among those who experienced the mass disaster of the great East Japan earthquake. Subjective health increases the most, followed by life satisfaction and happiness. On the other hand, insurance spending decreases the subjective well-being of those who did not experience the earthquake by approximately 3–7%. We conclude by monetizing the subjective well-being loss and calculating the extent to which insurance spending can compensate for it. The monetary value of subjective well-being buffered through insurance spending is approximately 33,128 USD for happiness, 33,287 USD for life satisfaction, and 19,597 USD for subjective health for a person in one year. Therefore, we confirm that life/health insurance serves as an ideal option for disaster adaptation. Our findings indicate the importance of considering subjective well-being, which is often neglected when assessing disaster losses.

In cross-sectional data, gaps in health insurance coverage are associated with worse health and lower utilization of preventive services. The authors investigated if these associations persisted 2-6 years after disruption of insurance coverage in a cohort of young adults. Data from the National Longitudinal Survey of Youth 1997, a longitudinal cohort study of participants who were ages 13-17 years in 1997, were analyzed. Annual interview data from 2007 through 2017 were included and analyzed in 2021. Health outcomes (general self-rated health, annual preventive care use, and work-related health limitations) in each year were regressed on insurance coverage status, classified as: continuous private coverage, continuous public coverage, gap in coverage, or year-round lack of coverage. In a series of models, insurance coverage status was lagged by 2, 4, or 6 years to capture long-term associations with health outcomes. The analytic sample included 8197 young adults contributing 49,580 observations. Contemporaneous gaps in coverage were associated with 17% lower odds of reporting better self-rated health (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.78, 0.88

Background The Affordable Care Act of 2010 extended health insurance through expansion of Medicaid and subsidies for commercial insurance. Prior work has produced differing results in associating expanded insurance with improvements in health care processes and outcomes. Evaluating specific mechanisms of care processes and their association with insurance expansion may help reconcile those results. Methods and results We used inpatient hospitalization data in the Nationwide Inpatient Sample (NIS) Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality from 1/1/2008 to 9/30/2015. We included all hospitalizations for acute myocardial infarction (AMI). As a primary outcome, we defined percent rate of AMI hospitalizations receiving percutaneous coronary intervention (PCI) per month. In the non-Medicare (intervention) group, there was a relative decrease of 0.2% of the monthly trend before and after expansion (95% CI [-0.3%, -0.1%]). In the Medicare group, there was a relative decrease of 0.1% of the monthly trend before and after expansion (95% CI [-0.2%, 0%]). Conclusions We did not detect a relative difference in PCI for AMI associated with insurance expansion under health reform.

The aim of this study is to determine the problems faced by individuals living with cancer (ILCs) in accessing health services during the COVID-19 pandemic in Turkey. This qualitative study’s sample consisted of 18 volunteer interviewees from 10 cancer-related patient associations in Turkey. Research data were collected by semi-structured interview method. Data collection and analysis were carried out simultaneously. In the sessions where all researchers participated together, the data were coded with a common view, and main and sub-themes were determined. In the analysis of the data the inductive thematic analysis method was applied. Information was gathered under two main themes: compliance with the measures taken and access to health services. Lack of information about nutrition, physical activity, psychological problems, caused by the lockdown and social distance measures taken within the scope of the pandemic should be accepted as problems within the scope of the right of individuals to access health, and additional programs should be prepared to minimize these. Cancer types should be considered in delaying diagnosis, treatment, and controls related to cancer, so that patients are not harmed at least or at all. It is important to ensure that patients do not hesitate to attend diagnosis, treatment, and controls with the anxiety of being infected with COVID-19, both in transportation to health facilities and in terms of preventing transmission in health facilities. © 2022, Universidad de Chile - Centro Interdisciplinario de Estudios en Bioetica. All rights reserved.

High-deductible health plans (HDHPs) are increasingly common in the U.S. health insurance market and are intended to reduce the use of low-value services, but evidence suggests that HDHP enrollees also reduce the use of high-value services. This study examined the effects of HDHPs on enrollees with mental health conditions, a population with high levels of unmet treatment need, often because of financial barriers. Enrollees with a co-occurring substance use disorder have greater treatment needs and unique barriers to care, perhaps changing their response to an HDHP.Commercial health insurance claims data in a difference-in-differences design was used to evaluate the effect of an employer's offer of an HDHP on 6,627,128 enrollee-years among enrollees with mental health conditions, stratified by having a co-occurring substance use disorder or not.Among enrollees without a co-occurring substance use disorder, an HDHP offer was associated with a 4.8% (95% confidence interval [CI]=2.4%-7.2%) reduction in overall spending on mental health care, despite an 11.3% (95% CI=1.0%-21.6%) increase in spending on mental health-related emergency department visits. Among enrollees with a co-occurring substance use disorder, no significant changes attributable to an HDHP offer were found in most categories of spending on combined mental health and substance use disorder care, apart from a 4.5% (95% CI=1.9%-7.2%) reduction in spending on psychotropic medications.HDHPs may reduce use of necessary care among enrollees with mental health conditions, which could exacerbate undertreatment in this population and result in adverse health outcomes.

"Network adequacy regulations" expand patients' access to hospitals by mandating a lower bound on the number of hospitals that health insurers must include in their networks. Such regulations, however, compromise insurers' bargaining position with hospitals, which may increase hospital reimbursement rates, and may consequently be passed through to consumers in the form of higher premiums. In this paper, I quantify this effect by developing a model that endogenously captures: (i) how insurers form hospital-networks, (ii) how they bargain with hospitals over rates by threatening to drop them out of network or to replace them with an out of network hospital, and (iii) how they set premiums in an imperfectly competitive market. I estimate this model using detailed data from a Massachusetts health insurance market, and I simulate the effects of a range of regulations. I find that "tighter" regulations, which force insurers to include more than 85% of the hospital-systems in the market, raise the average reimbursement rates paid by some insurers by at least 28%. More moderate regulations, however, can expand the hospital networks without leading to large hikes in reimbursement-rates.

Project Work presented as the partial requirement for obtaining a Master's degree in Statistics and Information Management, specialization in Risk Analysis and Management Loss reserves are typically one of the largest liabilities on an insurer’s balance sheet since they can have a significant impact on profits as well as the insurer’s solvency. The Chain Ladder model is an outstanding actuarial reserving technique that has been applied over the years to estimate Incurred But Not Reported claims. This project aims to provide the most accurate estimates possible for the calculation and prediction of reserve claim amounts in the context of corporate health insurance. For this, the Chain Ladder approach is compared with machine learning algorithms such as the Support Vector Machine (SVM), the Random Forest (RF), the Extreme Gradient Boosting (XGBoost) and Neural Networks (NN).

Indonesia has implemented the National Health Insurance (Jaminan Kesehatan Nasional/JKN) program administered by the BPJS Kesehatan (Health Care and Social Security Agency) to improve the quality of community health and well-being. In eight years, JKN implementation has had many challenges; complicated registration, premium, unsatisfactory service, and the lack of community participation. Policies regarding JKN should be known and understood. This study aimed to know the knowledge, attitudes, and behaviour towards health insurance that will be useful for stakeholders to develop public policies. This study was conducted in Umbulsari B sub-village in Sumberharjo, Prambanan, Yogyakarta, the lowest area of JKN participation based on Sleman HDSS data. We used a cross-sectional design study among 91 respondents who filled out a paper sheet questionnaire that consisted of five sections; demographic characteristics and insurance participation, knowledge, attitudes, actions, and satisfaction with the JKN program. Then, the community service activities; coordination with local stakeholders; JKN participation identification using CHIKA; educational media production and publication. Local stakeholders said that awareness about JKN is low. CHIKA data identification from 529 ID shows that 78.1% had become JKN participants, and 73.3% were "active". The respondents answered most of each knowledge point correctly (score >90%). But there are several things that respondents disagree with: "every participant will get the same health services (19.78%) in attitude point, and health workers in health facilities do not discriminate (21.21%) in satisfaction point. Then 21.21% of respondents rarely use health services routinely for medical check-ups. We developed educational media about the importance of JKN, as well as using CHIKA and Pandawa tutorials. Education about health insurance needs to be carried out continuously according to the local cultural context and innovations so that the community remains protected from the financial burden of accessing health services.

In many countries, governments use payment systems to compensate health insurers more for enrollees with higher expected costs. However, little empirical research has examined whether these payment systems should also include health insurers' administrative costs. We provide two sources of evidence that health insurers with a more morbid population have higher administrative costs. First, we show at the customer level a causal relationship between individual morbidity and individual administrative contacts with the insurer, using the weekly evolution of the number of individual customer contacts (calls, emails, in-person visits etc.) of a large Swiss health insurer. Using a difference-in differences design, we find that the onset of a chronic illness causes on average a persistent increase of about 40% in individuals' contacts with the health insurer. Second, we provide evidence that this relationship also holds for total administrative costs at the insurer level. We study twenty years of Swiss health insurance market data and find a positive elasticity of around 1, indicating that, all else equal, an insurer with a more morbid population, equal to 1% more health care spending, faces about 1% higher administrative costs., + ID der Publikation: unilu_68256 + Sprache: Englisch + Letzte Aktualisierung: 2023-06-09 15:28:56

Background Healthcare workers play an important part in the delivery of health insurance benefits, and their role in ensuring service quality and availability, access, and good management practice for insured clients is crucial. Tanzania started a government-based health insurance scheme in the 1990s. However, no studies have specifically looked at the experience of healthcare professionals in the delivery of health insurance services in the country. This study aimed to explore healthcare workers’ experiences and perceptions of the provision of health insurance benefits for the elderly in rural Tanzania. Methods An exploratory qualitative study was conducted in the rural districts of Igunga and Nzega, western-central Tanzania. Eight interviews were carried out with healthcare workers who had at least three years of working experience and were involved in the provision of healthcare services to the elderly or had a certain responsibility with the administration of health insurance. The interviews were guided by a set of questions related to their experiences and perceptions of health insurance and its usefulness, benefit packages, payment mechanisms, utilisation, and availability of services. Qualitative content analysis was used to analyse the data. Results Three categories were developed that describe healthcare workers´ experiences and perceptions of delivering the benefits of health insurance for the elderly living in rural Tanzania. Healthcare workers perceived health insurance as an important mechanism to increase healthcare access for elderly people. However, alongside the provision of insurance benefits, several challenges coexisted, such as a shortage of human resources and medical supplies as well as operational issues related to delays in funding reimbursement. Conclusion While health insurance was considered an important mechanism to facilitate access to care among rural elderly, several challenges that impede its purpose were mentioned by the participants. Based on these, an increase in the healthcare workforce and availability of medical supplies at the health-centre level together with expansion of services coverage of the Community Health Fund and improvement of reimbursement procedures are recommended to achieve a well-functioning health insurance scheme.

Objective: The objective of this study was to evaluate England's Best Practice Tariff (BPT) and consider potential implications for Medicare patients should the US adopt a similar plan.Summary Background Data: Since the beginning of the Affordable Care Act, Medicare has renewed efforts to improve the outcomes of older adults through introduction of an expanding set of alternative-payment models. Among trauma patients, recommended arrangements met with mixed success given concerns about the heterogeneous nature of trauma patients and resulting outcome variation. A novel approach taken for hip fractures in England could offer a viable alternative.Methods: Linear regression, interrupted time-series, difference-in-difference, and counterfactual models of 2000–2016 Medicare (US), HES-APC (England) death certificate-linked claims (≥65y) were used to: track US hip fracture trends, look at changes in English hip fracture trends before-and-after BPT implementation, compare changes in US-versus-English mortality, and estimate total/theoretical lives saved.Results: 806,036 English and 3,221,109 US hospitalizations were included. Following BPT implementation, England's 30-day mortality decreased by 2.6 percentage-points (95%CI: 1.7–3.5) from a baseline of 9.9% (relative reduction 26.3%). 90- and 365-day mortality decreased by 5.6 and 5.4 percentage-points. 30/90/365-day readmissions also declined with a concurrent shortening of hospital length-of-stay. From 2000–2016, US outcomes were stagnant (p > 0.05), resulting in an inversion of the countries’ mortality and > 38,000 potential annual US lives saved.Conclusions: Process measure pay-for-performance led to significant improvements in English hip fracture outcomes. As efforts to improve US older adult health continue to increase, there are important lessons to be learned from a successful initiative like the BPT.

This study investigated the association between interest in Pre-exposure Prophylaxis (PrEP) in the US using Google Health Trends as a source of big data and state policy variables of Medicaid expansions under the Affordable Care Act (ACA) and initiation of PrEP Assistance Programs (PrEP-AP). As of December 2019, thirty-three states and the District of Columbia have accepted federal Medicaid funding provided through the ACA to expand eligibility to low-income adults. Among these expansion states, eight states also implemented PrEP-AP, a program that finances PrEP. A difference-in-differences approach estimated how changes in Google search for PrEP before and after the expansion differed across expansion and non-expansion states. Analyses also gauged whether the magnitude of the correlation between Medicaid expansions and Google searches was higher in states that also initiated PrEP-AP. Findings indicated that the Medicaid expansions were associated with a higher share of Google searches for PrEP keywords ( β = 1.536 , S.E. =.36, p .001 ). Moreover, the magnitude of correlation for some keywords was higher in states that also implemented PrEP-APs.

The onset of COVID-19 across the world has elevated interest in geographic information systems (GIS) for pandemic management. In Germany, however, most spatial analyses remain at the relatively coarse level of counties. In this study, we explored the spatial distribution of COVID-19 hospitalizations in health insurance data of the AOK Nordost health insurance. Additionally, we explored sociodemographic and pre-existing medical conditions associated with hospitalizations for COVID-19. Our results clearly show strong spatial dynamics of COVID-19 hospitalizations. The main risk factors for hospitalization were male sex, being unemployed, foreign citizenship, and living in a nursing home. The main pre-existing diseases associated with hospitalization were certain infectious and parasitic diseases, diseases of the blood and blood-forming organs, endocrine, nutritional and metabolic diseases, diseases of the nervous system, diseases of the circulatory system, diseases of the respiratory system, diseases of the genitourinary and symptoms, and signs and findings not classified elsewhere.

Objective: The study aimed to assess the determinants of enrolment in health insurance schemes among people living with HIV.Design: The study was a cross-sectional study. A pre-tested interviewer-administered questionnaire was used to collect information from 371 HIV clients attending the clinic. Chi-square statistic was used for bi-variate analysis, and analytical decisions were considered significant at a p-value less than 0.05. Logistic regression was done to determine predictors of enrolment in health insurance.Setting: The study was carried out in the HIV clinic of Alex Ekwueme Federal University Teaching Hospital Abakaliki, NigeriaParticipants: HIV clients attending a clinicResult: Mean age of respondents was 45.4±10.3, and 51.8% were males. Almost all the respondents were Christians. Only 47.7% were married, and most lived in the urban area. Over 70% had at least secondary education, and only 34.5% were civil servants. About 60% of the respondents were enrolled in a health insurance scheme. Being single (AOR: 0.374, CI:0.204-0.688), being self-employed (AOR: 4.088, CI: 2.315-7.217), having a smaller family size (AOR: 0.124, CI: 0.067-0.228), and having the higher income (AOR: 4.142, CI: 2.07-8.286) were predictors of enrolment in a health insurance scheme.Conclusion: The study has shown that enrolment in a health insurance scheme is high among PLHIV, and being single, self-employed, having a smaller family size, and having a higher monthly income are predictors of enrolment in the health insurance scheme. Increasing the number of dependants that can be enrolled so that larger families can be motivated to enrol in health insurance is recommended.

This paper investigates how the design of health insurance plans influences individuals' treatment decisions. We derive several hypotheses how the framing of incentives in a plan affects behavior and test these hypotheses in a laboratory experiment. Our results show that rebates are more effective in containing costs, as individuals request significantly less inefficient low-value care under rebates than under cost-sharing. We elicit individuals' degree of loss aversion but find no evidence that loss aversion influences utilization rates. Instead, our results suggest that relative thinking and the difficulty of understanding the dynamic incentive structure drive the design effect.JELI13, I18, D02, D91

Background The influence of healthcare system factors on treatment pathways for breast cancer has been studied extensively in lower-middle-income countries (LMICs), but in upper-middle-income countries (UMICs), this area is understudied. This article focuses on the experiences of breast cancer patients in Türkiye, a UMIC with a universal healthcare system. It explores variations in treatment pathways based on the type of health insurance provider (private or state). Methods The study uses an exploratory qualitative method based on in-depth interviews with 12 breast cancer patients. The inclusion criteria were Turkish nationality, female gender, and having received treatment from a private hospital within one year of the interview. A purposeful sampling strategy was employed to recruit patients who had either social health insurance only or who had private health insurance in addition to their social health insurance. A two-stage thematic analysis of the interview data was conducted. First, we examined whether the type of insurance provider makes a difference in treatment pathways; we then identified healthcare system factors that explain these differences. Results The study revealed two distinct pathways to treatment. These differ in terms of financial protection, service coverage, and patients’ sense of equity. Patients with private insurance reported easy access to timely and comprehensive treatment. Those without, however, had to navigate complicated routes to treatment; they generally had to resort to seeking treatment from more than one hospital. We found two healthcare system factors that explained the differences: a failure to fully enforce the mandates of the state’s social health insurance in the private hospital sector and growing reliance on private insurance to gain access to essential services. Conclusions Based on data from the Turkish case, we conclude that healthcare system factors are indeed influential in shaping treatment pathways for breast cancer in UMICs with universal healthcare. These factors include a failure to fully enforce the mandates of the state’s social health insurance programme in the private hospital sector and a growing reliance on private insurance to gain access to essential services. We note that this contrasts dramatically with the situation in LMICs, where the main factors are low-quality care and shortages of medical staff, medicines, and technologies.

Governments in many low- and middle-income countries are developing health insurance products as a complement to tax-funded, subsidized provision of health care through publicly operated facilities. This paper discusses two rationales for this transition. First, health insurance would boost fiscal revenues for health care, as post-treatment out-of-pocket payments to providers would be replaced by pre-treatment insurance premia to health ministries. Second, increased patient choice and carefully designed physician reimbursements would increase quality in the health care sector. This essay shows that, at best, these objectives have only been partially met. Despite evidence that health insurance has provided financial protection, consumers are not willing to pay for unsubsidized premia. Health outcomes have not improved despite an increase in utilization. The authors argue that this is not because there was no room to improve the quality of care but because behavioral responses among health care providers have systematically undermined the objectives of these insurance schemes.

Purpose: Adolescents and young adults (AYAs) have experienced inferior improvements in cancer survival outcomes. One potential explanation is the low rate of enrollment in cancer clinical trials. While the reasons behind this are multifactual, sociodemographic factors are probably contributory. We examined the impact of factors such as insurance type and race/ethnicity on clinical trial enrollment among AYAs treated for cancer at an academic medical center. Methods: We identified AYAs (ages 15-39 years) treated for cancer at the University of North Carolina between April 2014 and April 2019. Cancer registry data were linked to electronic health record data to associate treatment and sociodemographic factors with clinical trial enrollment. A multivariable log-binomial model was used to estimate adjusted risk ratios. Results: In a 5-year period, 1574 AYA patients were identified, 59% female, 21% non-Hispanic Black and 9% Hispanic. Overall, 37% of AYAs participated in any clinical trial and 14% enrolled on a therapeutic trial. When compared to publicly insured AYAs, those with private insurance [adjusted RR: 1.52, 95% CI: 1.05-2.22] or with no insurance [adjusted RR: 2.12, 95% CI: 1.34-3.33] were more likely to enroll in a therapeutic clinical trial. Hispanic AYAs were less likely to enroll [adjusted RR: 0.50, 95% CI: 0.27-0.93] when compared to non-Hispanic White patients. Conclusions: Rates of clinical trial enrollment among AYAs vary based on health insurance type and race/ethnicity, suggesting possible disparities in access. Attention to resource, cultural, and language barriers may improve trial enrollment and cancer outcomes among vulnerable AYA subpopulations.

Disenrollment from health plans purchased on Affordable Care Act (ACA) Marketplaces is frequent; little is known whether disenrollment from off-Marketplace plans is as common or about the experiences and consequences of disenrollment. Using longitudinal administrative data on 2017-2018 nongroup plan enrollment linked with survey data, we analyze plan disenrollment in one regional insurance carrier servicing three states. Overall, 71% of enrollees disenrolled from their 2017 plan. Disenrollment was associated with purchasing through an ACA Marketplace, the carrier making significant changes to an enrollee’s plan benefit design, being healthier, being younger, and paying a higher premium for their 2017 plan in 2018. Experiencing financial burden or poor access to preferred providers was not associated with disenrollment. Most disenrollees (93.2%) enrolled in other coverage, often at a lower premium, but lacked confidence that they could afford needed care. These results can inform policy to support enrollees through coverage transitions and foster stability in the nongroup market.

The Patient Protection and Affordable Care Act (ACA), fully implemented by 2015, has significantly increased the number of Americans with health insurance. However, its impact on physician reimbursement (PR) is not well studied. Our objective was to determine the ACA's impact on the professional component of PR for selected vascular surgery (VS) procedures and vascular laboratory (VL) studies at our institution.PR for the following 5 VS procedures and 4 VL studies were obtained from our billing department: CPT 34803 (Endovascular aortic repair, EVAR), 35301 (carotid endarterectomy, CEA), 35656 (lower extremity bypass, LEB), 36010 (introduction of catheter into vena cava, ICVC), 36200 first, 93922 (ankle brachial index, ABI), 93925 (lower extremity arterial duplex, LEA duplex), 93970 (lower extremity venous duplex, LEV Duplex), and 93990 (hemodialysis duplex). The data was organized by payer: Medicare, Medicaid, Commercial Insurers (CI), and Other. PR was studied pre-ACA (January 2008 through December 2009) and post-ACA (January 2015 through December 2016). The post-ACA PR and inflation adjusted reimbursement (IAR) in 2016 dollars using the consumer price index (CPI) were calculated and compared using one-sample t-test. The percent difference between the post-ACA PR and IAR was also compared.PR for 1,637 VS procedures and 16,333 VL studies was analyzed. The post-ACA PR was significantly lower than the IAR for most Medicare and Medicaid procedures. For EVAR, post-ACA reimbursement was overall on par with the IAR but significantly lower for Medicare. For CEA, post-ACA reimbursement was overall lower than IAR. For LEB, overall average PR was lower than IAR, with statistically significant lower Medicare and Medicaid (P0.001) payments. For ICAo, overall PR was significantly lower than the IAR and this was true across all insurance types. In contrast, for ICV, the post-ACA reimbursement was higher than IAR for all payers but did not reach statistical significance (P = 0.25). The post-ACA PR was significantly higher than the IAR for most VL studies, except for Medicare PR. The percent change for VS procedures were mostly negative for the Medicaid and Medicare groups. This results in potential annual shortcomings of $2, 862 and $20,923 respectively.When comparing reimbursement before and after ACA implementation, Medicare and Medicaid PR for most VS procedures has not kept up with inflation. However, for most VL procedures, PR has exceeded inflation. Further efforts are needed to support Vascular Surgery reimbursement including higher valuation of the Medicare Conversion factor.

There is a continuous increase in health costs, thereby increasing pressure on individuals and consequently making the amounts claimed by the insured to be on the increase. In this study, data was collected from a large local insurance company in Zimbabwe for the period from January 2012 to December 2016. The aim of this study was to analyse the distribution and future pattern of insurance health claim system using time series approach. Akaike information criterion and Schwarz Bayesian criterion were used to select the adequate model through maximum likelihood estimation methods. ARIMA (0, 0, 0) (1, 0, 1) [12] is the model that was chosen to forecast claim amounts. The use of ARIMA models proves to be an excellent instrument for predicting and capturing the cost trend of health claims which can help in decision making to insurance companies. Keywords: ARIMA; Box-Jenkins; health insurance; time series.

Background: Despite the importance of and social concern regarding prevention of diabetes at younger ages, limited data are available. This study sought to analyze changes in the prevalence of type 2 diabetes mellitus (T2DM) in Koreans younger than 30 years according to sex, age, and level of income.Methods: The dataset analyzed in this study was derived from health insurance claims recorded in the National Health Insurance Service (NHIS) database. Participants’ level of income was categorized as low (quintile 1

Aim: To evaluate the association between functional literacy and the recognition of the word “bruxism” among adolescentes. Method: This was a cross-sectional study carried out in a mid-sized city in Brazil. The sample consisted of 375 schoolchildren, age 12, and 368, aged 15 to 19 years, selected at random. Two calibrated examiners (Kappa > 0.80) applied the oral health literacy instrument, validated for adolescents, the “Rapid Estimate of Adult Literacy in Dentistry” (BREALD-30) and the recognition of the word “bruxism” was used as a dependent variable, in addition to a questionnaire on functional literacy (Functional Literacy Index – INAF). Parents/caregivers answered a sociodemographic questionnaire. Unadjusted analysis and logistic regression were performed for complex samples (p < 0.05). Results: In the final model, the 12-year-old adolescents who were most likely not to recognize the word “bruxism” were those from public schools (OR = 2.83; 95% CI: 1.79-4.46; p = 0.001), without health insurance (OR = 2.02; 95% CI: 1.21-3.37; p = 0.007), and with a lower level of functional literacy (OR = 2.66; 95% CI: 1, 66-4.26; p < 0.001). Adolescents, aged 15 to 19, who had a greater chance of not recognizing the word “bruxism” were those with the lowest level of functional literacy (OR = 3.29; 95% CI: 1.93-5.60; p < 0.001), who lived with more people at home (OR = 2.04; 95% CI: 1.02-4.11; p = 0.040), who had parents/guardians with a low level of education (OR = 1.97; 95% CI: 1.15-3.36; p = 0.013). and who had never been to the dentist (OR = 3.08; 95% CI: 1.26-7.52; p = 0.03). Conclusion: The recognition of the term “bruxism” among 12-year-olds was influenced by the presence of a health plan and a higher level of functional literacy. In the older age group, the higher level of functional literacy, the smaller number of people at home, the higher level of education of the person in charge, and the individual’s visit to the dentist influenced the recognition of the term. Uniterms: Health literacy. Bruxism. Oral health. Pediatric dentistry.

Even when heavily subsidized, a substantial portion of people choose to forgo purchasing health insurance coverage. In this note, I introduce an explanation for this phenomenon which does not assume choice errors, incorrect beliefs, differently priced uncompensated care, or information asymmetries. When individuals are incapable of freely trading off health and wealth and the initial allocation of goods is suboptimal from their perspective, the standard result of demand for actuarially fair insurance in a single good world does not generalize to the health insurance context. Thus, people might not purchase full health insurance coverage even if it is priced at actuarially fair levels. I argue that this situation is particularly likely to occur in the low‐income population, and hence it is relevant for the achievement of universal health coverage.

Objectives: Oral health is an integral part of women's health, yet many women face barriers and go without necessary dental care. The objectives of this study were to (1) examine and compare pregna...

Like other assisted reproductive technology (ART) procedures, the cost of egg freezing (EF) is significant, presenting a potential barrier to access. Given recent technological advancements and rising demand for EF, it is timely to reassess how EF is funded. An online cross-sectional survey was conducted in Victoria, Australia and was completed by 656 female individuals. Participants were asked their views on funding for both medical and non-medical EF. The median age of participants was 28 years (interquartile range 23–37 years) and most participants were employed (44% full-time, 28% part-time, 33% students). There was very high support for public funding for medical EF (n = 574, 87%), with 302 (46%) participants indicating support for the complete funding of medical EF through the public system. Views about funding for non-medical EF were more divided; 43 (6%) participants supported full public funding, 235 (36%) supported partial public funding, 150 (23%) supported coverage through private health insurance, and 204 (31%) indicated that non-medical EF should be self-funded. If faced with the decision of what to do with surplus eggs, a high proportion of participants indicated that they would consider donation (71% to research, 59% to a known recipient, 52% to a donor programme), indicating that eggs surplus to requirements could be a potential source of donor eggs. This study provides insights that could inform policy review, and suggests revisiting whether the medical/non-medical distinction is a fair criterion to allocate funding to ART.

Many children gained insurance with the 2014 Affordable Care Act's (ACA) Medicaid Expansion (ME), yet its impact on access to pediatric tertiary surgical care remains unknown. We examined the effect of ME on rates of elective, ambulatory surgery (EAS), especially among publicly-insured and ethnoracial-minority patients.Surgical patients ≤18 years between 2012 and 2018 were identified using the Pediatric Health Information System. Interrupted time series analyses were conducted to predict the monthly proportion of publicly-insured patients and EAS rates in ME and nonexpansion states.3,270,842 patients were included. Nonexpansion states demonstrated a 1.10% (p0.05) increase in the proportion of publicly-insured patients at ACA implementation, which then plateaued. No immediate change was observed in ME states, but there was an annual 1.08% (p0.01) decrease in subsequent years. Publicly-insured EAS rates decreased by 1.09% (p0.01) in nonexpansion states; no change was observed in ME states. A 3.36% (p0.01) increase in EAS rates was observed in nonexpansion and ME states. The gap in EAS rates increased between private and publicly-insured patients in nonexpansion, but not ME states.Increased coverage for children in ME states was not associated with more access to tertiary pediatric surgical care; however, while nonexpansion states saw an increase in insurance-based disparities, ME states did not. Though insurance coverage is critical to access, other factors may be contributing to persistent disparities in access to pediatric surgical care.

Social accountability is an important strategy towards ensuring that political leaders and actors implement the right policies in the interest of the entire society. In 2007, a community-based health insurance programme was implemented in selected rural communities in Kwara State, Nigeria, through collaboration between the Dutch Health Insurance Fund, PharmAccess Foundation, the Kwara State Government, and Hygeia Nigeria Limited to provide access to basic healthcare for the people. After operating for 9 years, the programme stopped in 2016. This paper describes how social and political accountability shaped the introduction, functioning, and stoppage of the CBHI programme. The study adopted a qualitative approach for data collection, particularly in-depth (n = 22) and key informant interviews (n = 32). Findings indicate that the community-based health insurance programme was proposed by the foreign agency and that the state government was instrumental in the stoppage of the programme. Also, the change in government (via voting against a political bloc that had been in power since 2003) in Kwara State during the 2019 general elections was among the accountability measures employed by the citizenry in reaction to the stoppage of the Community-Based Health Insurance programme. The implication of this is that the current government, expectedly, will not only draw up a more robust healthcare policy for implementation but will also ensure that the people are carried along through adequate social and political accountability mechanisms.

Aims/Introduction To investigate the national trend in the prescription of first‐line non‐insulin antidiabetic agents and total medical costs (TMCs) after prescribing the drug in Japanese patients with type 2 diabetes. Materials and Methods Using the National Database of Health Insurance Claims and Specific Health Check‐ups of Japan covering almost the entire Japanese population, we calculated the proportion of each antidiabetic drug from 2014 to 2017, and determined the factors associated with drug selection. The TMCs in the first year after starting the drugs were calculated, and factors associated with the costs were also determined. Results Among 1,136,723 new users of antidiabetic agents, dipeptidyl peptidase‐4 inhibitors were the most prescribed (65.1%), followed by biguanides (15.9%) and sodium–glucose cotransporter 2 inhibitors (7.6%). Sodium–glucose cotransporter 2 inhibitor and biguanide use increased during 2014–2017 (2.2%–11.4% and 13.7%–17.2%, respectively), whereas the others decreased. Biguanides were not prescribed at all in 38.2% of non‐Japan Diabetes Society‐certified facilities. The TMCs were the lowest among those who started with biguanides. Fiscal year, age, sex, facility, number of beds and comorbidities were associated with drug choice and TMCs. There were wide regional variations in the drug choice, but not in the TMCs. Conclusions Unlike in the USA and Europe, dipeptidyl peptidase‐4 inhibitor is the most prescribed first‐line medication for type 2 diabetes patients in Japan, while there is a wide variation in the drug choice by facility‐type and prefecture.