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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]

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]

Purpose: This paper aims to evaluate Ghana's National Health Insurance Scheme (NHIS) on healthcare utilisation by exploring its heterogeneous effects based on residential status and wealth. Design/methodology/approach: The study used the Ghana Socioeconomic Panel Survey (GSPS) datasets. An instrumental variable strategy, specifically the two-stage residual inclusion (2SRI), was employed to control endogenous NHIS membership. Findings: Generally, the results show that NHIS improves healthcare utilisation (i.e. visits to a health facility and formal care). Concerning the heterogeneous effects of health insurance on healthcare utilisation, the results revealed that NHIS members are more likely to seek care, irrespective of their residence status. The results further indicate that the probability of visiting a health facility and utilising formal care increases for the poorest NHIS participants. Based on these, the authors conclude that NHIS provides equitable healthcare access and utilisation for its vulnerable populations, who are beneficiaries. Originality/value: To the best of the authors' knowledge, this paper is the first to explore the heterogeneous effects of NHIS on healthcare utilisation across residential and income subpopulations. Splitting the dataset by residential status to examine healthcare utilisation inequality is worthwhile. In addition, analysing utilisation in terms of health care type would show whether Ghana's NHIS may be viewed as welfare-enhancing through increased formal health care utilisation. Peer review: The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-05-2023-0330 [ABSTRACT FROM AUTHOR]

Many health insurance markets are organized by principles of regulated competition. Regulators of these markets typically apply risk equalization (aka risk adjustment) and risk sharing to mitigate risk selection. Risk equalization and risk sharing can have various positive and negative effects on efficiency and fairness. This paper provides a comprehensive framework for ex-ante evaluation of these effects. In a first step, we distinguish 22 potential effects. In a second step, we summarize and discuss quantitative measures used for evaluating risk equalization and risk sharing schemes in academic research. To underline the relevance of our work, we compare our framework with an existing framework that was previously used in the Dutch regulated health insurance market. We conclude that this framework is incomplete and uses inappropriate measures. To avoid suboptimal policy choices, we recommend policymakers (1) to consider the entire spectrum of potential effects and (2) to select their measures carefully. [ABSTRACT FROM AUTHOR]

Research on financial literacy seeks to determine whether costly financial mistakes can be avoided. Decisions all consumers face are whether to purchase health insurance, purchase prescriptions, pursue recommended medical testing, and seek medical help for related problems by comparing perceived costs and benefits. Using data from the National Financial Capability Study, this paper provides evidence that financial literacy is a significant determinant in health insurance demand that also reduces the probability of less desirable health-related financial behaviors. [ABSTRACT FROM AUTHOR]

The aim of the paper is to propose a new comprehensive retirement insurance solution (CRIS) that, by offering appropriate modules, can be flexibly adapted to customers' needs during the accumulation of funds and entitlements and during retirement. Technically, the product is life-insurance-based and includes insurance for sickness and in-capacity, long-term care (LTC), work activation expenses, hospital stays, and tontine and Luxembourg policies. Due to consumers' changing expectations and needs, the technical dimension of this solution is based on a three-layer insurance product in which individual parts of the protection are supplemented by several additional benefits (types of assistance) that improve the quality of life of insurance participants and allow the ongoing use of the product. The basis for considering such a new insurance product is the theory of change (ToC), which makes it possible to build considerable flexibility into such a solution. A SWOT analysis was used to position the proposed solution in relation to other insurance products and social security offered by the state. [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]

The Philippines is a source of labor for many countries. Roughly 10 million overseas Filipinos are working and living outside of the Philippines. This paper examines the association between sociodemographic characteristics (sex, age, educational level, and income) and self-rated physical and mental health, access to healthcare, and health habits among immigrant Filipinos living in Santa Cruz de Tenerife, Spain. Through convenience sampling, Filipino migrants (n = 103) aged 18 years and above participated in the online survey between October 2022 and March 2023. The data were analyzed using descriptive statistical analysis and chi-square. Almost all respondents self-rated their health as excellent and very good. Female respondents are more affected by mental health. Most are enrolled in the Universal Health System of Spain (public insurance). There is more utilization of private health insurance among respondents aged 60 years and above and high-wage earners. Cigarette smoking and alcohol drinking are associated with males. More than half of the respondents perform weekly exercise occasionally or never. These findings suggest a potential need for targeted interventions with an emphasis on the practice of preventive health and the promotion of healthy lifestyles, especially among financially disadvantaged migrants with lesser health access. [ABSTRACT FROM AUTHOR]

Nurses are at high risk of burnout and subsequent mental health concerns due to problems with overstaffing, immense workload volume, and personal health risks associated with the job. Effective mental health treatments are available but potential barriers to receiving care may prevent nurses from benefiting. The Emotional Health and Well-Being Clinic (EHWC) at Houston Methodist is an outpatient mental health clinic offering therapy and medication management services for employees and employee dependents of our institution. The EHWC is uniquely positioned to observe how nurses utilize mental health services and to address barriers to effective care for this vital group of healthcare professionals. This paper provides descriptive data on the utilization of mental health services by nurses in the EHWC and a discussion of possible challenges faced by this group when seeking care. Based on these data, we propose potential solutions to ensure that nurses can achieve maximum benefit from outpatient mental health services. [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]

Background: Universal Health Coverage has been openly recognized in the United Nations health-related Sustainable Development Goals by 2030, though missing under the Millennium Development Goals. Ghana implemented the National Health Insurance Scheme programme in 2004 to improve financial access to healthcare for its citizens. This programme targeting low-income individuals and households includes an Exempt policy for older persons and indigents. Despite population ageing, evidence of the participation and perceptions of older persons in the scheme in cash grant communities is unknown. Hence, this paper examined the prevalence, perceptions and factors associated with health insurance enrollment among older persons in cash grant communities in Ghana. Methods: Data were from a cross-sectional household survey of 400 older persons(60 + years) and eight FGDs between 2017 and 2018. For the survey, stratified and simple random sampling techniques were utilised in selecting participants. Purposive and stratified sampling techniques were employed in selecting the focus group discussion participants. Data analyses included descriptive, modified Poisson regression approach tested at a p-value of 0.05 and thematic analysis. Stata and Atlas-ti software were used in data management and analyses. Results: The mean age was 73.7 years. 59.3% were females, 56.5% resided in rural communities, while 34.5% had no formal education. Two-thirds were into agriculture. Three-fourth had non-communicable diseases. Health insurance coverage was 60%, and mainly achieved as Exempt by age. Being a female [Adjusted Prevalence Ratio (APR) 1.29, 95%CI:1.00–1.67], having self-rated health status as bad [APR = 1.34, 95%CI:1.09–1.64] and hospital healthcare utilisation [APR = 1.49, 95%CI:1.28–1.75] were positively significantly associated with health insurance enrollment respectively. Occupation in Agriculture reduced insurance enrollment by 20.0%. Cited reasons for poor perceptions of the scheme included technological challenges and unsatisfactory services. Conclusion: Health insurance enrollment among older persons in cash grant communities is still not universal. Addressing identified challenges and integrating the views of older persons into the programme have positive implications for securing universal health coverage by 2030. [ABSTRACT FROM AUTHOR]

Health insurance fraud is a significant problem affecting insurance providers and policyholders. To address the rising problem of fraudulent activities in the health insurance sector, this paper proposes a pioneering blockchainbased system aimed at increasing transparency and security. Utilizing a hybrid blockchain architecture, the system incorporates a consensus algorithm influenced by practical byzantine fault tolerance (PBFT) and proof of activity (PoA) to ensure reliability and efficiency in distributing mining power. Developed using Python, extensive testing confirms the system's performance and security metrics. Results show that a block size containing one transaction is 1.63 KB, with 1.2 KB for data and 0.43 KB for identification and hashing. Operational tests demonstrate that a single participant can upload 850 transactions to the transaction pool, with validation completed in just 7.49 seconds. Block appending time for these transactions is a swift 10 seconds. Notably, the system exhibits resilience against data tampering, detecting unauthorized changes within 881.3 milliseconds across 10,000 blocks and identifying irregularities in the transaction pool within 8.78 seconds. Additionally, to enhance data privacy, patient information is accessible only through a unique QR code, providing an extra layer of security; this research represents a significant advancement in combatting fraud and safeguarding data privacy. [ABSTRACT FROM AUTHOR]

Sample surveys are extensively used to provide reliable direct estimates for large areas or domains with enough sample sizes at national and regional levels. However, zones are unplanned domains by the Demographic and Health Survey (DHS) program and need more sample sizes to produce direct survey estimates with adequate precision. Conducting surveys in small areas (like zones) is too expensive and time-consuming, making it unfeasible for developing countries like Ethiopia. Therefore, this study aims to use the Hierarchical Bayes (HB) Small Area Estimation (SAE) model to estimate the Community-Based Health Insurance (CBHI) coverage at the zone levels in Ethiopia. To achieve this, we combined the 2019 Ethiopia Mini-Demographic and Health Survey (EMDHS) data with the 2007 population census data. SAE has addressed the challenge of producing reliable parameter estimates for small or even zero sample sizes across Ethiopian zones by utilizing auxiliary information from the population census. The results show that model-based estimates generated by the SAE approach are more accurate than direct survey estimates of CBHI. A map of CBHI scheme coverage was also used to visualize the spatial variation in the distribution of CBHI scheme coverage. From the CBHI scheme coverage map, we noticed notable variations in CBHI scheme coverage across Ethiopian zones. Additionally, this research identified areas with high and low CBHI scheme coverage to improve decision-making and increase coverage in Ethiopia. One of the novelties of this paper is estimating the non-sampled zones; therefore, the policymakers will give equal attention similar to the sampled zones. [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]

Background and Aims: The United States of America and Sweden both contain a public and private component to their healthcare systems. While both countries spend a similar amount per capita on public healthcare expenditures, the United States spends significantly more in the private healthcare sector. Sweden has a social democratic model of health care, and given its identity as a welfare state, private health insurance providers have a small and nuanced role. Methods: This paper was completed after searches were queried for "Sweden," "United States," and variants of the words "insurance," "public," "private," "Medicare," "Medicaid," "public," and "costs." A preliminary search in May 2022, yielded 78 articles, of which 45 were ultimately considered relevant for this review. Inclusion criteria consisted of English language articles, topic relevance, and verification of MEDLINE‐indexed journals. These searches were performed in PubMed, Google Scholar, Embase, and Cochrane. Summary findings of these searches are compiled in this review. Results: Sweden guarantees low‐cost appropriate care to all citizens with equitable access; however, drawbacks of its system include high financial burden, lack of primary care infrastructure, as well as geographical and socioeconomic inequities. On the other hand, the United States' healthcare system is built around the private sector with public health insurance reserved only for the most vulnerable patient populations. Conclusion: Our goal is to provide an overview, compare the role of private health insurance in both countries, and highlight policies that have had beneficial effects in each nation. Possible solutions to the drawbacks of each nation's health insurance policies could be addressed by additional support to Sweden's vulnerable population by developing a program similar to the US' Medicare Advantage program. Conversely, the United States may benefit from increasing access to public health insurance, especially in instances where families face unemployment. [ABSTRACT FROM AUTHOR]

This paper presents a dynamic general equilibrium model designed to examine the macroeconomic effects and welfare implications of alternative reforms to the US health insurance system. Specifically, it scrutinizes the extent to which health care reform can mitigate inefficiencies stemming from market imperfections in the health insurance industry. The model considers a stochastic overlapping generations framework, incorporating heterogeneous agents who are subject to uncertain health shocks. These individuals make optimal decisions regarding labor supply, health insurance, and medical services. Given that the optimal levels of medical consumption and hours worked are endogenous, this setting encapsulates general equilibrium effects. The model is calibrated to US data, and numerical simulations suggest that suitable adjustments to the present health insurance system can broaden coverage and enhance welfare. This improvement is achieved by reducing adverse selection, improving overall health status, and lessening tax distortions on labor supply. [ABSTRACT FROM AUTHOR]

Colombia has extensive laws prohibiting discrimination against sexual minority people. However, violence and discrimination toward sexual minorities are still frequent. While a growing body of research shows that sexual minority people experience elevated rates of discrimination and domestic abuse globally, little research has been conducted on these issues affecting sexual minorities in Colombia specifically. Using minority stress theory as a conceptual framework, this paper aims to fill this gap by examining the prevalence of experiencing intimate partner violence (IPV) and witnessed discrimination and the relationship of these stressors to self-reported health among a national sample of sexual minority Colombians. We found that bisexual individuals experienced higher rates of physical and sexual IPV, compared to lesbian and gay individuals. Additionally, sexual minority Colombians who experienced IPV and witnessed discrimination were more likely to report having poorer health, compared to those who had not. We discuss the implications of our findings for future research and clinicians working with sexual minority clients. [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]

Introduction: Depression is the leading cause of disability worldwide and has become a health issue of global concern. Based on the "System of Health Accounts 2011" (SHA 2011) for patients with depression, this paper studies the changes in the current curative expenditure (CCE) of outpatient depression in Liaoning Province, China, and provides policy recommendations. Method: A stratified multistage random sample of 56,994 patients with depression included from 1,227 healthcare facilities in Liaoning Province were included. The significance of differences in variables within groups was analyzed by univariate analysis (including descriptive statistics analysis, Mann-Whitney U test and Kruskal-WallisH test), and factors influencing depression outpatient CCE were analyzed by multiple linear regression analysis and constructing structural equation models (SEM). Results: The CCE of outpatient depression was ranging from CNY 75.57 million to CNY 100.53 million in 2015-2020, with the highest of CNY 100.53 million in 2018, CNY 103.28 million in 2019. Medical expenditures are mainly concentrated in general hospitals and provincial healthcare institutions, accounting for about 90% of all provincial scope expenditures. The multiple regression results show that provincial healthcare institutions, purchase of drug, select medical treatment for depression, general hospitals and urban employees' health insurance are the main influencing factors for depression outpatient CCE. The results of SEM show that insurance status negative impact outpatient expenditure. Conclusion: Health insurance is an important factor in equitable access to healthcare resources for patients, and medication expenditure is the influential factor affecting the high expenditure of outpatient clinics. It is of great importance to reduce the medical burden of patients by increasing the coverage of medical insurance, increasing the proportion of bills that are eligible for reimbursement, and improving the system by guaranteeing the supply of psychotropic medication. [ABSTRACT FROM AUTHOR]

In Austria, exercise therapy is an accredited profession that requires academic training on a university’s master level. However, exercise therapy is not listed in the service plans of health and medical insurance funds and is therefore not reimbursed as a health service for patients. This position paper aims to compile the scientific evidence of the efficacy and effectiveness of exercise therapy as a treatment component in medical care. It also informs about the skills and competencies that exercise therapists acquire during their university education in sport science. Based on that, the necessity to include exercise therapy as a health service for patients is argued. Additionally, legal parity for exercise therapists within the healthcare professions offering evidence-based treatment methods is advocated. Numerous studies confirm that exercise therapy clearly leads to improvements in musculoskeletal, internal, neurological, psychiatric, and psychosomatic diseases. Exercise therapy is thus a highly evidence-based, low-sideeffect component of prevention, treatment, and rehabilitation measures for almost all chronic diseases. It has a positive impact on pathogenesis, symptoms, fitness, quality of life, morbidity, and mortality of patients. The five-year academic training in sport science for exercise therapists conveys medical, theoretical knowledge, and practical skills on training and exercise, communication-related, sports-, and movement-related skills, as well as a profound education in scientific methodology. Consequently, the integration of exercise as therapeutic treatment into the healthcare system is highly indicated from a medical, societal and economic perspective. A new legal framework offering self-employment regulations for exercise therapists is required. [ABSTRACT FROM AUTHOR]

The U.S. health care system is often criticized for being the most expensive in the world while delivering mediocre health outcomes. While policymakers on both the right and left agree about the need for reform, they disagree strongly about whether that reform should involve a smaller role for government or a larger role. At the same time, the U.S.' high costs and mediocre health outcomes likely are at least partly attributable to lifestyle choices that occur outside of the health care system, creating another possible avenue for intervention. This introduction to the symposium on "Free Markets and Health Care" discusses how welfare economics provides a useful tool in evaluating the appropriateness of government involvement in markets related to health and health care. The papers in the symposium provide important new evidence to help inform debates about, for instance, regulations on health care providers and insurers, health insurance expansions, and policies designed to influence health behaviors. [ABSTRACT FROM AUTHOR]

Objectives: This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance (CBHI) scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms. There is growing concern about the financial sustainability of CBHI schemes in developing countries. However, few empirical studies have identified potential contributors, including ex-ante and ex-post moral hazards. Methods: We implement a household fixed-effect panel data regression model, drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia. Results: The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals. However, CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms. Particularly, on average, we estimate about 4-6 h delay for malaria symptoms, a little above 4 h for tetanus, and 10-11 h for tuberculosis among the insured households. Conclusions: While there is evidence that CBHI improve the utilization of outpatient or primary care services, our study suggests that insured members may wait longer before visiting health facilities. This delay could be partly due to moral hazard problems, as insured households, particularly those from rural areas, may consider the opportunity costs associated with visiting health facilities for minor symptoms. Overall, it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention. [ABSTRACT FROM AUTHOR]

Effective citizen engagement is crucial for the success of social health insurance, yet little is known about the mechanisms used to involve citizens in low- and middle-income countries. This paper explores citizen engagement efforts by the National Health Insurance Fund (NHIF) and their impact on health insurance coverage within rural informal worker households in western Kenya. Our study employed a mixed methods design, including a cross-sectional household survey (n  = 1773), in-depth household interviews (n  = 36), six focus group discussions with community stakeholders and key informant interviews (n  = 11) with policymakers. The findings reveal that NHIF is widely recognized, but knowledge of its services, feedback mechanisms and accountability systems is limited. NHIF enrolment among respondents is low (11%). The majority (63%) are aware of NHIF, but only 32% know about the benefit package. There was higher awareness of the benefit package (60%) among those with NHIF compared to those without (28%). Satisfaction with the NHIF benefit package was expressed by only 48% of the insured. Nearly all respondents (93%) are unaware of mechanisms to provide feedback or raise complaints with NHIF. Of those who are aware, the majority (57%) mention visiting NHIF offices for assistance. Most respondents (97%) lack awareness of NHIF's performance reporting mechanisms and express a desire to learn. Negative media reports about NHIF's performance erode trust, contributing to low enrolment and member attrition. Our study underscores the urgency of prioritizing citizen engagement to address low enrolment and attrition rates. We recommend evaluating current citizen engagement procedures to enhance citizen accountability and incorporate their voices. Equally important is the need to build the capacity of health facility staff handling NHIF clients in providing information and addressing complaints. Transparency and information accessibility, including the sharing of performance reports, will foster trust in the insurer. Lastly, standardizing messaging and translations for diverse audiences, particularly rural informal workers, is crucial. [ABSTRACT FROM AUTHOR]

Hierarchical diagnosis and treatment (HDT) is an important exploration direction to alleviate the rising pressure of health expenses and medical insurance fund expenditure in China, and to maintain and protect the public health in this country. In recent years, the construction of compact county medical communities (CCMC) has become the primary approach for implementing the HDT. Utilizing the quasi-natural experiment of the pilot project of CCMC in Sichuan Province in 2019, coupled with county-level data extracted from the ' Sichuan Provincial Health Statistics Yearbook ' spanning the years 2008 to 2021, this research evaluates the effect of the pilot project of CCMC on promoting HDT under the medical insurance package payment model. The results show that the pilot project of CCMC has significantly increased the number of consultations per capita of medical and health institutions in pilot counties by 0.434 times, of which the number of consultations per capita of primary medical institutions has increased by 0.340 times; the number of hospitalizations per capita in public hospitals and primary medical institutions in pilot counties increased significantly, and the surgery rate of inpatients in public hospitals increased by 5% compared to before the pilot. There was no significant impact on the allocation of medical facilities and human resources in the pilot counties. Therefore, the construction of CCMC under the medical insurance package payment mode has promoted the realization of the county-level HDT. These findings provide valuable insights for healthcare policy, especially in developing and implementing effective strategies for HDT in county-level medical institutions. [ABSTRACT FROM AUTHOR]

This study investigate how the Urban identity(UI) influence the entrepreneurial choice of the migrants. Drawing on the identity economics theory in combination with microscopic perspective on entrepreneurship, we conclude that the UI increases the odds of self-employment of the migrants by 19.91% after solving endogenous problem in our sample of 126385 individuals from the China Migrants Dynamic Survey. We test the moderating effect of medical insurance and find that the interaction coefficient is positive. This study further reveals that the expanding social networks, improving urban integration, and increasing income are the three main mechanisms through which the UI influences the entrepreneurial choice of the migrants. So, we derive results consistent with our hypotheses. The findings have implications for both the entrepreneurship and national policy literature. [ABSTRACT FROM AUTHOR]

In the current digital era, organizations face enormous difficulties in efficiently managing and utilizing the power of documents due to the exponential growth of information. In this research, a novel Intelligent Document Management System (IDMS) is proposed by digitizing healthcare claim settlement documents like medical bills, discharge summaries, clinical reports, doctor's prescriptions, etc. The existing documentation process is very time- consuming and cumbersome for the patient and his family during the treatment of the patient at the hospital. Moreover, it becomes even more challenging when a patient is going to be discharged from the hospital and has to wait for clearance to avail of the cashless claim facility. The scope of the paper is limited to the digitization of three types of documents namely Adhaar Card, Pan Card, and hospital invoice. The proposed method is used to extract the textual information in the form of a JSON/CSV file format, which can be used in an Intelligent Document Management System (IDMS) for Health Care insurance claim settlement. The findings show an accuracy of 94.09% is achieved for the hospital invoice using AWS services whereas the performance of the proposed system using heuristic approach for Aadhar Card and PAN Card is 83.13% and 70.3% respectively. The integration of AI technologies and web services in the digitization of the document management process presents a significant role in the healthcare applications like medical insurance policies, claim settlement processes, etc. This study serves as a foundation for developing intelligent document management systems that streamline processes, improve accessibility, and optimize the utilization of valuable information in the healthcare domain. [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]

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]

Background Despite sophisticated risk equalization, insurers in regulated health insurance markets still face incentives to attract healthy people and avoid the chronically ill because of predictable differences in profitability between these groups. The traditional approach to mitigate such incentives for risk selection is to improve the risk-equalization model by adding or refining risk adjusters. However, not all potential risk adjusters are appropriate. One example are risk adjusters based on health survey information. Despite its predictiveness of future healthcare spending, such information is generally considered inappropriate for risk equalization, due to feasibility challenges and a potential lack of representativeness. Methods We study the effects of high-risk pooling (HRP) as a strategy for mitigating risk selection incentives in the presence of sophisticated– though imperfect– risk equalization. We simulate a HRP modality in which insurers can ex-ante assign predictably unprofitable individuals to a ‘high risk pool’ using information from a health survey. We evaluate the effect of five alternative pool sizes based on predicted residual spending post risk equalization on insurers’ incentives for risk selection and cost control, and compare this to the situation without HRP. Results The results show that HRP based on health survey information can substantially reduce risk selection incentives. For example, eliminating the undercompensation for the top-1% with the highest predicted residual spending reduces selection incentives against the total group with a chronic disease (60% of the population) by approximately 25%. Overall, the selection incentives gradually decrease with a larger pool size. The largest marginal reduction is found moving from no high-risk pool to HRP for the top 1% individuals with the highest predicted residual spending. Conclusion Our main conclusion is that HRP has the potential to considerably reduce remaining risk selection incentives at the expense of a relatively small reduction of incentives for cost control. The extent to which this can be achieved, however, depends on the design of the high-risk pool. [ABSTRACT FROM AUTHOR]

Objectives: Home visiting programs often provide targeted, long-term services to disadvantaged and vulnerable families with children, though briefer, universal interventions like Family Connects are increasingly being disseminated to bring home visiting to scale. Extending research by the Family Connects developers, this paper presents findings from the first independent implementation study of the intervention. Method: Observational data were drawn from program records entered between August 2017 and February 2020 at a new Family Connects site in Racine County, WI. Indicators of program acceptance, participation, and fidelity were examined. Data collected during home visits were used to describe family needs and demographics. An analysis of data gathered after program completion examined client satisfaction and referral connections. Results: Of 2,304 families who were offered the program, 1,778 (77.2%) accepted services and 1,107 (48.0%) received services. Replicating prior findings, the program was implemented with high fidelity. Most participants needed some education (99.4%), and over half (50.6%) had a need that warranted a referral. Family needs varied by race/ethnicity, educational attainment, and health insurance status. Postprogram data gathered from 648 participants revealed high levels of program satisfaction and high rates of referral connections. Conclusion: Interpretations of the findings and implications for health equity are discussed. [ABSTRACT FROM AUTHOR]

Using medical insurance (MI) to shift employees' health risks outside is an important risk management tool for modern firms. Existing studies usually treat firms' contributions to employees' MI only as a labor cost. However, contributing to MI also has indirect benefits, such as improved labor productivity and R&D innovation, which consequently increase corporate value. This paper studies the impact of firms' MI contributions for employees on corporate value, using social insurance collection system reform in China as a natural experiment. Results show that, first, the reform increases firms' contributions to employees' MI funds. Second, the increase has a positive impact on firms' market‐to‐book ratio. These effects can be explained by enhanced labor productivity, firm efficiency, and innovation. Heterogeneity analysis suggests that the effects are more pronounced for firms in high R&D industries, areas with high pollution, or areas with better medical and labor supplies. [ABSTRACT FROM AUTHOR]

Background: A linchpin to realizing the internal circulation (referring to the domestic cycle of production, distribution and consumption) is reducing residents' saving rate and expanding the domestic needs. However, rural residents in China demonstrate a strong propensity to save money. Methods: In light of practical characteristics of urban-rural health integration promoted in different places, the three-phase data (from 2014 to 2018) and the dual difference-in-differences model of the China Labor-force Dynamics Survey (CLDS) are used to empirically investigate the impact of urban-rural health insurance integration on rural household savings. Results: Research reveals that urban-rural health integration can reduce the health risks and medical risks facing rural households, thus weakening the motivation of precautionary savings. The analysis of heterogeneity reveals that the integration of urban-rural health insurance significantly influences the savings rates of households headed by older individuals, particularly women, with lower levels of educational attainment. Besides, the single-tier health insurance system can have a more significant impact, whereas the multi-tier insurance system may not significantly affect the savings rate. Conclusion: Based on the aforesaid research conclusions, this article believes that in order to reduce the savings rate of rural households and expand consumption, the health insurance system should be further improved. [ABSTRACT FROM AUTHOR]

This paper summarizes emerging practice and research issues in the health insurance industry. We provide an industry overview, epitomize business analytics applications, and outline current and emerging problems of interest to key stakeholders and researchers in information systems, operations management, and healthcare management. Specifically, we focus on three areas of research that are of importance to the health insurance industry as well as the healthcare system: (i) management and evaluation of intervention programs, (ii) creation of effective provider networks, and (iii) emerging issues such as the impact of a pandemic, patient communication and steering, and technological innovations in health care. We lay out brief details of how each of these problems can be formulated, where the data can be acquired (public and/or proprietary data sets), and provide guidance for solving them. For several of these problems, we provide models that span causal modeling, predictive modeling, and prescriptive modeling. [ABSTRACT FROM AUTHOR]

The article "Health insurance as a crime-fighting tool" discusses a study conducted by Monica Deza, Thanh Lu, Johanna Catherine Maclean, and Alberto Ortega on the relationship between access to health insurance and crime rates. The study focuses on the 2005 Medicaid disenrollment in Tennessee, where 190,000 nonelderly, nondisabled enrollees lost their health insurance. The authors found evidence of a significant increase in crime rates for at least two years after the disenrollment, particularly in assaults and thefts. The study suggests that providing access to health insurance for vulnerable populations can potentially reduce crime. However, the authors acknowledge that their findings may not be applicable to the current Medicaid-covered population or post-Affordable Care Act insurance options. [Extracted from the article]

Detection of medical insurance fraud is of significant research importance. Currently, most methods focus on supervised data, but identifying gang fraud requires exploring relationships among gang members, for which labeled data cannot be obtained in advance, this makes unsupervised models more suitable. In this paper, we propose an unsupervised model based on knowledge graph and the Louvain algorithm for identifying medical insurance gang fraud. Firstly, a knowledge graph is constructed based on medical records using the NetworkX algorithm to establish a knowledge graph of anti-gang fraud in medical insurance, facilitating the summarization of risk rules after community division. Then, the Louvain algorithm is applied to the patient–doctor relationship network to discover communities, and then we divide the entire knowledge graph into four levels of communities with high, medium, low, and no apparent risk, respectively. Different measures are proposed for communities with different risk levels for supervision. To demonstrate the superiority of the proposed model, it is compared with other unsupervised models on multiple datasets for gang fraud identification. By comparing the correct partition rate, the superiority of the proposed model in the research of medical insurance gang fraud identification is demonstrated, providing an effective unsupervised learning method for identifying medical insurance gang fraud, facilitating the proposal of prevention and control measures, and preventing fraudulent incidents. • The problem of fraudulent medical insurance funds with group crime is very serious. • Medical insurance gang fraud detect by an unsupervised model based on knowledge graph. • Build a knowledge graph and find the community using NetworkX and Louvain algorithm. • The risk score of communities are calculated by the summarized risk rules to divide into four levels. • It can be used to provide prevention and control suggestions and prevent fraud cases. [ABSTRACT FROM AUTHOR]

A key challenge in data mining, machine learning and artificial intelligence concerns data quality. Process mining is not an exception. A range of data quality problems exists in process data, some of which caused by activity labels. While automated techniques can be used for remedying data quality problems, they are effective up to a point and the aid of domain experts is required (cf. the "human-in-the-loop" paradigm in artificial intelligence). They are eminently suited to fix incorrect labels, but hard to engage as the repair task can be time-consuming and tedious. Gamification may offer a promising solution to this challenge. In this paper, we examine what motivational drives can be exploited to gamify activity-label repair, specifically those with identical semantics but different syntax. We conducted two experiments. First we recruited experts from the insurance domain to repair labels using our gamified system. Results show that log quality was improved, and participants had a positive experience interacting with the system. To validate the generalisability of the approach, our second experiment involved 30 participants who repaired a real-life medical log. We found promising results on quality improvement of the log and comparison with automatic approaches. This work contributes to process mining by improving activity-label quality in event logs and by turning data cleaning from the least enjoyable task to a fun experience for users. By bringing together elements from gamification, crowdsourcing ("humans-in-the-loop"), and process mining, this study contributes to improving the reliability of data-driven decision making in machine learning and artificial intelligence. • We investigated the impact of gamification on expert engagement in label repair. • We examined experts' motivations to contribute knowledge. • Two experiments were conducted in the insurance and medical domains. • We observed improvement in the quality of the event log. • Epic meaning, development, and relatedness along with other drives motivate experts. [ABSTRACT FROM AUTHOR]

Background: In Germany, skin cancer screening (SCS) is available free of charge every two years to all those with statutory health insurance over the age of 35. General Practitioners (GP) can carry out the screening if they have completed an 8-hour training course. GPs play a crucial role in the implementation of SCS and act as gatekeepers between initial patient contact and referral to dermatologists. Objective: To record how comprehensively GPs carry out SCS in terms of patient information and body examination, as well as to explore GPs opinions on the feasibility of SCS. Methods: A cross-sectional survey was conducted. A questionnaire was sent to GPs with permission to perform SCS in two regions of Germany (Bavaria and Saxony) between August and September 2021. Data were analyzed using descriptive analysis. Subgroup analysis was performed according to regions (federal state, location of physician´s office), professional experience (experience in years, number of monthly screenings, age) and gender. Open questions were evaluated using qualitative content analysis. Results: In the survey, 204 GPs responded. Genitalia (40.7%, 83/203), anal fold (62.3%, 127/204) and oral mucosa (66.7%, 136/204) were the least examined body regions during screening. Information on risks (false-positive findings: 18.6%, 38/203; false-negative findings: 13.2%, 27/203; overdiagnosis: 7.8%, 16/203) and benefits (48.0%, 98/202) were not always provided. GPs who performed screenings more frequently were more likely to provide information about the benefits of SCS (p<0.001; >10 vs. <5 screenings per month). Opinions were provided on uncertainties, knowledge requirements, structural and organizational requirements of SCS, SCS training and evaluation. The organization and remuneration of the SCS programme was seen as a barrier to implementation. GPs expressed uncertainties especially in unclear findings and in dermatoscopy. Conclusion: Uncertainties in the implementation of the SCS should be addressed by offering refresher courses. Good networking between GPs and dermatologists is essential to improve SCS quality. [ABSTRACT FROM AUTHOR]

Background: Air pollution affects residents' health to varying extents according to differences in socioeconomic status. However, there has been a lack of research on whether air pollution contributes to unfair health costs. Methods: In this research, data from the China Labour Force Dynamics Survey are matched with data on PM2.5 average concentration and precipitation, and the influence of air pollution on the health expenditures of residents is analysed with econometric methods involving a two-part model, instrument variables and moderating effects. Results: The findings reveal that air pollution significantly impacts Chinese residents' health costs and leads to low-income people face health inequality. Specifcally, the empirical evidence shows that air pollution has no significant influence on the probability of residents' health costs (β = 0.021, p = 0.770) but that it increases the amount of residents' total outpatient costs (β = 0.379, p < 0.006), reimbursed outpatient cost (β = 0.453, p < 0.044) and out-of-pocket outpatient cost (β = 0.362, p < 0.048). The heterogeneity analysis of income indicates that low-income people face inequality due to health cost inflation caused by air pollution, their total and out-of-pocket outpatient cost significantly increase with PM2.5 (β = 0.417, p = 0.013; β = 0.491, p = 0.020). Further analysis reveals that social basic medical insurance does not have a remarkable positive moderating effect on the influence of air pollution on individual health inflation (β = 0.021, p = 0.292), but supplementary medical insurance for employees could reduce the effect of air pollution on low-income residents' reimbursed and out-of-pocket outpatient cost (β=-1.331, p = 0.096; β=-2.211, p = 0.014). Conclusion: The study concludes that air pollution increases the amount of Chinese residents' outpatient cost and has no significant effect on the incidence of outpatient cost. However, air pollution has more significant impact on the low-income residents than the high-income residents, which indicates that air pollution leads to the inequity of medical cost. Additionally, the supplementary medical insurance reduces the inequity of medical cost caused by air pollution for the low-income employees. [ABSTRACT FROM AUTHOR]

Background: Based on CSS 2019 data, this article analyzes the impact of Basic Medical Insurance for Urban and Rural Residents (BMIUR) on perceived social equity of residents. Method: Using the CSS data of 2019, this article analyzes the influence of BMIUR on the perception of social equity of residents, on the basis of 2SLS model and mediating effect model. Results: We find that BMIUR has a significantly positive impact on the perception of social equity. That is to say, BMIUR can improve residents' evaluation of social equity and further promote the level of social equity, which makes residents more happiness. The conclusion remains valid after using robustness test and propensity score matching to conduct counterfactual reasoning. The discussion of mechanism indicates that the influence of BMIUR is mediated by enhancing social capital, improving satisfaction of income distribution and reducing self-paid medical expenses. This study also finds that the influence of BMIUR is more obvious in the low-income, low-skilled and mid-west groups. Conclusion: The reform of the medical security system should be regarded as a foothold for improving people's well-being and promoting social equity; Expanding people's social capital through multiple channels and improving income distribution mechanisms; Strengthen vocational skills training, especially to provide more public services and social security for low-income groups, low-skilled groups, and groups in the western region of China, in order to improve the welfare and policy effectiveness of China's social security reform. [ABSTRACT FROM AUTHOR]

Objective: In this study, the impact of medical insurance and old-age security on the use of medical services by the older population with disabilities is analyzed. A reference for decision makers is provided to improve medical and old-age security policies and enhance the use of medical services by the older population. Methods: Data were drawn from 3,737 older people with disabilities aged 65 years or above from the 2018 China Longitudinal Healthy Longevity Survey. A two-part model based on social ecological theory was used for both analysis and group prediction. Results: In terms of the use of outpatient medical services, old-age pension significantly increased the probability of outpatient visits for this population group (P < 0.05). Urban employee/resident medical insurance, the new rural cooperative medical insurance, and retirement pension significantly affected medical expenses. In terms of the use of inpatient medical services, the new rural cooperative medical insurance and retirement pension significantly influenced the choice of inpatient medical services; retirement pension increased inpatient medical expenditure (p < 0.01). The expected average probability of hospitalization, unconditional expected cost, and conditional expected cost for the older population with disabilities were 49.5%, RMB 6629.31, and RMB 3281.51, respectively. Both conditional and unconditional expected costs were significantly higher for older people with disabilities with the following attributes: male, married, no less than three chronic conditions, and unassisted daily care; costs were lower for older people with disabilities who are female, not married, had less than three chronic conditions, and had a spouse, child, or other caregiver. Conclusion: Medical insurance and old-age security can significantly promote the utilization of medical services by the older population with disabilities. It is therefore recommended to focus on strengthening the support and health management of these people who are unattended to improve the effective use of health services and better meet their needs. [ABSTRACT FROM AUTHOR]

Aims/Introduction: To estimate the prevalence, awareness, treatment, control rate, and influence factors of type 2 diabetes in Fujian province and provide the scientific basic for prevention. Materials and Methods: A population‐based study with the analysis of binary logistic regression was carried out to estimate the odds ratios of the influencing factor on type 2 diabetes. Data of the Patient‐Centered Evaluative Assessment of Cardiac Events (PEACE) in southeast China were used. The study sample originated from 12 counties in Fujian province and included 135,352 permanent residents aged 35–75 years in 2021. Results: The prevalence of type 2 diabetes was 18.32% (24,801/135,352). Among them, 13,921 (56.13%) were aware of their condition, 11,894 (47.96%) were receiving treatment, and 4,537 (18.29%) had achieved control of blood glucose. Multivariate logistic regression analysis showed that older age, men, low‐family income, low‐education level, urban locality, no medical insurance, and histories of myocardial infarction, stroke, dyslipidemia, hypertension, alcohol consumption, and obesity were associated with a higher prevalence of type 2 diabetes. Conclusions: The prevalence of type 2 diabetes among residents aged 35–75 years in southeast China is high, whereas the status of its low awareness, treatment and control is severe, warranting a broad‐based global strategy, including greater efforts in earlier screening, and more effective and affordable treatment is essential. [ABSTRACT FROM AUTHOR]

Background: Patient experience plays an essential role in improving clinical effectiveness and patient safety. It's important to identify factors influencing patient experience and to improve quality of healthcare. Objective: To identify factors that influence patient experience in hospital wards. Methods: We conducted a systematic review including six databases; they were PubMed, CINAHL, Embase, PsycInfo, ProQuest, and Cochrane. Studies were included if they met the inclusion criteria. The JBI checklist was used to perform quality appraisal. We used 5 domains of the ecological model to organize and synthesize our findings to comprehensively understand the multi-level factors influencing the issue. Result: A total of 138 studies were included, and 164 factors were identified. These factors were integrated into 6 domains. All domains but one (survey-related factors) could be mapped onto the attributes of the ecological framework: intrapersonal, interpersonal, institutional, community, and public policy level factors. All factors had mixed effect on patient experience. The intrapersonal level refers to individual characteristics of patients. The interpersonal level refers to interactions between patients and healthcare providers, such as the caring time spent by a nurse. The institutional level refers to organizational characteristics, rules and regulations for operations, such as hospital size and accreditation. The community level refers to relationships among organizations, institutions, and informational networks within defined boundaries, such as a hospital located in a larger population area. Public policy level refers to local, state, national, and global laws and policies, including health insurance policies. The sixth domain, survey-related factors, was added to the framework and included factors such as survey response rate and survey response time. Conclusion: The factors influencing patient experience are comprehensive, ranging from intrapersonal to public policy. Providers should adopt a holistic and integrated perspective to assess patient experience and develop context-specific interventions to improve the quality of care. PROSPERO registration number CRD42023401066: [ABSTRACT FROM AUTHOR]

Background: Emerging adults aged 18–30 years face challenges during life transitions, with an added burden of navigating the health care system and additional costs associated with diabetes. This stress is compounded by overall low levels of health insurance literacy in this population, as people may not know about available financial and health care resources to minimize suboptimal diabetes outcomes. This study aimed to tailor a financial and health insurance toolkit to emerging adults with type 1 diabetes, including racially, ethnically diverse, and Medicaid-insured individuals, through community-based participatory action research. Methods: An academic research team and community members from a national organization held six online community advisory board (CAB) content-creation meetings to understand how to tailor a financial and health insurance Toolkit. The CAB was comprised of six racially and insurance-diverse emerging adults with type 1 diabetes and four content experts (clinical, financial, and insurance). Six 60-minute online CAB meetings were held via University Hospitals (UH)-encrypted Zoom over five months. Pre-reading materials were emailed to CAB members before the meetings. A moderator established the purpose of each meeting and briefly discussed meeting rules before each meeting commenced. During the meetings, the moderator guided the discussions and provided the CAB members opportunities to respond and build on one another's feedback. A deductive thematic qualitative analysis was utilized. Three researchers independently coded the cross-referenced and de-identified CAB meeting transcripts and then convened to reach a group consensus. Two CAB members performed member-checking. Results: The following key themes emerged to tailor the Toolkit: ensuring that content covers empowerment and self-advocacy, including genuine stories and multimedia visuals for aesthetics, addressing clinician bias, acknowledging racial and ethnic disparities in care, incorporating cultural representation, and demystifying Medicaid stigma. Conclusions: By successfully partnering with the CAB and a community organization through a community-based participatory action research approach, we will develop a financial and health insurance Toolkit tailored to the needs of racially and ethnically diverse and Medicaid-insured emerging adults with type 1 diabetes. Plain English Summary: Aim of the research: This study aims to tailor a financial and health insurance Toolkit to emerging adults, ages 18–30, with type 1 diabetes. Including the insight from racially and ethnically diverse and Medicaid-insured individuals in developing the Toolkit is essential. Background to the research: Emerging adults with type 1 diabetes have stressful challenges such as navigating the healthcare system, the costs of diabetes, and general diabetes self-management. This stress is worsened by low levels of health insurance literacy and leads to suboptimal diabetes outcomes. This issue affects many individuals but dramatically impacts those who are racially and ethnically diverse or Medicaid-insured. Design and methods used: Six online content-creation meetings were held to understand the Toolkit content needs and preferences. We analyzed the meeting transcripts to uncover common themes. Patient and public involvement: An academic research team, a national organization (The Diabetes Link), and a Community Advisory Board (CAB) partnered together. The CAB members were racially and insurance-diverse emerging adults with type 1 diabetes and content (financial, insurance, clinical diabetes) experts. We will continue to collaborate with the CAB members to develop a research protocol to test the effects of the Toolkit. Dissemination: The research findings will be shared with young adult type 1 diabetes stakeholders, healthcare providers, and community and professional organizations. Dissemination strategies will include publications, community and scientific conference presentations, community events, and social media resources and content. The finalized Toolkit will be publicly available on the Diabetes Link Resource Hub. [ABSTRACT FROM AUTHOR]

Background: The Family Physician Programme is a key health reform in Iran that faces significant challenges in urban areas, particularly in Mazandaran and Fars provinces The study aims to critically evaluate the challenges encountered in the Urban Family Physician Program, with a particular focus on the perspectives of insurance organizations. Methods: A qualitative approach was adopted, involving semi-structured interviews with 22 experts and managers from basic health insurance funds. Snowball sampling facilitated participant selection, and interviews proceeded until saturation. Data analysis utilized content analysis and Atlas-T software, adhering to COREQ criteria. Results: Implementation problems of the urban family physician program were categorized into ten Categories and 22 Subcategories, including financing, stewardship, human resources, structure, culture, information system, payment, monitoring and control, the function of insurance organizations, and implementation. Conclusion: The urban family physician program's implementation challenges, as viewed by health insurance organizations, underscore the necessity for strategic decision-making in financing, payment models, electronic system integration, structural adjustments, comprehensive monitoring, evaluation, cultural considerations, and appropriate devolution to insurance entities. [ABSTRACT FROM AUTHOR]

Background: The aim is to estimate age- and sex-specific direct medical costs related to diagnosed type 1 and type 2 diabetes in Germany between 2010 and 2040. Methods: Based on nationwide representative epidemiological routine data from 2010 from the statutory health insurance in Germany (almost 80% of the population's insurance) we projected age- and sex-specific healthcare expenses for type 1 and 2 diabetes considering future demographic, disease-specific and cost trends. We combine per capita healthcare cost data (obtained from aggregated claims data from an almost 7% random sample of all German people with statutory health insurance) together with the demographic structure of the German population (obtained from the Federal Statictical Office), diabetes prevalence, incidence and mortality. Direct per capita costs, total annual costs, cost ratios for people with versus without diabetes and attributable costs were estimated. The source code for running the analysis is publicly available in the open-access repository Zenodo. Results: In 2010, total healthcare costs amounted to more than €1 billion for type 1 and €28 billion for type 2 diabetes. Depending on the scenario, total annual expenses were projected to rise remarkably until 2040 compared to 2010, by 1–281% for type 1 (€1 to €4 billion) and by 8–364% for type 2 diabetes (€30 to €131 billion). In a relatively probable scenario total costs amount to about €2 and €79 billion for type 1 and type 2 diabetes in 2040, respectively. Depending on annual cost growth (1% p.a. as realistic scenario vs. 5% p.a. as very extreme setting), we estimated annual per capita costs of €6,581 to €12,057 for type 1 and €5,245 to €8,999 for type 2 diabetes in 2040. Conclusions: Diabetes imposes a large economic burden on Germany which is projected to increase substantially until 2040. Temporal trends in the incidence and cost growth are main drivers of this increase. This highlight the need for urgent action to prepare for the potential development and mitigate its consequences. [ABSTRACT FROM AUTHOR]

Objectives: To analyze the costs and medication patterns of patients with chronic kidney disease (CKD) and comorbidities in Xuzhou, China, using a large electronic medical records database. Methods: Data were obtained from an electronic medical records database. The annual per-person and per-visit cost of hospitalization, as well as the proportions of those costs, are presented. Results: The majority of the participants were middle-aged men, and had medical insurance. Glomerulonephritis was the primary cause of CKD in patients with an identified etiology. The average per-visit cost of hospitalization for the CKD-renal anemia and CKD-mineral and bone disorder groups was 8,674.5 (5,154.3-13,949.6) and 8,182.6 (4,798.2-12,844.7) Yuan, respectively, which was greater than that of the other groups. The major expenses incurred were for diagnostics, drug usage, surgical procedures, laboratory tests and material costs. Conclusion: The substantial burden imposed by CKD with comorbidities indicates the importance of implementing public health strategies aimed at detecting and preventing these conditions in the general population. With the aging population, our nation may experience a greater CKD-related economic burden. [ABSTRACT FROM AUTHOR]

Introduction: Population aging and internal migration have become the "norm" in China's population development. Influenced by both "mobility" and "old age," internal elderly migrants (IEMs) face the second-level digital divide problems primarily characterized by digital technology usage gap, which can lead to adverse health outcomes. Understanding the impact of the digital divide on the health of IEMs can provide effective solutions to meet the health needs of this particular group and facilitate their better integration into a digital society. Therefore, this study aims at exploring the impact of the digital divide on the health of IEMs, and identifying priorities and recommendations for improving IEMs' health by mitigating the adverse effects of the digital divide. Methods: In the 2017 China Migrant Dynamic Survey (CMDS), a cross‑sectional sample of 169,989 internal migrants in 32 provincial units across China was recruited by stratified probability proportionate to size sampling (PPS). We focus on IEMs and require interviewees to be 60 years and older. Therefore, we excluded samples younger than 60 years of age and retained only 6,478 valid samples. Subsequently, STATA 17.0 software was applied to analyze the data. Based on the research objective and Grossman's model of health demand, we empirically tested using ordered logit regression. Results: The digital divide does affect the health of IEMs in general and its negative effects tend to decrease significantly with age. In terms of groups, its impact showed noticeable group differences in residence arrangement, public health services and medical insurance coverage. Compared with IEMs who live alone or only live with their spouse, have not received public health service, and have not been covered by any medical insurance, the digital divide imposes a smaller adverse impact on the health of IEMs who live with at least one offspring, have received public health service, and have covered in at least one medical insurance. In terms of potential mechanisms, among the effects of digital divide on the health of IEMs, the mediating effect of urban integration is not significant, the social interaction has only a partial mediating effect, and the medical convenience has a significant mediating effect. Conclusion: Our findings confirm the existence of the third-level digital divide among IEMs concerning health, that is, the digital divide has adverse health outcomes for this group, and underscore the important implications of reducing the negative impact of the digital divide in improving the health status of IEMs. [ABSTRACT FROM AUTHOR]

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The current research, guided by the intersectionality theory and the Institute of Medicine's healthcare access model, explored the determinants of preventive care utilization within the Asian American community. Analyzing data from the Asian American Quality of Life Survey (with a sample size of 2535), logistic regression models were employed, incorporating various factors: demographic variables, immigration-related variables, health and access, and patient–provider relationship. Results revealed that longer stays in the U.S., having health insurance coverage, having a usual source of care, and higher satisfaction levels with prior healthcare services were associated with increased odds of utilizing preventive healthcare. These findings contribute to our comprehension of preventive care utilization among Asian Americans and offer practical insights for targeted interventions in social work and public health and strategic healthcare planning. [ABSTRACT FROM AUTHOR]