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Videotapes can provide useful records for insurance purposes when schools suffer fire or other calamitous damage. This article describes the production, editing, and storage of videotaped records of the contents of school rooms that contain specialized equipment or materials. (PGD)

A policy statement prepared by a joint committee of the American Association of University Professors and the Association of American Colleges about retirement plans and plans for insurance benefits for faculty members and administrators is presented. (MLW)

Effective personal financial planning results in sound decisions in the areas of insurance, accumulating capital, retirement planning, and tax planning. Appropriate financial planning concerns everyone--regardless of his or her stage in life. (MLW)

ImportanceSignificant insurance status disparities have been demonstrated in head and neck cancer (HNC) outcomes. The effects of insurance status on HNC outcomes may be explained by differential access to high-quality care.ObjectiveTo evaluate the association of insurance status with the quality of the treating hospital and receipt of guideline-compliant care among patients with HNC.Design, setting, and participantsThis retrospective cohort study of data from the California Cancer Registry dataset linked with discharge records and hospital characteristics from the California Department of Health Care Access and Information included adult patients with HNC diagnosed between January 1, 2010, and December 31, 2019. Data were analyzed from May 10, 2023, to March 25, 2024.ExposuresInsurance status: commercial, Medicare, Medicaid, uninsured, other, or unknown.Main outcomes and measuresQuality of the treating hospital (tertiles), receipt of National Comprehensive Cancer Network guideline-compliant care, and overall survival.ResultsA total of 23 933 patients (mean [SD] age, 64.8 [12.3] years; 75.3% male) met the inclusion criteria. Treatment in top-tertile hospitals (hazard ratio, 0.87; 95% CI, 0.79-0.95) was associated with improved overall survival compared with treatment in bottom-tertile hospitals. Medicare (odds ratio [OR], 0.78; 95% CI, 0.73-0.84), Medicaid (OR, 0.60; 95% CI, 0.54-0.66), and uninsured (OR, 0.38; 95% CI, 0.29-0.49) status were associated with lower likelihood of treatment in high-quality hospitals compared with commercial insurance. Among patients with advanced disease, Medicaid (OR, 0.72; 95% CI, 0.62-0.83) and uninsured (OR, 0.64; 95% CI, 0.44-0.93) patients were less likely to receive dual-modality therapy. Among patients with surgically resected advanced disease, Medicaid coverage (OR, 0.73; 95% CI, 0.58-0.93) was associated with lower likelihood of receiving adjuvant radiotherapy.Conclusions and relevanceThis study found significant insurance disparities in quality of care among patients with HNC. These findings highlight the need for continued health insurance reform in the US to improve the quality of insurance coverage, in addition to expanding access to health insurance.

OBJECTIVE: There has been little evidence of the impact of preventive services during pregnancy covered under the Affordable Care Act (ACA) on birthing parent and infant outcomes. To address this gap, this study examines the association between Medicaid expansion under the ACA and birthing parent and infant outcomes of low-income pregnant people. METHODS: This study used individual-level data from the 2004-2017 annual waves of the Pregnancy Risk Assessment Monitoring System (PRAMS). PRAMS is a surveillance project of the Centers for Disease Control and Prevention and health departments that annually includes a representative sample of 1,300 to 3,400 births per state, selected from birth certificates. Birthing parents outcomes of interest included timing of prenatal care, gestational diabetes, hypertensive disorders of pregnancy, cigarette smoking during pregnancy, and postpartum care. Infant outcomes included initiation and duration of breastfeeding, preterm birth, and birth weight. The association between ACA Medicaid expansion and the birthing parent and infant outcomes were examined using difference-in-differences estimation. RESULTS: There was no association between Medicaid expansion and the outcomes examined after correcting for multiple testing. This finding was robust to several sensitivity analyses. CONCLUSIONS FOR PRACTICE: Study findings suggest that expanded access to more complete insurance benefits with limited cost-sharing for pregnant people, a group that already had high rates of insurance coverage, did not impact the birthing parents and infant health outcomes examined.

BACKGROUND: A myriad of federal, state, and organizational policies are designed to improve access to evidence-based healthcare, but the impact of these policies likely varies due to contextual determinants of, reinterpretations of, and poor compliance with policy requirements throughout implementation. Strategies enhancing implementation and compliance with policy intent can improve population health. Critically assessing the multi-level environments where health policies and their related health services are implemented is essential to designing effective policy-level implementation strategies. California passed a 2019 health insurance benefit mandate requiring coverage of fertility preservation services for individuals at risk of infertility due to medical treatments, in order to improve access to services that are otherwise cost prohibitive. Our objective was to document and understand the multi-level environment, relationships, and activities involved in using state benefit mandates to facilitate patient access to fertility preservation services. METHODS: We conducted a mixed-methods study and used the policy-optimized exploration, preparation, implementation, and sustainment (EPIS) framework to analyze the implementation of Californias fertility preservation benefit mandate (SB 600) at and between the state insurance regulator, insurer, and clinic levels. RESULTS: Seventeen publicly available fertility preservation benefit mandate-relevant documents were reviewed. Interviews were conducted with four insurers; 25 financial, administrative, and provider participants from 16 oncology and fertility clinics; three fertility pharmaceutical representatives; and two patient advocates. The mandate and insurance regulator guidance represented two Big P (system level) policies that gave rise to a host of little p (organizational) policies by and between the regulator, insurers, clinics, and patients. Many little p policies were bridging factors to support implementation across levels and fertility preservation service access. Characterizing the mandates functions (i.e., policy goals) and forms (i.e., ways that policies were enacted) led to identification of (1) intended and unintended implementation, service, and patient outcomes, (2) implementation processes by level and EPIS phase, (3) actor-delineated key processes and heterogeneity among them, and (4) inner and outer context determinants that drove adaptations. CONCLUSIONS: Following the midstream and downstream implementation of a state health insurance benefit mandate, data generated will enable development of policy-level implementation strategies, evaluation of determinants and important outcomes of effective implementation, and design of future mandates to improve fit and fidelity.

BACKGROUND: While insurance reimbursements allay a portion of costs associated with cardiac operations, uncovered and additional fees are absorbed by patients. An examination of financial toxicity (FT), defined as the burden of patient medical expenses on quality of life, is warranted. Therefore, the present study used a nationally representative database to demonstrate the association between insurance status and risk of financial toxicity (FT) among patients undergoing major cardiac operations. METHODS: Adults admitted for elective coronary artery bypass grafting (CABG) and isolated or concomitant valve operations were assessed using the 2016-2019 National Inpatient Sample. FT risk was defined as out-of-pocket expenditure >40% of post-subsistence income. Regression models were developed to determine factors associated with FT risk in insured and uninsured populations. To demonstrate the association between insurance status and risk of FT among patients undergoing major cardiac operations. RESULTS: Of an estimated 567,865 patients, 15.6% were at risk of FT. A greater proportion of uninsured patients were at risk of FT (81.3 vs. 14.8%, p

Following New York’s highest court’s reinstatement of New York Insurance Regulation 187 in October 2022, consumer advocates have been hopeful that customer-focused standards supporting client best interest and only suitable products would next be adopted in California. As it happened, the California Department of Insurance had concerns over NAIC’s Model Annuity Suitability Regulation not going far enough to place the buyer’s interests above those of the seller (the agent or the carrier) and was inspired to press for New York-style regulations covering not just the sale of annuities but also life insurance. While 36 states have (as of April 2023) adopted the NAIC regulation, California has yet to do so, but is obligated to adopt at least minimum standards by 2025 or be in peril of federal intervention. The timing seemed appropriate for enhanced protection for consumers buying cash value life insurance and annuities. But during California’s harsh winter and early spring, strong headwinds pushed hard on more than its fragile climate. [ABSTRACT FROM AUTHOR]

Deliberate ignorance is the willful choice not to know the answer to a question of personal relevance. The question of whether a man is the biological father of his child is a sensitive issue in many cultures and can lead to litigation, divorce, and disinheritance. Thanks to DNA tests, men are easily able to resolve the uncertainty. Psychological theories that picture humans as informavores who are averse to ambiguity suggest men would do a DNA test, as does evolutionary theory, which considers investing in raising a rival's offspring a mistake. We conducted two representative studies using computer-based face-to-face interviews in Germany (n = 969) and Spain (n = 1,002) to investigate whether men actually want to know and how women would react to this desire. As a base line, Germans (Spanish) estimated that 10% (20%) of fathers mistakenly believe that they are the biological father of their child. Nevertheless, in both countries, only 4% of fathers reported that they had performed a DNA paternity test, while 96% said they had not. In contrast, among men without children, 38% (33%) of Germans (Spanish) stated they would do a DNA test if they had children, mostly without telling their partners. Spanish women with children would more often disapprove of a paternity test or threaten their husbands with divorce (25%) than would German women (13%). We find that a simple test of risk aversion, measured also by the purchase of non-mandatory insurances, is correlated with not wanting to know. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess the economic burden of prostate cancer in Iran by analyzing direct medical costs, direct non-medical costs, and indirect costs. We conducted a cross-sectional cost-of-illness study in Khorramabad, located in western Iran, during 2023, using a prevalence-based, bottom-up approach. Data were collected from 285 prostate cancer patients using questionnaires, interviews, and patient records. Results: Our study estimated the economic burden of prostate cancer at $744,990. Direct medical costs accounted for 63.50% of this, totaling $153,330, with therapy being the largest component. Direct non-medical costs were $62,130, and indirect costs from productivity losses were $209,760. The calculated overall cost per patient was $2,614.88. Extrapolating from the 2021 Global Burden of Disease data, which reported approximately 83,000 prostate cancer patients in Iran, the national economic burden is estimated at $217,034,040. This substantial burden highlights the need for improved insurance coverage and early detection. The findings suggest that policymakers and healthcare providers in Iran should develop standardized cost analysis methods and enhance financial protection to alleviate economic strain and improve healthcare outcomes and sustainability. [ABSTRACT FROM AUTHOR]

Strong claims have been made about the significance of the concept of security in modern governance. The study of security has developed from its post-1945 focus on the state’s role in securing the population from external threat to include broader and critical perspectives, which seek to embed the concept of security in its cultural and historical contexts. This article traces the origins of contemporary security culture in Australia to the first half of the twentieth century. It examines the concept of security from debates about the provision of national insurance and the amelioration of the suffering of the Great Depression to the Curtin and Chifley Labor governments’ postwar reconstruction program in the 1940s. The article argues that the origins of national security culture in the present lie in mid-twentieth-century debates about the role of the state in securing the population from economic deprivation, unemployment and ill health. [ABSTRACT FROM AUTHOR]

Rapid and accurate maps of floods across large domains, with high temporal resolution capturing event peaks, have applications for flood forecasting and resilience, damage assessment, and parametric insurance. Satellite imagery produces incomplete observations spatially and temporally, and hydrodynamic models require tradeoffs between computational efficiency and accuracy. We address these challenges with a novel flood model which predicts surface water area from the U.S. National Water Model using a convolutional neural network (NWM‐CNN). We trained NWM‐CNN on 780 flood events, at a 250 m resolution with an RMSE of 4.58% on held out validation geographies. We demonstrate NWM‐CNN across California during the 2023 atmospheric rivers, comparing predictions against Sentinel‐1 mapped flood observations. We compared historical predictions from 1979 to 2023 to flood damage reports in Sacramento County, California. Results show that NWM‐CNN captures inundation extent better than the Height Above Nearest Drainage (HAND) approach (25%–36% RMSE, respectively). Plain Language Summary: We use machine learning (ML) to map floods quickly and accurately over large areas, which can help with predicting flooded extent, understanding impact, and aiding flood insurance and response. On their own, satellite images don't catch everything because they may be obscured or unavailable at the peak of a flood. Computer models that predict floods require a trade‐off between speed, accuracy, and resolution. Our solution uses ML to learn from the U.S. National Water Model and satellite images from past floods to predict how much of an area will be covered in water. We demonstrate this on floods in California in 2023 caused by atmospheric rivers, and we looked back at floods in Sacramento County from 1979 to 2023. We compared our method to another commonly used model and found ours was more accurate, making it a promising tool for future flood mapping and response planning. Key Points: Convolution neural networks (CNN) are suitable for rapid modeling of surface water dynamics for large‐scale inundation mappingWe deploy a CNN for continuous flood mapping across all of California during the devastating 2023 atmospheric river (AR) eventsInundation extent across Sacramento is more accurately predicted with CNN than the Height Above Nearest Drainage (HAND) [ABSTRACT FROM AUTHOR]

The probability of ruin of an insurance company is one of the main risk measures considered in risk theory, and the problems of its calculation and approximation have attracted much attention. Statistical estimations have been developed on the ruin probability in infinite time for insurance loses from heavy-tailed distributions. However, these estimation suffer heavily from under-coverage or have a robustness problem. We therefore need another method for estimating the probability of ruin in infinite time for heavy-tailed losses. In this paper, we introduce a robust estimator of the infinite-time probability of ruin for such distributions. Our methodology is based on extreme value theory, which offers adequate statistical results for such distributions. Our approach is based on a sensitive distribution known as the t-Hill estimator (t-score or score moment estimation) for the index of any tail distribution and introduced in Fabiáan and Stehlík. We establish their asymptotic normality, and through a simulation study, illustrate their behaviour in terms of absolute bias and mean squared error. The simulation results show that our estimators perform well and that they are fairly robust to outliers. [ABSTRACT FROM AUTHOR]

Background: Efficiency, equity and financial risk protection are key health systems objectives. Equitable distribution of health care is among the priority strategic initiative of the government of Ethiopia. However, data on the distribution of interventions benefits or on disease burden disaggregated by subpopulations to guide health care priority setting is not available in Ethiopia. Methods: Aligned with policy documents, we identified the following groups to be the worse off in the Ethiopian context: under-five children, women of reproductive age, the poor, and rural residents. We used the Delphi technique by a panel of 28 experts to assign a score for 253 diseases/conditions over a period of two days, in phases. The expert panel represented different institutes and professional mix. Experts assigned a score 1 to 4; where 4 indicates disease/condition predominantly affecting the poor and rural residents and 1 indicates a condition more prevalent among the wealthy and urban residents. Subsequently, the average equity score was computed for each disease/condition. Results: The average scores ranged from 1.11 (for vitiligo) to 3.79 (for obstetric fistula). We standardized the scores to be bounded between 1 and 2; 1 the lowest equity score and 2 the highest equity score. The scores for each disease/condition were then assigned to their corresponding interventions. We used these equity scores to adjust the CEA values for each of the interventions. To adjust the CEA values for equity, we multiplied the health benefits (the denominator of the cost-effectiveness value) of each intervention by the corresponding equity scores, resulting in equity adjusted CEA values. The equity adjusted CEA was then used to rank the interventions using a league table. Conclusions: The Delphi method can be useful in generating equity scores for prioritizing health interventions where disaggregated data on the distribution of diseases or access to interventions by subpopulation groups are not available. [ABSTRACT FROM AUTHOR]

Aim Materials and Methods Results Conclusions To comprehensively examine the range of co‐morbidities among males and females with a diagnosis of obesity.This cross‐sectional retrospective study used US commercial and Medicare claims data from Merative MarketScan Research Databases to identify adults (age ≥ 18 years) with a diagnosis of obesity with continuous insurance coverage from 2018 to 2020. Co‐morbidities were tabulated based on coded diagnoses, and prevalences were calculated in males and females across age groups. Age‐adjusted odds ratios (ORs) determined differences in co‐morbidities between the sexes.Of an eligible sample of 6.9 million, we identified 2 028 273 individuals with at least one obesity‐related International Classification of Diseases, 10th Revision, Clinical Modification code. The proportions of males and females with obesity were 43.0% versus 57.0%. The most prevalent co‐morbidities among males and females were hypertension (62.8% vs. 52.2%), dyslipidaemia (63.3% vs. 50.3%) and depression and/or anxiety (D/A; 29.7% vs. 48.5%). The prevalence of D/A was high in the younger age group, but steadily decreased with age in both sexes; however, hypertension and dyslipidaemia continued to increase with age. The presence of diagnosis of hypertension and dyslipidaemia was 6‐8 years earlier in males than in females. Females had higher odds than males for osteoarthritis (OR 1.33), depression (OR 2.22) or osteoporosis (OR 7.10); all P < .0001.Males with obesity received a diagnosis of cardiovascular risk factors at an earlier age than females, which may have contributed to the higher prevalence of coronary heart disease. Understanding sex‐specific variations in co‐morbidities across ages can support early screening and diagnosis of risk clusters for optimal obesity management. [ABSTRACT FROM AUTHOR]

Cancer is the top leading cause of death among Latino people. Lack of health insurance is a significant contributor to inadequate cancer detection and treatment. Despite healthcare policy expansions such as the Affordable Care Act, Latino people persistently maintain the highest uninsured rate among any ethnic and racial group in the US, especially among Latino individuals who are immigrants or part of a mixed immigration status household. Recognizing that immigration status is a critical factor in the ability of Latino community members to seek health insurance and access healthcare services, a few US states and the District of Columbia have implemented policies that have expanded coverage to children and adults regardless of immigration status. Expansion of Medicaid eligibility regardless of immigration status may significantly benefit Latino communities, however the facilitators and barriers to enrolling in these programs need to be evaluated to ensure reach and achieve health equity across the cancer control continuum for all Latinos. [ABSTRACT FROM AUTHOR]

Objective To develop a framework and index for measuring universal health coverage (UHC) at the district level in India and to assess progress towards UHC in the districts. Methods We adapted the framework of the World Health Organization and World Bank to develop a district-level UHC index (UHCd). We used routinely collected health survey and programme data in India to calculate UHCd for 687 districts from geometric means of 24 tracer indicators in five tracer domains: reproductive, maternal, newborn and child health; infectious diseases; noncommunicable diseases; service capacity and access; and financial risk protection. UHCd is on a scale of 0% to 100%, with higher scores indicating better performance. We also assessed the degree of inequality within districts using a subset of 14 tracer indicators. The disadvantaged subgroups were based on four inequality dimensions: wealth quintile, urban--rural location, religion and social group. Findings The median UHCd was 43.9% (range: 26.4 to 69.4). Substantial geographical differences existed, with districts in southern states having higher UHCd than elsewhere in India. Service coverage indicator levels were greater than 60%, except for noncommunicable diseases and for service capacity and access. Health insurance coverage was limited, with about 10% of the population facing catastrophic and impoverishing health expenditure. Substantial wealth-based disparities in UHC were seen within districts. Conclusion Our study shows that UHC can be measured at the local level and can help national and subnational government develop prioritization frameworks by identifying health-care delivery and geographic hotspots where limited progress towards UHC is being made. [ABSTRACT FROM AUTHOR]

Background: Family support (FS) is a key social determinant of health for transgender and gender-diverse (TGD) young adults. We examined the association between FS and health outcomes in young adults seeking gender-affirming hormone therapy (GAHT) from a US telehealth service. Methods: Cross-sectional data from TGD young adults ages 18–24 (n = 7,740) who provided demographic information and information on FS at intake were analyzed. Relationships between FS, geography, insurance status, rates of depression, and smoking status were examined. Results: Less than half of respondents reported having FS. Patients with FS reported lower rates of depression and higher incidence of previous gender-affirming medical care (e.g., hormone therapy, surgeries), had lower rates of being uninsured, and were more likely to reside in the Northeast or Western United States. Young adults assigned female at birth had higher rates of FS. Conclusion: FS may mitigate mental health disparities in TGD young adults including rates of depression. FS and insurance status are closely related in a geographically diverse population seeking telehealth services. The finding underscores the importance of FS as a social determinant of health and the unique characteristics of patients seeking telehealth services. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The annual mean spending measures typically used to study longitudinal trends mask distributional and seasonal variation that is relevant to patients' perceptions of health care affordability and, in turn, provider collections. This study describes shifts in the distribution and seasonality of plan and patient out-of-pocket spending from 2012 through 2021. STUDY DESIGN: Analysis of multipayer commercial claims.data. METHODS: Medical spending per enrollee was calculated by summing inpatient, outpatient, and professional services, which comprised plan payments and out-of-pocket payments (deductible, coinsurance, co-payment). To account for the long right tail of the spending distribution, enrollees were stratified by their decile of annual medical spending, and annual mean spending estimates were calculated overall and by decile. Mean spending estimates were also calculated by quarter-year. RESULTS: Inflation-adjusted medical spending grew most quickly among the highest decile of spenders, without proportional growth in their out-of-pocket expenses. Out-of-pocket spending increased for the majority of enrollees in our sample prior to the COVID-19 pandemic, in real dollars and as a share of total medical spending. Out-of-pocket spending was increasingly concentrated in the early months of the calendar year, driven by deductible spending, and was lower in 2020 and 2021, plausibly due to policies limiting cost sharing for COVID-19--related services. CONCLUSIONS: Insurance is working well to protect the highest spenders at the cost of reduced insurance generosity among spenders elsewhere in the distribution. The increasing cross-subsidization among enrollees through cost-sharing design--vs premiums--is a trend to watch among rising public concerns about underinsurance and medical debt. [ABSTRACT FROM AUTHOR]

Background The Affordable Care Act (ACA) increased private nonemployer health insurance options, expanded Medicaid eligibility, and provided preexisting health condition protections. We evaluated insurance coverage among long-term adult survivors of childhood cancer pre- and post-ACA implementation. Methods Using the multicenter Childhood Cancer Survivor Study, we included participants from 2 cross-sectional surveys: pre-ACA (2007-2009; survivors: n = 7505; siblings: n = 2175) and post-ACA (2017-2019; survivors: n = 4030; siblings: n = 987). A subset completed both surveys (1840 survivors; 646 siblings). Multivariable regression models compared post-ACA insurance coverage and type (private, public, uninsured) between survivors and siblings and identified associated demographic and clinical factors. Multinomial models compared gaining and losing insurance vs staying the same among survivors and siblings who participated in both surveys. Results The proportion with insurance was higher post-ACA (survivors pre-ACA 89.1% to post-ACA 92.0% [+2.9%]; siblings pre-ACA 90.9% to post-ACA 95.3% [+4.4%]). Post-ACA insurance increase in coverage was higher among those aged 18-25 years (survivors: +15.8% vs +2.3% or less ages 26 years and older; siblings +17.8% vs +4.2% or less ages 26 years and older). Survivors were more likely to have public insurance than siblings post-ACA (18.4% vs 6.9%; odds ratio [OR] = 1.7, 95% confidence interval [CI] = 1.1 to 2.6). Survivors with severe chronic conditions (OR = 4.7, 95% CI = 3.0 to 7.3) and those living in Medicaid expansion states (OR = 2.4, 95% CI = 1.7 to 3.4) had increased odds of public insurance coverage post-ACA. Among the subset completing both surveys, low- and mid-income survivors (<$40 000 and <$60 000, respectively) experienced insurance losses and gains in reference to highest household income survivors (≥$100 000), relative to odds of keeping the same insurance status. Conclusions Post-ACA, more childhood cancer survivors and siblings had health insurance, although disparities remain in coverage. [ABSTRACT FROM AUTHOR]

Comprehensive computerized gait analysis (CGA) alters orthopedic surgical plans and improves outcomes. Despite these documented benefits, CGA is not widely available to all patients who could be helped by it. Research Question: Do social determinants of health impact access to CGA? Retrospective review of patients seen for CGA from 2021 to 2022. Dates of referral, insurance approval and completion of CGA, demographics and insurance type were extracted from patient records. Zip codes were used to determine the neighborhood socioeconomic status (SES). Data were analyzed using non-parametric statistics. Insurance type affected time to authorization (private insurance/self-pay: median 9 days; HMO insurance: median 51.5 days; public insurance: median 27 days; p=0.0004). Once authorized, insurance type did not affect time to schedule and complete CGA (p=0.76). Lower neighborhood SES was associated with longer time to authorization but shorter time to complete CGA once authorized. Rescheduling was associated with longer time to complete CGA once authorized (median 29.5 vs. 16 days, p<0.0001). White, non-Hispanic families tended to reschedule more often than non-white or Hispanic families (35 % vs. 18 %, p=0.07). Knowledge of barriers to CGA is necessary in order to design and implement effective strategies to widen its availability to all whom it could benefit. Social determinants of health and insurance type are associated with delays in authorization for CGA. Families with public insurance and HMO coverage experience delays in obtaining insurance authorization compared to PPO/self-pay patients, whose tests did not require prior authorization. However, there can also be delays in scheduling and completing CGA once authorized. This is a multi-faceted issue that requires further research. • Low neighborhood SES and public or HMO insurance delayed authorization for CGA. • Low neighborhood SES and public or HMO insurance did not delay CGA once authorized. • White, non-Hispanic patients had high neighborhood SES and rescheduled more often. • Primary language and race/ethnicity did not impact access to CGA. [ABSTRACT FROM AUTHOR]

This editorial comments on the article by Kim et al. [ABSTRACT FROM AUTHOR]

The multiple benefits of family-based treatment (FBT) used in substance use disorder (SUD) treatment include increased treatment engagement, better treatment outcomes, and cost-effectiveness compared to other behavioral health treatment modalities. However, the prevalence and types of FBTs offered among SUD treatment facilities are largely unknown. The present study used data collected during 2009–2010 from 325 treatment centers in the United States to (1) explore the prevalence in the utilization of FBT in SUD treatment, and (2) identify differences between treatment facilities that do and do not offer FBT. Results indicated that the adoption of FBT was negatively associated with the percentage of clients who were unemployed or involved in the criminal justice system at time of intake, and positively related to the number of hours of individual therapy and treatment center emphasis on utilizing the 12 Steps. Additionally, the majority of treatment centers that followed the American Society of Addiction Medicine (ASAM) clinical guidelines offered FBT. Lastly, the percentage of families involvement was negatively associated with centers' proportion of revenues from Medicaid (i.e., health insurance for those with limited income) and positively associated with treatment center revenues from private insurance. The impact of having FBT in SUD treatment centers is discussed. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to examine the association between Medicaid dental benefits for pregnant people and dental care use among very young children in Medicaid. We hypothesized that children living in states with more generous dental benefits for Medicaid-enrolled pregnant people would be more likely to have a recent dental visit. Methods: This national cross-sectional study used pooled 2017–2019 data from the National Survey of Children's Health, as well as state Medicaid policy data. The study sample included children aged 0–2 enrolled in Medicaid. Multivariable logistic regression models estimated the association between Medicaid dental benefit generosity for pregnant people and the child having a dental visit in the past year. Results: Children in states with emergency-only dental coverage for pregnant people were 2.5 times as likely to have had a dental visit than children in states with extensive coverage (OR 2.48, 95% CI 1.35–4.53). In supplemental analyses excluding children living in Texas, there was no longer an association between dental coverage for pregnant people and dental utilization among young children (OR 1.52, 95% CI 0.82–2.83). Conclusions for practice: Young children in states that provided emergency-only dental benefits for pregnant people in Medicaid had significantly higher odds of dental utilization than young children in states with more generous dental benefits for pregnant people. This relationship disappeared after excluding the state Texas, which had the highest rate of child dental utilization in the country and provided emergency-only dental benefits for pregnant people in Medicaid. Significance: In previous research, dental benefit generosity for Medicaid-enrolled pregnant people has been found to be related to utilization of dental care for pregnant people, and dental benefit generosity for adults has been found to have spillover effects on children's dental care use. This is the first study to examine the relationship between Medicaid dental benefit generosity for pregnant people and dental care use among very young children. [ABSTRACT FROM AUTHOR]

Reduction mammaplasty improves the quality of life by providing functional and aesthetic benefits to women with macromastia. This study contributes to the existing literature on socioeconomic and clinical barriers to referral for plastic surgery procedures by focusing specifically on reduction mammaplasty. Patients with macromastia were identified via a chart review in a single institution from 2021–2022. The treatment pathway for each patient was characterized by reception of referral, completion of plastic surgery consultation, and eventual reception of surgery. After controlling for clinical covariates, multivariate logistic regression was applied to quantify the independent impact of race, insurance, and language status on the completion of surgery (p < 0.05). The final patient cohort included 425 women with macromastia. Among the 151 patients who were first seen by a primary care physician, 64 (42%) completed an initial plastic surgery consultation. Among all patients, 160 (38%) eventually underwent reduction mammaplasty. Multivariate regression predictions indicated a lower likelihood of completing breast reduction surgery in patients with current smoking history (OR: 0.08, 95% CI: 0.01–0.59) and higher body mass index (BMI) (OR: 0.94, 95% CI: 0.90–0.97) (p < 0.05). Minority race and ethnicity, private insurance status, and primary language status were not significant predictors of this outcome (p > 0.05). In this study, the socioeconomic variables were not independent predictors of breast reduction surgery completion. However, the association of minority race and ethnicity and nonprivate insurance status with the most common reasons for breast reduction deferral suggest an indirect influence of socioeconomic status on the treatment pathway. [ABSTRACT FROM AUTHOR]

Depression occurs among the elderly, leading to increased use of medical facilities, adversely affecting quality of life (QoL), and increasing mortality. Fewer studies have been conducted to explore the factors that contribute to depression among the elderly. The purpose of this study was to identify the factors that trigger depression in this population. This research used descriptive analysis with a cross-sectional design. A total of 247 participants completed a questionnaire containing socio-demographic information and the geriatric depression scale-15 (GDS-15). The data were analyzed for correlation using the chi-square test. There was a significant relationship between insurance and occupation and depression in rural communities in Central Java, Indonesia. Insurance and occupation influence elderly individuals’ preparation for old age, ensuring they have sufficient finances through old age savings, which enables them to be financially secure. The population needs to prepare for old age by calculating their retirement fund requirements, saving and investing, and obtaining insurance for pension and health fund protection. [ABSTRACT FROM AUTHOR]

In the United States (U.S.), chronic pain poses substantial challenges in rural areas where access to effective pain management can be limited. Our literature review examines chronic pain management in rural U.S. settings, identifying key issues and disparities. A comprehensive search of PubMed, Web of Science, and Google Scholar identified high-quality studies published between 2000 and 2024 on chronic pain management in the rural U.S. Data were categorized into thematic areas, including epidemiology, management challenges, current strategies, research gaps, and future directions. Key findings reveal that rural populations have a significantly higher prevalence of chronic pain and are more likely to experience severe pain. Economic and systemic barriers include a shortage of pain specialists, limited access to nonpharmacologic treatments, and inadequate insurance coverage. Rural patients are also less likely to engage in beneficial modalities like physical therapy and psychological support due to geographic isolation. Additionally, rural healthcare providers more often fulfill multiple medical roles, leading to burnout and decreased quality of care. Innovative approaches such as telehealth and integrated care models show the potential to improve access and outcomes. Our review highlights the need for increased telehealth utilization, enhanced provider education, and targeted interventions to address the specific pain needs of rural populations. [ABSTRACT FROM AUTHOR]

The insurance industry is one of the largest financial areas that due to its service nature, customers can create different values, and the marketing efforts of insurance companies in attracting and retaining different groups of customers have led them to implement various loyalty programs, in which one of the criteria for grouping customers is the customer lifetime value (CLV). In this regard, this research has been conducted with the aim of designing and evaluating the loyalty program of insurance industry customers based on their lifetime value as an applied mixed exploratory, and cross-sectional research. The statistical population of the classification stage was 800 customers registered in the database of Shiraz insurance branches in 2018, and the statistical sample for prioritizing loyalty programs was 40 customers who were randomly selected using the Morgan table and based on access and willingness to participate in the study, the sample was completed. In the first stage, through systematic review, 28 loyalty programs were identified, and 15 valid programs were extracted using the content validity ratio (CVR), and these programs were categorized, and the Kappa index was used to assess categorization reliability. Therefore, in the second stage, the weights of LRFM indexes were determined with the analytic hierarchy process (AHP) and then the customers were classified into four groups of keys, intermittent, prodigal, and uncertain clusters customers using their data in insurance branches databank. Finally, the customers' priority of identified programs in each group was determined using the fuzzy best–worst method (FBWM). The findings show that from the perspective of customers, intangible and long-term programs are more attractive to key customers, while for intermittent customers, long-term tangible loyalty programs, for uncertain customers, immediate loyalty programs, and for prodigal customers, intangible loyalty programs are more attractive. The results of this study can be used in the formulation of loyalty programs in the insurance industry, in such a way that suitable loyalty programs are considered for each group of customers depending on the customers' CLV. Such as in designing loyalty programs, the tangibility and time horizon must be considered. Also, each group of programs must be suitable to customers' CLV. [ABSTRACT FROM AUTHOR]

Being able to pivot quickly from in-person visits to telehealth and conduct an effective remote physical exam is possible with the right workflows. [ABSTRACT FROM AUTHOR]

Low income households in agrarian developing economies face considerable livelihood risks, which have negative impacts on welfare. A growing literature focuses on internal constraints on development, which can negatively affect saving and investment behavior. Here I propose that internal constraints may also hinder risk management. Specifically, I present a theoretical model that explores how fairness preferences may create an internal constraint on risk sharing, particularly in a context of wealth inequality, and thereby also affect demand for formal insurance. To test this theory, I utilize a lab experiment, conducted in Ghana, to investigate the impact of wealth inequality on utilization of risk‐management tools, interpersonal risk sharing and formal insurance, and explore how fairness preferences may mediate this effect. I find that inequality reduces risk sharing and increases demand for insurance. Moreover, I find suggestive evidence that fairness preferences create an internal constraint on risk sharing under inequality. [ABSTRACT FROM AUTHOR]

Despite the growing demand for long‐term care (LTC), the uptake of private LTC insurance (LTCI) is low and even declining in the United States. One reason is the complexity of LTCI decisions. Researchers have therefore suggested to support decision‐making abilities. This paper shows, however, that such support would not unambiguously enhance functioning of the LTCI market. We analyze whether selection arises from two correlated but different decision‐making abilities at old age, education and numeracy, and interactions thereof with private information. Using historical data from the Health and Retirement Survey we find that education generates adverse selection, which is only partially offset by advantageous selection due to numeracy. In addition, individuals with greater decision‐making abilities make better LTCI choices, amplifying selection by education and numeracy. This points at a trade‐off between decision simplicity and selection in insurance markets and suggests other steps are needed to enhance the performance of private LTCI markets. [ABSTRACT FROM AUTHOR]

We propose a multiperiod insurance model under a bonus–malus system with two rate classes and consider an insured who has purchased full insurance for her losses. To explore the potential advantage of underreporting her insurable losses, the insured follows a barrier strategy and only reports lossses above the barrier to the insurer. We obtain a unique equilibrium declaration strategy in closed form for a risk‐neutral insured who maximizes her expected wealth, and in semiclosed form for a risk‐averse insured who maximizes her expected exponential utility of wealth, both over an exogenous random horizon. We find that the equilibrium barriers for the two classes are equal and strictly greater than zero, offering a theoretical explanation for the underreporting of insurable losses, a form of ex post moral hazard. Finally, we consider the case of three rate classes and show, through numerical examples, that the equilibrium barriers are not equal. [ABSTRACT FROM AUTHOR]

Data is an important resource for public and private sector agencies who manage flood risk. Insurance companies use various types of data to assess, categorize, and price a property’s flood risk, including flood hazard areas and property-specific characteristics. Government agencies, such as municipalities, also use data to identify flood-prone areas and make decisions that prevent and mitigate property flood damages, such as development restrictions and infrastructure upgrades. In a time of rising economic flood damages and future climate risk uncertainties, there are increasing calls to foster flood risk governance integration “through information transfer, coordination, and cooperation” (Gilissen et al. 2016, p. 12). This study presents the Resilience Bridge Platform (“RB Platform”)—a data platform designed to facilitate the exchange of flood risk and resilience data between insurers and Canadian municipal officials. Senior staff and executives in both sectors evaluated the RB Platform and weighed in on the Platform’s ability to foster cross-sector collaboration and drive actions that could reduce the number of high-risk “uninsurable” properties. The study discusses the strengths, weaknesses, and lessons learned from the evaluation of the RB Platform as a tool to foster integrated governance for effective flood risk management. [ABSTRACT FROM AUTHOR]

The arrival of “big data” promises new degrees of precision in understanding human behavior. Could it also allow drawing a finer line between “choice” and “circumstances”? In a culture in which individual responsibility continues to be celebrated, this raises questions about new opportunities for institutional design with a stronger focus on individual responsibility. But what is it that can be learned from big data? In this paper I argue that we should not expect a “god’s eye view” on choice versus circumstances from big data. “Responsibility” is a social construct that depends on the logic of different social situations, as well as our epistemic access to certain counterfactuals (e.g., whether an agent “could have acted differently”). It is this epistemic dimension that changes with the arrival of big data. But while this might help overcome some epistemic barriers, it might also create new problems, e.g., because of polluted and hence biased data. This is not just a theoretical problem; it is directly connected to the regulation of insurance. The new developments force us to directly confront questions about mutualist versus solidaristic forms of insurance, and more generally about how much weight to ascribe to individual responsibility, given all we know about unequal background circumstances. [ABSTRACT FROM AUTHOR]

Latinx persons have lower levels of health insurance coverage than other racial and ethnic groups even after passage of the Patient Protection and Affordable Care Act (ACA). Using 182 interviews from the American Voices Project, this study examines how U.S.-born Latinx adults experience health-care coverage and health-care use. Interview data demonstrate that health-care access is insufficient to ensure full health-care use. Health-care use costs are so high that they are insurmountable for Latinx Americans. Wealth and liquid assets constrain and are constrained by health-care use. Family members become a safety net. This study can inform policies and programs aiming to improve equity in Latinx individuals' health-care access by centering the importance of reducing economic costs of health-care use. [ABSTRACT FROM AUTHOR]

This article explores the integration of cyberrisk quantification into risk governance, specifically focusing on risk appetite and tolerance. It acknowledges the challenges organizations face in this area and suggests that cyberrisk quantification can help address these challenges. The article outlines a framework for operationalizing risk governance, including steps such as CRQ assessments and setting risk appetite. It emphasizes the importance of aligning risk reduction projects with an organization's risk appetite and adjusting the budget accordingly. The text also discusses the importance of quantitatively governing cybersecurity, managing cyberrisk, and considering risk transfer strategies such as cyberinsurance. It highlights the need for capital allocation to account for residual risk not covered by insurance. Overall, the article provides guidance on aligning cybersecurity with other operational risks and improving risk governance. [Extracted from the article]

This article describes the design and analysis of web‐based choice experiments that examine how the demand for earthquake protection in Quebec and British Columbia (BC), Canada, is influenced by the default option and the structure of the insurance plan. Homeowners in both provinces were given the opportunity to purchase protection against earthquake losses when presented with one of the following options: the current private insurance plan and proposed public–private Risk Pools with different levels of the public layer. The default frame was changed so the homeowner could either opt‐in by purchasing this coverage or opt‐out of being given this protection and receiving a premium discount. Assigning participants to the public–private Risk Pools rather than the current private insurance plan increases the likelihood of purchasing earthquake insurance protection by an odds ratio of 2.7 or greater in BC and Quebec. Furthermore, opt‐out enrollment design substantially increases take‐up of earthquake protection relative to opt‐in enrollment. The policy implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

AbstractIn the context of actuarial science, the second largest claim amount is crucial to insurance analysis since they provide useful information for determining annual premium. In this article, we provide sufficient conditions of the second largest claim amounts arising from two sets of dependent and heterogeneous individual risk models according to various stochastic orders. It is first shown that the reversed hazard order between the occurrence probabilities vectors implies the reversed hazard order of the second largest claim amounts under certain conditions. Second, sufficient conditions are established for the usual stochastic ordering of the second largest claim amounts arising from heterogeneous dependent individual risk models under copula dependence. Finally, several examples illustrating the theoretical results are presented as well. [ABSTRACT FROM AUTHOR]

Peru has a fragmented health insurance system in which most insureds can only access the providers in their insurer's network. The two largest sub-systems covered about 53% and 30% of the population at the start of the pandemic; however, some individuals have dual insurance and can thereby access both sets of providers. We use data on 24.7 million individuals who belonged to one or both sub-systems to investigate the effect of dual insurance on COVID-19 mortality. We estimate recursive bivariate probit models using the difference in the distance to the nearest hospital in the two insurance sub-systems as Instrumental Variable. The effect of dual insurance was to reduce COVID-19 mortality risk by 0.23% compared with the sample mean risk of 0.54%. This implies that the 133,128 COVID-19 deaths in the sample would have been reduced by 56,418 (95%CI: 34,894, 78,069) if all individuals in the sample had dual insurance. [ABSTRACT FROM AUTHOR]

This paper attempts to analyse the effect of insurance development on sophistication measured by the economic complexity index. Empirical analyses are carried out on a sample of 36 African countries over the period 2003-2019. In order to limit potential endogeneity biases, we run the two-step system Generalized Method of Moments and the Lewbel estimator. Empirical results, robust to a set of sensitivity analyses, show that insurance development can foster economic complexity in Africa. Moreover, when distinguishing between life and non-life insurance, empirical results remain globally unchanged, with a greater effect of non-life insurance as compared to that of life insurance. Furthermore, the mediation analysis enabled us to identify innovations and investments as some transmission channels through which insurance development may affect economic complexity in Africa. Thus, African leaders would do well to improve the regulation of the insurance business to enable it to participate effectively in financing the economy and managing risks, thereby stimulating economic complexity. [ABSTRACT FROM AUTHOR]

Background: In recent years, Iran has witnessed a remarkable increase in the incidence of cancer. This has led to an emerging challenge in the field of oncofertility, which seeks to address the impact of cancer treatments on fertility and endeavors to preserve reproduction. The study assessed healthcare providers' awareness, attitudes, and practices regarding fertility preservation (FP) in Iran. Methods: A cross-sectional study was conducted to assess healthcare providers' knowledge, attitudes, and practices regarding oncofertility. An online self-made oncofertility survey of twenty-four items was administered to randomly selected participants from a list of healthcare providers registered with the Medical Council. The data were collected anonymously via Google Forms. Descriptive statistics, including number (n), prevalence (%), mean, and standard deviation, were calculated using SPSS 26.0. Additionally, chi-square tests were used to examine associations between categorical variables. Participants were categorized into oncology, obstetrics and gynecology (OB/GYN), and other specialties. Results: A total of 423 responses were received and analyzed. Approximately 60% of the participants were obstetrics and gynecology subspecialists, while the remaining participants represented various disciplines such as surgery (9.7%), radiotherapy (6.4%), nuclear medicine (5.2%), and pediatrics (1.4%). More than 30% of the participants had not received any specific education about oncofertility, and more than 20% stated that FP strategies are not part of their routine treatment plan for young cancer patients. Oncologists had more education than those in the Obstetrics & Gynecology group. Half the participants were unaware of insurance coverage, and FP options were infrequently recommended. Conclusions: These findings highlight the urgent need to enhance healthcare workers' knowledge and attitudes toward FP in Iran and enable them to provide comprehensive support and guidance to cancer patients. [ABSTRACT FROM AUTHOR]

Introduction: The length of stay (LOS) in psychiatric hospitals is regularly used as an indicator of inpatient care efficiency and quality indicator. Psychiatric hospitalizations have been linked to a variety of clinical and patient-related factors. The objectives of this study were to assess the duration of stay in psychiatric hospital in Lebanon and to evaluate the LOS associated factors. Methods: A five years retrospective study was conducted at the Psychiatric hospital of the Cross between January 2018 and December 2022. Data on hospital admissions was obtained from medical files and the LOS was defined as the time in days elapsed between the admission and discharge date as noted in the medical file. Results: The mean duration of the global length of the stay was 28.35 ± 26.57 days, with a range between 2 and 300 and a median of 21.00 days. Being diagnosed with schizophrenia (Beta = 10.25), having a public insurance (Beta = 4.09) and having an intermediate social status (Beta = 3.45) were significantly associated with higher length of stay. Being a female (Beta = − 5.15), married (Beta = − 3.94) and older age (Beta = − 0.17) were significantly associated with lower length of stay. Conclusion: The importance of social factors should be highlighted, as they are necessary components of patients' wellbeing and may facilitate the decision of discharge. Being single, male gender and a diagnosis of schizophrenia were associated with a longer stay at the psychiatric hospital. Further studies are needed to explore the clinical implication of the factors related to LOS in order to identify patients with a higher probability for prolonged hospitalization, to plan necessary interventions for these specific situations. [ABSTRACT FROM AUTHOR]

Background: Limited research exists on the comorbidity of pulmonary tuberculosis with non-communicable diseases (NCDs) and its implications for healthcare utilization in Indonesia. The lack of investigation into NCD comorbidity among pulmonary tuberculosis patients could adversely affect both the healthcare system and the national health insurance scheme. Understanding the NCD comorbidity among pulmonary tuberculosis patients, associated factors, and healthcare utilization is crucial for ensuring the effective and efficient delivery of health services. Method: This study utilized an observational cross-sectional design based on anonymized sample data from tuberculosis cases covered by Indonesia's National Health Insurance in 2021. Chi-square tests were employed to analyze dependent and independent variables, while unadjusted and adjusted logistic regressions were used to explore further associations. Results: The prevalence of NCD comorbidity in tuberculosis patients was 11.81%. Aged over 60 (aOR 5.16; [CI] 4.23—6.3), married (aOR 1.19; [CI] 1.05—1.34), and unemployed (aOR 1.27; [CI] 1.08—1.49) were associated with the NCD comorbidity in pulmonary tuberculosis patients. Factors associated with increased inpatient service utilization among pulmonary tuberculosis patients included aged over 60 (aOR 5.69; [CI] 4.81—6.74), male (aOR 1.32; [CI] 1.23—1.40), self-employment (aOR 1.42; [CI] 1.29—1.56), having insurance subsidized by central government (aOR 1.89; [CI] 1.73—2.08) or local government funds (aOR 1.75; [CI] 1.58—1.93), and having comorbidity non-communicable diseases (aOR 1.80; [CI] 1.66—1.96). Conclusion: Pulmonary tuberculosis patients exhibit a significant prevalence of NCD comorbidity, which substantially impacts healthcare utilization. Early detection and management of these conditions are critical to mitigate burdens on both the healthcare system and the financial sustainability of the national health insurance scheme. Integrating health services for tuberculosis and NCDs through bidirectional screening is essential for comprehensive patient care. [ABSTRACT FROM AUTHOR]

Background: Mental illnesses are common among children and negatively impact wellbeing during childhood as well as later in life. However, many children with these conditions are not able to access needed mental health care. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) was created to reduce gaps in access to care by providing primary care providers with referral resources, access to behavioral health consultations, and training on mental health topics. Objectives: The purpose of this study was 1) to assess the effectiveness of the WI CPCP in Milwaukee County, providing specific insights into provider's ability to care for child mental health, and 2) identify challenges Milwaukee PCPs faced in providing mental health care to child patients and contextualize these challenges in a conceptual framework of access to health care. Methods: A cross-sectional mixed-methods secondary data analysis was conducted using data collected from online baseline and nine-month follow-up surveys completed by providers participating in the program practicing in Milwaukee County from 2014 to 2022. Provider confidence and skill in providing mental health care was analyzed quantitatively using Two-sample Wilcoxon rank-sum (Mann–Whitney) tests (baseline vs. follow-up survey responses) and descriptive statistics (follow-up survey only). Provider challenges to providing mental health care were analyzed qualitatively using a thematic analysis research approach. Results: Results from quantitative analyses showed that provider confidence and skill in treating childhood anxiety and depression improved from baseline to follow-up. Results from qualitative analyses were categorized by factors within and beyond the scope of WI CPCP. Within the scope of WI CPCP, providers reported a lack of knowledge of referral options and a lack of training in mental health care as well as a lack of knowledge in assessing and treating mental disorders. Still, many barriers to mental healthcare access persist that are beyond the scope of WI CPCP, such as long wait times and a lack of insurance coverage. Conclusions: This study supports the effectiveness of the program to improve access to care for children. However, there is a need for additional solutions such as better reimbursement for mental health professionals and expanded insurance coverage. [ABSTRACT FROM AUTHOR]

Background No national study has evaluated changes in the appropriateness of US outpatient antibiotic prescribing across all conditions and age groups after the coronavirus disease 2019 (COVID-19) outbreak in March 2020. Methods This was an interrupted time series analysis of Optum's de-identified Clinformatics Data Mart Database, a national commercial and Medicare Advantage claims database. Analyses included prescriptions for antibiotics dispensed to children and adults enrolled during each month during 2017–2021. For each prescription, we applied our previously developed antibiotic appropriateness classification scheme to International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes on medical claims occurring on or during the 3 days prior to dispensing. Outcomes included the monthly proportion of antibiotic prescriptions that were inappropriate and the monthly proportion of enrollees with ≥1 inappropriate prescription. Using segmented regression models, we assessed for level and slope changes in outcomes in March 2020. Results Analyses included 37 566 581 enrollees, of whom 19 154 059 (51.0%) were female. The proportion of enrollees with ≥1 inappropriate prescription decreased in March 2020 (level decrease: −0.80 percentage points [95% confidence interval {CI}, −1.09% to −.51%]) and subsequently increased (slope increase: 0.02 percentage points per month [95% CI,.01%–.03%]), partly because overall antibiotic dispensing rebounded and partly because the proportion of antibiotic prescriptions that were inappropriate increased (slope increase: 0.11 percentage points per month [95% CI,.04%–.18%]). In December 2021, the proportion of enrollees with ≥1 inappropriate prescription equaled the corresponding proportion in December 2019. Conclusions Despite an initial decline, the proportion of enrollees exposed to inappropriate antibiotics returned to baseline levels by December 2021. Findings underscore the continued importance of outpatient antibiotic stewardship initiatives. [ABSTRACT FROM AUTHOR]

Despite the increasing efficacy of modern medicine in diagnosing and treating cancer, survivors often face discrimination in employment, economics, insurance, and society. Law no. 193/2023, also known as the "Oncological Oblivion Law", aims to provide an initial legislative response to discrimination against cancer survivors in Italy. After defining oncological oblivion in Article 1, the Law provides, in Articles 2, 3, and 4, directives to prevent discrimination against cancer survivors in the area of access to banking and insurance services, adoption procedures and access to or retention in employment. The aim of this work is to illustrate the content and the critical aspects of the recent Law 193/2023 in the landscape of European directives. The legislative process at the Chamber of Deputies and the Senate of the Italian Republic has been retraced through the consultation of preparatory works and bills registered on institutional databases. Law 193/2023 represents the first initiative in Italy aimed at the recognition of the right to oncological oblivion, not only in access to banking and insurance services as in other countries, but also in adoption, employment, and re-employment. Our opinion piece highlights the need for further clarification and expansion to prevent discrimination and protect the social–work–relational rights of people who have been affected by oncological diseases. [ABSTRACT FROM AUTHOR]