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This paper addresses the critical challenge of fraud detection in medical insurance claims, a pervasive issue causing significant financial losses in healthcare. The primary goal is to develop an advanced fraud detection approach by integrating multiple unsupervised machines learning algorithms, leveraging their collective strengths through a majority voting mechanism, where labelling of data is unavailable. Central to this approach is the ensemble of 18 novel unsupervised algorithms, specifically, anomaly detection models. The novelty lies in the majority voting system employed to aggregate the decisions from these diverse algorithms, enhancing the reliability and accuracy of fraud detection. To validate the effectiveness of the proposed system, a dual approach is employed. Firstly, human experts in the medical insurance field review a subset of claims to establish a benchmark for the model's performance. Secondly, the system's effectiveness is quantitatively assessed using key statistical metrics. The system utilizes real-world insurance claim data to ensure quality and relevance, where the two datasets were collected from countries in the Gulf region. The findings reveal significant improvement in fraud detection at various activity levels; from doctor, provider, and patient, where the patient model reached 79 % precision. The system not only aligns well with human expert judgments but also demonstrates superior performance on the specified statistical metrics, indicating effective clustering and anomaly detection. Some real use cases were captured by the model and deeply investigated by human experts, which demonstrated advantages by the proposed approach in detecting fraud at multiple levels, of providers, doctors, and patients. [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]

[Display omitted] • Blockchain and AI integration enhances healthcare security and efficiency. • Synergy aims for a secure healthcare metaverse via blockchain–AI. • Addressing technical and privacy issues is vital for integration success. • Future focus on setting interoperability standards and privacy investments. • Joint research and teamwork are essential for blockchain–AI advancements. This perspective paper explores the synergistic potential of blockchain and artificial intelligence (AI) in transforming healthcare. It begins with an overview of blockchain's role in healthcare data management, security, the pharmaceutical supply chain, clinical trials, and health insurance. The discussion then shifts to the impact of AI on healthcare, followed by an examination of integrated AI–blockchain platforms and their benefits. Technical challenges, limitations, and solutions related to these technologies are scrutinized. The paper addresses regulatory compliance and ethical considerations, and proposes future directions for their implementation. It concludes with research and implementation guidelines, offering a roadmap for harnessing blockchain and AI to enhance healthcare outcomes. [ABSTRACT FROM AUTHOR]

• Empirical framework for estimating income growth effect and income distribution. • Mincer model, OLS and GMM methods. • CHNS surveys from rural residents during 1991–2015. • Energy poverty threatens individual health and household efficiency. • Energy poverty harms resident income growth. This paper proposes a novel empirical framework for inclusive growth estimation by extending the traditional Mincer model. Based on the 42,126 observations from 1991 to 2015 obtained in the China Health and Nutrition Survey, this paper applies the ordinary least squares regression and generalized system method of moments estimation to explore the growth effect and inclusiveness of energy out-of-poverty on rural resident income. The results confirm the significant income inclusive growth effect prompted by energy out-of-poverty. Those with water infrastructure accessibility and medical insurance gain more than those without energy out-of-poverty in rural China. The better-educated benefit more than their counterparts from energy out-of-poverty in the eastern and middle regions. This paper provides valuable insights to understand the positive and vital role of energy out-of-poverty on income-inclusive growth. [ABSTRACT FROM AUTHOR]

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

• Patients are satisfied with telehealth services in the context of an active pandemic. • An advantage of telehealth is more easily fitting in therapy around other commitments. • Future funding models should consider a hybrid model of face-to-face and telehealth. Electronic Survey. Internationally the COVID-19 pandemic has resulted in an unprecedented shift from face-to-face therapy to telehealth services. This paper explores the patient experience and satisfaction with telehealth hand therapy in a metropolitan setting during a period (March 1 to May 31, 2021) of 'moderate' COVID-19 risk when there was minimal community transmission of COVID-19. Patients attending telehealth services were invited to participate in an English language online survey at the conclusion of their therapy session via a pop-up invitation. During the recruitment period there were 123 survey responses (29% response rate; 98% completion rate). Half of the respondents (n = 78, 53%) reported saving between 10 and 29 minutes of travel time (each way) by attending a telehealth appointment, while 36% (n = 44) saved more than 30 minutes (each way). Almost all respondents (n = 117, 95%) noted telehealth should be used in the future. The main benefit for telehealth was more easily fitting appointments around other commitments, followed by reducing stress and costs surrounding hospital attendance. Most participants (n = 97, 79%) reported no challenges using telehealth. The most cited challenges included the therapist not being able to provide hands on treatment (n = 14, 11%) and for seven respondents getting the technology to work (6%). The elevated level of participant satisfaction of attending telehealth sessions informs us that this mode of therapy delivery could benefit patients in a post-pandemic environment. Metropolitan funding models prior to the pandemic did not allow for this mode of therapy and hence consideration for an ongoing hybrid funding model of both face-to-face and telehealth should be considered by policy makers, insurance and government funding bodies. [ABSTRACT FROM AUTHOR]

Analyzing the net social welfare of a public health insurance policy necessitates an accurate estimation of its impact on the private health insurance market. This paper presents new evidence of the effect of public health insurance on private health insurance market by exploiting a quasi-experiment of Urban Resident Basic Medical Insurance (URBMI) in China. Our findings indicate that the implementation of URBMI has no significant effect on the aggregated private health insurance market. However, upon dividing the private health insurance market into medical and illness insurance markets, we observe a significant crowding-out effect of URBMI on the former but not the latter. This finding may help explain the mixed results in the literature, which typically lumps all segments of private health insurance markets together. In terms of the possible channels, we find that the crowding-out effect of public health insurance on private health insurance is through lowering the cost of health services, raising the accessibility to health services or reducing health risks. [ABSTRACT FROM AUTHOR]

Objectives: Current guidelines mandate organ donation to be financially neutral such that it neither rewards nor exploits donors. This systematic review was conducted to assess the magnitude and type of costs incurred by adult living kidney donors and to identify those at risk of financial hardship.Methods: We searched English-language journal articles and working papers assessing direct and indirect costs incurred by donors on PubMed, MEDLINE, Scopus, the National Institute for Health Research Economic Evaluation Database, Research Papers in Economics, and EconLit in 2005 and thereafter. Estimates of total costs, types of costs, and characteristics of donors who incurred the financial burden were extracted.Results: Sixteen studies were identified involving 6158 donors. Average donor-borne costs ranged from US$900 to US$19 900 (2019 values) over the period from predonation evaluation to the end of the first postoperative year. Less than half of donors sought financial assistance and 80% had financial loss. Out-of-pocket payments for travel and health services were the most reported items where lost income accounted for the largest proportion (23.2%-83.7%) of total costs. New indirect cost items were identified to be insurance difficulty, exercise impairment, and caregiver income loss. Donors from lower-income households and those who traveled long distances reported the greatest financial hardship.Conclusions: Most kidney donors are undercompensated. Our findings highlight gaps in donor compensation for predonation evaluation, long-distance donations, and lifetime insurance protection. Additional studies outside of North America are needed to gain a global prospective on how to provide for financial neutrality for kidney donors. [ABSTRACT FROM AUTHOR]

Blockchain technology has piqued the interest of businesses of all types, while consistently improving and adapting to business requirements. Several blockchain platforms have emerged, making it challenging to select a suitable one for a specific type of business. This paper presents a classification of over one hundred blockchain platforms. We develop smart contracts for detecting healthcare insurance frauds using the top two blockchain platforms selected based on our proposed decision-making map approach which selects the top suitable platforms for healthcare insurance frauds detection application. Our classification shows that the largest percentage of platforms can be used for all types of application domains, the second biggest percentage for financial services, and a small number is to develop applications in specific domains. Our decision-making map and performance evaluations reveal that Hyperledger Fabric surpassed Neo in all metrics for detecting healthcare insurance frauds. [ABSTRACT FROM AUTHOR]

Fuzzy clustering is an effective clustering approach that divides the dataset into fuzzy segments. Fuzzy clustering and outlier detection are two interconnected processes. Outlier detection is essential because it discloses hidden patterns and crucial information about a dataset and is beneficial in a wide range of applications like fraud detection, military surveillance, identifying computer network intrusions, image processing, insurance or health care, etc. Many fuzzy clustering techniques are robust to anomalies since they limit the outlier's impact on the cluster's centroid. In this paper, we have compared four fuzzy clustering techniques namely Fuzzy C-means (FCM), Noise Clustering (NC), Credibilistic Fuzzy C-means (CFCM), and Density Oriented Fuzzy C - Means (DOFCM) on the basis of some crucial properties that are essential for efficient outlier detection. To better evaluate the feasibility of all these techniques, we experimentally evaluated these techniques on six datasets (two Real and four Synthetic) in the presence of noise and outliers. The results of the comparative analysis show that DOFCM outperforms all other techniques in terms of outlier detection and cluster formation. This research will surely benefit any researcher willing to detect outliers in their study using fuzzy clustering or either implicitly or explicitly working on fuzzy clusters. [ABSTRACT FROM AUTHOR]

In 2020, an estimated 8 to 12 million Americans started an online fundraising campaign to cover the cost of healthcare. In this paper, we study the causes and consequences of medical crowdfunding using data from GoFundMe, one of the largest online fundraising platforms. First, we show that the ACA Medicaid expansion had a statistically meaningful effect in reducing the number of health-related GoFundMe campaigns. This suggests that the demand for crowdfunded medical care could be driven, in part, by lack of health insurance coverage. Next, we show that the growth of medical crowdfunding can exacerbate group-level inequality by reinforcing existing disparities in health access. Specifically, we document that GoFundMe campaigns organized by individuals with distinctively African-American or Hispanic surnames and first-names are significantly less likely to meet their fundraising target and raise less funds overall than those organized by individuals with neutral or distinctively White names. We conclude by investigating the channels underlying these racial disparities in crowdfunding success. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between locus of control (LOC) and the demand for supplementary health insurance (SUPP). Drawing on longitudinal data from Germany, we document robust evidence that individuals internal LOC increases the take up of supplementary private health insurance (SUPP). We find that the effect of one standard deviation increase in the measure of internal LOC on the probability of SUPP purchase is equivalent to a 14 percent increase in household income. Second, we find that the positive association between self-reported health and SUPP becomes small and insignificant when we control for LOC. These results suggest that LOC might be an unobserved individual trait that can partly explain previously documented evidence of advantageous selection into SUPP. Third, we find comparable results using data from Australia, which enhances the external validity of our results. [ABSTRACT FROM AUTHOR]

Government decentralisation also called 'government devolution' (GD) can provide an alternative to the 'build in' accountability mechanism of markets by influencing both the choice as well as the perceived quality of public versus private health care. To test this hypothesis, this paper exploits the gradual decentralisation of the political stewardship of the Spanish National Health System (NHS) using a difference-in-differences design. We find that GD (abandoning centralised governance) increases the choice and quality of (measured by the preference for, perceptions of, and satisfaction with) public health care (NHS) compared to private health care. Consistently, we also find that the GD reduces the uptake of private health insurance among higher income and education groups. These effects are mainly driven by improvements in health care quality as well as policy innovation and diffusion. [ABSTRACT FROM AUTHOR]

The aim of this paper was to perform a mortality evaluation of skin cancer screening (SCS) in Germany using General Local Health Insurance Fund (AOK) data. AOK-insured men and women aged 35–99 years who died of cutaneous malignant melanoma in 2015–2016 were identified. Controls were AOK-insured people who survived to the end of each case's year of death. For each case, 10 controls were matched. The SCS history of each individual was reconstructed using the billing codes 01745 and 01746. In total, 1037 melanoma deaths and 10,370 controls were included. Cumulative SCS prevalence increased among controls over calendar years, as expected (males and females, 2009: 13.5% and 12.5%; 2015: 52.1% and 55.1%). In contrast, among cases, cumulative SCS prevalence was already high in 2009 and did not show a monotonic increase over the years of diagnosis. Of the 1037 melanoma deaths, 224 (21.6%) had at least one SCS settled in the 12 months after diagnosis. A mortality evaluation with health insurance data alone is not possible because SCS billing codes are not only used for real SCS but also for occasion-related diagnostic work-up of abnormal skin findings. A mortality evaluation with health insurance data requires an individual linking with data of the screening physician and the cancer registries. • The German skin cancer screening program was started in August 2008. • To date, no mortality evaluation has taken place. • Using health insurance data, we conducted a case–control study. • Health insurance data on skin cancer screening in Germany are biased. • Billing codes for screening are also used for diagnostic work-up of skin cancer. [ABSTRACT FROM AUTHOR]

Abstract With Universal Health Coverage (UHC) now entrenched among the top global development priorities, questions arise as to the conditions under which politicians commit to UHC and why certain strategies for health financing and access are favoured over others. The Ethiopian government has been piloting and scaling-up Community-Based Health Insurance (CBHI) for the informal sector since 2010 and is establishing Social Health Insurance for formal sector workers as a means of achieving UHC. CBHI covers 11 million people making it one of the largest health insurance schemes in Africa. This paper employs a process tracing methodology to examine the political drivers of the adoption and evolution of state health insurance based on 28 key informant interviews conducted between 2015 and 2018 with politicians, policymakers and donor officials. The paper highlights the inadequacy of existing theories—focusing on interest group mobilisation, electoral competition and bureaucratic actors—for explaining the Ethiopian case. Instead the paper proposes an 'Adapted Political Settlements' framework that explains the state's push to expand CBHI and stalled progress on SHI. This framework highlights the interests and ideas of the ruling coalition as important drivers of reform. In a context of ruling party dominance and minimal threat from electoral competition, the ruling coalition has sought to build political legitimacy through the delivery of socioeconomic progress, including health services. The policy idea of health insurance, meanwhile, has secured elite commitment due to its fit with deeply held ideas within the ruling coalition concerning the importance of self-reliance and resource mobilisation for development. Finally, the centralisation of power within the ruling coalition prior to 2012 enabled the emergence of a long-term developmental vision and the marginalisation of opposition to health insurance, while fragmentation of the ruling coalition since 2012 has led SHI to stall. Highlights • Ethiopia is pursuing Universal Health Coverage through health insurance. • Interest group, electoral and bureaucratic theories cannot explain the policy choices. • 'Adapted Political Settlements' framework explains CBHI expansion and SHI stalling. • Key factors include ruling coalition dominance and coherence, and party ideology. • The Ethiopian scheme was inspired by a study tour to Rwanda's Mutuelles de Santé. [ABSTRACT FROM AUTHOR]

Abstract Although the causes of asthma are inconclusive, it is fairly known that exposure to outdoor air pollutants can cause asthma, especially children's asthma morbidity. Whereas transportation is one of the major sectors that generate air pollutants, previous research that investigates the correlation between transportation and asthma narrowly focuses on the contribution of automobile traffic to children's asthma. Developing three spatial regression models (a spatial lag (SL) model, a spatial error (SE) model, and a general spatial (SAC) model), this paper investigates the roles of a variety of transportation factors in two distinct stages of children's asthma morbidity; asthma and severe asthma. With consideration to asthma-related socio-economic factors in the City of Seoul, the SE (R2 = 0.31) and SAC (R2 = 0.34) models consistently indicate that three out of four transportation factors associate with children's severe asthma at statistically significant level. They include the negative influence of bus transit and dense intersections, and the positive influence of active transportation activities on children's asthma severity. Interestingly, however, no significant contribution of transportation factors to children's asthma morbidity was identified by the SE (R2 = 0.29) and SAC (R2 = 0.28) models. Shedding more light on the complexity of children's asthma morbidity and severity, this paper proposes collaborative partnerships not only among multi- dimensional agencies, but also among multi-level government organizations. Highlights • Transportation factors become a significant contributing factor to children's severe asthma rather than asthma morbidity. • The transportation factors include bus transit, dense intersections, and active transportation activities. • The strong public health insurance program reduces the influence of socio-economic characteristics on children's asthma. • It is important to consider children asthma when planning transportation strategies such as Complete Streets. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship between insurance status and contraceptive use, with health care access as a mediating variable.Study Design: This study uses data from the 2017 Behavioral Risk Factor Surveillance Survey to determine whether having a personal healthcare provider and experiencing cost as a barrier to care mediate the relationship between health insurance status and contraceptive use among women at risk of unintended pregnancy. Contraceptive use is measured 3 ways: as a binary variable (use vs non-use), by prescription status, and by tiered effectiveness.Results: Having insurance increases the odds of using all categories of contraception. Having a personal health care provider mediates this relationship, with having a personal health care provider increasing the odds of using any contraceptive, using a prescription method, and using a tier I or tier II method. Experiencing cost as a barrier to care is not associated with contraceptive use in weighted multivariable models but does mediate the relationship between having insurance and using tier-II methods.Conclusions: These findings suggest that having health insurance and an ongoing relationship with a health care provider are key to ensuring consistent access to the full range of contraceptive options. This is particularly relevant in light of the ongoing policy debates regarding laws intended to increase health insurance access and decrease barriers to contraceptive use.Implications: This paper updates and extends previous findings to show that the relationship between healthcare access and contraceptive use persists after the implementation of the Affordable Care Act and that having a personal provider partially explains this relationship. [ABSTRACT FROM AUTHOR]

While many results from the treatment-effect and related literatures are familiar and have been applied productively in health economics evaluations, other potentially useful results from those literatures have had little influence on health economics practice. With the intent of demonstrating the value and use of some of these results in health economics applications, this paper focuses on one particular class of parameters that describe probabilities that one outcome is larger or smaller than other outcomes ("inequality probabilities"). While the properties of such parameters have been exposited in the technical literature, they have scarcely been considered in informing practical questions in health evaluations. This paper shows how such probabilities can be used informatively, and describes how they might be identified or bounded informatively given standard sampling assumptions and information only on marginal distributions of outcomes. The logic of these results and the empirical implementation thereof-sampling, estimation, and inference-are straightforward. Derivations are provided and several health-related applications are presented. [ABSTRACT FROM AUTHOR]

Workplace injuries are a serious public health problem, potentially leading to loss of earnings, medical expenses, disability and even death for working people. Maritime transport workers - seafarers - are exposed to higher risks of workplace injuries than is the general land-based workforce. China has the world's largest population of international seafarers. Under Chinese law, as elsewhere, losses from workplace accidents are compensated in the form of financial entitlements. However, Chinese seafarers face tremendous challenges in the workers' compensation claim process. This paper investigates the experiences of Chinese seafarers in claiming this compensation, in order to assess the protective capacity of Chinese workers' compensation, known as the Work-Related Injury Insurance System. Drawing on therapeutic jurisprudence, it explores the anti-therapeutic effects that Chinese seafarers confront in the claims process. Based on an analysis of regulatory documents and interview data with the informants - including seafarers, their family members and managerial professionals in the shipping industry - the findings suggest that current work-related injury insurance is unable to provide sufficient assistance for Chinese seafarers. Instead of obtaining effective therapeutic remedies following accidental trauma, Chinese seafarers (and their families) are indeed likely to suffer additional harm in the process of claiming compensation. The paper suggests that further measures should be adopted to improve work-related injury insurance coverage among seafarers, and that efficient sanctions should be strengthened against infringements of seafarers' rights. [ABSTRACT FROM AUTHOR]

Summary This paper presents the results of 20 randomized experiments aimed at understanding the low take-up of in-patient health insurance observed in developing countries. Take-up does not increase when participants receive information about the product, or an assistance to register, or small subsidies of 2, 10, or 30%. Take-up does not increase when the same information is provided by local respected community leaders, when participants are offered an in-kind gift (a chicken) if they register, when participants are offered the possibility to contribute lower and more frequent payments, or the possibility to pay by cellphone. A full subsidy generates a mere 45% take-up (with no retention after one year). In contrast to these low take-up rates, presenting the same information without any subsidies to existing informal groups raises take-up to 12% (still 7% after one year), as well as trust and knowledge of the product. Social networks play a major role in the adoption of health insurance. This paper provides a cost-effective way to increase take-up of health insurance, while subsidies are found to be largely ineffective at raising take-up in the long run. [ABSTRACT FROM AUTHOR]

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]

The United States offers two markedly different subsidy structures for private health insurance. When covered through employer-based plans, employees and their dependents benefit from the exclusion from taxable income of the premiums. Individuals without access to employer coverage may obtain subsidies for Marketplace coverage. This paper seeks to understand how the public subsidies embedded in the privately financed portion of the U.S. healthcare system impact the payments families are required to make under both ESI and Marketplace coverage, and the implications for finance equity. Using the Household Component of the Medical Expenditure Panel Survey (MEPS-HC) and Marketplace premium data, we assess horizontal and vertical equity by calculating public subsidies for and expected family spending under each coverage source and using Lorenz curves and Gini and concentration coefficients. Our study pooled the 2018 and 2019 MEPS-HC to achieve a sample size of 10,593 observations. Our simulations showed a marked horizontal inequity for lower-income families with access to employer coverage who cannot obtain Marketplace subsidies. Relative to both the financing of employer coverage and earlier Marketplace tax credits, the more generous Marketplace premium subsidies, first made available in 2021 under the American Rescue Plan Act, substantially increased the vertical equity of Marketplace financing. While Marketplace subsidies have clearly improved equity within the United States, we conclude with a comparison to other OECD countries highlighting the persistence of inequities in the U.S. stemming from its noteworthy reliance on employer-based private health insurance. • United States uses employer and individual private health insurance coverage. • No recent investigations of horizontal and vertical equity of U.S. private coverage. • Analysis of Gini coefficients and Lorenz curves suggests regressivity. • Public policies including insurance subsidies can reduce inequities. [ABSTRACT FROM AUTHOR]

Health insurance expansions can improve health outcomes by increasing access to healthcare. This is especially true among the poorer segments of the population, who may not be able to afford the cost of healthcare, or might lack the information about where to seek proper medical care. In this paper we examine whether increased access to health insurance has historically reduced height inequality by promoting body growth, particularly among poor individuals, and so enhanced their height, a widely used and well-established anthropometric health and well-being indicator. We draw on data from a large global panel of countries for which we could measure height inequality. Our evidence documents that indeed within-country differences in height inequality decreased following health insurance expansions towards near-universal coverage. • First study: health insurance reduces height and health inequality. • Large global sample over 200 years. • "Big picture" of health inequality in the long run. • Instrumental variable techniques suggest causal relationship. [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]

Vaccines have produced remarkable impact in reducing the global burden of disease. Thanks to Gavi-the Vaccine Alliance, which supports eligible countries to increase access to the new and underused vaccines. Gavi support depends on economic growth, whereby low-income countries contribute 0.2 USD per dose of supported vaccines, while middle-income countries contribute by price fraction that increases gradually by 15% annually. A country must become fully self-financing within five years when its economy reaches 1,630 USD GNI per capita. Recently, Tanzania, Benin, Haiti, Nepal, and Tajikistan became middle-income countries triggering gradual reduction in Gavi support. This paper first compares the socio-demographic characteristics, immunization program performance, and health financing strategies of these countries and second, explores domestic financing strategies that Tanzania can use to close the funding gap. Although the five countries are similar economically, they vary in demography, health financing strategies, extent of donor dependency, and strength of immunization programs. Some health indicators are not any better than those in low-income countries. Tanzania receives the largest financial support from Gavi and is projected to be fully self-financing by 2043. The potential domestic funding opportunities include to increase Government budget, use of innovative financing strategies, and health insurance, complemented with enhanced program efficiency. [ABSTRACT FROM AUTHOR]

Children and youth with special health care needs (CYSHCN) use disproportionately more health care resources than non-CYSHCN, and their unique needs merit additional consideration. Spending on health care in the United States is heavily concentrated on acute illnesses through fee-for-service (FFS). Payment reform frameworks have focused on shifting away from FFS, addressing health outcomes and the experience of care while lowering costs, particularly for high resource utilizers. The focus of payment reform efforts to date has been on adults with chronic illnesses, with less priority given to investment in children's health and life course. Spending for children's health is also considered an investment in their growth and development with long-term outcomes at stake, so research questions should focus on where and how such spending should be targeted. This paper discusses high-priority research topics in the area of health care financing for CYSHCN in the context of what is currently known and important knowledge gaps related to investment for CYSHCN. It proceeds to describe 3 potential research projects that can address these topics, following a framework informed by the priority questions identified in a previous multistakeholder research agenda development process. We focus on 3 areas: benefits, payment models, and quality measures. Specific aims and hypotheses are offered, as well as suggestions for approaches and thoughts on potential implications. [ABSTRACT FROM AUTHOR]

This study uses the China Health and Nutrition Survey data to investigate the relationship between infrastructure construction and health inequality, particularly by exploring a quasi-natural experiment, namely, high-speed rail (HSR) projects. We find that HSR accessibility improves the health of local residents with a coefficient of 0.298, which means that HSR operation will lead to a 2.30% increase in health. HSR accessibility also increases individual income, per capita household income, and the probability of purchasing medical insurance, thereby increasing the health level of individuals. Further analysis shows that HSR reduces the health gap across gender and urban–rural areas. Unfortunately, HSR also increases the health gap among different income groups. • This paper evaluates the health effects of high-speed rail (HSR). • HSR accessibility improves the health of local residents. • HSR accessibility have increased the health gap among different income groups. • HSR layout should be complementary with medical resources. [ABSTRACT FROM AUTHOR]

The characteristic features of 21st-century corporate capitalism – monopoly and financialization – are increasingly being recognized by public health scholars as undermining the foundations of human health. While the "vectors" through which this is occurring are well known – poverty, inequality, climate change among others – locating the root cause of this process in the nature and institutions of contemporary capitalism is relatively new. Researchers have been somewhat slow to study the relationship between contemporary capitalism and human health. In this paper, we focus on one of the leading causes of death in the United States; cancer, and empirically estimate the relationship between various measures of financialization and monopoly in the US healthcare system and cancer mortality. The measures we focus on are for the hospital industry, the health insurance industry, and the pharmaceutical industry. Using a fixed effects model with different specifications and control variables, our analysis is at the state level for the years 2012–2019. These variables include data on population demographic controls, social and economic factors, and health behavior and clinical care. We compare Medicaid expansion states with non-Medicaid expansion states to investigate variations in state-level funded health insurance coverage. The results show a statistically significant positive correlation between the HHI index in the individual healthcare market and cancer mortality and the opioid dispensing rate and cancer mortality. • We analyze how corporate capitalism is related to cancer mortality. • Recently, corporate capitalism has become more common in the healthcare industry. • We find a correlation between hospital net revenue, profit, and cancer mortality. • There is a link between the HHI index in insurance markets and cancer mortality. [ABSTRACT FROM AUTHOR]

Health insurance is one of the main financing mechanisms currently being used in low and middle-income countries to improve access to quality services. Tanzania has been running its National Health Insurance Fund (NHIF) since 2001 and has recently undergone significant reforms. However, there is limited attention to the causal mechanisms through which NHIF improves service coverage and quality of care. This paper aims to use a system dynamics (qualitative) approach to understand NHIF causal pathways and feedback loops for improving service coverage and quality of care at the primary healthcare level in Tanzania. We used qualitative interviews with 32 stakeholders from national, regional, district, and health facility levels conducted between May to July 2021. Based on the main findings and themes generated from the interviews, causal mechanisms, and feedback loops were created. The majority of feedback loops in the CLDs were reinforcing cycles for improving service coverage among beneficiaries and the quality of care by providers, with different external factors affecting these two actions. Our main feedback loop shows that the NHIF plays a crucial role in providing additional financial resources to facilities to purchase essential medical commodities to deliver care. However, this cycle is often interrupted by reimbursement delays. Additionally, beneficiaries' perception that lower-level facilities have poorer quality of care has reinforced care seeking at higher-levels. This has decreased lower level facilities' ability to benefit from the insurance and improve their capacity to deliver quality care. Another key finding was that the NHIF funding has resulted in better services for insured populations compared to the uninsured. To increase quality of care, the NHIF may benefit from improving its reimbursement administrative processes, increasing the capacity of lower levels of care to benefit from the insurance and appropriately incentivizing providers for continuity of care. • The NHIF influences service coverage and quality in complex ways. • NHIF reimbursement is crucial for facilities and its delay affects inputs for quality. • Lower levels of care benefit less from NHIF. • Need to improve reimbursement process to enhance quality of care. [ABSTRACT FROM AUTHOR]

This paper shows that selection incentives in downstream markets distort upstream prices. It is possible for inputs to be priced above the value that the good has for final consumers. We apply this idea to pharmaceutical companies selling drugs to a health insurance market with selection problems. We specify the conditions under which drugs are sold at prices exceeding treatment value. Another feature of the model is an excessive private incentive to reduce market size, e.g. in the form of personalized medicine. [ABSTRACT FROM AUTHOR]

The turn towards Universal Health Coverage (UHC) in the past decade raises the question of the role of the state, following years of state withdrawal and a fragmented approach to public health. Senegal introduced its version of UHC, Couverture Maladie Universelle (CMU) in 2013 and this paper explores early efforts to fund it through the establishment of community-based health insurance (CBHI). The paper draws on ethnographic research at mutual health organisations, or mutuelles de santé as they are commonly referred to in francophone countries, which manage CBHI. The research was carried out as part of broader doctoral fieldwork on poverty and social protection in the capital, Dakar, in 2017–18. Responding to recent calls for the move away from the voluntary nature of CBHI with government subsidies and the professionalisation of management, this paper considers the financial strain that mutuelles were under. By drawing on the concept of 'improvisation' as it has come to be employed in recent ethnographies of health infrastructure in contexts of scarcity, the paper attends to the ways in which mutuelles and the voluntary workers that run them sought alternative forms of support, with a particular focus on patronage and partnership. I argue that what might appear to be very minimal gestures of support and material investment serve to maintain a sense of hope and potential in CMU, one however that is fragile and potentially unsustainable. [ABSTRACT FROM AUTHOR]

This paper takes a different approach to estimating demand for medical care that uses the negotiated prices between insurers and providers as an instrument. The instrument is viewed as a textbook "cost shifting" instrument that impacts plan offerings, but is unobserved by consumers. The paper finds a price elasticity of demand of around -0.20, matching the elasticity found in the RAND Health Insurance Experiment. The paper also studies within-market variation in demand for prescription drugs and other medical care services and obtains comparable price elasticity estimates. [ABSTRACT FROM AUTHOR]

With the passing of Royal Decree-Law 16/2012, Spain's national health system switched from a model defined by universal and free health care principles, to a private insurance system that excluded large population groups. Based on a qualitative research design, this paper examines the media treatment of undocumented immigrants' prerogatives to public health care in Spain (2012–2018). The analysis of 234 articles, drawn from three major Spanish newspapers, reveals three frames that underscore the media's "rhetorics of inclusion," which argue for the extension of free medical services to irregular immigrantsa topic traditionally underestimated by the literature. The moralist frame, supported by social justice arguments, is found in tandem with the cost-benefit frame that advocates for immigrants' health care access as a means for containing medical expenses. The overall predominance of the legalist frame largely relies on arguments that reflect a Spanish political culture rooted in the universality of health rights. [ABSTRACT FROM AUTHOR]

In health care systems with a competitive health insurance market, governments or other sponsors (e.g. employers) often subsidize premiums to encourage enrolment. These subsidies are typically independent of plan choice leaving the absolute premium differences in place so as not to distort consumer choice of plan. Such subsidies do, however, change the relative premium differences across plans, which, according to theories from behavioral economics, can affect choice. Consumers might be sensitive to differences relative to a reference premium ("relative thinking"). Furthermore, consumers might be particularly sensitive to a reference premium of zero ("zero-price effect"), a relevant range for some subsidized health insurance markets. This paper tests these ideas with two sources of evidence. We argue that observed equilibria in Germany and the U.S. Medicare Advantage markets are consistent with a powerful zero-price effect, resulting in an equilibrium focal pricing at zero. This contrasts with the Netherlands where equilibrium premiums are well above zero. In an empirical test using hypothetical questions in a web-based survey in these three countries, we also find evidence for both a relative thinking and a zero-price effect in the demand for health insurance. Our findings imply that well-designed subsidies can leverage relative thinking to increase demand elasticity for health plans. Creation of a powerful reference price (e.g., at zero), however, risks subverting price competition. [ABSTRACT FROM AUTHOR]

Scientific and technological advances increasingly allow for better tailoring of health insurance plans to individual health risk profiles. This development questions the sustainability of health plans that feature strong cross-subsidization across different health risk types and health behaviors. An important observation is that the willingness to cross-subsidize risks in health plans might depend on whether the risk is uncontrollable by individuals, such as genetic risk, or modifiable via health behaviors. This paper provides the results of an experiment on the willingness to pool genetic risk in health insurance. Subjects' overall health risk has an assigned, uncontrollable genetic risk part that differs across individuals as well as a behavioral risk part, which can be reduced by costly effort. Participants can decide between a pooling, community-rated group insurance scheme and an insurance with a fully individually risk-adjusted premium. In the experimental variation, the group insurance scheme either includes behavioral risk or separates it out via individual premium discounts. Although we observe social preferences for pooling, only a low level of actual genetic risk pooling emerges across the experimental conditions. This is due to both large heterogeneity in social preferences across subjects, and the dynamics of the willingness to pay for group insurance in the different experimental markets. [ABSTRACT FROM AUTHOR]

This paper develops a model of insurance choice and derives the implications for insurance plan selection when consumers are loss averse. Previous work has shown that health insurance plan switching costs can increase welfare by reducing adverse selection. Loss aversion provides a natural mechanism for modeling non-pecuniary switching costs and thus gives a basis for modeling insurance choice in environments where explicit switching costs might be minimal. I also derive a test for the presence of both adverse selection and switching costs based on differential spending of switchers and non-switchers. I test this model using data from a benefits firm providing employment-based health insurance. Employees choose between low and high coverage plans from the same insurer during the annual open enrollment period, and explicit switching costs are likely to be low. I assume employees take their current plan as the reference point for choosing the next year's plan. I find evidence of adverse selection and significant switching costs. [ABSTRACT FROM AUTHOR]

Objective: This paper shall first investigate the informatics areas and applications of the four Traditional Medicine systems - Traditional Chinese Medicine (TCM), Ayurveda, Traditional Arabic and Islamic Medicine and Traditional Malay Medicine. Then, this paper shall examine the national informatics infrastructure initiatives in the four respective countries that support the Traditional Medicine systems. Challenges of implementing informatics in Traditional Medicine Systems shall also be discussed.Methods: The literature was sourced from four databases: Ebsco Host, IEEE Explore, Proquest and Google scholar. The search term used was "Traditional Medicine", "informatics", "informatics infrastructure", "traditional Chinese medicine", "Ayurveda", "traditional Arabic and Islamic medicine", and "traditional malay medicine". A combination of the search terms above was also executed to enhance the searching process. A search was also conducted in Google to identify miscellaneous books, publications, and organization websites using the same terms.Results: Amongst major advancements in TCM and Ayurveda are bioinformatics, development of Traditional Medicine databases for decision system support, data mining and image processing. Traditional Chinese Medicine differentiates itself from other Traditional Medicine systems with documented ISO Standards to support the standardization of TCM. Informatics applications in Traditional Arabic and Islamic Medicine are mostly ehealth applications that focus more on spiritual healing, Islamic obligations and prophetic traditions. Literature regarding development of health informatics to support Traditional Malay Medicine is still insufficient. Major informatics infrastructure that is common in China and India are automated insurance payment systems for Traditional Medicine treatment. National informatics infrastructure in Middle East and Malaysia mainly cater for modern medicine. Other infrastructure such as telemedicine and hospital information systems focus its implementation in modern medicine or are not implemented and strategized at a national level to support Traditional Medicine.Conclusion: Informatics may not be able to address all the emerging areas of Traditional Medicine because the concepts in Traditional Medicine system of medicine are different from modern system, though the aim may be same, i.e., to give relief to the patient. Thus, there is a need to synthesize Traditional Medicine systems and informatics with involvements from modern system of medicine. Future research works may include filling the gaps of informatics areas and integrate national informatics infrastructure with established Traditional Medicine systems. [ABSTRACT FROM AUTHOR]

This paper examines the origins of consumerist discourse in health care from a communication perspective via a historical textual analysis of health writing in popular magazines from 1930 to 1949. The focus is on Consumers Union's Consumer Reports and the American Medical Association's lay health magazine, Hygeia . Findings from Consumer Reports show that the consumer movement of the 1930s–40s staunchly advocated for universal health insurance. Whereas consumer rights language nowadays tends towards individual choice and personal responsibility, consumerism in health care during that era articulated ideas about consumer citizenship, framing choice and responsibility in collectivist terms and health care as a social good. This paper also illuminates the limits and weaknesses of a central tenet in consumerism—freedom of choice—by analyzing stories in Hygeia about the doctor–patient relationship. A textual analysis finds that the AMA's justification in the 1930s–40s against socialized medicine, i.e., the freedom to choose a doctor, was in practice highly controlled by the medical profession. Findings show that long before the rhetoric of the “empowered consumer” became popular, some patients exercised some choice even in an era when physicians achieved total professional dominance. But these patients were few and tend to occupy the upper socioeconomic strata of US society. In reality choice was an illusion in a fee-for-service era when most American families could not afford the costs of medical care. [ABSTRACT FROM AUTHOR]

Objectives: Many low- and middle-income countries have introduced State-funded health programmes for vulnerable groups as part of global efforts to universalise health coverage. Similarly, India introduced the Rashtriya Swasthya Bima Yojana (RSBY) in 2008, a publiclyfunded national health insurance scheme for people below the poverty line. The authors explore the RSBY's genesis and early development in order to understand its conceptualisation and design principles and thereby establish a baseline for assessing RSBY's performance in the future. Study design: Qualitative case study of the RSBY in Delhi. Methods: This paper presents results from documentary analysis and semi-structured interviews with senior-level policymakers including the former Labour Minister, central government officials and affiliates, and technical specialists from the World Bank and GIZ. Results: With national priorities focused on broader economic development goals, the RSBY was conceptualised as a social investment in worker productivity and future economic growth in India. Hence, efficiency, competition, and individual choice rather than human needs or egalitarian access were overriding concerns for RSBY designers. This measured approach was strongly reflected in RSBY's financing and benefit structure. Hence, the programme's focus on only the 'poorest' (BPL) among the poor. Similarly, only costlier forms of care, secondary treatments in hospitals, which policymakers felt were more likely to have catastrophic financial consequences for users were covered. Conclusions: This paper highlights the risks of a narrow approach driven by developmental considerations alone. Expanding access and improving financial protection in India and elsewhere requires a more balanced approach and evidence-informed health policies that are guided by local morbidity and health spending patterns. [ABSTRACT FROM AUTHOR]

The economic crisis of the late 2000's had numerous social and political repercussions on most European countries. In this paper we aim to study the influence of the austerity measures deemed by the economic and financial meltdown on one of the most vulnerable and important systems in any country: healthcare. The empiric approach uses panel data analysis to highlight the effects of the economic crisis on each of the 34 analyzed countries, during the time span 2006-2012. The advantage of this method resides in the ability to offer both cross-time and cross-section results, as well as interactions. Our findings show a consistent tendency of European governments to diminish the spending on healthcare during the crisis, leading to the increase of out of pocket payments is some countries, which do not have a robust health insurance policy and a decrease in the number of people accessing healthcare services in the other countries. Another notable result is that there is a consistent delay between the economic crisis and the impact on healthcare, yet, when the shock is felt it is most likely to have an influence for some time, even after the economy has recovered. Some side effects could even be permanent as it is the case with hospitals being closed or personnel being laid off. The findings in this paper suggest that in times of economic crisis, the right approach is to maintain the spending levels in healthcare, since otherwise people are exposed to even greater risks such as catastrophic spending, disease or even death. [ABSTRACT FROM AUTHOR]

This paper examines the elderly's response to a cost-sharing reduction in health insurance in China. We exploit a cost sharing policy in Urban Employee Basic Medical Insurance that substantially reduces out-of-pocket medical expenditures for the elderly who have reached 60 years old, and conduct a regression discontinuity with a difference-in-difference strategy (RD-DD) to address endogeneity. We find consistent evidence that cost sharing significantly increases the elderly's hospital utilization, and the estimated price elasticity is −0.67. We find a larger effect on high-cost diseases such as cancer and treatments in high-level hospitals. Many elderly people in China and other developing countries suffer from the underuse of health services due to low income and the expense of medical care. In contrast to most previous studies on cost sharing, which focus exclusively on developed countries, the results of our study provide insights to effectively increase healthcare use among the elderly in developing economies. [ABSTRACT FROM AUTHOR]

• Extreme temperatures lead to an increase in local fiscal pressure. • Areas with intensive agriculture and low power consumption are more sensitive. • Productivity, population mobility, and power supply are the main mechanisms. • PMC reform mitigated the fiscal revenue loss and increased fiscal expenditure. This paper investigates the impact of climate change on government fiscal pressure using local governments' fiscal data in China from 2000 to 2020. While previous studies have extensively explored the effects of climate change on individuals and economies, there has been limited research on the negative effects of climate change from a government fiscal perspective. Our study makes contributions by using county-level fiscal data in China, allowing for a detailed examination of the fiscal implications of weather extremes. Moreover, we comprehensively analyze the underlying mechanisms involving population mobility, industrial structure, and electricity consumption. The empirical results indicate that each additional day of extreme temperature in a year leads to a CNY 0.002 billion increase in the general public budget deficit, which is equivalent to 0.1093% of the local fiscal deficit. Furthermore, local governments heavily reliant on agriculture, experiencing low electricity consumption, and significant population outflows face even greater challenges. Notably, medical insurance and the "province-managing-county" reform program emerge as crucial mitigating factors against fiscal pressures. By providing a thorough assessment of climate change's fiscal impact on local governments, this research contributes to the theoretical foundation for governmental initiatives aimed at reducing carbon emissions. [ABSTRACT FROM AUTHOR]

In an era of considerable uncertainty about future prospects for development assistance to fund major health programmes in Sub-Saharan Africa, social health insurance is increasingly being considered as an alternative mechanism for increasing financing health. However, empirical support for social health insurance in sub-Saharan Africa remains sparse. The main aim of this study was to examine the viability of increasing health financing through social health insurance in Zambia. The paper uses a large nationally representative household survey to estimate the expected mean and total willingness to pay for social health insurance. The revenue potential of social health insurance for health sector funding is assessed. The results show that despite a high level of public support for social health insurance, with 80% willing to join a social insurance scheme, the estimated mean monthly willingness-to-pay is relatively low at Zambian Kwacha 55 (US$8.8 in 2014 dollars) per household. The evidence presented in this paper suggests that the revenue potential of social health insurance would not be sufficient to fund major improvements in quality of care for insured members, let alone cross-subsidize benefits to non-members. • Despite the high level of public support for SHI, the level of WTP is low. • WTP declines steeply with a decrease in income and is lower among informal sector workers. • High coverage of the population would only be feasible if premiums are set very low. • Estimated revenue of SHI is insufficient to finance major improvements in quality. [ABSTRACT FROM AUTHOR]

• A joint analysis of health insurance and hospitalization addressing endogeneity. • Higher uptake of insurance by chronically ill people indicates adverse selection. • Hospitalization increases with health insurance indicate a possible moral hazard. • Identifying thresholds of the continuous covariates with observed non-linear patterns. • Chronically ill females, older adults, rural residents are often neglected. The Indian healthcare sector is growing at a rapid pace; nevertheless, inequality in healthcare consumption and catastrophic healthcare expenditure is also increasing at an alarming rate. In addition to socioeconomic differences, poor healthcare infrastructure, and inadequate risk-pooling mechanisms; asymmetric information in the healthcare market is also a potential contributor to this inequity and increasing costs. The consequences of information asymmetry are adverse selection (AS) and moral hazard (MH). AS occurs if people with health risks (high-risk individuals) are more prone to buying health insurance as compared to low-risk individuals. MH occurs when insured individuals are more likely to use healthcare than the uninsured individuals, inflating insurance premiums and medical care costs. Empirically, AS and MH lead to endogeneity due to unobserved heterogeneity. In practice, endogeneity is often addressed by using the instrumental variable estimation technique; however, this approach suffers from identification problems. Therefore, in this paper, we use an instrument-free semi-parametric copula regression technique to examine how health insurance status affects hospitalization using a sample of individuals from a large nationally representative survey for India. Our results suggest the presence of AS and potential MH in the Indian healthcare market. We observe that chronically ill individuals are probable sources of AS, which leads to possible MH. A spline regression analysis suggests nonlinearity in health insurance choice and healthcare utilization across age, education, family size, and household consumption expenditure. We find chronically ill women in India exhibit less insurance coverage and lower hospital care usage. We also identify the vulnerable groups, such as older adults and rural residents, who have low insurance participation and high healthcare consumption. Our results indicate toward the need for evidence-based health care policy to manage the healthcare system and support the disadvantaged population of India. [ABSTRACT FROM AUTHOR]

The societal value of unpaid caregiving is estimated to exceed $470 billion annually. In spite of the high value care they provide, caregivers experience significant financial burden. This paper examines the sources and impact of financial burden on cancer caregivers. Survey of the published peer-reviewed literature complemented by Web-based sources. Caregivers for cancer patients may experience financial burden disproportionately relative to other caregivers because of the intensity of care they provide and the cost and complexity of cancer treatment. Financial burden stems from employment loss and cost of care and can continue long after the death of the patient. Few federal policy protections are available for caregivers. Oncology nurses can play an important role in recognizing the needs of caregivers and act as navigators to connect caregivers to available resources. [ABSTRACT FROM AUTHOR]

The conventional method for developing health care plan payment systems uses observed data to study alternative algorithms and set incentives for the health care system. In this paper, we take a different approach and transform the input data rather than the algorithm, so that the data used reflect the desired spending levels rather than the observed spending levels. We present a general economic model that incorporates the previously overlooked two-way relationship between health plan payment and insurer actions. We then demonstrate our systematic approach for data transformations in two Medicare applications: underprovision of care for individuals with chronic illnesses and health care disparities by geographic income levels. Empirically comparing our method to two other common approaches shows that the "side effects" of these approaches vary by context, and that data transformation is an effective tool for addressing misallocations in individual health insurance markets. [ABSTRACT FROM AUTHOR]

Abstract The Brazilian Unified Health System was created in the late 1980s to ensure free universal access to health care and was funded by taxes and social contributions. The persistent inequity in access to health services in favour of richer individuals in Brazil has been observed in the literature. However, to the best of our knowledge, no measurement of inequality in medicine use or private health insurance (PHI) among children has been performed with longitudinal data. This paper uses inequality indices and their decompositions to analyse the income-related inequalities/inequities in children's health care in the city of Pelotas, Brazil, using longitudinal data following children from 12 to 72 months of age. Our sample with data in all waves has between 1877 and 2638 children (varying according to outcome). We seek to answer three questions: i) How does the inequality/inequity in health care evolve as children grow up? ii) What are the main factors associated with inequality in children's health care? iii) How much of the change in inequality/inequity is explained by mobility in children's health care and income mobility? We found that inequities in health care have their beginnings in early childhood but that there was a reduction in inequity at 72 months of age. Ownership of children's PHI was associated with greater pro-rich inequity in health care. The reduction in inequality/inequity was linked to mobility in the sense that initially poorer children had greater gains in health care (a greater increase in PHI ownership and a lower reduction in medicine use). Despite this improvement among the poorest, apparently, the Brazilian public health service seems to fail to ensure equity in health care use among children, with possible long-term consequences on inequalities in health. Highlights • The inequities in health care have their beginnings even in early childhood. • Income and mother's education have a strong contribution in the inequalities. • Private health insurance has strong contribution in inequalities of medicine use. • There was reduction in inequity for children's health care in Pelotas/Brazil. • This improvement for poorest children occurred when they reached 72 months. [ABSTRACT FROM AUTHOR]

This paper estimates the effect of Medicaid prescription drug spending on mortality. I use the group- and state-specific roll out of Medicaid drug coverage to isolate plausibly exogenous variation in drug expenditures. I find that a $1 increase in Medicaid drug expenditures per resident reduces mortality from internal causes by 2.0 deaths per hundred thousand, a decline of 0.23%. I find relatively large effects for: (1) medically-treated diseases which pose an immediate risk of death, (2) impoverished areas which received a disproportionate share of state Medicaid dollars, and (3) areas with a high ratio of medical to surgical physicians. [ABSTRACT FROM AUTHOR]