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Background: Kenya aims to achieve universal health coverage (UHC) by 2030 and has selected the National Health Insurance Fund (NHIF) as the 'vehicle' to drive the UHC agenda. While there is some progress in moving the country towards UHC, the availability and accessibility to NHIF-contracted facilities may be a barrier to equitable access to care. We estimated the spatial access to NHIF-contracted facilities in Kenya to provide information to advance the UHC agenda in Kenya. Methods: We merged NHIF-contracted facility data to the geocoded inventory of health facilities in Kenya to assign facility geospatial locations. We combined this database with covariates data including road network, elevation, land use, and travel barriers. We estimated the proportion of the population living within 60- and 120-minute travel time to an NHIF-contracted facility at a 1-x1-kilometer spatial resolution nationally and at county levels using the WHO AccessMod tool. Results: We included a total of 3,858 NHIF-contracted facilities. Nationally, 81.4% and 89.6% of the population lived within 60- and 120-minute travel time to an NHIF-contracted facility respectively. At the county level, the proportion of the population living within 1-hour of travel time to an NHIF-contracted facility ranged from as low as 28.1% in Wajir county to 100% in Nyamira and Kisii counties. Overall, only four counties (Kiambu, Kisii, Nairobi and Nyamira) had met the target of having 100% of their population living within 1-hour (60 min) travel time to an NHIF-contracted facility. On average, it takes 209, 210 and 216 min to travel to an NHIF-contracted facility, outpatient and inpatient facilities respectively. At the county level, travel time to an NHIF-contracted facility ranged from 10 min in Vihiga County to 333 min in Garissa. Conclusion: Our study offers evidence of the spatial access estimates to NHIF-contracted facilities in Kenya that can inform contracting decisions by the social health insurer, especially focussing on marginalised counties where more facilities need to be contracted. Besides, this evidence will be crucial as the country gears towards accelerating progress towards achieving UHC using social health insurance as the strategy to drive the UHC agenda in Kenya. [ABSTRACT FROM AUTHOR]

Simple Summary: Despite consensus recommendations, national genetic counseling and testing rates for gynecological cancers remain relatively low. Prior studies have also shown that referrals are fewer for people of minority backgrounds. This initial study aimed to determine what genetic counseling and testing rates are found in a diverse patient setting. High rates of genetic counseling and testing are demonstrated, with no racial disparities. Both endometrial and ovarian cancer data are presented simultaneously in a single study in the first of its kind, helping provide a broader combined perspective. Point-of-care genetic counseling and testing by gynecologic oncologists is a strategy that can be similarly adopted at other institutions to potentially reduce disparities. Further studies can identify other factors responsible for the successful counseling and testing rates and how they can be used to broaden the reach of these services at other centers with similar diverse populations. We investigated genetic counseling and testing rates for patients with gynecologic malignancy at a tertiary care center with a large minority population. Our retrospective cohort included newly diagnosed epithelial ovarian, fallopian tube, peritoneal, or endometrial cancer patients between January 2014 and June 2022. For endometrial cancer, 373 patients were identified. A total of 207 (55%) patients were screened using mismatch repair immunohistochemistry (MMR IHC). A total of 82 (40%) had MMR deficiencies on IHC. Of these, 63 (77%) received genetic counseling. A total of 62 (98%) underwent genetic testing, and ultimately, 7 (11%) were diagnosed with Lynch syndrome (LS). The overall rate of LS was 1.9%. MMR IHC testing increased steadily, reaching 100% in 2022. For ovarian cancer, 144 patients were identified. A total of 104 (72%) patients received genetic counseling, and 99 (95%) underwent genetic testing. Rates were not influenced by race, ethnicity, insurance type, or family history of cancer. They were significantly different by cancer stage (p < 0.01). The proportion of patients who received genetic counseling increased from 47% in 2015 to 100% in 2022 (p < 0.01). Most counseling was performed by a gynecologic oncologist (93%) as opposed to a genetic counselor (6.7%). Overall, 12 (8.3%) patients were BRCA+. High rates of counseling and testing were observed with few disparities. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the finding from a proof-of-concept specialty pharmacy services program integrated into the patient experience for both occupational postexposure prophylaxis (oPEP) and nonoccupational PEP (nPEP) patients receiving HIV prevention medications at hospital-based emergency departments (EDs). Topics discussed include ED pharmacy operations, summary of specialty pharmacy services workflow, and study findings.

Background: Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC. Methods: Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs. Findings: The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles (n = 38) discussed sexual health domains including: GBV (n = 23); HIV/STI (n = 19); and CSE (n = 12). Over one-third (n = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care (n = 13); contraception (n = 13); fertility (n = 1); and safe abortion (n = 1). Eight included both reproductive and sexual health. Most grey literature (n = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels. Conclusions: This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC. Plain English summary: Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs. [ABSTRACT FROM AUTHOR]

Background Infants covered by Medicaid have higher respiratory syncytial virus (RSV) hospitalization rates than those with commercial insurance, but findings are limited to the inpatient setting. This birth cohort study describes healthcare encounters for RSV across all settings among infants covered by Medicaid and the Children's Health Insurance Program. Methods Medicaid claims for infants born and residing in Arizona (AZ), California (CA), Florida (FL), Michigan (MI), North Carolina (NC), New York (NY), and Texas (TX) were analyzed for first diagnosis of RSV in 2016–2018 using International Classification of Diseases, Tenth Revision codes. Encounters on the day of first diagnosis were examined by setting in 7 states and by setting and race in CA, FL, and NC. Results A total of 80 945 infants were diagnosed with RSV in 7 states in 2016–2018. The highest encounter rates for first RSV diagnosis were in the emergency department (ED) in 5 states (11.0–33.4 per 1000 in AZ, CA, FL, MI, and NY) and outpatient setting in 2 states (54.8 and 68.5 per 1000 in TX and NC). Significantly higher outpatient encounter rates were found in CA and NC for White infants compared to non-White infants. In NC, ED encounter rates were significantly higher for non-White infants than White infants, whereas in CA, the rates were comparable. In these 2 states, hospitalization rates were similar across groups. In FL, compared with White infants, non-White infants had significantly higher encounter rates in each setting on the day of first RSV diagnosis. Conclusions This is the first study to describe the burden of RSV by setting and race. Medicaid infants who are newly diagnosed with RSV have the highest burden in ED and outpatient settings. [ABSTRACT FROM AUTHOR]

Purpose: A major barrier to glaucoma medication adherence is the patient's out-of-pocket costs. At the University of Chicago Medical Center (UCMC), the institutional pharmacy piloted a program to query out-of-pocket costs for each patient's medication list based on their insurance coverage. This study aims to describe the impact of this collaboration between the glaucoma service and the outpatient pharmacy service. Methods: This study is a single institution, retrospective chart review of glaucoma patients with a formulary inquiry placed by a single glaucoma specialist between 4/1/2020 and 2/28/2022. Main outcome measures included medications before and after formulary inquiries, additional steps required to access the medications (ie, formulary exceptions, prior authorizations, tier exceptions), and out-of-pocket costs. Results: A total of 343 formulary inquiries, representing 568 individual medication inquiries, were conducted. Out of the 568 medication inquiries, only 78 could be filled for an affordable price without any additional steps. For 45 inquiries, additional steps were required for the medication to become covered at an affordable price. The remaining 445 inquires required additional steps with subsequent denial or prohibitive out-of-pocket costs. Conclusion: The UCMC workflow provided transparent out-of-pocket costs for patients to access glaucoma medications. This workflow may be cost-effective as it minimizes the burden on the overall system by reducing the number of patients who are unable to fill a prescription at the pharmacy due to issues with coverage or affordability. This model of physician-pharmacy collaboration can guide other institutions to implement similar workflows which directly mitigate costs and improve quality of care. [ABSTRACT FROM AUTHOR]

Context: Best practice guidelines for the recovery and return to work (RTW) of people with mental disorders recommend access to the services of an interdisciplinary team combining pharmacological, psychological and work rehabilitation interventions. In the Canadian context, primary healthcare services are responsible for providing these services for people with common mental disorders, such as depressive or anxiety disorders. However, not everyone has easy access to these recommended primary healthcare services, and previous studies suggest that multiple personal, practice‐related and organizational factors can influence the patient's journey. Moreover, previous studies documented that family physicians often work in silos and lack the knowledge and time needed to effectively manage by themselves patients' occupational health. Thus, the care and service trajectories of these patients are often suboptimal and can have important consequences on the person's recovery and RTW. Objective and Population Studied: Our study aimed to gain a better understanding of the patient journeys and the factors influencing their access to and experience with primary healthcare services while they were on sick leave due to a common mental disorder. Methods: A descriptive qualitative research design was used to understand and describe these factors. Conventional content analysis was used to analyze the verbatim. Results: Five themes describe the main factors that influenced the patient's journey of the 14 participants of this study: (1) the fragmented interventions provided by family physicians; (2) patients' autonomy in managing their own care; (3) the attitude and case management provided by the insurer, (4) the employer's openness and understanding and (5) the match between the person's needs and their access to psychosocial and rehabilitation services. Conclusions: Our findings highlight important gaps in the collaborative practices surrounding the management of mental health‐related sick leave, the coordination of primary healthcare services and the access to work rehabilitation services. Occupational therapists and other professionals can support family physicians in managing sick leaves, strengthen interprofessional and intersectoral collaboration and ensure that patients receive needed services in a timelier manner no matter their insurance coverage or financial needs. Patients of Public Contribution: This study aimed at looking into the perspective of people who have lived or are currently experiencing a sick leave related to a mental health disorder to highlight the factors which they feel hindered their recovery and RTW. Additionally, two patient partners were involved in this study and are now engaged in the dissemination of the research results and the pursuit of our team research programme to improve services delivered to this population. [ABSTRACT FROM AUTHOR]

This study developed a new family of distributions, the Marshall-Olkin generalized distribution. A novel model, the Marshall-Olkin Lomax (NMOL) distribution, was introduced into this family. The NMOL distribution exhibited a variety of density forms, including symmetry, right-skewness, reversed-J shape, upside-down bathtub curves, and scenarios with growing, decreasing, and mixed trends. From a practical perspective, the NMOL model was used to assess the failure and insurance data. Furthermore, a group-acceptance sampling plan (GASP) was developed based on the NMOL distribution, with the median serving as a quality criterion. This analysis also included numerical and graphical representations of the expected shortfalls and values at risk. Simulation studies were conducted to evaluate the effectiveness of the proposed estimation methods, and the findings significantly validated the NMOL model. However, this new distribution family and model has wide-ranging applications in sectors such as engineering, survival analysis, hydrology, and economics. [ABSTRACT FROM AUTHOR]

The American Diabetes Association advises clinicians of the potential for insulin overbasalization in the management of type 2 diabetes. Described as the titration of basal insulin beyond an appropriate dose, overbasalization increases risks for adverse effects such as hypoglycemia and weight gain without achieving the glycemic targets needed to optimally manage the disease. There is a need to determine the prevalence of and clinical factors that can lead to overbasalization. This study aimed to assess the prevalence of and characterize the patient variables associated with overbasalization in a family medicine practice. [ABSTRACT FROM AUTHOR]

Objective: The presence of disparities in access to health care and insurance coverage can have a tremendous impact on health care outcomes. Programs like the Affordable Care Act were implemented to improve health care access and to address the existing inequities. The objective of this study was to identify any disparities that exist between males and females regarding health care coverage and out-of-pocket cost to health care. Methods: This analysis was a cross-sectional study using the Behavioral Risk Factor Surveillance System survey data collected between 2013 and 2018. The primary predictor was sex assigned at birth (with the binary option of male vs. female). The primary outcome was adequate health coverage. Survey participants who indicated that they had health insurance with no out-of-pocket cost barriers to receiving medical care were considered to have adequate health coverage, while participants who did not meet these criteria were considered to have inadequate health coverage. Covariates measured were age, race/ethnicity, educational level, employment status, and annual household income. SAS survey procedures and weighting methods were used to measure the association between the sex and adequate health coverage, after controlling for covariates. Results: The data spanning 6 years included 2,249,749 adults, of whom 1,898,097 (84.4%) had adequate health coverage. Females made up 55.8% (N = 1,256,243) of the total sample. About 32.6% (N = 733,216) survey participants were aged ≥65 years. Most respondents, 77.6%, were White (Non-Hispanic). Across the 6-year period, females were more likely to have health insurance but with out-of-pocket costs that served as a barrier to their medical care (adjusted odds ratios with 95% CI from 2013 to 2018 were 1.36 [1.29–1.43], 1.38 [1.32–1.46], 1.31 [1.24–1.38], 1.33 [1.26–1.40], and 1.32 [1.25–1.40], respectively). Conclusions: Females were more likely than males to indicate an out-of-pocket cost barrier to medical care despite having health insurance. [ABSTRACT FROM AUTHOR]

BACKGROUND: To analyze safety in patients who switched from a reference drug to a biosimilar and to characterize providers’ perceptions about the prescribing of biosimilars. METHODS: This retrospective chart review was conducted at a multi-site academic health system and included patients who received bevacizumab or trastuzumab and were switched to the respective biosimilars, bevacizumab-awwb or trastuzumab-dkst, between October 2019 and February 2021. A survey was also administered to hematology/oncology providers that characterized their comfort with prescribing and their knowledge of biosimilars. RESULTS: This study included 185 patients, of whom 88 were in the bevacizumab group and 97 were in the trastuzumab group. After converting to a biosimilar, 25% and 23% of the patients who received bevacizumab and trastuzumab, respectively, had new adverse events. After the conversion, there were 2 instances of hypersensitivity in the bevacizumab group and 1 in the trastuzumab group. Only 2% and 6% of patients in the bevacizumab and trastuzumab biosimilar groups, respectively, switched back to the reference drug. Of the 41 providers surveyed, the majority felt comfortable or very comfortable prescribing a biosimilar for an FDA-approved indication (68%). The most common concerns noted were insurance coverage (30%) and the level of knowledge or comfort with biosimilars (20%). CONCLUSION: The results of this study demonstrated that conversion from a reference drug to a biosimilar is safe. Although the majority of providers felt comfortable prescribing biosimilars, insurance coverage and level of knowledge about or comfort with prescribing biosimilars were common concerns. [ABSTRACT FROM AUTHOR]

Background: Despite the recognized benefits of structured cancer screening, tests outside organized screening programs are common. Comprehensive reports on outside program screening in Europe are lacking, but the Flemish breast cancer (BC) and colorectal cancer (CRC) screening programs monitor data on non-organized tests prescribed by GPs and specialists. Methods: Using data at aggregated level, logistic regression was used to examine the relationship between health care utilization and screening coverage in 308 Flemish municipalities during 2015-18. Results: With regards to BC, municipalities with higher rates of gynecologists' visits had lower odds of coverage inside (-8%) and higher odds of coverage outside (þ17%) the program. By contrast, municipalities with higher rates of GP visits, had higher odds of coverage inside (þ6%) and lower odds of coverage outside (-7%) the program. As for CRC, municipalities with higher rates of visits gastroenterologists' visits had lower odds of coverage inside (-3%). Instead, municipalities with higher rates of GP visits, had higher odds of coverage both inside (þ2%) and outside (þ5%) the program. Municipalities with higher percentages of people with chronic conditions had higher odds of coverage within both the BC and CRC programs (þ5% and þ3%), and lower odds of outside screening (-7% and -6%). Municipalities with higher percentages of people 65þ with dementia and with mood disorders had, respectively, higher odds (þ13% and þ5%) and lower odds (-3% and -4%) of coverage inside both the BC and CRC programs. Conclusion: Our findings underscore the impact of healthcare utilization on cancer screening coverage at the municipal level in Flanders. [ABSTRACT FROM AUTHOR]

Background: Tasmania has the most rurally and remotely dispersed population of young people in Australia with high rates of youth experiencing mental ill health and socioeconomic disadvantage. Standard descriptions of mental healthcare provision are necessary for evidence-informed mental healthcare policy, planning and implementation. This systematic scoping study aimed to: (1) map and describe the characteristics of community-based youth mental health services (including substance-use) for young people in Tasmania, Australia and (2) identify gaps in service accessibility and provision. Methods: A list of eligible services was developed through a systematic search and consultation with key stakeholders. Data were collected from a representative from each eligible service via an interview or online survey. A standardised framework was used to classify, describe and map services. Thematic analysis was used to analyse service providers' perceived gaps to service access and provision. Results: Twenty-eight community-based mental health services for youth were identified, predominantly located in the major city of Tasmania's three service regions. Service gaps include the 'missing middle', lack of integrated supports and limited service capacity. Conclusions: The findings highlight the limited availability, accessibility and capacity of youth mental health services across Tasmania. Recommendations focus on increasing accessibility of rural/regional supports, provision of assertive outreach, psychosocial support, integrated care and strengthening the rural mental health workforce. These findings may inform the (re)design/(re)development of community-based youth mental health services in Tasmania. The findings may also guide evidence-informed mental health service planning, decision-making, development and implementation of integrated models of youth mental health care across Australia. Standard descriptions of mental healthcare provision are needed to inform evidence-based mental healthcare policy, planning and implementation. Systematic service scoping and mapping of community-based youth mental health services in Tasmania, Australia highlighted the limited availability and accessibility of supports available for young people (aged under 25 years) experiencing mental illness. These findings may inform the (re)design, (re)development and implementation of community-based youth mental health services, including a focus on integrated models of youth mental healthcare. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the association between the onset of the COVID-19 pandemic and change in low-value cancer services. STUDY DESIGN: In this retrospective cohort study, we used administrative claims from the HealthCore Integrated Research Environment, a repository of medical and pharmacy data from US health plans representing more than 80 million members, between January 1, 2016, and March 31, 2021. METHODS: We used linear probability models to investigate the relation between the onset of the COVID-19 pandemic and 4 guideline-based metrics of low-value cancer care: (1) conventional fractionation radiotherapy instead of hypofractionated radiotherapy for early-stage breast cancer; (2) non--guideline-based antiemetic use for minimal-, low-, or moderate- to high-risk chemotherapies; (3) off-pathway systemic therapy; and (4) aggressive end-of-life care. We identified patients with new diagnoses of breast, colorectal, and/or lung cancer. We excluded members who did not have at least 6 months of continuous insurance coverage and members with prevalent cancers. RESULTS: Among 117,116 members (median [IQR] age, 60 [53-69] years; 72.4% women), 59,729 (51.0%) had breast cancer, 25,751 (22.0%) had colorectal cancer, and 31,862 (27.2%) had lung cancer. The payer mix was 18.7% Medicare Advantage or Medicare supplemental and 81.2% commercial non-Medicare. Rates of low-value cancer services exhibited minimal changes during the pandemic, as adjusted percentage-point differences were 3.93 (95% CI, 1.50-6.36) for conventional radiotherapy, 0.82 (95% CI, -0.62 to 2.25) for off-pathway systemic therapy, -3.62 (95% CI, -4.97 to -2.27) for non--guideline-based antiemetics, and 2.71 (95% CI, -0.59 to 6.02) for aggressive end-of-life care. CONCLUSIONS: Low-value cancer care remained prevalent throughout the pandemic. Policy makers should consider changes to payment and incentive design to turn the tide against low-value cancer care. [ABSTRACT FROM AUTHOR]

It is documented that wheelchair failures occur frequently, repair times are lengthy, and users often experience adverse consequences. This study aims to gather evidence on efficiency of current wheelchair repair processes from the perspective of complex rehabilitation technology (CRT) suppliers who perform repairs within the United States. A 20 statement survey was developed to identify barriers and facilitators related to wheelchair repairs across the domains of administrative and operational factors as well as to identify future opportunities for improvement. Key statements in these areas included time to perform a repair, documentation requirements, tracking repair progress, reimbursement, technician competency, emerging strategies and preventative maintenance. The online survey was broadly disseminated to a nationwide network of CRT suppliers for data collection. A total of 127 responses were received. Results showed that administrative statements received the lowest scores while those statements dealing with future opportunities received the highest scores. Areas of the industry that suppliers were in most disagreement with included wait time for insurance approval, reimbursement for parts, reimbursement for technician travel time and lack of coverage for preventative maintenance. Telehealth system usage, preventative maintenance coverage, tracking repairs and repair scheduling were future opportunities that suppliers were in most agreement with. Administrative issues exist in the CRT industry due to restrictive insurance policies associated with repairs and maintenance. Future opportunities to improve the process exist including payment models and the application of telehealth, device monitoring and service-based performance incentives to reduce adverse consequences to the user. Highlights the direct importance and barriers faced within the wheelchair repair industry by CRT suppliers. In a sample of CRT suppliers, there is agreement there exists many administrative and operational issues related to wheelchair repairs. There is agreement among survey respondents of opportunities to investigate further telehealth and remote strategies, preventative maintenance coverage and online tracking for wheelchair repairs. [ABSTRACT FROM AUTHOR]

The article describes how socioeconomic inequities contribute to discrepant unintentional injury risks and calls for an expansion of investment in innovative and targeted prevention strategies to narrow this disparity. Topics include the impact of poverty on injury, barriers and opportunities to implementation of injury prevention, and recommendations for advocacy groups, health care organizations, and community organizations.

The traditional modeling of dependence among branches in non-life insurance has historically rested on the assumption of independence between risks. However, recent studies have brought to light that overlooking the interdependence between risks is not prudent. An illustrative example is found in automobile insurance, where a discernible connection exists between the number of claims in the Automobile Damage branch and those in the Automobile Civil Liability branch. This paper aims to delve into the utilization of copula functions for modeling the interrelationships among claims charges across diverse branches within a non-life insurance portfolio. Moreover, it seeks to assess the consequential impacts of these dependencies on the capital requirements of AXA Insurance in the Moroccan market. Our research concentrates on four pivotal branches within AXA Insurance, namely "work accidents", "automobile civil liability", "disability", and "fire, marine, aviation, and transport". Through a thorough analysis encompassing dependency measurements, independence tests, and various graphical representations, we have substantiated the existence of interdependencies among the claim costs associated with these four risk branches. Importantly, our findings underscore that assuming independence leads to a slight underestimation of the capital requirement needed for effective risk accumulation management by the insurer. [ABSTRACT FROM AUTHOR]

Calling attention to the growing intersection between the insurance and technology sectors—or 'insurtech'—this article is intended as a bat signal for the interdisciplinary fields that have spent recent decades studying the explosion of digitization, datafication, smartification, automation, and so on. Many of the dynamics that attract people to researching technology are exemplified, often in exaggerated ways, by emerging applications in insurance, an industry that has broad material effects. Based on in-depth mixed-methods research into insurance technology, I have identified a set of interlocking logics that underly this regime of actuarial governance in society: ubiquitous intermediation, continuous interaction, total integration, hyper-personalization, actuarial discrimination, and dynamic reaction. Together these logics describe how enduring ambitions and existing capabilities are motivating the future of how insurers engage with customers, data, time, and value. This article surveys each logic, laying out a techno-political framework for how to orient critical analysis of developments in insurtech and where to direct future research on this growing industry. Ultimately, my goal is to advance our understanding how insurance—a powerful institution that is fundamental to the operations of modern society—continues to change, and what dynamics and imperatives, whose desires and interests are steering that change. The stuff of insurance is far too important to be left to the insurance industry. [ABSTRACT FROM AUTHOR]

To determine the distribution and quantity of ophthalmic care consumed on Affordable Care Act (ACA) plans, the demographics of the population utilizing these services, and the relationship between ACA insurance coverage plan tier, cost sharing, and total cost of ophthalmic care consumed. This cross-sectional study analyzed ACA individual and small group market claims data from the Wakely Affordable Care Act (WACA) 2018 dataset, which contains detailed claims, enrollment, and premium data from Edge Servers for 3.9 million individual and small group market lives. We identified all enrollees with ophthalmology-specific billing, procedure, and national drug codes. We then analyzed the claims by plan type and calculated the total cost and out-of-pocket (OOP) cost. Among 3.9 million enrollees in the WACA 2018 dataset, 538,169 (13.7%) had claims related to ophthalmology procedures, medications, and/or diagnoses. A total of $203 million was generated in ophthalmology-related claims, with $54 million in general services, $42 million in medications, $20 million in diagnostics and imaging, and $86 million in procedures. Average annual OOP costs were $116 per member, or 30.9% of the total cost, and were lowest for members with platinum plans (16% OOP) and income-driven cost sharing reduction (ICSR) subsidies (17% OOP). Despite stable ocular disease distribution across plan types, beneficiaries with silver ICSR subsidies consumed more total care than any other plan, higher than platinum plan enrollees and almost 1.5× the cost of bronze plan enrollees. Ophthalmic care for enrollees on ACA plans generated substantial costs in 2018. Plans with higher OOP cost sharing may result in lower utilization of ophthalmic care. [ABSTRACT FROM AUTHOR]

This study examines the relationship between science and technology insurance (S&T insurance) and regional innovation from a macro innovation input-output perspective. Based on provincial panel data from 2010–2019, the impact of S&T insurance on regional innovation is examined using a dynamic panel regression model. The results indicate that S&T insurance has a significant promotion effect on innovation inputs with a lagged effect but a negative effect on innovation outputs. Further, there is regional and subject heterogeneity in the role of S&T insurance. S&T insurance has a significant effect on innovation input in the central and eastern regions, but not in the western regions; S&T insurance has a significant effect on innovation in enterprises, but not on non-enterprise organisations. This study also examines whether there is a spillover effect of S&T insurance on regional innovation. The results show a spillover effect on innovation inputs but no spillover effect on innovation outputs. Finally, the authors suggest promoting the development of the S&T insurance market to improve regional innovation capacity. [ABSTRACT FROM AUTHOR]

A major reason for the gendered division of parental leave use is the financial compensation during leave. Swedish national parental leave benefit provides 77.6 percent of earlier earnings up to an income ceiling, but collective agreements cover part of the income loss above the ceiling during leave. We focus on the importance of such collective agreements by examining fathers' parental leave take-up across the 2000s, as agreements were expanded during this period in time. We combine register data for the period 2001 to 2011 with the Longitudinal Integrated Database for Health Insurance and Labour Market Studies (LISA) being the key data source. The main division of agreements is between the state, the municipality and county, and the private sector. Results indicate that fathers with income above the income ceiling increase their use over the time period. Especially in the private sector a polarisation can be seen, where high income fathers increase their leave use, while fathers with lower income fall behind. As we do not find stronger increase in fathers' leave use in sectors where agreements expanded across time there is no evident support of a direct effect of the top-ups. [ABSTRACT FROM AUTHOR]

Objectives. To produce a database of private insurance hearing aid mandates in the United States and quantify the share of privately insured individuals covered by a mandate. Methods. We used health-related policy surveillance methods to create a database of private insurance hearing aid mandates through January 2023. We coded salient features of mandates and combined policy data with American Community Survey and Medicare Expenditure Panel Survey–Insurance Component data to estimate the share of privately insured US residents covered by a mandate from 2008 to 2022. Results. A total of 26 states and 1 territory had private insurance hearing aid mandates. We found variability for mandate exceptions, maximum age eligibility, allowable frequency of benefit use, and coverage amounts. Between 2008 and 2022 the proportion of privately insured youths (aged ≤ 18 years) living where there was a private insurance hearing aid mandate increased from 3.4% to 18.7% and the proportion of privately insured adults (19–64 years) increased from 0.3% to 4.6%. Conclusions. Hearing aid mandates cover a small share of US residents. Mandate exceptions in several states limit coverage, particularly for adults. Public Health Implications. A federal mandate would improve hearing aid access. States can also improve access by adopting exception-free mandates with limited utilization management and no age restrictions. (Am J Public Health. 2024;114(4):407–414. https://doi.org/10.2105/AJPH.2023.307551) [ABSTRACT FROM AUTHOR]

This study examined how interruptions in insurance coverage affect purchases of prescription drugs for young adults. It used data spanning 2014 to 2018 from Kentucky's prescription drug monitoring program, which tracked the universe of federally-regulated (Schedule II–V) prescription drugs dispensed in the state. The study employed a regression discontinuity design based on the age limit at 26 for dependent insurance coverage for children. At age 26, the probability of purchasing a prescription decreased by 5%, with all subcategories of prescriptions affected. The share of generic prescriptions increased for stimulants (the only category observed with substantial branded prescriptions). By age 27, prescription purchases returned to levels observed at 25, but the share purchased with public insurance and the generic share for stimulants remained higher. The findings suggest that interruptions in insurance coverage decrease prescription drug utilization by young adults and that public insurance programs such as Medicaid are important for resuming treatment. [ABSTRACT FROM AUTHOR]

Objective: To measure differences in access to contraceptive services based on history of incarceration and its intersections with race/ethnicity and insurance status. Data Sources and Study Setting: Primary data were collected from telephone calls to physician offices in Alabama, Louisiana, and Mississippi in 2021. Study Design: We deployed a field experiment. The outcome variables were appointment offers, wait days, and questions asked of the caller. The independent variables were callers' incarceration history, race/ethnicity, and insurance. Data Collection Methods: Using standardized scripts, Black, Hispanic, and White female research assistants called actively licensed primary care physicians and Obstetrician/Gynecologists asking for the next available appointment for a contraception prescription. Physicians were randomly selected and randomly assigned to callers. In half of calls, callers mentioned recent incarceration. We also varied insurance status. Principal Findings: Appointment offer rates were five percentage points lower (95% CI: −0.10 to 0.01) for patients with a history of incarceration and 11 percentage points lower (95% CI: −0.15 to −0.06) for those with Medicaid. We did not find significant differences in appointment offer rates or wait days when incarceration status was interacted with race or insurance. Schedulers asked questions about insurance significantly more often to recently incarcerated Black patients and recently incarcerated patients who had Medicaid. Conclusions: Women with a history of incarceration have less access to medical appointments; this access did not vary by race or insurance status among women with a history of incarceration. [ABSTRACT FROM AUTHOR]

Objective: To describe insurance patterns and discontinuity during pregnancy, which may affect the experiences of the pregnant person: their timely access to care, continuity of care, and health outcomes. Data Sources and Study Setting: Data are from the PROMISE study, which utilizes data from community‐based health care organizations (CHCOs) (e.g., federally qualified health centers that serve patients regardless of insurance status or ability to pay) in the United States from 2005 to 2021. Study Design: This descriptive study was a cohort utilizing longitudinal electronic health record data. Data Collection/Extraction Methods: Insurance type at each encounter was recorded in the clinical database and coded as Private, Public, and Uninsured. Pregnant people were categorized into one of several insurance patterns. We analyzed the frequency and timing of insurance changes and care utilization within each group. Principal Findings: Continuous public insurance was the most common insurance pattern (69.2%), followed by uninsured/public discontinuity (11.8%), with 6.4% experiencing uninsurance throughout the entirety of pregnancy. Insurance discontinuity was experienced by 16.6% of pregnant people; a majority of these reflect people transitioning to public insurance. Those with continuous public insurance had the highest frequency of inadequate prenatal care (19.5%), while those with all three types of insurance during pregnancy had the highest percentage of intensive prenatal care (16.5%). The majority (71.7%–81.2%) of those with a discontinuous pattern experienced a single insurance change. Conclusions: Insurance discontinuity and uninsurance are common within our population of pregnant people seeking care at CHCOs. Our findings suggest that insurance status should be regarded as a dynamic rather than a static characteristic during pregnancy and should be measured accordingly. Future research is needed to assess the drivers of perinatal insurance discontinuity and if and how these discontinuities may affect health care access, utilization, and birth outcomes. [ABSTRACT FROM AUTHOR]

We examine the problem of determining Pareto-optimal (PO) insurance contracts when the insurer imposes an ex ante upper limit on disbursement. The problem is similar in spirit to that of Cummins & Mahul (2004), but it extends it in two directions: first, we use the more general and more flexible class of distortion premium principles; and second, we allow for heterogeneity in beliefs between the insurer and the insured. We unify the settings of Ghossoub (2019a, 2019b), and we adapt the approaches therein to encompass the case of a policy limit. First, we show that PO contracts are those that result from a budget-constrained optimization problem for the DM. We then provide a closed-form characterization of optimal contracts. Our result is similar in spirit to that of Cummins & Mahul (2004), who show that when policy limits are introduced to Arrow's model, PO contracts are limited deductible contracts. While Ghossoub (2019a, 2019b) shows that variable deductible contracts are optimal, the results of the present paper indicate that limited variable deductible contracts are optimal when policy limits are present. We illustrate our results via numerical examples. [ABSTRACT FROM AUTHOR]

Often the barriers that arise in healthcare are due to healthcare professionals lack of education, exposure, and transphobia. Another potential barrier is due to geographical location of living in a rural area where there is a lack of healthcare services. This phenomenological study investigated barriers faced by transgender individuals who were transitioning in a rural area, focusing particularly on institutional barriers present in the healthcare system. Transgender individuals were recruited using convenience and snowball sampling. Data were collected via in-depth, face-to-face interviews in a rural area of the Midwest in the United States (n = 8). Transgender participants discussed themes of discrimination among healthcare providers based on gender. Participants reported gender markers as a barrier for healthcare services, such as inappropriate or incomplete response options on billing and medical forms. Participants perceived discrimination among gynecology, psychiatry, and medical emergency staff, and pharmacists. Overall, transgender individuals experienced mistreatment while transitioning in a rural area which created issues with participants' progress in transitioning. This study shows that education for all types of healthcare providers is needed regarding transgender health. Particularly in rural areas—many of which continue to lack essential healthcare services for the general population—the transgender population might not receive the culturally sensitive and appropriate attention they require. [ABSTRACT FROM AUTHOR]

Farmworkers in Michigan face precarious and exploitative labor conditions that affect their access to affordable, fair, and quality housing, which are key social determinants of health. We sought to assess the health, working conditions, and housing access, affordability, and quality of farmworkers living in and outside of employer-provided housing during the COVID-19 pandemic. We conducted a mixed methods cross-sectional study in collaboration with community partners from the Michigan Farmworker Project and the Michigan Department of Civil Rights. We assessed housing, labor conditions, and general health through in-depth phone interviews with seasonal, migrant, and H-2A farmworkers (n = 63) during the height of the COVID-19 pandemic (2020–2021) in Michigan. Descriptive analyses of these data included comparisons by type of farmworker and type of housing (employer-provided or other). The majority of farmworkers interviewed were women and seasonal farmworkers and spoke primarily Spanish. A significant share of farmworker participants reported living in poverty (38.3%) and had low or very low food security (27.0%). Nearly half of farmworkers (47.6%) rated their health as "fair" or "poor" during the year prior to the interview, and more than a third reported 3 or more chronic conditions (39.6%) and lack of health insurance coverage (38.7%). Among the 43 workers tested, 25.6% reported testing positive for COVID-19. Farmworkers reported experiences of objectification and dehumanization. Three-quarters of workers reported feeling that they were treated as less than human by supervisors and one-third reported verbal abuse. Farmworkers also experienced challenges exacerbated by their social vulnerability that impeded them from finding affordable, quality housing. Regarding housing quality, the majority of workers (80.6%) reported one or more environmental hazards around their residence, and about a third reported not having air conditioning (33.%) and lacking a functioning washing machine (33.9%). Concerns about the quality of drinking water accessible to workers and exposure to chemicals were shared by participants. This study adds valuable knowledge to the understanding of the systemic barriers to housing and work conditions for female and male seasonal, migrant, and H-2A farmworkers in Michigan. Shortcomings in the regulatory and policy environment result in precarious housing and work conditions, including exploitative labor practices. These conditions negate equality, fairness, and health equity, important tenants for public health. [ABSTRACT FROM AUTHOR]

Courts never tire of saying an insurance policy is "just a contract" and subject to ordinary rules of contract law. Contract here signals a plain language approach that strives for formal neutrality between the parties. Yet courts also frequently rely on a narrative that an insurance policy strives to be a 'just contract" with special pro-policy holder rules that reach beyond the plain language. How is insurance simultaneously "just a contract" and a 'just contract? " Prior scholarship has noted the confusion, but this Article aims to reconcile the dueling narratives. When the issue relates to scope or breadth of coverage--whether a loss is included within the bounds of the policy--strict construction gains the upper hand. But when the focus is on the suite of rights that flow from coverage--such as expanded remedies available upon an insurer breach--courts craft coverage rights which are deeper than what can be derived from the plain meaning of the policy. This distinction makes sense considering the degree of uncertainty posed in each setting. Broadening a policy to risks beyond its coverage base threatens to upend the match between risks and premiums. By contrast, the cost of deeper insurance is derivative of risks already assumed by the policy and thus more predictable to the insurer. This analysis gives courts a framework to understand when they should treat insurance law differently from contract law. Furthermore, because plain language exerts a strong pull over the entire landscape of contract law, clearly presenting counterexamples and their rationale should prevent courts from importing plain language concepts into areas of insurance law that are anchored on competing normative foundations. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to describe real-world adjuvant therapy (AT) use by disease substage and assess determinants of treatment choice among patients with stage III melanoma. Methods: This non-interventional retrospective study included survey responses and data from patient records provided by US medical oncologists. Survey responses, patient demographic/clinical characteristics, treatment utilization, and reasons for treatment were reported descriptively. The association between patient and disease characteristics and AT selection was assessed using logistic and multinomial regression models, overall and stratified by AJCC8 substage (IIIA vs. IIIB/C/D) and type of AT received (anti-PD1 monotherapy, BRAF/MEK, no AT), respectively. Results: In total 152 medical oncologists completed the survey and reviewed the charts of 507 patients (168 stage IIIA; 339 stages IIIB/IIIC/IIID); 405 (79.9%) patients received AT (360/405 (88.9%) received anti-PD1 therapy; 45/405 (11.1%) received BRAF/MEK therapy). Physicians reported clinical guidelines (61.2%), treatment efficacy (37.5%), and ECOG performance status (31.6%) as drivers of AT prescription. Patient-level data confirmed that improving patient outcomes (79%) was the main reason for anti-PD1 prescription; expected limited treatment benefit (37%), patient refusal (36%), and toxicity concerns (30%) were reasons for not prescribing AT. In multivariable analyses stage IIIB/IIIC/IIID disease significantly increased the probability of receiving AT (odds ratio [OR] 1.74) and anti-PD1 therapy (OR 1.82); ECOG 2/3 and Medicaid/no insurance decreased the probability of AT receipt (OR 0.37 and 0.42, respectively) and anti-PD1 therapy (OR 0.41 and 0.42, respectively) among all patients and patients with stage IIIA disease. Conclusion: Most patients were given AT with a vast majority treated with an anti-PD1 therapy. Physician- and patient-level evidence confirmed the impact of disease substage on AT use, with stage IIIA patients, patients without adequate insurance coverage, and worse ECOG status having a lower probability of receiving AT. [ABSTRACT FROM AUTHOR]

Background: The Government of North Macedonia's Primary Health Care reform is committed to leaving no one behind on the path to Universal health Coverage (UHC). During mid-2022 to March 2023, the World Health Organization (WHO) collaborated with the Government and other national stakeholders for an assessment of barriers to effective coverage with health services experienced by adult citizens, with a specific focus on rural areas and subpopulations in situations of vulnerability. Methods: This study constituted the piloting of a draft forthcoming WHO handbook on assessing barriers for health services, grounded in the Tanahashi framework for effective coverage with health services. In North Macedonia, the convergent parallel mixed methods study involved four sources. These were: a nationally representative Computer Assisted Telephone Interview Survey (1,139 respondents); 24 key informant interviews with representatives from government, professional associations, non-governmental and civil society organizations, and development partners; 12 focus groups in four regions with adults from vulnerable/high risk groups in rural areas and small urban settlements and an additional focus group with persons with disabilities; and a literature review. Instrument design was underpinned by the Tanahashi framework, which also orientated data triangulation and deductive analysis. The research team synergistically incorporated emerging themes in an inductive way. A key component of the assessment was participatory design of the study protocol with inputs from national stakeholders as well as participatory deliberation of the results and the ways forward. Results: Despite considerable progress towards UHC in North Macedonia, the assessment elucidated remaining challenges. These included: insufficient numbers of health workers, in general and particularly in the more disadvantaged regions of the country; inadequate number of outpatient medicines covered by health insurance; distance and transportation obstacles, including indirect travel costs, particularly in rural areas; adverse gender norms and relations for both women and men inhibiting timely treatment seeking; perceived discrimination by providers on multiple grounds; bottlenecks including waiting times to get appointments for specialist referrals; and lack of patient adherence, due several factors including costs of medicines and health products. Conclusions: The outputs from this study of barriers to effective coverage with health services for adult citizens of North Macedonia are feeding into the ongoing Primary Health Care reform, and provide evidence for equity-related actions in the forthcoming National Development Strategy. [ABSTRACT FROM AUTHOR]

Background: The construction of the ordered health delivery system in China aims to enhance equity and optimize the efficient use of medical resources by rationally allocating patients to different levels of medical institutions based on the severity of their condition. However, superior hospitals have been overcrowded, and primary healthcare facilities have been underutilized in recent years. China has developed a new case-based payment method called "Diagnostic Intervention Package" (DIP). The government is trying to use this economic lever to encourage medical institutions to actively assume treatment tasks consistent with their functional positioning and service capabilities. Methods: This study takes Tai'an, a DIP pilot city, as a case study and uses an interrupted time series analysis to analyze the impact of DIP reform on the case severity and service scope of medical institutions at different levels. Results: The results show that after the DIP reform, the proportion of patients receiving complicated procedures (tertiary hospitals: β3 = 0.197, P < 0.001; secondary hospitals: β3 = 0.132, P = 0.020) and the case mix index (tertiary hospitals: β3 = 0.022, P < 0.001; secondary hospitals: β3 = 0.008, P < 0.001) in tertiary and secondary hospitals increased, and the proportion of primary-DIP-groups cases decreased (tertiary hospitals: β3 = -0.290, P < 0.001; secondary hospitals: β3 = -1.200, P < 0.001), aligning with the anticipated policy objectives. However, the proportion of patients receiving complicated procedures (β3 = 0.186, P = 0.002) and the case mix index (β3 = 0.002, P < 0.001) in primary healthcare facilities increased after the reform, while the proportion of primary-DIP-groups cases (β3 = -0.515, P = 0.005) and primary-DIP-groups coverage (β3 = -2.011, P < 0.001) decreased, which will reduce the utilization efficiency of medical resources and increase inequity. Conclusion: The DIP reform did not effectively promote the construction of the ordered health delivery system. Policymakers need to adjust economic incentives and implement restraint mechanisms to regulate the behavior of medical institutions. [ABSTRACT FROM AUTHOR]

Background: This study was designed to identify factors associated with at least one emergency department (ED) visit and those associated without consultation by a general practitioner or paediatrician (GPP) before ED visit. Levels of annual consumption of healthcare services as a function of the number of ED visit were reported. Methods: This retrospective study focused on children < 18 years of age living in mainland France and followed for one-year after their birth or birthday in 2018. Children were selected from the national health data system, which includes data on healthcare reimbursements, long-term chronic diseases (LTD) eligible for 100% reimbursement, and individual complementary universal insurance (CMUc) status granted to households with a low annual income. Adjusted odds ratios (OR) were estimated using multivariate logistic regression. Results: There were 13.211 million children included (94.2% of children; girls 48.8%). At least one annual ED visit was found for 24% (1: 16%, 2: 5%, 3 or more: 3%) and 14% of visits led to hospitalization. Factors significantly associated with at least one ED visit were being a girl (47.1%; OR = 0.92), age < 1 year (9.1%; OR = 2.85), CMUc (22.7%, OR = 1.45), an ED in the commune of residence (33.3%, OR = 1.15), type 1 diabetes (0.25%; OR = 2.4), epilepsy (0.28%; OR = 2.1), and asthma (0.39%; OR = 2.0). At least one annual short stay hospitalisation (SSH) was found for 8.8% children of which 3.4% after an ED visit. A GPP visit the three days before or the day of the ED visit was found for 19% of children (< 1 year: 29%, 14–17 years: 13%). It was 30% when the ED was followed by SSH and 17% when not. Significant factors associated with the absence of a GPP visit were being a girl (OR = 0.9), age (1 year OR = 1.4, 14–17 years OR = 3.5), presence of an ED in the commune of residence (OR = 1.12), epilepsy LTD (OR = 1.1). Conclusion: The low level of visits to GPP prior to a visit to the ED and the associated factors are the elements to be taken into account for appropriate policies to limit ED overcrowding. The same applies to factors associated with a visit to the ED, in order to limit daily variations. [ABSTRACT FROM AUTHOR]

Background: China is exploring payment reform methods for patients to address the escalating issue of increasing medical costs. While most district hospitals were still in the stage of Single Disease Payment (SDP) due to conditions, there is a scarcity of research on comprehensive assessment of SDP. This study aims to evaluate the implementation of SDP in a district hospital, and provided data support and scientific reference for improving SDP method and accelerating medical insurance payment reform at district hospitals. Methods: Data was collected from 2337 inpatient medical records at a district hospital in Fuzhou, China from 2016 to 2021. These diagnoses principally included type 2 diabetes, planned cesarean sections, and lacunar infarction. Structural variation analysis was conducted to examine changes in the internal cost structure and dynamic shifts in medical expenses for both the insured (treatment group) and uninsured (control group) patients, pre- and post-implementation of the SDP policy on August 1, 2018. The difference-in-differences (DID) method was employed to assess changes in hospitalization expenses and quality indicators pre- and post-implementation. Furthermore, subjective evaluation of medical quality was enhanced through questionnaire surveys with 181 patients and 138 medical staff members. Results: The implementation of SDP decreased the medical expenses decreased significantly (P < 0.05), which can also optimize the cost structure. The drug cost ratio descended significantly, and the proportion of laboratory fee rose slightly. The changes in infection rate, cure rate, and length of stay indicated enhanced medical quality (P < 0.05). The satisfaction of inpatients with SDP was high (89.2%). Medical staff expressed an upper middle level of satisfaction (77.2%) but identified difficulties with the implementation such as "insufficient coverage of disease types". Conclusion: After the implementation of SDP in district hospitals, considerable progress has been achieved in restraining medical expenses, coupled with notable enhancements in both medical quality and patient satisfaction levels. However, challenges persist regarding cost structure optimization and underutilization of medical resources. This study suggests that district hospitals can expedite insurance payment reform by optimizing drug procurement policies, sharing examination information, and strengthening the management of medical records. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to identify factors associated with the cessation of human milk prior to neonatal intensive care unit (NICU) discharge for infants diagnosed with bronchopulmonary dysplasia (BPD). Study Design Participants were recruited from the Johns Hopkins BPD Clinic between January 2016 and October 2018. Clinical and demographic characteristics were analyzed based on whether participants stopped human milk before or after NICU discharge. Results Of the 224 infants included, 109 (48.7%) infants stopped human milk prior to discharge. The median duration of human milk intake was less for infants who stopped human milk prior to discharge compared with those who continued after discharge (2 vs. 8 months, p < 0.001). In multivariate regression analysis, pulmonary hypertension (odds ratio [OR]: 2.90; p = 0.016), public insurance (OR: 2.86; p < 0.001), and length of NICU admission (OR: 1.26 per additional month; p = 0.002) were associated with human milk cessation prior to NICU discharge. Conclusion Infants with BPD who have severe medical comorbidities and markers of lower socioeconomic status may be at higher risk for earlier human milk discontinuation. Key Points Half of infants in our study with BPD who received human milk stopped human milk prior to NICU discharge. For infants on human milk after discharge, the duration of human milk intake was 8.6 months. Infants with pulmonary hypertension, tracheostomies, and ventilation stopped human milk earlier. Non-White race, lower income, and public insurance were predictors of early human milk cessation. [ABSTRACT FROM AUTHOR]

Background: The emergence of high-priced potential cures has sparked significant health policy discussions in South Korea, where the healthcare system is funded through a single-payer National Health Insurance model. We conducted focus group interviews (FGIs) and accompanying surveys with diverse stakeholders to comprehensively understand related issues and find better solutions to the challenges brought by these technologies. Methods: From October to November 2022, 11 FGIs were conducted with stakeholders from various sectors, including government payers, policy and clinical experts, civic and patient organisations, and the pharmaceutical industry, involving a total of 25 participants. These qualitative discussions were supplemented by online surveys to effectively capture and synthesise stakeholder perspectives. Results: Affordability was identified as a critical concern by 84% of stakeholders, followed by clinical uncertainty (76%) and limited value for money (72%). Stakeholders expressed a preference for both financial-based controls and outcome-based pricing strategies to mitigate these challenges. Despite the support for outcome-based refunds, payers raised concerns about the feasibility of instalment payment models, whether linked to outcomes or not, due to the specific challenges of the Korean reimbursement system and the potential risk of 'cumulative liabilities' from ongoing payments for previously administered treatments. In addition, the FGIs highlighted the need for clear budgetary limits for drugs with high uncertainties, with mixed opinions on the creation of special silo funds (64.0% agreement). Less than half (48%) endorsed the use of external reference pricing, currently applied to such essential drugs in South Korea. A significant majority (84%), predominantly non-pharma stakeholders, advocated for addressing cost-effectiveness uncertainty through re-assessment once long-term clinical data become available. Conclusions: This study uncovers a broad agreement among stakeholders on the need for more effective value assessment methodologies for high-priced potential cures, stressing the importance of more robust and comprehensive re-assessment supported by long-term data collection, rather than primarily relying on external reference pricing. Each type of stakeholders exhibited a cautious approach to their specific uncertainties, suggesting that new funding strategies should accommodate these uncertainties with predefined guidelines and agreements prior to the initiation of managed entry agreements. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic accelerated the integration of telemental health services for older adults. But such digitization also created new complexities regarding equitable access, privacy, and regulation. This article summarizes the evolving digital mental health landscape, focusing on regulatory frameworks, inherent risks, and the transformative potential of technology, particularly artificial intelligence (AI). Also covered are shifts in Medicare coverage and calls for standardized guidelines, interdisciplinary collaboration and robust regulation focused on patient privacy and AI ethics. Despite challenges, AI-driven diagnostic, monitoring, and intervention tools offer insights into mental health trajectories, using data generated by wearables, social media, and immersive technologies. [ABSTRACT FROM AUTHOR]

As the main path for realizing the value of forestry carbon sinks, forestry carbon sink credit financing is of great value in revitalizing forestry carbon sink resources, enhancing the value of carbon sink assets, and alleviating the financing constraints of carbon sink operating enterprises. At present, some regions in China have explored the pilot forestry carbon sinks pledge financing business, but are faced with the realistic dilemma that it is difficult to replicate and promote the existing model. This article analyzes the financing mode and existing deficiencies of typical cases, examines the problems forestry carbon sink credit financing is currently facing, and explores the fundamental reasons affecting the forestry carbon sinks to play the role of pledge. The study finds that: ① The legal attributes of forestry carbon sinks are not clear, and there is a lack of legal basis for the change of relevant rights and interests involved in the process of pledge establishment. ② The lack of standards for assessing the value of forestry carbon sinks makes it difficult for banks to recognize the results of the assessment of the value of the pledge. ③ It is difficult to dispose of the forestry carbon sink assets and realize the pledge right, and the banks cannot effectively control the risk of credit defaults due to the lack of realization paths for the pledge right. Therefore, by introducing the policy pledge, value recognition, and financial credit enhancement functions of forestry carbon sink insurance and the guarantee credit enhancement role of the carbon sink storage mechanism in the realization of the pledge right, this study innovatively puts forward three forestry carbon credit financing models, namely, 'forest right mortgage with forestry carbon sink pledge + carbon sink value insurance + forest right (carbon sink) storage guarantee,' 'forestry carbon sink (expected return right) value insurance policy pledge + carbon sink storage guarantee,' and 'forestry carbon sink asset pledge + carbon sink price index insurance,' providing feasible paths for the promotion of forestry carbon sink pledge financing. Finally, in view of the constraints of forestry carbon credit financing, specific strategies are proposed to promote the effective development of forestry carbon credit financing in five aspects: improving the institutional framework of forestry carbon sinks, unifying the standard of carbon sink assessment and accounting, optimizing and innovating carbon insurance products, establishing the guarantee system for the storage of carbon sinks, and constructing the financial support system for forestry carbon sinks. [ABSTRACT FROM AUTHOR]

• Treating pulmonary exacerbations in the hospital may be better than at home. • We looked for characteristics related to where people received treatment. • People with Medicaid and received treatment for shorter times were more likely to receive care in the hospital. • Practical, not clinical, factors play a large role in where treatment occurs. Previous studies indicate that hospital rather than home treatment of pulmonary exacerbations (PEx) in people with cystic fibrosis (CF) can improve outcomes. We evaluated characteristics of adult participants from the Standardized Treatment of Pulmonary Exacerbations (STOP2) trial with two separate comparisons: (1) those who were treated initially in hospital (N = 768) to those treated initially at home (N = 214) and (2) those treated only in hospital (N = 328) to those who were treated only at home or both at home and in hospital (N = 654). Participants who had Medicaid insurance, were treated for shorter duration, and traveled longer to reach treatment centers were more likely to have been treated initially in the hospital. Having Medicaid insurance, being treated for a shorter duration, and being male were associated with being treated only in the hospital. This analysis suggests decisions about the location of treatment are based on pragmatic factors rather than on clinical characteristics. [ABSTRACT FROM AUTHOR]

Background: Little is known regarding how patient insurance status influences outcomes after extensor tendon-injury repair. We aim to establish a relationship between the outcomes of primarily repaired extensor tendon injuries and patient insurance status. We hypothesize that commercially insured patients will achieve superior outcomes due to more facile access to postoperative hand therapy and fewer barriers to appropriate postoperative care. Methods: A retrospective chart review was conducted of patients who underwent primary extensor tendon repair in any zone, excluding the thumb, at a single large safety-net hospital. Inclusion criteria included a minimum of eight weeks of follow-up, complete data available for review, and an extensor tendon injury requiring primary surgical repair. Four cohorts were examined: patients with commercial insurance, patients with Medicare/Medicaid, patients with county hospital-sponsored insurance, and uninsured patients. Statistical analysis was performed using Chi-Square and ANOVA analyses, with significance defined as p ≤ 0.05. Results: Of the 62 patients (100 digits) included, 20 had commercial insurance, 12 had Medicare/Medicaid, 13 had hospital-sponsored insurance, and 17 were uninsured. Except for mean age, there were no significant differences between groups in terms of demographic data, medical comorbidities, or digit characteristics. There were also no significant differences in mean follow-up, time to return to full activity, or surgical complications among groups. Procedure duration differed significantly between groups, with procedures lasting longer in uninsured patients. Postoperative final flexion total arc of motion (TAM) and extension measurements were similar across all groups. Additionally, hand therapy visits did not differ significantly between groups. Conclusions: Following extensor tendon repair, patient insurance status did not affect outcomes in terms of final range of motion, return to full activity, or postoperative complications. [ABSTRACT FROM AUTHOR]

Due to diminishing ice shelves in the Arctic, no doubt caused by climate change, previously unnavigable marine spaces are opening up, which in turn may provide new maritime routes. The shipping and maritime industry may capitalise on these routes more in the future as they provide shorter sailing times, and may assist with increasing oil and gas exploration and extraction in the region. However, increased maritime expansion in the Arctic comes with a number of unique risks and hazards for the insured and insurer. This opinion therefore seeks to discuss the implications of the multitude of risks that are associated with Arctic shipping from a marine insurance perspective and to highlight some of the gaps in existing regulatory frameworks. It is argued that marine insurers require improved data and risk management methodologies in order to better calculate the premiums of Hull & Machinery (H&M) and Protection & Indemnity (P&I) insurance policies for ships travelling through the Arctic. Until such time as these risks can be adequately assessed, evaluated, and managed by insurers; which of course is extremely difficult, due to the extreme environment, the unpredictability of climate change, a lack of key data, and the complexity of the various scenarios that can unfold in the Arctic environment, the practical viability of Arctic shipping remains doubtful. To date, insurers have paid out more in ship damage that has occurred in the Arctic than they have collected in premiums, which in itself is problematic. This situation may change in the future if Arctic shipping grows, and if it does the insurance market will no doubt, need to respond. [ABSTRACT FROM AUTHOR]

The article "Voluntary Health Insurance in the GSVG" provides an overview of the various options for voluntary health insurance within the framework of the GSVG. The GSVG provides, among other things, for continued insurance coverage upon leaving mandatory insurance and the possibility of establishing health insurance coverage for certain family members. In addition, § 9 GSVG allows for the receipt of sickness benefits in the event of incapacity for work due to illness through the conclusion of supplementary insurance. Continued insurance coverage immediately follows the end of the previous health insurance to ensure uninterrupted insurance coverage. Continued insurance in the statutory health insurance is an important instrument to enable uninsured individuals to be included in the solidarity community and protect them from the risks and premiums of private health insurance. [Extracted from the article]