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The Employee Retirement Income Security Act of 1974 (ERISA) not only regulates employer-sponsored retirement benefits but also extends to employer-sponsored health plans, preempting state and local regulations. Proponents argue that ERISA preemption creates a uniform regulatory environment for employers, reducing administrative costs and fostering innovation. Large employers value ERISA preemption for its ability to offer consistent benefits across states, lower costs, and promote workforce mobility. If ERISA preemption were eroded, employers may face higher costs and potential challenges in providing health benefits. [Extracted from the article]

Objective: Given the consequences of delayed treatment and diagnosis of craniosynostosis, this study reviews the literature on sociodemographic risk factors and disparities associated with delayed craniosynostosis treatment. Design: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search of PubMed/Medline and Embase was performed by two independent reviewers. Included studies discussed craniosynostosis health disparities. Demographic characteristics and outcomes were analyzed. Setting: Not applicable. Patients: Patients with craniosynostosis. Interventions: Standard surgical intervention for craniosynostosis. Results: Our literature search yielded 273 studies, of which 18 were included for analysis. Included studies represented data from 31 256 U.S. patients with craniosynostosis. Sixty percent of patients (n = 16 510) were White, 13.8% were Hispanic/Latino, 6.2% were Black/African American, 1.3% were Asian, 0.3% were American Indian or Alaska Native, and 0.1% were Native Hawaiian or Pacific Islander. Average age at surgery was 6.36 months for White patients, 10.63 months for Black patients, and 9.18 months for Hispanic patients. Minority racial and/or ethnic status was a risk factor for delayed presentation, and increased incidence of open surgery, complication rates, hospital charges, operative time, anesthesia duration, and hospital length of stay. Government-funded health insurance was associated with delayed intervention and increased complications. Conclusions: Minority craniosynostosis patients experience delays in intervention and increased complication rates. Our findings highlight the importance of expedited and equitable referrals, screenings, and treatment, and the need for a standardized approach to investigating longitudinal demographic and outcomes data in this population. [ABSTRACT FROM AUTHOR]

Context: Insurance coverage for abortion in states where care remains legal can alleviate financial burdens for patients and increase access. Recent policy changes in Illinois required Medicaid and some private insurance plans to cover abortion care. This study explores policy implementation from the perspectives of patients using their insurance to obtain early abortion care. Methodology: Between July 2021 and February 2022, we interviewed Illinois residents who recently sought abortion care at ≤11 weeks of pregnancy. We also interviewed nine key informants with experience providing or billing for abortion or supporting insurance policy implementation in Illinois. We coded interview transcripts in Dedoose and developed code summaries to identify salient themes across interviews. Results: Most participants insured by Illinois Medicaid or eligible for enrollment received full coverage for their abortions; most with private insurance did not and faced challenges learning about coverage status. Some opted not to use insurance, often citing privacy concerns. Participants who benefited from abortion coverage expressed relief, gave examples of other financial challenges they could prioritize, and described feeling in control of their abortion experience. Those without coverage described feeling stressed, uncertain, and constrained in their decision‐making. Conclusion: When abortion was fully covered by insurance, it reduced financial burdens and enhanced reproductive autonomy. Illinois Medicaid policy—with seamless enrollment options and appropriate reimbursement rates—offers a model for improving abortion access in other states. Further investigation is needed to determine compliance among private insurance companies and increase transparency. [ABSTRACT FROM AUTHOR]

Mandated health insurance coverage for expensive in vitro fertilization (IVF) treatment varies widely in generosity across the US states. We find that more generous coverage within the states that mandate any coverage causes a greater incidence of multiple births, which are costly and can be risky. While more generosity is associated with fewer embryos transferred, this effect is outweighed by greater overall utilization of IVF. In addition, more generous coverage is associated with differences in the composition of patients, where more older women with lower fertility pursue treatment. This is mirrored by lower rates of child adoption by older women in those states. Utilization and compositional effects imply that increased access without regulation might impose additional burdens on the health-care system. [ABSTRACT FROM AUTHOR]

We investigate whether state health insurance parity laws adopted in the 1990s and 2000s for substance use disorder (SUD) treatment reduce traffic fatalities in the United States. Impaired driving is a major contributing factor to US traffic fatalities. State health insurance parity laws compel private insurers to cover SUD treatment more generously—on par with physical health services. We employ 21 years of administrative data from the Fatality Analysis Reporting System. We estimate both two-way fixed-effects regressions and an interaction-weighted estimator that is robust to potential bias attributable to heterogenous and dynamic treatment effects with staggered policy adoption. Our findings indicate that state parity law passage reduces overall traffic fatality rates by 2.8 percent, with larger effects for fatalities that involve alcohol. These findings suggest that state regulations requiring private insurers to equitably cover SUD treatment can improve traffic safety. [ABSTRACT FROM AUTHOR]

This document provides an overview of the negative consequences of the prior authorization process in healthcare, which prioritizes cost containment over patient well-being. It presents case studies where patients experienced delays in receiving necessary treatments due to prior authorization denials, resulting in adverse outcomes. The article argues for reforms to prioritize patient care and discusses the challenges and regulations associated with prior authorizations. It also discusses the history and development of managed care and utilization management in the United States, highlighting the growth of health maintenance organizations (HMOs) and preferred provider organizations (PPOs). The document explores the impacts of prior authorization on healthcare costs and quality, as well as the timeframes and delays associated with the process. It questions the prioritization of contractual obligations over human life in coverage denials and suggests potential solutions to improve the prior authorization process. [Extracted from the article]

The Affordable Care Act (ACA), also known as Obamacare, was enacted in 2010 to expand access to affordable healthcare in the United States. It aimed to increase insurance coverage through measures such as Medicaid expansion and the establishment of health insurance marketplaces. The marketplaces provide a centralized and transparent place for individuals to compare and purchase health insurance plans, with subsidies available to make coverage more affordable. The ACA has led to increased stability in the marketplaces, with more insurers participating and premiums stabilizing. However, challenges remain in terms of affordability and enrollment. The New York marketplace is highlighted as a successful model, and the use of health reimbursement arrangements and their impact on small employers is discussed. The ACA marketplaces have also had positive effects on entrepreneurship by providing affordable coverage options. Overall, while progress has been made, there are ongoing challenges in achieving a fully stable and accessible healthcare marketplace. [Extracted from the article]

Aim: This study aimed to investigate the current status of progestogen treatment for pregnant women at a high risk for preterm birth (PTB) in childbirth healthcare facilities in Japan. Methods: A web‐based nationwide questionnaire survey regarding progestogen use for prevention of PTB was conducted among childbirth healthcare facilities from 2019 to 2021. Results: Valid responses were obtained from 528 facilities (25.2% of those surveyed), including 155 tertiary perinatal facilities (making up 92.3% of all tertiary perinatal care facilities). In the survey period, progestogen treatment was implemented in 207 facilities (39.2%) for PTB prevention. Regarding types of progestogens, 17α‐hydroxyprogesterone caproate was used in 170 facilities (82.1%), with a low dose (125 mg/week) administered in 62.9% of the facilities to comply with the regulations of the national health insurance system, although 250 mg/week is considered the best dose. Vaginal progesterone was used in 36 facilities (17.4%), although the cost of vaginal progesterone was not covered by health insurance. Of the facilities not administering progestogen treatment, approximately 40% expressed that vaginal progesterone would be their first choice for PTB prevention in daily practice if it would be covered by health insurance in the future. Conclusions: Due to the current regulations of the Japanese health insurance system, 17α‐hydroxyprogesterone caproate, rather than vaginal progesterone, was mainly used for PTB prevention. Despite global evidence supporting vaginal progesterone as the approach with the highest efficacy, only a limited number of facilities have utilized it due to the current drug use regulations in Japan. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The South African government is moving toward universal health coverage (UHC) with the passing of the National Health Insurance (NHI) Bill. Access to quality primary healthcare (PHC) is the cornerstone of UHC principles. The South African governmental health department have begun focusing efforts on improving the efficiency and functionality of this system; that includes the involvement of private healthcare professionals and medical insurance companies. This study sought to explore perceptions of medical insurance company personnel on PHC re-engineering as part of NHI restructuring. A qualitative research design was adopted in this study. Semi-structured interviewed were conducted on 10 participants. Their responses were audio recorded and transcribed utilizing Microsoft Word® documents. Nvivo® was used to facilitate the analysis of data. A thematical approach was used to categories codes into themes. Although participants were in agreement with the current healthcare reform in South Africa. The findings of this study have highlighted several gaps in the NHI Bill at the current point in time. In order to achieve standardized quality of care at a primary level; it is imperative that reimbursement frameworks with clearly detailed service provision and accountability guidelines are developed. [ABSTRACT FROM AUTHOR]

Background: The concept of universal health coverage (UHC) encompasses both access to essential health services and freedom from financial harm. The World Health Organization's Maternal Newborn Child and Adolescent Health (MNCAH) Policy Survey collects data on policies that have the potential to reduce maternal morbidity and mortality. The indicator, "Are the following health services provided free of charge at point-of-use in the public sector for women of reproductive age?", captures the free provision of 13 key categories of maternal health-related services, to measure the success of UHC implementation with respect to maternal health. However, it is unknown whether it provides a valid measure of the provision of free care. Therefore, this study compared free maternal healthcare laws and policies against actual practice in three countries. Methods and findings: We conducted a cross-sectional study in four districts/provinces in Argentina, Ghana, and India. We performed desk reviews to identify free care laws and policies at the country level and compared those with reports at the global level. We conducted exit interviews with women aged 15–49 years who used a component service or their accompanying persons, as well as with facility chief financial officers or billing administrators, to determine if women had out-of-pocket expenditures associated with accessing services. For designated free services, prevalence of expenditures at the service level for women and reports by financial officers of women ever having expenditures associated with services designated as free were computed. These three sources of data (desk review, surveys of women and administrators) were triangulated, and chi-square analysis was conducted to determine if charges were levied differentially by standard equity stratifiers. Designation of services as free matched what was reported in the MNCAH Policy Survey for Argentina and Ghana. In India, insecticide-treated bed nets and testing and treatment for syphilis were only designated as free for selected populations, differing from the WHO MNCAH Policy Survey. Among 1046, 923, and 1102 women and accompanying persons who were interviewed in Argentina, Ghana, and India, respectively, the highest prevalence of associated expenditures among women who received a component service in each setting was for cesarean section in Argentina (26%, 24/92); family planning in Ghana (78.4%, 69/88); and postnatal maternal care in India (94.4%, 85/90). The highest prevalence of women ever having out of pocket expenditures associated with accessing any free service reported by financial officers was 9.1% (2/22) in Argentina, 64.1% (93/145) in Ghana, and 29.7% (47/158) in India. Across the three countries, self-reports of out of pocket expenditures were significantly associated with district/province and educational status of women. Additionally, wealth quintile in Argentina and age in India were significantly associated with women reporting out of pocket expenditures. Conclusions: Free care laws were largely accurately reported in the global MNCAH policy database. Notably, we found that women absorbed both direct and indirect costs and made both formal and informal payments for services designated as free. Therefore, the policy indicator does not provide a valid reflection of UHC in the three settings. [ABSTRACT FROM AUTHOR]

The article titled "Symposium: Firmin DeBrabander's Life After Privacy: Reclaiming Democracy in a Surveillance Society" explores the erosion of privacy in the age of Big Data and discusses the challenges of resisting this trend. It examines the power dynamics between the state, corporations, and individuals, highlighting their role in governing and controlling personal information. The author argues for the importance of privacy and suggests shifting focus towards a political conception of public life inspired by civil rights and labor movements. The article acknowledges the complexity of privacy and its applications, but emphasizes the need to push back against Big Data and defend privacy as a threat to individual identities. [Extracted from the article]

Purpose: To estimate the number of practicing nurses required to resolve staffing differences between capital and non-capital regions and analyze the relationship between regional differences in staffing and salary. Methods: Using public data on population, patients, newly licensed nurses, practicing nurses, and annual salaries, regional differences were analyzed in newly licensed nurses per population, practicing nurses per population, practicing nurses per patient (i.e., staffing level), and salary. The number of additionally required practicing nurses was estimated by multiplying staffing differences by the number of patients in the lower-staffed region. Results: During 2002~2022, 71,107 and 243,611 newly licensed nurses were supplied, while the number of practicing nurses increased by 91,886 and 88,070 in the capital and non-capital regions, respectively. The non-capital region had more practicing nurses per population, whereas the capital region had more practicing nurses per patient. In 2020, 31,330 practicing nurses were additionally required in the non-capital region. Salaries were higher in the capital region, and regional salary differences increased during 2011~2020. Regional salary differences were associated with regional staffing differences and the number of additionally required practicing nurses. Conclusion: Government and health insurance policies are required to encourage hospitals in the non-capital region to improve staffing and salaries. [ABSTRACT FROM AUTHOR]

Background: According to Israel's National Health Insurance Law (1994), the Ministry of Health is responsible for the provision of health services in the country including physiotherapy services; moreover, the Special Education Law (1988), stipulates that physiotherapy services for children with motor disabilities, as well as other allied health services, are provided by the Ministry of Education in educational settings. Thus, children with motor disabilities are entitled PT services under two different laws by two different ministries. Method: To describe the physiotherapy services for children with motor disabilities and examine how policymakers view these services, we conducted a qualitative study including in-depth semi-structured interviews with 10 policymakers from the Ministry of Health and the Ministry of Education, and the national directors of physiotherapy services from three of the four health maintenance organizations in Israel. Results: Study results indicate that there is an array of physiotherapy services and providers. Despite the regulation of these services for children with motor disabilities, uncertainty and lack of knowledge were found about various issues. Therefore, the thematic analysis was structured around four descriptive questions: Where do the children receive physiotherapy? Who is eligible for physiotherapy treatment and who receives treatment? What interventions do children with motor disabilities receive? Who provides therapy for children with motor disabilities? Conclusions: Policymakers are dubious regarding the provision of these services, questioning whether children with motor disabilities receive physiotherapy services according to their needs. In addition, the abundance of suppliers does not necessarily improve the quality of services provided to children with motor disabilities, which may ultimately harm their developmental potential. [ABSTRACT FROM AUTHOR]

Since the 2000s, hundreds of government-funded health insurance (GFHI) schemes were introduced in India. These schemes are meant to prevent poorer households from incurring catastrophic health expenditures. Through GFHIs, policy-makers want to mobilize the decision-making powers of private consumers in a liberalized healthcare market. Patients are called upon to act as 'co-creators' of healthcare value by optimizing supply through demand. Based on long-term ethnographic fieldwork with insurance users in South India, we argue that GFHIs fail because people experience the value of insurance in drastically different ways that only partly overlap with how the policy assumes they value insurance. In addition, the hollow promises of health coverage can be experienced as so frustrating that signing up for health insurance actually makes people feel devalued. [ABSTRACT FROM AUTHOR]

The rising cost of private health insurance and constraints within public health systems are global concerns. Genetic testing presents a transformative opportunity for health care to enhance health outcomes and optimise resource allocation through personalised medicine, early diagnosis, targeted treatments, managed care, and improved drug development. However, ethical and policy issues arise, including privacy, discrimination and equitable access to testing. Balancing these against potential health benefits poses a complex challenge. While some advocate for restricting health insurers from using genetic data, others argue that well-regulated private insurance can ensure affordability, improved health outcomes, and innovative care adoption. This article explores examples of improved health outcomes through genetic testing, identifies areas of risk related to insurers' use of genetic data, evaluates the adequacy of New Zealand's legal framework, and emphasises the need for ethical and equitable policy solutions. The broader issues of data governance, biases in algorithms, and implications of artificial intelligence and machine learning warrant separate exploration. [ABSTRACT FROM AUTHOR]

The European Health Insurance Card was adopted after long and slow procedures, in order to consolidate the internal market. Nowadays, it has become an important piece of the European health policy and of the European identity. The European citizens can have medical benefits in another Member State that the State where they have a medical insurance, benefits that are necessary and in the absence of which, these citizens should end their stay and return to the State of insurance. The medical assistance can be necessary even because of pre-existing or chronic diseases, pregnancy and birth. The European Health Insurance Card cannot be used in case of planned medical assistance. The medical assistance thus received can be free of charge, partially free of charge or not, according to the legislation of each Member State. In contrast to its jurisprudence in the field of planned medical treatments, the European Court of Justice has decided that a partial reimbursement in this case is not contrary to free movement of services. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has caused delays and restrictions in providing medical services. In response to the medical surge, countries with social insurance systems provided financial incentives to medical institutions. This study aimed to present the directions for health insurance support by comparing countries in terms of the domains and contents of COVID-19 health insurance support to ensure timely support in case of future pandemics. Methods: An analysis framework was developed to compare health insurance policy interventions for COVID-19 and non-COVID-19 domains, and detailed policy interventions were divided into sub-domains (space, staff, and stuff) for each domain. Data were collected by country from the websites of the Ministry of Health and Social Insurers, Organisation for Economic Co-operation and Development, and European Observatory on Health Systems and Policies and were analyzed using qualitative comparative analysis. Results: The countries provided comprehensive support for both the COVID-19 and non-COVID-19 domains. In the COVID-19 domain, overall support was provided in all three sub-domains. Additional cost support was provided to prevent infection and provide secure facilities to treat confirmed patients. Outpatient services were mainly supported, and an intensive intervention was developed in the staff sub-domain for the non-COVID-19 domain. The point of policy intervention was the surge of the first confirmed case. Continuous revisions were subsequently made. The government provided financial support through health insurance. Conclusions: Regarding where policy support through health insurance should be focused, the workload of medical personnel increased according to the change in the service provision environment due to the pandemic, and the medical service delivery system changed to prevent further infection. Consequently, incentives should be provided to aid the provision of stable services to patients and should be an auxiliary means to implement the national quarantine policy more effectively via a health insurance response system that promptly provides additional financial support in case of future crises. [ABSTRACT FROM AUTHOR]

Tanzania developed its 2016–26 health financing strategy to address existing inequities and inefficiencies in its health financing architecture. The strategy suggested the introduction of mandatory national health insurance, which requires long-term legal, interministerial and parliamentary procedures. In 2017/18, improved Community Health Fund (iCHF) was introduced to make short-term improvements in coverage and financial risk protection for the informal sector. Improvements involved purchaser–provider split, portability of services, uniformity in premium and risk pooling at the regional level. Using qualitative methods and drawing on the policy analysis triangle framework (context, content, actors and process) and criteria for procedural fairness, we examined the decision-making process around iCHF and the extent to which it met the criteria for a fair process. Data collection involved a document review and key informant interviews (n  = 12). The iCHF reform was exempt from following the mandatory legislative procedures, including processes for involving the public, for policy reforms in Tanzania. The Ministry of Health, leading the process, formed a technical taskforce to review evidence, draw lessons from pilots and develop plans for implementing iCHF. The taskforce included representatives from ministries, civil society organizations and CHF implementing partners with experience in running iCHF pilots. However, beneficiaries and providers were not included in these processes. iCHF was largely informed by the evidence from pilots and literature, but the evidence to reduce administrative cost by changing the oversight role to the National Health Insurance Fund was not taken into account. Moreover, the iCHF process lacked transparency beyond its key stakeholders. The iCHF reform provided a partial solution to fragmentation in the health financing system in Tanzania by expanding the pool from the district to regional level. However, its decision-making process underscores the significance of giving greater consideration to procedural fairness in reforms guided by technical institutions, which can enhance responsiveness, legitimacy and implementation. [ABSTRACT FROM AUTHOR]

This mixed-methods study examines mechanisms connecting the deployment of economic, social, and health care resources to emotional distress and physical health outcomes. Examining such mechanisms is critical for informing strategies, policies, and other interventions for reducing health disparities and improving refugee health in the United States and other resettlement contexts. Data for this study were collected as part of a randomized control trial in a mid-sized city in the Southwestern United States. Two-hundred ninety recently resettled (<3 years) refugee adults from 143 households were enrolled in the study (36.2% Afghan, 32.8% Iraqi/Syrian, and 31.0% Great Lakes African; 52% women). Qualitative interview data were collected via semistructured interviews. A longitudinal structural equation path model of quantitative data from three time points over 12 months tested hypotheses that emerged from qualitative findings. In semistructured interviews, refugees in the United States (a) attributed the development of worse or new physical health problems to postresettlement stressors related to financial instability and limited social support that contributed to their emotional distress and (b) reported several barriers to accessing health care in the United States, including insufficient knowledge of health care resources, inadequate patient–provider communication, and navigating complex American health insurance systems, all of which exacerbated their physical health problems. Guided by these qualitative findings, longitudinal quantitative data revealed that: (a) postmigration stressors were associated with emotional distress and poor self-reported physical health, (b) emotional distress mediated the association between postmigration stressors and global health satisfaction, and (c) emotional distress was negatively associated with global health satisfaction. Findings document stressors refugees experience in the context of the unique environment created by the American health care system and how these stressors contribute to poor physical health through increased emotional distress. Public Policy Relevance Statement: Refugees have a higher prevalence of physical health problems compared to native residents of their host countries. Multiple barriers exist for refugees in addressing both their preexisting and post-migration-related health problems. It is essential that policymakers explore the barriers refugees face in accessing health care in the unique environment created by the United States. Health care system, as well as understand how these stressors contribute to poor physical health through increased emotional distress. [ABSTRACT FROM AUTHOR]

Thirty-eight states and the District of Columbia (DC) have dense breast notification laws that mandate varying levels of patient notification about breast density after a mammogram, and these cover over 90% of American women. On March 10, 2023, the Food and Drug Administration issued a final rule amending regulations under the Mammography Quality Standards Act for a national dense breast reporting standard for both patient results letters and mammogram reports. Effective September 10, 2024, letters will be required to tell a woman her breasts are "dense" or "not dense," that dense tissue makes it harder to find cancers on a mammogram, and that it increases the risk of developing cancer. Women with dense breasts will also be told that other imaging tests in addition to a mammogram may help find cancers. The specific density category can be added (eg, if mandated by a state "inform" law). Reports to providers must include the Breast Imaging Reporting and Data System density category. Implementing appropriate supplemental screening should be based on patient risk for missed breast cancer on mammography; such assessment should include consideration of breast density and other risk factors. This article discusses strategies for implementation. Currently 21 states and DC have varying insurance laws for supplemental breast imaging; in addition, Oklahoma requires coverage for diagnostic breast imaging. A federal insurance bill, the Find It Early Act, has been introduced that would ensure no-cost screening and diagnostic imaging for women with dense breasts or at increased risk and close loopholes in state laws. [ABSTRACT FROM AUTHOR]

The issuance of the BPJS National Health Insurance Law was a government effort to enhance the welfare of citizens by making it mandatory for them to become BPJS health insurance participants, with a deadline set for January 2019. However, as of May 2022, around 13.79% (according to Worldometer) or 12.26% (according to the Home Ministry) of citizens have not yet joined, due to various factors, including issues related to the BPJS health insurance membership regulations. This paper aims to provide clarity on the construction of health insurance membership regulations as outlined in Law Number 24 of 2011 concerning the Social Security Agency connected to the National Social Security System. The research utilized a descriptive analysis with a statutory approach, along with secondary data obtained through a library study to collect data, and systematic and teleological analysis to analyze the data. The results of the study indicate that the construction of BPJS health insurance membership regulations follows the Stufen theory, which is in accordance with the hierarchy of occupying concrete norms (Hans Kelsen) or formalgezets (Hans Nawiasky). [ABSTRACT FROM AUTHOR]

The article focuses on the impact of state drug testing laws on opioid therapy patients and their implications for employment-based health plans. It highlights that state drug testing laws increase testing rates among chronic pain patients prescribed opioids but have no impact on opioid prescribing rates, suggesting that these laws are an important diagnostic tool for doctors in treating employees most in need of opioid therapy.

Copyright of Transformations in Business & Economics is the property of Vilnius University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Muslim contemporary scholars disagree on whether health insurance is acceptable under Islamic law. The disparities arose as a result of health insurance being a contemporary issue that did not exist during the legislative Islamic era, although there are many legal verses that encourage the spirit of cooperation, shared responsibility, joint indemnity, common interest, and solidarity. This article presents the historical development of Islamic insurance and its classification; and clarifies the provision and modus operandi of health insurance. Most importantly, this article finds that several perspectives exist on the provision of health insurance in Islamic law. Some argue that health insurance is haram (forbidden) because it contains riba (interest), maisir (gambling), gharar (uncertainty) and other void elements, while others argue that it is permitted in circumstances of dharurah (necessity) and if the insurance firm operates as a mutual cooperation. This article argues that the cooperative health insurance is founded on the principles of Shariah and recommends that the Muslim communities adopt this Shariahcompliant health insurance model. [ABSTRACT FROM AUTHOR]

The article discusses several court cases related to health insurance, life insurance and disability insurance laws in the U.S. Topics include the efforts of U.S. courts to address whether deaths were accidental within the meaning of accidental death policies as in the case Wickman v. Northwestern National Insurance Co., and Northern District of Iowa's ruling on whether the insured's drug overdose was a suicide and therefore not an accident in Richmond v. Life Insurance Co. of North America.

As per the goals of the family physician program, it is essential to pay attention to the effectiveness and performance of FPP. Although the implementation of the FPP program is an important development in the discussion of rural health insurance and the provision of health services and referral systems in the country, the evidence suggests that by identifying challenges and taking appropriate action, this plan can be improved. This study aimed to investigate the challenges of rural Family Physician Policy (FPP) in northern Iran. This study comprised a mixed method. The former intended to identify the challenges of rural FFP using the narrative review method. To achieve a comprehensive list of challenges, a narrative review and content analysis were performed and semi-structured interviews were held with key stakeholders of FPP in the north of Iran, including physicians, managers, and policymakers. Identified challenges were categorized into eight categories including the weakness of the health insurance system, low comprehensiveness of executive guidelines, inappropriate recruitment and maintenance of human resources, weakness of cultural context, low efficacy of health information management system, poor educational effectiveness, inappropriate motivational mechanisms, and weakness of the referral system. As per the quantitative findings, "weakness of the referral system" and "inappropriate recruitment and maintenance of human resources" had the lowest and highest weaknesses, respectively. To address existing challenges in the rural FPP, a comprehensive plan of action should be developed with an emphasis on human resource management, health information management system, comprehensive rural health insurance, and legislation. [ABSTRACT FROM AUTHOR]

After Dobbs v. Jackson Women's Health Organization, the United States Constitution may no longer protect abortion, but a surprising federal statute does. That statute is called the Employee Retirement Income Security Act of 1974 ("ERISA"), and it has long been one of the most powerful preemptive statutes in the entire United States Code. ERISA regulates "employee benefit plans," which are the vehicle by which approximately 155 million people receive their health insurance. Plans are thus a major private payer for health benefits--and therefore abortions. While many post-Dobbs anti-abortion laws directly bar abortion by making either the receipt or provision of abortion illegal, other anti-abortion laws target activities thought to facilitate abortion, most notably paying for abortions. Some of these laws, or proposed laws, attempt to punish paying for out-ofstate abortions, i.e., paying for abortions in a state where abortions are legal. ERISA says otherwise. If the plan covers abortion as a benefit, ERISA preempts laws purporting to bar plans in states where abortion is banned from paying for out-of-state abortions. It likewise preempts laws attempting to obligate plans to "report" on pending or completed abortions obtained by plan members. For the first time in the scholarly literature, this Article explains how and why that is the case--and thus the underappreciated importance of ERISA in the post-Dobbs world. [ABSTRACT FROM AUTHOR]

And there is a dire need for health promotion professional involvement in the ACP process, as 70% of Americans do not have an advance care plan.[37] How Can Health Promotion Professionals Incorporate ACP into Their Work? By looking beyond individual behavior and starting the ACP discussion, health promotion professionals can tackle SDOH thereby making health promotion efforts more effective. Sara S. Johnson, PhD1 1ProChange Behavior Solutions, South Kingstown, RI, USA As health promotion professionals, we spend the vast majority of our time focused on how to optimize well-being and promote vitality. This article aims to promote incorporating Advance Care Planning (ACP) into health promotion work. [Extracted from the article]

Background: Health, disability, and community services are increasingly transitioning from government-led to participant-led funding models, which intend to increase choice and control for service users. Allied health practitioners, who provide many frontline services within the resultant marketised environment, must adjust their knowledge and skills to meet participants' expectations. However, future workforce strategies to address allied health student capabilities to provide these services have received limited attention. This study explored shifting understandings and practices related to allied health student placements during the implementation of a participant-led funding model within the Australian disability sector: the National Disability Insurance Scheme (NDIS). Methods: Data for this study came from a two-year disability workforce project exploring allied health placements. Service providers, participants, university representatives, disability advocates and students participated in 48 interviews and two focus groups to provide perspectives on allied health workforce and student placements. The findings result from secondary deductive analysis undertaken following project completion that used Gidden's (1984) Structuration Theory as a conceptual lens to identify structures and actions related to the marketised service environment that influenced how allied health student placements were undertaken. Results: The findings were organised using two Structuration concepts: knowledgeability, and duality of structure. These described how service providers, supervisors and students understood, legitimised and prioritised placement activities, and how these structures influenced and were influenced by the actions of stakeholders across NDIS settings, contexts and time. Initially, existing placement structures were not compatible with new structures emerging in the disrupted NDIS service environment. However, over time, and responding to new knowledgeability of service providers, supervisors and students, placement structures were identified, monitored and adjusted to reflect perspectives of all stakeholders. Conclusions: Participant-led funding invoked structural changes in disability service provision that transformed how stakeholders understood placements and the role of students in service provision. Whilst there were new opportunities for placement, tensions were identified in how learning activities can be enacted within a marketised system in which resources are aligned to participant needs, and structures for workforce development and learning activities are less visible. Further conceptualisation of how student learning and workforce development activities can fit with contemporary funding models is necessary to meet participant, service provider and student needs. [ABSTRACT FROM AUTHOR]

Introduction: Nurses are professionals today seen as equal partners with doctors. The authority of the nurse in the exercise of their professional functions is governed by the Regulation of the Minister of Health no. 148/2010 so that nurses can carry out their professional activity. Every job has quite a significant risk, taking up the profession of a health worker or nurse. The authority and duties applied by nurses also have a heavy burden, so they must be covered by insurance. The importance of professional indemnity insurance or professional indemnity insurance for nurses in protecting unwanted risks of infected disease, and anything related to work accidents. Methods: This research using normative legal research methods, using normative legal is case studies in the form of legal behavior products, for example reviewing draft laws. The main subject of the study is law which is conceptualized as a norm or rule that applies in society and becomes a reference for everyone's behavior. In this research also using a conceptual legal approach that includes Burgerlijk Wetboek (BW), to analyzing the insurance law, nursing law, health law, hospital law, and related implementing regulations. Results: It is essential to get coverage from professional indemnity insurance as they only run errands in the hospital. Professional indemnity insurance protects against claims resulting from losses from actions related to nurse profession. Conclusions: Healthcare nurses must be covered by professional indemnity insurance. Hospitals are required to pay premiums. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease affecting approximately 1% of the population. The patient journey through the German health care system leads to high disease burden and substantial treatment costs. The EsmAiL study showed that an innovative, interprofessional, multimodal care-concept reduces disease activity and burden of HS compared to standard care. This paper examines the costs of treating HS in Germany and compares them with those of the innovative care concept implemented in EsmAiL. EsmAiL was a two-arm, multicenter, prospective randomized controlled trial including 553 adults with HS. The study was registered in the German Clinical Trials Registry (DRKS00022135). The control group (CG) remained in standard care, whereas the intervention group (IG) was referred to specialized so-called 'acne-inversa-centres (AiZ)' where patients were treated with a structured, interdisciplinary approach. The present paper analyses the treatment costs for a subpopulation based on health insurance cost data from the two largest German health insurers. Quality-Adjusted Life Years (QALY) was assessed based on Dermatology Life Quality Index (DLQI). Total annual treatment costs per patient were €3,966.07 in standard care (n = 89) and €3,974.37 in the innovative care (n = 93). The costs per additional QALY amounted to €12,698.72 in the IG. Given the conventional and established threshold of €22,600 to €33,900 per QALY, the innovative treatment in AiZ proved to be cost-effective. Treatment costs of HS are substantial and increase with disease severity. The new form of care is cost-effective and is expected to decrease costs in the long run. A structured, multimodal form of care reduces costs in the treatment of Hidradenitis suppurativa compared to standard care. [ABSTRACT FROM AUTHOR]

General Context The European Court of Justice has issued this judgement following a request for a preliminary ruling from the Niedersächsisches Finanzgericht (Finance Court, Lower Saxony, Germany). 24. 21 See, to that effect, judgments of 10 June 2010, I CopyGene i , C-262/08, EU:C:2010:328, paras 69 and 70, and of 5 March 2020, I Idealmed i III, C-211/18, EU:C:2020:168, para. The public interest objective pursued by that provision supports the interpretation that the discretion enjoyed by the Member States, in accordance with the case-law relates to all the establishments mentioned in that provision. [Extracted from the article]

Background: Health systems are dynamic and evolve over time. It is essential to look at the entire health system before implementing any intervention to modernize the whole health system or a component of it. This study analyzed the performance of the health system in the Kurdistan Region of Iraq and investigated potential reform steps to mitigate the identified challenges. Methods: A qualitative study was conducted in 2021 to recruit 37 key informants and decision-makers, advisors, and experts from the Kurdistan Parliament, Ministry of Health, Ministerial Council, Ministry of Finance, and external experts in the field of health. Thirtyone responded to a self-administered questionnaire of open-ended questions. Results: While the health system in the Kurdistan Region of Iraq had its own strengths and opportunities to modernize it further, there were much more weaknesses and threats to it. The areas that received much attention were the lack of vital laws such as the medical council, health insurance, public-private sector regulation, accreditation, food and drug administration, and the absence of a regional health policy and strategic plan. The parliament and executive authorities, represented by the different government agencies in the Kurdistan Region of Iraq, have a role in mitigating all the weaknesses and threats in the health system. Conclusions: The study provides policy evidence and a framework of the potential health strategies for the current and the coming government cabinets and parliament rounds in the Kurdistan Region of Iraq to improve the health sector and contribute to achieving sustainable development goals by 2030. It provides a road map for researchers to explore the current health system problems further and find suitable solutions. [ABSTRACT FROM AUTHOR]

Hailed as a major reform, the No Surprises Act (NSA) is a profoundly conservative law that aims neither to reform design of insurance, to regulate fees, nor to limit health care spending. The NSA mitigates a perverse but narrow problem: unpredictable and uncontrollable high out-of-pocket bills for individuals who are unable to receive care within their insurance network. However, the NSA neglects to address the broader high medical costs, limited choice of caregivers, and the resulting insecurity and unfairness that characterize American health care. It allows caregivers to extract high payments and insurers to restrict choice of caregivers. Insurers can continue to employ ineffective cost controls that generate unpredictable high out-of-pocket costs for patients--and high levels of denial of payments to doctors and hospitals. The law amputated the most politically and visibly gangrenous consequences of unregulated private insurance in the United States in ways that enable business as usual in private health insurance to persist, subject to unnecessarily complex arbitration rules that magnify administrative waste. [ABSTRACT FROM AUTHOR]

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This retrospective cohort study aimed to examine trends in pediatric (0–18 years old) hospitalizations due to dentoalveolar infection, before and after the inclusion of pediatric dental care in Israel's National Health Insurance Law. Data were collected from the medical records of one oral and maxillofacial surgery department. Data were compared between patients hospitalized during 2002–2010 (group A, n = 531) and 2011–2019 (group B, n = 381). The mean age of the cohort was 8 years. A dentoalveolar abscess was the main cause of hospitalizations in both groups. Group B exhibited a higher rate of previous dental treatment in general (p = 0.001), and of previous dental treatment for the tooth responsible for the infection (p = 0.03). The prevalent treatment during hospitalization combined intravenous antibiotics and extraction, with or without drainage (58.1%) for group A; and intravenous antibiotics and drainage (49.4%) for group B (p < 0.01). Dental care provided by the Israel's National Health Insurance should focus not only on operative treatment but also on oral health promotion and caries prevention, to reduce hospitalizations due to dentoalveolar infections. [ABSTRACT FROM AUTHOR]

Medicare and private insurance are often cast as diametrically opposed forces. This framing is not only inaccurate, but it obscures the dynamic relationship that has existed between these entities for several decades. Private insurers have been playing an active role in Medicare delivery since its passage in 1965, and their role has expanded over time. This Article seeks to illuminate the way privatization has impacted Medicare and what current privatization policy choices mean for its future. This Article draws from the copious literature on government administration and privatization to explain two key models of privatization within the Medicare program. Highlighting the way that privatization has impacted both forms of delivery will allow for more constructive conversations about striking the right role for private insurance in the future of American health care. The main argument of this Article unfolds in three parts. First, Part I begins by arguing that privatization should be understood as a spectrum of various models, rather than a finite, static instrument. This section argues that models of privatization that delegate high degrees of control to the hands of private insurers risk reduced public accountability through misaligned incentives and lower levels of transparency. Part II illuminates the two distinct models of privatization in Medicare and how each model responds to measures of public accountability. This analysis draws attention to the weaknesses of each model resulting from program design and highlights how Medicare Advantage--the more privatized model--has proven to be the most vulnerable to fraud and abuse due to a greater degree of misaligned incentives and more limited transparency. Finally, Part III seeks to fill a major gap in existing scholarship by offering recommendations for improving the privatized aspects of Medicare. Much attention has been paid to improving Medicare Advantage, but little has focused on the program's older and more timetested model. Stabilizing the role of private insurers in this program is a more responsible policy approach than continuing to tolerate the accountability challenges posed by Medicare Advantage. [ABSTRACT FROM AUTHOR]

The article titled "Titelei" was published in the magazine "GesR: Gesundheitsrecht" (Health Law). It is the issue from April 20, 2024, representing the 23rd year. The magazine covers topics such as medical law, hospital law, pharmacy law, and drug law. This issue presents various essays and judgments on these topics, including the billing fraud of the medical device provider, the conflict between data protection and data usage in the Health Data Usage Act, and the joinder of parties in medical liability proceedings. Various judgments of the Federal Court of Justice and the Federal Social Court are also discussed. The magazine is aimed at employees of health insurance companies, medical associations, lawyers, and social courts, providing valuable assistance in working with the complex regulations of health insurance law. [Extracted from the article]

Medicaid is a crucial component of the healthcare system’s response to Covid-19 and will also be important in how we respond to future pandemics. The current pandemic has not only strained the healthcare system but has left millions of individuals relying on Medicaid at a time in which the reassurance of coverage is more important than ever. It has also had a devastating impact on state budgets. This Article explores the role of Medicaid and proposes a solution to mitigate the repercussions Covid-19 has had on state budgets while ensuring the security of the country’s principal health insurance safety net at a time in which such security has never been more critical. The solution that is proposed and supported by this Article is action by Congress to pass legislation that will permanently increase the Federal Medicaid Assistance Percentage to provide states with desperately needed fiscal relief. [ABSTRACT FROM AUTHOR]