Hasil untuk "Insurance"

Stephen Coate, M. Ravallion

Zaw Min, Phitsanuruk Kanthawee, Pamornsri Inchon et al.

Abstract Background Migrant workers face multiple health risks and barriers to healthcare access, influenced by socioeconomic, occupational, and legal factors. Myanmar migrant workers constitute a significant portion of Chiang Rai Province’s labor force, yet their health-seeking behavior remains understudied. This study aimed to assess the health-seeking behavior of Myanmar migrant workers in Chiang Rai and identify factors influencing healthcare utilization, using Andersen’s healthcare utilization model. Methods A community-based cross-sectional study was conducted from May to June 2024 in ten Myanmar migrant communities in Mueang District, Chiang Rai, Thailand. A total of 355 participants, aged 18–60 years, were selected using proportionate random sampling. Data were collected through a validated, interviewer-administered questionnaire in the Myanmar language. Binary logistic regression analyses were performed to identify factors associated with healthcare utilization, with results expressed as odds ratios (ORs) and adjusted odds ratios (AORs) at 95% confidence intervals (CIs). Results In the multivariable logistic regression analysis, four variables were associated with healthcare utilization. Individuals aged ≥ 36 years were more likely to utilize healthcare services than those aged 18–35 years (AOR = 1.71, 95% CI: 1.11–2.64). Participants with monthly expenditures > 3,000 THB had higher odds of healthcare utilization (AOR = 1.96, 95% CI: 1.27–3.03), and those working > 8 h per day also showed greater utilization (AOR = 1.79, 95% CI: 1.07–2.97). Health insurance coverage demonstrated a marginal association with healthcare utilization (AOR = 1.60, 95% CI: 0.99–2.58, p = 0.054), suggesting a potential enabling effect despite borderline statistical significance. The most common major illnesses reported in the past six months were musculoskeletal disorders (23.4%) and injuries (18.8%). Conclusions Healthcare utilization among Myanmar migrant workers is shaped by demographic and enabling factors, particularly age, financial capacity, working conditions, and health insurance coverage. Strengthening health insurance schemes, regulating working hours, and enhancing migrant-inclusive community health programs are essential for improving equitable healthcare access in cross-border settings.

Likhita Nandigam, Christian M. Parobek, Taylor Moseley et al.

Abstract Objective Chronic kidney disease (CKD) can significantly affect pregnancy management and outcomes. Although up to 40% of adults with renal disease have an identifiable genetic cause, most pregnant patients with CKD do not undergo genetic testing, hindering tailored management during and after pregnancy. We assessed which pregnant patients with CKD were more likely to be referred for and undergo genetic counseling and testing. Study design This was an Institutional Review Board–approved retrospective cohort study of all patients who received prenatal care at Texas Children's Hospital between 2011 and 2024 and had a diagnosis of CKD or end‐stage renal disease (ESRD). Patients were identified using International Classification of Diseases, 10th Revision (ICD‐10) codes in the electronic medical record. Demographic, clinical, and genetic data were abstracted and overlaid with social vulnerability index data (2022 release). Bivariate analyses were used to assess associations between demographic and clinical factors and genetic evaluation. Results A total of 103 pregnant patients had a diagnosis of CKD or ESRD. The median gestational age at entry to prenatal care was 8.6 weeks. While a majority of patients (64%) were referred to genetic counseling for any reason, only one in four (27%) referrals mentioned a renal indication. Even fewer patients (8%) underwent genetic testing before, during, or after pregnancy to determine the etiology of their chronic renal disease. Among demographic, socioeconomic, and clinical variables, only renal transplant and a family history of renal disease were associated with a recommendation for a renal genetic workup. Commercial insurance coverage was associated with completion of a renal genetic workup. Conclusions The majority of pregnant patients with renal disease did not undergo renal genetic testing before, during, or after pregnancy. Commercial insurance coverage was the only demographic, socioeconomic, or clinical factor significantly associated with completion of a genetic workup. While genetic evaluation for renal disease among pregnant patients is associated with insurance status, it is underutilized across demographic and socioeconomic sectors and should be considered for pregnant patients with renal disease.

Ga Hui Yu, Chulmin Park, Myeong Geun Jeong et al.

ObjectiveThe objective of this study was to determine the implementation, clinical barriers, and unmet needs of repetitive transcranial magnetic stimulation (rTMS) and neuro-navigation systems for stroke rehabilitation.DesignWe employed a nationwide survey via Google Forms (web and mobile) consisting of 36 questions across rTMS and neuro-navigation systems, focusing on their implementation, perceptions, and unmet needs in stroke recovery. The survey targeted physiatrists registered in the Korean Society for Neuro-rehabilitation and in rehabilitation hospitals in South Korea.ResultsOf 1,129 surveys distributed, 122 responses were analyzed. Most respondents acknowledged the effectiveness of rTMS in treating post-stroke impairments; however, they highlighted significant unmet needs in standardized treatment protocols, guidelines, education, device usability, and insurance coverage. Unmet needs for neuro-navigation were also identified; only 7.4% of respondents currently used such systems, despite acknowledging their potential to enhance treatment accuracy. Seventy percent of respondents identified lack of prescription coverage, time and errors in preparation, and device cost as barriers to clinical adoption of neuro-navigation systems.ConclusionDespite recognition of the potential of rTMS in stroke rehabilitation, there is a considerable gap between research evidence and clinical practice. Addressing these challenges, establishing standardized protocols, and advancing accessible neuro-navigation systems could significantly enhance the clinical application of rTMS, offering a more personalized, effective treatment modality for stroke recovery.

Soo-Bin Lee, Hyun-Wook Chae, Ji-Won Kwon et al.

Numerous adolescents diagnosed with adolescent idiopathic scoliosis (AIS) often manifest symptoms indicative of functional gastrointestinal disorders (FGIDs). However, the precise connection between FGIDs and AIS remains unclear. The study involved adolescents drawn from sample datasets provided by the Korean Health Insurance Review and Assessment Service spanning from 2012 to 2016, with a median dataset size of 1,446,632 patients. The AIS group consisted of individuals aged 10 to 19 with diagnostic codes for AIS, while the control group consisted of those without AIS diagnostic codes. The median prevalence of FGIDs in adolescents with AIS from 2012 to 2016 was 24%. When accounting for confounding factors, the analysis revealed that adolescents with AIS were consistently more prone to experiencing FGIDs each year (2012: adjusted odds ratio (aOR), 1.21 [95% confidence interval (CI), 1.10–1.35], <i>p</i> < 0.001; 2013: aOR, 1.31 [95% CI, 1.18–1.46], <i>p</i> < 0.001; 2014: aOR, 1.24 [95% CI, 1.12–1.38], <i>p</i> < 0.001; 2015: aOR, 1.34 [95% CI, 1.21–1.49], <i>p</i> < 0.001; and 2016: aOR, 1.35 [95% CI, 1.21–1.50], <i>p</i> < 0.001). These findings suggest that AIS is correlated with an elevated likelihood of FGIDs, indicating that AIS may function as a potential risk factor for these gastrointestinal issues. Consequently, it is recommended to provide counseling to adolescents with AIS, alerting them to the heightened probability of experiencing chronic gastrointestinal symptoms.

Muhammad Qolbi Shobri, Rhavida Anniza Andyani, Maikel Jeksen

Social Security Agency for Health (SSAH) Madiun branch office incurred healthcare costs amounting to Rp1.5 trillion in 2023. Seeing the large amount of expenses incurred, it shows that the people of Madiun city largely trust SSAH with their health insurance. In the cost claim process, not all claims are accepted, which is caused by several factors, such as the type of work and medical records. This research will examine the risk and opportunities of utilizing SSAH insurance services in Madiun city. The methods used are Bayesian Logistic Regression and the C4.5 Algorithm. The purpose of this research is to identify the risk factors for utilizing SSAH services in Madiun City and to determine the best methods for classification. This research is expected to assist the SSAH in Madiun City in understanding the risks for SSAH participants in using insurance services and to serve as a reference for other researchers in using the best methods for classification. The research results show that medical history and gender have an influence on the risk of utilizing SSAH services in the city of Madiun. The best method in that classification is the C4.5 Algorithm method with an average accuracy rate of 66.82%.

Shahoo Zamani Dadanh, Shirin Zardoshtiyan

The present study aimed to identify and classify factors affecting women's free time with an emphasis on physical activity using an interpretive structural modeling approach. This study is applied research in terms of orientation and mixed in terms of research philosophy. The statistical population of this study included free-time experts, sports management experts, and experts in holding family and women's sports events. Theoretical sampling was used to identify the number of people and find the research direction. A theoretical saturation was achieved after conducting 15 in-depth interviews. In the qualitative section of the study, an in-depth interview tool was used to collect data. In the quantitative section, a questionnaire was used. To analyze the data in the qualitative section, three overlapping processes of open, axial, and selective coding were used. To analyze the data in the quantitative section, the interpretive structural modeling method was used in the ISM software. The results of the qualitative section revealed that the factors affecting women's free time with an emphasis on physical activity include 115 open codes, 33 concepts, and 14 primary categories. The results of the structural-interpretive model in the quantitative section also revealed the understanding of the need for women's sports, effective equipment and facilities, the socialization status of women's free time, and the income and financial status of women at the first individual level. The factors of the second level family’s social status, creating organizations for women's free time, and increasing women's awareness of free time were in the second level. Increasing and promoting physical activities in the form of free time for women and increasing people's socialization were placed in the third level. Financial support in the private and public sectors, education and paying attention to related research findings, and improvement of individual mental state were in the fourth level, and improving living conditions were in the fifth level. 1. Introduction Physical activity and sports are one of the best most effective ways to spend free time among women and girls. It can lead to their physical and mental health. Also, the inclusion of sports in women's and girls' free time requires increasing the level of awareness of people in society, accurate and correct management and planning, and appropriate facilities and infrastructure. Thus, it is essential to conduct detailed and comprehensive studies in this area to identify the challenges and limitations that women and girls face in doing physical activities and sports in their free time and to provide appropriate solutions to solve them. A comprehensive model should be provided to officials to improve the quality of free time of women and girls of the families with an approach based on physical and sports activities. Given what was stated, it is crucial to know how women and girls spend their free time as it ensures their mental and physical health and is an effective means for creating their physical, intellectual, and ethical growth. It will prevent many social deviations. Thus, the present study aims to identify and classify the factors affecting women's free time with an emphasis on physical activities using an interpretive structural modeling approach. 2. Literature Review Several studies have approved the benefits of exercise and physical activities on physical and mental health and preventing chronic diseases caused by a sedentary life (Lopez Gabbard and Rodriguez, 2013). Studies have revealed that people who express high levels of extraversion are more likely to participate in physical activity. However, people who express high levels of neuroticism tend to be less physically active (Keklainen, 2022 & Gottold, 2018). The way of spending free time plays a major role in people's mobility and physical activity, so the change in lifestyle due to the change in technology and modern life has reduced physical activities and people have been exposed to complications caused by it. Results of the studies indicate that a reduction in physical and sports activities is greater in females than in males (Valdelina et al., 2010). In this regard, Fakhri et al. (1401) examined the structural model of the effect of sports-based free time on the social self-efficacy of students with the mediating role of spiritual intelligence. The results revealed that sports-based free time positively affects social self-efficacy with the mediating role of spiritual intelligence. The results revealed that by increasing free time along with sports and physical activity and improving the spiritual intelligence of students, their social self-efficacy also increases and vice versa. Pourzabih Sarhami et al. (2023) reported that gender discrimination should be minimized and women's sports and recreation per capita should be increased with correct policy-making. Special attention has been paid to issues such as improving women's movement literacy in society, modeling and improving public attitudes toward women's physical and sports activities, diversifying recreational and sports activities for women, providing tax and insurance discounts for sports activists, and other cases, which were mentioned in the study. Giles and Uncesio (2020) conducted a study on single women's free time during the coronavirus outbreak. In this critical study, the researchers analyzed the impacts of these practices on their free time in two single, professional, childless women living alone. The researchers argued that in the current pandemic, women who do not have caregiving responsibilities may face more resentment or humiliation due to being engaged in regular free time activities. Researchers indicated that rejection from social and caring networks can cause feelings of selfishness, shame, and fear when participating in free time. Gimmez et al. (2021) investigated the sports and free time activities of Muslim women and stated that sporting events can foster nationalism. An analysis of current political and public discourses on Muslim women's sports and free time showed that this group is facing many limitations. Political regulations and attitudes interfere not only with the recreational activities of Muslim women but also with their clothing and movements. It is recommended that theoretical perspectives such as the social justice perspective in sports and free time activities of Muslim women be presented and supported so they can have equal access to sports and physical activities in their free time. 3. Methodology The present study is applied research in terms of orientation, comparative in terms of approach, descriptive in terms of purpose, and mixed (qualitative-quantitative) research in terms of research philosophy. Using the grounded theory method with Glazer's approach, the factors affecting women's free time were identified and classified with an emphasis on physical activities, and their mutual effects were investigated using interpretive structural modeling. The statistical population of this study in both sections included free-time experts, sports management experts, and experts in holding family and women's sports events. Theoretical sampling was used to identify the number of people. Theoretical saturation was achieved after conducting 12 in-depth and unstructured interviews, but the interviews continued up to 15 people for more confidence. In the qualitative section of the study, the in-depth interview tool was used to collect data. In the quantitative section of the study, a questionnaire was used as a research tool. The indicators of this questionnaire are adapted from the data of the qualitative section of the study. Accordingly, the extracted codes were placed in the form of questions and designed as a questionnaire. It was also prepared in the form of a questionnaire whose content validity was confirmed by 10 sports management professors who were outside the sample of the qualitative group. Accordingly, based on the grounded theory, 115 open codes, 33 concepts, and 14 primary categories were identified and categorized. Then, to examine the relationship between the sub-categories of the questionnaire, a structured self-interaction matrix was developed. In this step, the respondents were asked to specify the type of pairwise connection of the factors based on the introduced codes (V, A, X, O). 4. Results Finally, using the final access matrix, the themes of factors affecting women's free time were classified with an emphasis on physical activities. Based on Figure 1, understanding of the need for women's sports(D), effective equipment and facilities (E), the socialization status of women's free time (K), and the income and financial status of women (M) were placed in the first level, individual factors (B) were placed in the second level. The family’s social status (A), creating organizations for women's free time (F), and increasing women's awareness of free time (J) were placed in the third level. Increasing and promoting physical activities in the form of free time for women (C) and increasing people's socialization (G), financial support in the private and public sectors (I), education and paying attention to related research findings (L), and improvement of individual mental state were placed in the fourth level, and the improvement of living conditions (H) was placed in the fifth level. 5. Conclusion Based on the results of this study and the population of women in Iran, and knowing their special characteristics and conditions in the Islamic country of Iran, it is necessary to have proper knowledge of the current status before any planning. Also, appropriate local and government measures should be taken to meet their needs and demands by identifying their real problems and needs. n The high-level planners of the country, who are mostly men, should have a better understanding and a more complete insight into the physical activity status of women and their demands. Hence, since public sports and increasing women's participation in them play a vital role in their health and society’s health, and it is useful for the individual and social economy in reducing treatment costs, it is recommended that health planners increase the participation of women in sports and physical activity in their free time. Also, considering all aspects, it is necessary to develop appropriate and comprehensive programs and applications that compensate for the existing deficiencies, provide the conditions for more participation of women in this area, and provide exercise for all people.

Arisa Iba, Jun Tomio, Takehiro Sugiyama et al.

Background: Hospitalization for ambulatory care sensitive conditions (ACSCs) is potentially preventable with timely and effective primary care but may increase owing to poor access. Spatial access inequalities exist between Japan and other countries. This retrospective cohort study examined the association between admission for ACSC and spatial accessibility to primary care. Methods: We used claims data and spatial data of 50–74 years-old beneficiaries of the National Health Insurance program in a large city in Japan from April 2013–March 2014 and followed them until March 2015. We used a multilevel Poisson regression model to assess the association between the number of ACSC admissions, the distance to the nearest clinic, and the number of physicians in a given area, adjusting for age, gender, comorbidities, number of visits, and household income. Results: Among 126,666 eligible beneficiaries (mean age 65.8 years, 54% were women), 1,793 (1.4%) were hospitalized for ACSCs. The ACSC admission rate was significantly higher in those with a distance to the nearest clinic of >1 km than in those with <0.3 km (incident rate ratio [IRR] 1.32, 95% confidence interval [CI] 1.03–1.69). In the stratified analyses, a longer distance to the nearest clinic was associated with higher ACSC admission rates among women (≥0.3 km and <0.5 km: IRR 1.48, 95% CI 1.01–2.17; ≥0.5 km and <1 km: IRR 1.74, 95% CI 1.19–2.56; >1 km: IRR 1.98, 95% CI 1.29–3.03, respectively) and those aged ≥65 years (≥0.3 km and <0.5 km: IRR 1.38, 95% CI 1.07–1.79; ≥0.5 km and <1 km: IRR 1.38, 95% CI 1.06–1.80; >1 km: IRR 1.48, 95% CI 1.10–1.98). Conclusion: Unfavorable spatial access was associated with ACSC admissions, particularly among women and older adults.

David M Cutler, Sarah J. Reber

Soonman Kwon

J. Peloza

Iveta Grigorova, Aleksandar Karamfilov, Radostin Merakov et al.

In a rapidly evolving and often volatile crypto market, the ability to use historical data for simulations provides a more realistic assessment of how decentralized finance (DeFi) protocols might perform. This insight is crucial for participants, developers, and investors seeking to make informed decisions. This paper presents a comprehensive study evaluating the dynamic performance of a newly developed DeFi protocol—NOLUS. The main objective of this paper is to present and analyze the built realistic model of the platform. This model could be successfully used to analyze the stability of the platform under different environmental influences by performing various simulations and conducting experiments with different parameters that could not be realized with the real platform. In the article, the key components of the platform are presented in detail and the main dependencies between them are clarified, in addition to the ways of forming multiple variables, and the complex relations between them in the real protocol are explained. The main finding from the experimental part of the study is that the performance of the protocol representation accounts for the expected system behavior. Hence the system simulation could be successfully used to reveal essential protocol behaviors resulting from potential shifts in the crypto market environment and to optimize the protocol’s hyper parameters.

Qian Zhao, Sahadeb Upretee, Daoping Yu

Insurance loss data are usually in the form of left-truncation and right-censoring due to deductibles and policy limits, respectively. This paper investigates the model uncertainty and selection procedure when various parametric models are constructed to accommodate such left-truncated and right-censored data. The joint asymptotic properties of the estimators have been established using the Delta method along with Maximum Likelihood Estimation when the model is specified. We conduct the simulation studies using Fisk, Lognormal, Lomax, Paralogistic, and Weibull distributions with various proportions of loss data below deductibles and above policy limits. A variety of graphic tools, hypothesis tests, and penalized likelihood criteria are employed to validate the models, and their performances on the model selection are evaluated through the probability of each parent distribution being correctly selected. The effectiveness of each tool on model selection is also illustrated using well-studied data that represent Wisconsin property losses in the United States from 2007 to 2010.

Eric D. Brooks, MD, MHS, Fantine Giap, MD, Vincent Cassidy, MD et al.

Purpose: Obtaining prior authorization (PA) before treatment is becoming increasingly burdensome in oncology, especially in radiation oncology. Here, we describe the impact of a strategic novel operational PA redesign to shorten authorization time and to improve patient access to cancer care at a large United States academic proton therapy center. We ask whether such a redesign may be replicable and adoptable across oncology centers. Materials and Methods: Our PA redesign strategy was based on a 3-tiered approach. Specifically, we (1) held payors accountable to legally backed timelines, (2) leveraged expertise on insurance policies and practices, and (3) updated the submission, appeal writing, and planning procedures for PA. Metrics were compared at the following 3 time points: 6 months before, at phase-in, and at 6 months after intervention. Results: In analyzing the impact of improving PA access to care, the percentage of approvals for commercial proton beam therapy improved by an absolute 30.6% postintervention (P < .001). The proportion of commercially insured patients treated with proton beam therapy also increased by 6.2%, and the number of new starts rose by 11.7 patients/mo. Overall patient census increased by 13 patients/d. Median authorization time was 1 week, and 90% of surveyed providers reported reduced PA burden and improved patient care. Conclusion: This is the first validated, comprehensive operational strategy to improve access to cancer therapy while reducing the burden of PA. This novel approach may be helpful for addressing barriers to PA in medical and surgical oncology because the redesign is predicated on laws that regulate PA across disciplines.

Amy N. Finkelstein

A. Haider, D. Chang, D. Efron et al.

So-Ryoung Lee, Eue-Keun Choi, Eue-Keun Choi et al.

BackgroundLittle is known regarding the risk of clinical outcomes depending on the clustering of lifestyle behaviors after atrial fibrillation (AF) diagnosis. This study evaluated the association between a cluster of healthy lifestyle behaviors and the risk of adverse outcomes in patients with AF.MethodsUsing the Korean National Insurance Service database, patients who were newly diagnosed with AF between 2009 and 2016 were included. A healthy lifestyle behavior score (HLS) was calculated by assigning 1 point each for non-current smoking, for non-drinking, and for performing regular exercise from the self-reported questionnaire in health examinations. The primary outcome was defined as major adverse cardiovascular event (MACE), including ischemic stroke, myocardial infarction, and hospitalization for heart failure.ResultsA total of 208,662 patients were included; 7.1% in HLS 0, 22.7% in HLS 1, 58.6% in HLS 2, and 11.6% in HLS 3 groups. Patients with HLS 1, 2, and 3 were associated with a lower risk of MACE than those with HLS 0 (adjusted hazard ratio [95% confidence interval (CI)]: 0.788 [0.762–0.855], 0.654 [0.604–0.708], and 0.579 [0.527–0.636], respectively). After propensity score weighting, consistent results were observed. The risk reduction of healthy lifestyle combinations was consistently observed in various subgroups, regardless of the CHA2DS2-VASc score and oral anticoagulant use.ConclusionIncreased number of healthy lifestyle behaviors was significantly associated with lower MACE risk in patients with new-onset AF. These findings support the promotion of a healthy lifestyle to reduce the risk of adverse events in patients with AF.

Wei-Chiao Chang, Hanoch Livneh, Chieh-Tsung Yen et al.

BackgroundRecent evidence suggests that the use of orthopedic manual therapy (OMT) may lessen the subsequent risk of low back pain (LBP), but this association has not been examined among pregnant women who are at higher risk of LBP. This study aims to determine whether the addition of OMT to conventional LBP treatment before pregnancy could decrease the subsequent risk of LBP during pregnancy.MethodsFrom Taiwan's National Health Insurance Research Database, we identified 68,960 women, 20–55 years of age, with first pregnancy between 2001 and 2012. We then performed a nested case-control study in which 3,846 women with newly diagnosed LBP were matched to 3,846 controls according to age and cohort entry year. Multivariate conditional logistic regression was employed to estimate the association between OMT use before pregnancy and LBP during pregnancy.ResultsOMT users had a lower risk of LBP than did non-users, with an adjusted OR of 0.86 (95% CI, 0.78–0.93). Subgroup analysis showed that women with high intensity use of OMT treatment prior to pregnancy reported the lowest level of LBP during pregnancy by nearly 30%.ConclusionThe pre-pregnancy use of OMT treatment significantly decreased LBP risk during pregnancy, especially with high-intensity use. Thus, clinicians may consider recommending OMT for pregnant women to avoid possible obstetric complications during the pregnancy.

M. D. Tinasilov, A. R. Urkumbaeva

The economic market model of the organization of the healthcare system is one of the most high-quality, but at the same time one of the most expensive. In this regard, economic models of health systems in different countries can be established depending on the role and functions that the State plays in these processes. Operational management of the medical services market is reduced to meeting the needs of the population beyond the guaranteed level, ensuring the freedom of choice and sovereignty of consumers. Providing a multi-channel financing system would create the necessary flexibility and stability of the financial base of social and insurance medicine. The authors of the article suggest choosing three options for economic models of dependence of countries on the healthcare market.

J. Weerdt, S. Dercon