Hasil untuk "Insurance"

George E. Rejda, Ralph H. Wherry, M. Newman

M. Pauly

Zhuo Zhang, Ming Wang

Abstract The lagging development of agricultural insurance in the field of new agricultural and specialty agricultural products has become an inherent cause of structural imbalance in China’s agricultural insurance market. How to leverage the new agricultural products agricultural insurance market with limited financial payment capacity is especially critical to promote high-quality agricultural development. This paper constructs an evolutionary game analysis model of government-farmers-insurance companies and compares the effects of two differential subsidy models, “subsidizing farmers” and “subsidizing institutions”, on the participation and underwriting strategies of new agricultural insurance products. The conclusions show that only when the insurance company has positive returns (E-F > 0) can the insurance company provide insurance services, and the government provides subsidies for operating costs to ensure that the insurance company does not operate at a loss, which is the single strategic support condition for the insurance company to provide insurance products. The “insured farmers” approach, due to the scale effect of the insured farmers, will make the insurance company to ensure the profitability, raise the premium level or compress the market size. The adjustment of financial subsidies from “insuring farmers” to “insuring institutions” can ensure that the business scale of insurance companies can effectively leverage the supply of special agricultural insurance. Finally, this paper puts forward suggestions for the optimization of agricultural insurance policies in new agricultural business fields.

Scott E. Call, MD, Lisa Goto, MD, Gwynne Latimer, MD et al.

Background: Social drivers of health have been implicated as playing a major role in determining pediatric asthma outcomes. However, the impact of self-reported, family-level unmet social needs on asthma outcomes in critically ill pediatric patients is unknown. Objective: Our aim was to determine whether the presence of unmet social needs at the time of intensive care unit (ICU) admission are associated with ICU-related and postadmission outcomes. Methods: This was a 12-month (February 2022-January 2023) prospective cohort study at a single, urban pediatric health care system. Families of patients admitted to the pediatric ICU for asthma were screened for unmet social needs in multiple domains. Regression analyses were performed to correlate unmet needs with the following clinical outcomes: duration of bilevel positive airway pressure use; lengths of ICU and hospital stay; and rates of 6-month outpatient follow-up, ED visitation, and hospital readmission. Results: Of 164 screened families, 57% reported at least 1 unmet social need. Unmet needs were significantly associated with longer hospitalizations (ie, a 3% increase per year of age (odds ratio =1.03 [95% CI = 1.00-1.07]) and a higher likelihood of returning for emergency care (adds ratio =2.6 [95% CI = 1.1-6.2]), even after accounting for race, insurance payer, and medical comorbidities. Additionally, patients provided with resources reported fewer needs when rescreened at outpatient follow-up (median = –1 need [P = .001]). Conclusion: Families of critically ill pediatric patients with asthma reported a high rate of unmet social needs. Furthermore, those with needs were vulnerable to longer stays and repeat asthma exacerbations requiring emergency care. Identification of these families presents an opportunity to target a high-risk population with durable medical and social interventions.

Mary Killela, Cindy A. Turner, Amy Chevrier et al.

Background: Health insurance education could mitigate financial toxicity experienced by young adult (YA) cancer survivors by increasing confidence when navigating cancer care costs. This paper describes the protocol in a randomized controlled trial (RCT) to test a virtual patient navigation program designed to help YA cancer survivors understand their health insurance.Methods: This is a two-arm, multi-site (Huntsman Cancer Institute, Intermountain Health) RCT wherein intervention participants receive four sessions with a patient navigator and a booklet on insurance; usual care receives the booklet. We will enroll 300 YA cancer survivors (n = 200 intervention; n = 100 usual care) diagnosed with breast, testicular, lymphoma, sarcoma, colorectal, melanoma, or thyroid cancer between the ages of 26 and 39, who have completed treatment in the past two years. All participants will complete three surveys: enrollment, 6 months, and 12 months; medical records/insurance claims data will be collected out to 18-month follow-up. The primary outcomes include improvement in health insurance literacy and financial toxicity at 6 months. Secondary outcomes include adherence to cancer surveillance guidelines at 18 months. We will also conduct cost-effectiveness and budget impact analyses.Discussion: Anticipated results from this trial could identify key information that YA cancer survivors need to improve health insurance literacy and survivorship care.Trial registration: ClinicalTrials.gov identifier: NCT05829070. Registered on April 25, 2023.

Jeremy Jones, Michelle Rose, Noreena Lewis et al.

Introduction Although cost awareness and advocacy for quality care are core GME competencies, high-value care (HVC) curricula remain limited. Growing evidence shows families increasingly want cost conversations with providers, yet many providers feel ill-equipped. We developed a curriculum to increase pediatric residents’ understanding of cost determination and confidence discussing resources with families. Methods Using Kern's six-step approach, we created a two-session curriculum. Session 1 explores how health care charges translate to patient financial responsibility. Session 2 is a simulation in which participants make decisions from the caregiver perspective while incurring costs under randomly assigned insurance plans. Participants completed a postsession survey (session 1) and pre- and postsession evaluations (session 2). We used Wilcoxon signed-rank and chi-square tests to determine significant differences (p < .05). Results Seventy-four residents participated between 2022 and 2024. Most respondents rated each session as useful (≥98%). All reported improved understanding of cost determination after the first session. Simulation participation bolstered confidence in supporting families experiencing financial strain (increasing from 5% to 83%; p < .01). Ninety-six percent found the simulation format enhanced learning, and 87% planned to more frequently discuss costs with patients. Discussion This curriculum addresses a critical gap in HVC and health systems education by centering the patient's financial experience. The two-session format of a transparent explanation of costs, paired with a simulation experience, improved participants’ knowledge, self-efficacy in advocacy, and intent to practice cost-conscious care. Next steps include measuring knowledge retention, and having residents review actual bills issued for their own patients.

Farah Elkourdi, Chenhao Wei, LU Xiao et al.

Healthcare systems and applications are increasingly used to improve patient care. However, these applications face data security, privacy, and regulatory compliance challenges. The health insurance portability and accountability act (HIPAA) regulates the use and disclosure of patient health information. Ensuring HIPAA compliance in the software engineering process poses critical challenges to software engineering practitioners. This review focuses on understanding the state-of-the-art in the current literature for ensuring HIPAA compliance in the software development life cycle, namely, requirement gathering, software design, implementation, software testing, and evolution. The findings of this study shed light on software engineers in creating HIPAA compliance healthcare systems and applications. This literature review presents the key themes and trends in this research area. Also, it provides recommendations for future research in the intersection of software engineering methods and HIPAA compliance.

D. Mookherjee, I. Png

M. Seligman, P. Schulman

The reformulated learned helplessness model claims that the tendency to explain bad events by internal, stable, and global causes potentiates quitting when bad events are encountered. We tested this prediction in the work setting with individuals who frequently experience bad events. Explanatory style, as measured by the Attributional Style Questionnaire (ASQ), correlated with and predicted the performance of life insurance sales agents. In a cross-sectional study of 94 experienced agents, individuals scoring in the top half of the ASQ sold 37% more insurance in their first 2 years of service than those scoring in the bottom half. In a prospective 1-year study of 103 newly hired agents, individuals who scored in the top half of the ASQ when hired remained in their job at twice the rate and sold more insurance than those scoring in the bottom half of the ASQ. These two studies support the claim that a pessimistic explanatory style leads to poor productivity and quitting when bad events are experienced, and extend the usefulness of the ASQ to the workplace.

Behzad Alimoradian, Jeffrey Jakubiak, Stephane Loisel et al.

In this paper, we investigate the behavioral and statistical characteristics of cash flows for stable value funds provided by numerous U.S. employee benefit plans. We analyze participant-initiated aggregated cash flow data, representing approximately 80% of the market for large employer plans with stand-alone stable value wraps within a 401(k) offering. By leveraging this unique dataset and contextualizing the 401(k) ecosystem, we examine numerous behavioral lapse hypotheses. Our findings highlight key behavioral lapse hypotheses for modeling lapses and generating risk scenarios. We demonstrate that cash flows exhibit medium- to long-term non-monotonic trends. Factors within the plan sponsor’s ecosystem, such as employment growth, default 401(k) plan options, and the introduction of new investment options, significantly impact participant cash flow behavior indirectly. Moreover, we find that flight-to-safety behavior plays a dominant role during global market crises. Although the risk of mass lapses due to reputational issues is observed, their probability of occurrence is low. Other behavioral hypotheses discussed in the literature, such as the moneyness hypothesis, are found to be less prevalent in this context.

Roosa Perämäki, Mika Gissler, Meri-Maija Ollila et al.

Aims: Women with a history of gestational diabetes (GDM) have an increased risk of developing type 2 diabetes (T2DM). We studied the risk for T2DM in women with and without GDM in relation to body mass index (BMI) and examined whether insulin treatment for GDM associates with the risk of developing T2DM. In addition, we investigated whether the risk of developing T2DM after GDM had changed in 15 years. Methods: We used data by linking four registers; Medical Birth Register, Hospital Discharge Register and Primary Care Register run by THL Finnish Institute for Health and Welfare, and Medical Reimbursement Statistics run by the Social Insurance Institution of Finland (Kela). Registry data were collected from 2005 to 2020. The follow-up started from woman's delivery in 2006-2020 and ended to the diagnosis of T2DM or December 2020. Cox proportional hazard modelling was used to estimate the effect of GDM exposure to T2DM. To assess whether the risk of developing T2DM after GDM had changed in 15 years, we compared the HR between years 2006-2008 and 2018-2020. Results: In total, 462 401 women were included in the study: 96 353 (21%) women had previous GDM. There were 5370 (1.2%) women who developed T2DM after childbirth during the follow-up. Among women with prior GDM, 3995 (4.1%) developed T2DM, while 1375 (0.4%) women without prior GDM developed T2DM during follow-up. The mean follow-up was 6.86 years (SD 4.21) for women with GDM and 9.07 years (SD 4.35) for women without GDM. The hazard ratio (HR) for developing T2DM after GDM was 18.49 (95% CI 17.39-19.67). The incidence of T2DM in women with a history of GDM began to rise almost steadily from the first year of follow-up. As BMI increased, T2DM incidence increased in both women with and without prior GDM but more in women with prior GDM. Insulin treatment had an independent association with increased risk of T2DM (HR 3.81, 95% CI 3.57-4.07). We did not observe any difference in HR between years 2006-2008 and 2018-2020. Conclusions: The relative risk for T2DM was 11-fold for women with previous GDM compared to women without previous GDM. A higher BMI and insulin treatment increased the risk of future diabetes. All measures to prevent the conversion of GDM to T2DM should be taken especially among women with overweight or obesity.

Kin Wah Fung, Fitsum Baye, Seo H Baik et al.

<h4>Background</h4>Incidence of long COVID in the elderly is difficult to estimate and can be underreported. While long COVID is sometimes considered a novel disease, many viral or bacterial infections have been known to cause prolonged illnesses. We postulate that some influenza patients might develop residual symptoms that would satisfy the diagnostic criteria for long COVID, a condition we call "long Flu." In this study, we estimate the incidence of long COVID and long Flu among Medicare patients using the World Health Organization (WHO) consensus definition. We compare the incidence, symptomatology, and healthcare utilization between long COVID and long Flu patients.<h4>Methods and findings</h4>This is a cohort study of Medicare (the US federal health insurance program) beneficiaries over 65. ICD-10-CM codes were used to capture COVID-19, influenza, and residual symptoms. Long COVID was identified by (a) the designated long COVID code B94.8 (code-based definition), or (b) any of 11 symptoms identified in the WHO definition (symptom-based definition), from 1 to 3 months post-infection. A symptom would be excluded if it occurred in the year prior to infection. Long Flu was identified in influenza patients from the combined 2018 and 2019 Flu seasons by the same symptom-based definition for long COVID. Long COVID and long Flu were compared in 4 outcome measures: (a) hospitalization (any cause); (b) hospitalization (for long COVID symptom); (c) emergency department (ED) visit (for long COVID symptom); and (d) number of outpatient encounters (for long COVID symptom), adjusted for age, sex, race, region, Medicare-Medicaid dual eligibility status, prior-year hospitalization, and chronic comorbidities. Among 2,071,532 COVID-19 patients diagnosed between April 2020 and June 2021, symptom-based definition identified long COVID in 16.6% (246,154/1,479,183) and 29.2% (61,631/210,765) of outpatients and inpatients, respectively. The designated code gave much lower estimates (outpatients 0.49% (7,213/1,479,183), inpatients 2.6% (5,521/210,765)). Among 933,877 influenza patients, 17.0% (138,951/817,336) of outpatients and 24.6% (18,824/76,390) of inpatients fit the long Flu definition. Long COVID patients had higher incidence of dyspnea, fatigue, palpitations, loss of taste/smell, and neurocognitive symptoms compared to long Flu. Long COVID outpatients were more likely to have any-cause hospitalization (31.9% (74,854/234,688) versus 26.8% (33,140/123,736), odds ratio 1.06 (95% CI 1.05 to 1.08, p < 0.001)), and more outpatient visits than long Flu outpatients (mean 2.9(SD 3.4) versus 2.5(SD 2.7) visits, incidence rate ratio 1.09 (95% CI 1.08 to 1.10, p < 0.001)). There were less ED visits in long COVID patients, probably because of reduction in ED usage during the pandemic. The main limitation of our study is that the diagnosis of long COVID in is not independently verified.<h4>Conclusions</h4>Relying on specific long COVID diagnostic codes results in significant underreporting. We observed that about 30% of hospitalized COVID-19 patients developed long COVID. In a similar proportion of patients, long COVID-like symptoms (long Flu) can be observed after influenza, but there are notable differences in symptomatology between long COVID and long Flu. The impact of long COVID on healthcare utilization is higher than long Flu.

A. Raviv

A. Cameron, P. Trivedi, F. Milne et al.

Ika Putri Widiarti, Haerawati Idris

Background: Indonesia has been aiming toward universal health coverage since 2019, but it has yet to be achieved. The National Health Insurance (NHI) program provides individual services for women of reproductive age who require health care before pregnancy, during pregnancy, and at the time of labor. This study aims to analyze factors associated with independent NHI ownership among women of reproductive age in Indonesia. Methods: Secondary data from the Wave 5 Indonesia Family Life Survey (IFLS) involving 2,084 women of reproductive age were used. The chi-square test and logistic regression test were used for data analysis. Results: The percentage of women of reproductive age who have independent NHI was 48.4%. Age, region, residence, education, marital status, employment status, chronic disease history, health perception, and economic status were associated with the independent NHI ownership. Urban was found to be a predictor for insurance ownership. Conclusions: Women of reproductive age who live in urban areas are more likely to have NHI than those in rural areas. The Indonesian government should improve NHI ownership equality by expanding health insurance coverage in rural areas.

Oleh Semenenko, Victoriia Koverga, Oleksandr Ostapenko et al.

Мета роботи: є аналіз обсягів воєнних витрат Росії та їх структури у період 2010-2022 років з метою виявлення тенденцій підготовки РФ до війни з Україною, а також з метою розкриття воєнних втрат РФ у російсько-українській війні та формування рекомендацій щодо економічній протидії країни світу та України. Метод: основними методами досліджень є методи системного аналізу та синтезу економічних процесів, регресійного та кореляційного аналізу, методи економічної теорії та економічної логіки. Результати дослідження: розкрито структуру воєнних витрат Росії за досліджуваний період, визначені основні тенденції її зміни за роками, за обсягами воєнних витрат сформовано прогноз на наступний 2023 рік, зроблені висновки щодо дій Росії у війні та визначені практичні рекомендації щодо економічної та організаційної протидії Росії країнами світу та Україною. Теоретична цінність дослідження: основними результатами  досліджень за тематикою статті є: результати аналізу воєнних витрат Росії та їх структури за досліджуваний період, а також сформовані рекомендації щодо економічної та організаційної протидії Росії в умовах війни.

Riza C. Li, Kevin Ndura, Claudine T. Jurkovitz

ABSTRACT IMPACT: To improve care and services for patients with chronic disease, health systems are focusing on evaluating social determinants of health of populations at risk; this information is currently not available in electronic health records (EHR) but we show that it could be accessed by linking area deprivation index to EHR. OBJECTIVES/GOALS: To inform care delivery and policy, health care systems are studying ways of improving social determinants of health (SDoH) in patients with chronic disease such as diabetes (DM). Our goal was to better characterize the SDoH of a cohort of DM patients by using the area deprivation index (ADI). METHODS/STUDY POPULATION: Our study population included DM patients seen in primary care practices in 2013-2017. We integrated ADI levels to data extracted from electronic health records (EHR). ADI ranks neighborhoods by socioeconomic status calculated from income, education, employment and housing quality. ADI has 10 levels that we grouped into 5 categories of 2 levels. Addresses were geocoded using ArcMap to obtain census block groups information. We used multivariable logistic regression to calculate odds ratios (OR) and 95% confidence intervals [], with diabetic complications as a binary dependent variable, ADI levels as the exposure, and demographics, smoking status and number of comorbidities as confounders. RESULTS/ANTICIPATED RESULTS: Our study population included 8,558 patients: 56% were female, 61% white, 31% black, 28% were on Medicare, 66% on commercial insurance, median age was 55 years, 57% never smoked, 10% had no comorbidities, 42% had 3 or more comorbidities, and 37% developed diabetic-related complications. After evaluating collinearity and adjusting for confounders, our multivariable analysis showed that worsening ADI was associated with higher likelihood of complications. Compared to ADI level 1&2 (least disadvantaged), the ORs for patients residing in neighborhoods with ADI levels 3&4, 5&6, 7&8, 9&10 (most disadvantaged) were respectively 1.01 [0.88-1.16), 1.20 [1.04-1.39], 1.15 [0.99-1.33], 1.30 [1.11-1.52]. DISCUSSION/SIGNIFICANCE OF FINDINGS: Neighborhood ADI could provide precious information to health care providers when associated to the EHR. We found that neighborhoods with ADI level 9&10, which is not collected in the EHR, was significantly associated with a higher burden of disease. ADI could serve as a proxy for evaluating SDoH.

Seong Hee Kang, Dong-Hyuk Cho, Jimi Choi et al.

<h4>Background/aims</h4>We measured the association between underlying chronic hepatitis B (CHB) and antiviral use with infection rates among patients who underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing.<h4>Methods</h4>In total, 204,418 patients who were tested for SARS-CoV-2 between January and June 2020 were included. For each case patient (n = 7,723) with a positive SARS-CoV-2 test, random controls (n = 46,231) were selected from the target population who had been exposed to someone with coronavirus disease 2019 (COVID-19) but had a negative SARS-CoV-2 test result. We merged claim-based data from the Korean National Health Insurance Service database collected. Primary endpoints were SARS-CoV-2 infection and severe clinical outcomes of COVID-19.<h4>Results</h4>The proportion of underlying CHB was lower in COVID-19 positive patients (n = 267, 3.5%) than in COVID-19 negative controls (n = 2482, 5.4%). Underlying CHB was associated with a lower SARS-CoV-2 positivity rate, after adjusting for comorbidities (adjusted odds ratio [aOR] 0.65; 95% confidence interval [CI], 0.57-0.74). Among patients with confirmed COVID-19, underlying CHB tended to confer a 66% greater risk of severe clinical outcomes of COVID-19, although this value was statistically insignificant. Antiviral treatment including tenofovir and entecavir was associated with a reduced SARS-CoV-2 positivity rate (aOR 0.49; 95% CI, 0.37-0.66), while treatment was not associated with severe clinical outcomes of COVID-19.<h4>Conclusions</h4>Underlying CHB and antiviral agents including tenofovir decreased susceptibility to SARS-CoV-2 infection. HBV coinfection did not increase the risk of disease severity or lead to a worse prognosis in COVID-19.

Barbara J Smith, Michael Helgeson, Brenda Prosa et al.

BACKGROUND:Dental utilization patterns and costs of providing comprehensive oral healthcare for older adults in different settings have not been examined. METHODS:Retrospective longitudinal cohort data from Apple Tree Dental (ATD) were analyzed (N = 1,159 total; 503 outpatients, 656 long-term care residents) to describe oral health status at presentation, service utilization patterns, and care costs. Generalized estimating equation (GEE) repeated measures analysis identified significant contributors to service cost over the three-year study period. RESULTS:Cohort mean age was 74 years (range = 55-104); the outpatient (OP) group was younger compared to the long-term care (LTC) group. Half (56%) had Medicaid, 22% had other insurance, and 22% self-paid. Most (72%) had functional dentitions (20+ teeth), 15% had impaired dentitions (9-19 teeth), 6% had severe tooth loss (1-8 teeth), and 7% were edentulous (OP = 2%, LTC = 11%). More in the OP group had functional dentition (83% vs. 63% LTC). The number of appointments declined from 5.0 in Year 1 (OP = 5.7, LTC = 4.4) to 3.3 in Year 3 (OP = 3.6, LTC = 3.0). The average cost to provide dental services was $1,375/year for three years (OP = $1,427, LTC = $1,336), and costs declined each year, from an average of $1,959 (OP = $2,068, LTC = $1,876) in Year 1 to $1,016 (OP = $989, LTC = $1,037) by Year 3. Those with functional dentition at presentation were significantly less costly than those with 1-19 teeth, while edentulous patients demonstrated the lowest cost and utilization. Year in treatment, insurance type, dentition type, and problem-focused first exam were significantly associated with year-over-year cost change in both OP and LTC patients. CONCLUSION:Costs for providing comprehensive dental care in OP and LTC settings were similar, modest, and declined over time. Dentate patients with functional dentition and edentulous patients were less costly to treat. LTC patients had lower utilization than OP patients. Care patterns shifted over time to increased preventive care and decreased restorative care visits.

M. Miranda