Hasil untuk "Insurance"

Kazutaka Uchida, Keita Takahama, Kenshiro Higashi et al.

Abstract Background Cataract surgeries are increasing annually, making appropriate medical management essential. The routine use of systemic antimicrobial agents for preventing surgical site infections lacks strong evidence and may increase the risk of drug-resistant bacteria and adverse events. This study examined the impact of discontinuing cefazolin (CEZ) administration during the perioperative period of cataract surgery on the incidence of postoperative adverse events and medical costs. Methods Inpatient cataract surgery patients were divided into two groups: the CEZ-use group (April 2021 to March 2022) and the non-CEZ-use group (April 2022 to March 2023). The primary endpoints were the incidence of adverse events and medical costs, while the secondary endpoint was the incidence of endophthalmitis. Results A total of 265 patients were in the CEZ group, and 316 were in the non-CEZ group. Six postoperative adverse events (2.3%, 95% confidence interval: 0.8–4.9) occurred in the CEZ group, with an estimated 230 patients (80–490 from the 95% confidence interval) expected to experience adverse events per 10,000 patients using CEZ. The non-CEZ group had no adverse events and reduced drug costs by approximately 46,000 yen. Insurance claim amounts were also reduced. No cases of early postoperative endophthalmitis were observed in either group. Conclusions Discontinuation of CEZ prophylaxis during the perioperative period of cataract surgery effectively reduced the risk of adverse events. Medical for the period after discontinuing CEZ did not increase. Trial registration Retrospectively registered.

Hassan Marie Hassan, Saifaldin Amjad Ismail

The aim of this research is to show the impact of audit committees through their characteristics represented by (independence, financial and accounting experience, size, number of meetings) as an independent variable on Managerial overconfidence with its characteristics represented by (misjudgment, excessive optimism, illusion of control, cognitive bias) as a dependent variable. The study sample was represented by a number of professionals and stakeholders in the Iraqi environment that represents the study community, including banks, insurance companies, and auditors' offices. 30 paper forms and 200 electronic forms were distributed, and 227 forms were retrieved, as the number of valid forms for analysis was 211 forms. The questionnaire tool was used to collect and analyze data. Some measures were also used, including the (Significance level coefficients) tool, the (Cronbach's Alpha) scale, and the (KMO) scale. The statistical analysis program (SPSS Ver.22) and the (AMOS Ver. 20) program were relied upon in analyzing the data. The results of the statistical analysis showed the presence of Negative relationship between audit committees and managerial overconfidence.

Qianyu Wang, Wei-Tek Tsai, Tianyu Shi et al.

Abstract Detecting money laundering within financial networks presents a complex challenge due to the elusive behavior patterns of laundering agents, often resulting in data gaps. In this research, we propose a ‘Multiverse Simulation’ framework using a multi-agent system to generate synthetic datasets for anti-money laundering (AML) training and detection. This framework creates diverse virtual worlds, each with unique parameters to represent varying levels of illicit activity, thus mimicking the dynamics of money laundering and legitimate transactions. Our framework comprises two main types of agents: (1) the Detector, trained to identify laundering signs, and (2) Transaction agents, divided into those involved in laundering and those in legal transactions. These agents interact in a synthetic environment governed by rules that simulate real-world financial behaviors, enabling the generation of complex, realistic data. In the hide-and-seek multiverse simulation, the Detector learns to distinguish between licit and illicit transactions, a process refined by the evolving strategies of transaction agents to avoid detection. This adversarial setup fosters the co-evolution of laundering techniques and detection methods, enhancing system robustness. We demonstrate the efficacy of this approach by pre-training on synthetic cross-bank data, then evaluating with real-world data from the Elliptic dataset. Our results show that transfer learning significantly improves AML system performance, effectively bridging the gap between synthetic and authentic transaction patterns. The ‘Multiverse Simulation’ offers a scalable, dynamic approach to better understand and mitigate the gap between simulation and reality, contributing to more resilient and intelligent AML solutions.

Fang-Chin Hsu, Tzu-Hsuan Weng, Ta-Wei Pu et al.

Abstract Infectious intestinal diseases (IIDs) pose a significant health and economic burden worldwide. Recent observations at the Tri-Service General Hospital, Taiwan, suggest a potential association between IIDs and neurodegenerative diseases, prompting an investigation into this relationship. This study explored interactions between IIDs and neurodegenerative diseases. We conducted a population-based retrospective cohort analysis using data from the National Health Insurance Research Database (NHIRD) of Taiwan. Patients diagnosed with IIDs between 2000 and 2015 were identified along with a matched control group. Covariates, including demographics, comorbidities, and healthcare utilization were considered. The hazard ratios (HRs) of neurodegenerative diseases were assessed using a Cox proportional regression analysis. This study included 297,438 patients: 99,146 and 198,292 patients in the IID and control groups, respectively. Patients with IIDs showed a significantly higher overall risk of neurodegenerative diseases (adjusted hazard ratio [aHR] = 1.144, P < 0.001). Subgroup analyses revealed an elevated risk of Parkinson's disease, multiple sclerosis, and other neurodegeneration-associated disorders in the study group. Additionally, a positive correlation was observed between the frequency of medical visits for IIDs and neurodegenerative disease risk. This study provides evidence for a significant association between IIDs and the neurodegenerative disease risk. Early detection and management of IIDs may have implications for long-term neurological health outcomes. Further research is required to elucidate underlying mechanisms and develop targeted interventions and preventive strategies.

Mohd. Kamarulnizam Abdullah, Irma Rachmawati

Sea transportation experiences risks and material loss in its operation. The most significant risks include damage to the vessel and sea pollution due to ship collisions and accidents. The carrier should prioritize the risks. When the underwriter does not cover the risk, the shipowner should establish an association covering the loss among the members to the extent the underwriter does not cover it. This study will examine the importance of the Rule to P&I Clubs and its impact on Indonesian carriers and will also find the differences between P&I Club and Insurance. The research adopts Library Resarch Method, dogmatic legal approach, a descriptive and analytical nature.  Due to the method, the following sources have been used: Convention law, domestic legislation, case law, legal textbooks, journal articles, P&I Club Rules, preparatory works, and websites of international organizations and law firms. P&I CLUB covers many accidents which are not covered by any marine insurance. In pollution accidents, P&I covers every detail of the impact of pollution. The difference between P&I Club with marine loss insurance, in general, is that P&I Club covers the loss/damage more extensively, which is not covered by any marine insurance. Keywords: Protection, Indemnity, Carrier.

Saber A. Amin, Saber A. Amin, Lindsay J. Collin et al.

BackgroundThe treatment landscape for ovarian cancer has changed in recent years with the introduction of targeted therapies to treat patients with advanced disease. We investigated patient demographic and clinical factors associated with use of targeted therapies as a part of the first-line treatment for ovarian cancer.MethodsThis study included patients diagnosed with stage I–IV ovarian cancer between 2012 and 2019 from the National Cancer Database. Information on demographic and clinical characteristics were collected and described using frequency and percent across receipt of targeted therapy. Logistic regression was used to compute the odds ratios (ORs) and 95% confidence intervals (CI) associating patient demographic and clinical factors with receipt of targeted therapy.ResultsAmong 99,286 ovarian cancer patients (mean age 62 years), 4.1% received targeted therapy. The rate of targeted therapy receipt across racial and ethnic groups over the study period was fairly similar; however, non-Hispanic Black women were less likely to receive targeted therapy than their non-Hispanic White counterparts (OR=0.87, 95% CI: 0.76–1.00). Patients who received neoadjuvant chemotherapy were more likely to receive targeted therapy than those who received adjuvant chemotherapy (OR=1.26; 95% CI: 1.15–1.38). Moreover, among patients who received targeted therapy, 28% received neoadjuvant targeted therapy, with non-Hispanic Black women being most likely to receive neoadjuvant targeted therapy (34%) compared with other racial and ethnic groups.ConclusionsWe observed differences in receipt of targeted therapy by factors such as age at diagnosis, stage, and comorbidities present at diagnosis, as well as factors related to healthcare access—including neighborhood education level and health insurance status. Approximately 28% of patients received targeted therapy in the neoadjuvant setting, which could negatively impact treatment outcomes and survival due to the increased risk of complications associated with targeted therapies that may delay or prevent surgery. These results warrant further evaluation in a cohort of patients with more comprehensive treatment information.

Qiaohui Chen, Qiaohui Chen, Xiaoyuan Wang et al.

Acute kidney injury has always been considered a sword of Damocles over hospitalized patients and has received increasing attention due to its high morbidity, elevated mortality, and poor prognosis. Hence, AKI has a serious detrimental impact not only on the patients, but also on the whole society and the associated health insurance systems. Redox imbalance caused by bursts of reactive oxygen species at the renal tubules is the key cause of the structural and functional impairment of the kidney during AKI. Unfortunately, the failure of conventional antioxidant drugs complicates the clinical management of AKI, which is limited to mild supportive therapies. Nanotechnology-mediated antioxidant therapies represent a promising strategy for AKI management. In recent years, two-dimensional (2D) nanomaterials, a new subtype of nanomaterials with ultrathin layer structure, have shown significant advantages in AKI therapy owing to their ultrathin structure, large specific surface area, and unique kidney targeting. Herein, we review recent progress in the development of various 2D nanomaterials for AKI therapy, including DNA origami, germanene, and MXene; moreover, we discuss current opportunities and future challenges in the field, aiming to provide new insights and theoretical support for the development of novel 2D nanomaterials for AKI treatment.

Sunday O. Edeki, Sunday E. Fadugba, Chaudry Masood Khalique

Deposit insurance is a mechanism by which financial institutions are stabilized. The danger of a bank’s inability to meet its consumer commitments due to its suspended license is insured through deposit insurance practices. A flat-rate insurance scheme would contribute to moral hazard and a financial panic when banks indulge in dangerous practices. Hence, a reliable model with an explicit solution is required. This paper considers a risk rate model for deposit insurance engendered by the classical Black Scholes Option Pricing Model. The solutions are obtained via the application of Banach Contraction Mapping or Method. The procedures involved are straightforward, easy, and flexible, even without giving up accuracy. The desired explicit solutions are obtained with less computational time.

Kai Xu

To explore the mechanism of negative emotions of the elderly in normalization period of COVID-19. The self-rating Depression Anxiety Stress Scale, epidemic attention scale, subjective economic status scale and physical health perception scale were used to investigate 318 elderly people in 2021. There were significant differences in negative emotions among the elderly in Henan in China with different gender, education background, medical insurance and whether they contacted suspected cases (all P &lt; 0.05), but there was no significant difference on religious belief (P &gt; 0.05); Attention to epidemic information was positively correlated with negative emotion (r = 0.492, P &lt; 0.01), and negatively correlated with subjective economic status (r = −0.138, P &lt; 0.05); Negative emotions were negatively correlated with subjective economic status (r = −0.455, P &lt; 0.01) and health perception (r = −0.277, P &lt; 0.01); health perception was no significant correlation with epidemic attention(r = −0.047, P &gt; 0.05) and subjective economic status (r = −0.033, P &gt; 0.05). Bootstrap test found that epidemic attention can significantly predict negative emotion of the elderly (β = 0.492, P &lt; 0.001), subjective economic status played a partial mediating role between epidemic attention and negative emotions (β = 0.438, −0.395, P &lt; 0.001), and health perception moderated the first half of the mediating path (β = 0.403, P &lt; 0.001, 95% CI = [0.286~0.521]). Epidemic attention has a significant positive impact on the negative emotions of the elderly in Henan during normalization period of COVID-19, and it has effect indirectly through subjective economic status; health perception plays a moderator role in the impact of epidemic attention on subjective economic status.

Chang JW, Liu CS, Tsai HL

Jei-Wen Chang,1– 3 Chin-Su Liu,3,4 Hsin-Lin Tsai3,5 1Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan; 2Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 3Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; 4Division of Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; 5Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, TaiwanCorrespondence: Hsin-Lin Tsai, Division of Pediatric Surgery, Department of Surgery, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Road, Beitou District, Taipei City, Taiwan, Tel +886-2-2875-2101, Fax +886-2-2875-7105, Email hltsai@vghtpe.gov.twPurpose: Children with vesicoureteral reflux (VUR) are at an increased risk of recurrent urinary tract infections (UTIs). Early detection and treatment of VUR are important to prevent renal function impairment. Therefore, the aims of this study were to determine the epidemiology of VUR and to identify clinical factors associated with VUR in Taiwanese children with a first documented UTI.Patients and Methods: We conducted this nationwide retrospective study using the Longitudinal Health Insurance Database 2010. Children ≤ 6 years of age who were admitted and received intravenous antibiotics for a newly diagnosed UTI were included. Multivariate logistic regression analysis was used to identify independent factors associated with VUR.Results: Overall, 388 (10.2%) of the children had VUR. The median (interquartile range) age at diagnosis of VUR was 0.5 (0.3– 1.3) years. Among the children with VUR, the age at first UTI and the age at diagnosis of VUR were significant lower in the males than in the females. Age ≤ 1 year at the first UTI (odds ratio (OR), 1.3; 95% confidence interval (CI): 1.0– 1.7), renal agenesis and dysgenesis (OR, 4.1; 95% CI: 1.3– 13.1), hydronephrosis (OR, 2.2; 95% CI: 1.7– 2.9), duplex collecting system/ectopic kidney/ectopic ureter (OR, 13.0; 95% CI: 8.1– 20.8), neuropathic bladder (OR, 4.7; 95% CI: 2.0– 11.1) and spina bifida (OR, 5.9; 95% CI: 1.3– 27.8) were independent factors for VUR.Conclusion: The children with VUR were more likely to have small kidneys and progression to end-stage renal disease. VUR was common in the children with a UTI and who were ≤ 1 year of age. Clinicians should arrange ultrasound to diagnose urinary tract anomalies. Infants with urinary tract anomalies, neuropathic bladder and spina bifida should receive further voiding cystourethrography to diagnose VUR early, as this may help to prevent renal damage.Keywords: congenital anomalies of the kidney and the urinary tract, vesicoureteral reflux, urinary tract infection, risk factor

Joseph B. Richardson PhD, William Wical MA, Nipun Kottage BS et al.

Low-income young Black men experience a disproportionate burden of violent injury in the United States. These men face significant disparities in healthcare insurance coverage and access to care. The Affordable Care Act (ACA) created a new healthcare workforce, Navigators and In-Person Assisters (IPAs), to support low-income minority populations with insurance enrollment. Using a longitudinal qualitative case study approach with Navigators and IPAs at the two busiest urban trauma centers in Maryland, this study identifies the culturally and structurally responsive enrollment strategies used by three Navigators/IPAs as they enrolled violently injured young Black men in healthcare insurance coverage. These approaches included gaining their trust and building rapport and engaging female caregivers during enrollment. Navigators and IPAs faced significant barriers, including identity verification, health literacy, privacy and confidentiality, and technological issues. These findings offer novel insight into the vital work performed by Navigators and IPAs, as they attempt to decrease health disparities for young Black male survivors of violence. Despite high rates of victimization due to violent firearm injury, little is known about how this population gains access to healthcare insurance. Although the generalizability of this research may be limited due to the small sample size of participants, the qualitative case study approach offers critical exploratory data suggesting the importance of trauma-informed care in insurance enrollment by Navigators and IPAs. They also emphasize the need to further address structural issues, which affect insurance enrollment and thus undermine the well-being of young Black men who have survived violent injury.

Chia-Jui Yang, Hsiu-Yin Wang, Tse-Chih Chou et al.

Background: To determine the prevalence of chronic comorbidities and associated medication costs in Taiwanese HIV patients in order to increase awareness of the disease burden among healthcare providers and patients. Methods: HIV-diagnosed patients receiving highly active antiretroviral therapy (HAART; 2010–2013) were identified from the Taiwan National Health Insurance Research Database with the corresponding International Classification of Diseases, ninth revision (ICD-9) code. Comorbidities (type II diabetes mellitus, hypertension, dyslipidemia, major depressive disorder, acute coronary syndrome, and cholelithiasis/nephrolithiasis) were identified according to ICD-9 or relevant medication use. Comorbidity medication and associated costs were identified using the drug classification code from the Anatomical Therapeutic Chemical classification system code series and series outpatient prescriptions. Results: Of 20,726 HIV-diagnosed Taiwanese patients (2010–2013), 13,142 receiving HAART were analyzed. Prevalence of all chronic comorbidities was significantly greater (p < 0.0001) in patients aged ≥40 years versus <40 years (diabetes mellitus, 14.95% vs. 3.30%; hypertension, 46.73% vs. 26.83%; dyslipidemia, 34.93% vs. 18.37%; depression, 23.75% vs. 19.88%; acute coronary syndrome, 1.16% vs. 0.21%; nephrolithiasis/cholelithiasis, 7.26% vs. 4.56%; >2 comorbidities, 24.80% vs. 7.21%). An increase in comorbidity medication spending (2010 vs. 2013 medication costs) was observed (antidyslipidemia, $88,878 vs. $168,180; antihyperglycemia, $32,372 vs. $73,518; antidepressants, $78,220 vs. $125,971; sedatives, $60,009 vs. $85,055; antihypertension, $47,115 vs. $95,134), contributing to overall treatment costs increasing almost two-fold from 2010 to 2013. Conclusions: Among HIV-infected Taiwanese patients receiving HAART, significant increases in comorbidity prevalence with age, along with rising comorbidity medication costs, suggest the need for preventative as well as chronic care. Keywords: Cost-burden, Epidemiology, Healthcare, Prevention, Taiwan

Daphne N. McRae, Nazeem Muhajarine, Patricia A. Janssen

Abstract Background Some observational studies have shown improved birth outcomes for women of low socioeconomic position (SEP) receiving antenatal midwifery versus physician care. To understand for whom and under what circumstances midwifery care is associated with better birth outcomes we examined whether psychosocial risk including substance use, mental illness, social assistance, residence in a neighbourhood of low/moderate SEP, and teen maternal age modified the association between model of care (midwifery versus physician) and small-for-gestational-age (SGA) or preterm birth (PTB) for women of low SEP. Methods For this retrospective cohort study, maternity data from the British Columbia Perinatal Data Registry were linked with Medical Services Plan billing data. We report adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for SGA birth (< the 10th percentile) and PTB (< 37 weeks’ completed gestation). For tests of interaction between antenatal models of care and psychosocial risk, p-values < 0.10 were considered statistically significant. Women were eligible for inclusion if they were residents of British Columbia, Canada, carried a singleton fetus, had low to moderate medical/obstetric risk, birthed between April 1, 2008 and Dec. 31, 2012, and received a health insurance subsidy (n = 33,937). Results Midwifery versus obstetrician patients had lower odds of PTB. The difference was 31% larger among substance users (aOR 0.24, 95% CI: 0.11–0.54) compared to non-substance users (aOR 0.55, 95% CI: 0.45–0.68). Additionally, there was a 34% statistically significant absolute difference in odds of PTB for midwifery versus obstetrician patients with both mental illness and substance use (aOR 0.18, 95% CI: 0.06–0.55) compared to women with neither mental illness nor substance use (aOR 0.52, 95% CI: 0.41–.66). Results demonstrated a consistent association between midwifery versus physician care and lower odds of SGA, yet effects were not statistically significantly different for women with higher or lower psychosocial risk. Conclusion Among low SEP women in British Columbia, Canada, antenatal midwifery compared to obstetrician care was associated with reduced odds of PTB. Odds were lower among women with substance use, and mental illness and substance use, than among women without these risk factors.

Sukhyun Ryu, Eili Y. Klein, Byung Chul Chun

Abstract Background β-Lactam/β-lactamase inhibitors (BLBLIs) were introduced into clinical practice as an alternative to carbapenems for treating multi-drug–resistant Klebsiella pneumoniae infections. However, little is known about the relationship between BLBLI treatment and antimicrobial resistance. In this study, we investigated the trends and the temporal association between antibiotic use and antimicrobial resistance in K. pneumoniae isolates obtained between 2012 and 2016. Methods Data regarding quarterly consumption (total number of prescriptions per quarter) of all BLBLIs, all third-generation cephalosporins, and all fluoroquinolones at a tertiary care hospital were obtained from the Korean Health Insurance Review and Assessment Service. Susceptibility data (isolation rate of antibiotic resistance per quarter) were obtained from the existing database of the same tertiary hospital. Regression analysis was used to analyze annual trends and cross-correlations to assess the temporal association on a quarterly basis between antibiotic consumption and antibiotic resistance in K. pneumoniae. Results The rate of resistance to piperacillin/tazobactam in K. pneumoniae significantly increased over the study period (p < 0.01). The consumption of all BLBLIs was also found to be significantly correlated with the rate of resistance to piperacillin/tazobactam (β = 0.66; p < 0.01), ceftazidime (β = 0.54; p = 0.02), and levofloxacin (β = − 0.60; p = 0.01) with two-quarter lags. Furthermore, the consumption of all third-generation cephalosporins was significantly correlated with rates of K. pneumoniae resistance to ceftazidime (β = 0.64; p < 0.01) with a two-quarter lag and levofloxacin (β = 0.50; p = 0.03) with a quarter lag. The consumption of all fluoroquinolones correlated with resistance rates to ceftazidime (β = 0.14; p < 0.01) with a two-quarter lag. Conclusions The rate of resistance to piperacillin/tazobactam in K. pneumoniae increased significantly over the study period and was significantly correlated with BLBLI consumption. While BLBLIs can potentially be utilized as an alternative to carbapenems, our findings reinforce concerns of resistance to these drugs. Further research is needed to understand the implications on resistance of utilizing BLBLIs as a carbapenem-sparing option.

Yi-Rong Lin, Mei-Yao Wu, Jen-Huai Chiang et al.

Abstract Background Many patients with gynecological disorders seek traditional medicine consultations in Asian countries. This study intended to investigate the utilization of traditional Chinese medicine (TCM) in patients with dysfunctional uterine bleeding (DUB) in Taiwan. Methods We analyzed a cohort of one million individuals randomly selected from the National Health Insurance Research Database in Taiwan. We included 46,337 subjects with newly diagnosed DUB (ICD-9-CM codes 626.8) from January 1, 1997 to December 31, 2010. The patients were categorized into TCM seekers and non-TCM seekers according to their use of TCM. Results Among the subjects, 41,558 (89.69%) were TCM seekers and 4,779 (10.31%) were non-TCM seekers. Patients who were younger tended to be TCM seekers. Most of the patients had also taken Western medicine, especially tranexamic acid and non-steroidal anti-inflammatory drugs (NSAIDs). More than half of TCM seekers (55.41%) received combined treatment with both Chinese herbal remedies and acupuncture. The most commonly used TCM formula and single herb were Jia-Wei-Xiao-Yao-San (Bupleurum and Peony Formula) and Yi-Mu-Cao (Herba Leonuri), respectively. The core pattern of Chinese herbal medicine for DUB patients consisted of Jia-Wei-Xiao-Yao-San, Xiang-Fu (Rhizoma Cyperi), and Yi-Mu-Cao (Herba Leonuri). Conclusions TCM use is popular among patients with DUB in Taiwan. Further pharmacological investigations and clinical trials are required to validate the efficacy and safety of these items.

Mohammad Keshavarz, Shahabeddin Abhari

One of the most common and important therapeutic tools used by physicians is prescription. The use of digital systems in the health field has many benefits and significant impacts on the health system. One of these systems is digital prescription. In this article, First, we will review the existing infrastructure and work done in this area, and then with a new perspective on health issues, we will provide a new infrastructure. Instead of introduction and use of a product or a system or statistical work , we aim to reviewe fundamental issues in the field of health system and present a strategic plan in the field of medicine from the perspective of experts of medical informatics and IT specialists. In fact, we will present a strategic plan and will provide infrastructure in the health field The infrastructure needed to create a digital system will be provided in order to increase productivity in various aspects of the health system; also, the interactions between different parts of this infrastructure will be discussed. The advantages of this project will be reviewed from the perspective of various elements involved in the health system; these include patients, doctors, health system managers, pharmacies, pharmaceutical distribution companies, insurance office and other organizations, such as the environmental organizations, tax office, etc. and benefits of each one will be reviewed

Wiktor A. Snieżycki, Marina J. Surmacz

Continuous growth of expenditures of public health services, in a combination to the limited possibilities of state budget, induces to constant search of more effective ways of the branch financing. Principle of socially focused state constrains attempts of radical change of health services financing in Belarus and becomes a most important reason of budgetary model preservation. Tactical directions of public health services reforming in Belarus, which introduction will allow to raise the efficiency of the branch financing, are discussed in the article, strategic prospects of reforming are opened.

Victoria Pattison de Menil, Martin Knapp, David McDaid et al.

The gap in Kenya between need and treatment for mental disorders is wide, and private providers are increasingly offering services, funded in part by private health insurance (PHI). Chiromo, a 30-bed psychiatric hospital in Nairobi, forms part of one of the largest private psychiatric providers in East Africa. The study evaluated the effects of insurance on service use and charge, questioning implications on access to care. Data derive from invoices for 455 sequential patients, including 12-month follow-up. Multi-linear and binary logistic regressions explored the effect of PHI on readmission, cumulative length of stay, and treatment charge. Patients were 66.4% male with a mean age of 36.8 years. Half were employed in the formal sector. 70% were admitted involuntarily. Diagnoses were: substance use disorder 31.6%; serious mental disorder 49.5%; common mental disorder 7%; comorbid 7%; other 4.9%. In addition to daily psychiatric consultations, two-thirds received individual counselling or group therapy; half received lab tests or scans; and 16.2% received ECT. Most took a psychiatric medicine. Half of those on antipsychotics were given only brands. Insurance paid in full for 28.8% of patients. Mean length of stay was 11.8 days and, in 12 months, 16.7 days (median 10.6). 22.2% were readmitted within 12 months. Patients with PHI stayed 36% longer than those paying out-of-pocket and had 2.5 times higher odds of readmission. Mean annual charge per patient was Int$ 4,262 (median Int$ 2,821). Insurers were charged 71% more than those paying out-of-pocket--driven by higher fees and longer stays. Chiromo delivers acute psychiatric care each year to approximately 450 people, to quality and human rights standards higher than its public counterpart, but at considerably higher cost. With more efficient delivery and wider insurance coverage, Chiromo might expand from its occupancy of 56.6% to reach a larger population in need.

Berger Ariel, Edelsberg John, Sanders Kafi N et al.

<p>Abstract</p> <p>Background</p> <p>Schizophrenia and bipolar disorder are chronic debilitating disorders that are often treated with second-generation antipsychotic agents, such as aripiprazole, quetiapine, and ziprasidone. While patients who are hospitalized for schizophrenia and bipolar disorder often receive these agents at discharge, comparatively little information exists on subsequent patterns of pharmacotherapy.</p> <p>Methods</p> <p>Using a database linking hospital admission records to health insurance claims, we identified all patients hospitalized for schizophrenia (ICD-9-CM diagnosis code 295.XX) or bipolar disorder (296.0, 296.1, 296.4-296.89) between January 1, 2001 and September 30, 2008 who received aripiprazole, quetiapine, or ziprasidone at discharge. Patients not continuously enrolled for 6 months before and after hospitalization (“pre-admission” and “follow-up”, respectively) were excluded. We examined patterns of use of these agents during follow-up, including adherence with treatment (using medication possession ratios [MPRs] and cumulative medication gaps [CMGs]) and therapy switching. Analyses were undertaken separately for patients with schizophrenia and bipolar disorder, respectively.</p> <p>Results</p> <p>We identified a total of 43 patients with schizophrenia, and 84 patients with bipolar disorder. During the 6-month period following hospitalization, patients with schizophrenia received an average of 101 therapy-days with the second-generation antipsychotic agent prescribed at discharge; for patients with bipolar disorder, the corresponding value was 68 therapy-days. Mean MPR at 6 months was 55.1% for schizophrenia patients, and 37.3% for those with bipolar disorder; approximately one-quarter of patients switched to another agent over this period.</p> <p>Conclusions</p> <p>Medication compliance is poor in patients with schizophrenia or bipolar disorder who initiate treatment with aripiprazole, quetiapine, or ziprasidone at hospital discharge.</p>

Cristina CIURARU-ANDRICA

<p>The problem of insufficient financial resources of the State Social Insurance Budget, reflected in its growing deficit, is quite current. In this context, the institution responsible for the administration of the public pension system, namely the National House of Public Pensions, should operate in a more efficient manner with the available resources that are smaller than the demand. Reality, however, shows a different situation: irregularities, errors and deficiencies in the administration of the public pension system, resulting in a substantial damage. This diminishes the rights of today’s and tomorrow’s pensioners.</p>