Hasil untuk "Insurance"

Thomas Köhne

Yu CS, Wu JL, Shih CM et al.

Cheng-Sheng Yu,1– 4,&ast; Jenny L Wu,5,&ast; Chun-Ming Shih,6– 8 Kuan-Lin Chiu,9 Yu-Da Chen,9,10 Tzu-Hao Chang5,11 1Graduate Institute of Data Science, College of Management, Taipei Medical University, New Taipei City, 235603, Taiwan; 2Clinical Data Center, Office of Data Science, Taipei Medical University, New Taipei City, 235603, Taiwan; 3Fintech Innovation Center, Nan Shan Life Insurance Co., Ltd., Taipei, 11049, Taiwan; 4Beyond Lab, Nan Shan Life Insurance Co., Ltd., Taipei, 11049, Taiwan; 5Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, New Taipei City, 235603, Taiwan; 6Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan; 7Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, 11031, Taiwan; 8Taipei Heart Institute, Taipei Medical University, Taipei, 11031, Taiwan; 9Department of Family Medicine, Taipei Medical University Hospital, Taipei, 11031, Taiwan; 10School of Medicine, College of Medicine, Taipei Medical University, Taipei, 11031, Taiwan; 11Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei, 11031, Taiwan&ast;These authors contributed equally to this workCorrespondence: Tzu-Hao Chang; Yu-Da Chen, Email kevinchang@tmu.edu.tw; 153072@h.tmu.edu.twPurpose: As HF progresses into advanced HF, patients experience a poor quality of life, distressing symptoms, intensive care use, social distress, and eventual hospital death. We aimed to investigate the relationship between morality and potential prognostic factors among in-patient and emergency patients with HF.Patients and Methods: A case series study: Data are collected from in-hospital and emergency care patients from 2014 to 2021, including their international classification of disease at admission, and laboratory data such as blood count, liver and renal functions, lipid profile, and other biochemistry from the hospital’s electrical medical records. After a series of data pre-processing in the electronic medical record system, several machine learning models were used to evaluate predictions of HF mortality. The outcomes of those potential risk factors were visualized by different statistical analyses.Results: In total, 3871 hF patients were enrolled. Logistic regression showed that intensive care unit (ICU) history within 1 week (OR: 9.765, 95% CI: 6.65, 14.34; p-value < 0.001) and prothrombin time (OR: 1.193, 95% CI: 1.098, 1.296; < 0.001) were associated with mortality. Similar results were obtained when we analyzed the data using Cox regression instead of logistic regression. Random forest, support vector machine (SVM), Adaboost, and logistic regression had better overall performances with areas under the receiver operating characteristic curve (AUROCs) of > 0.87. Naïve Bayes was the best in terms of both specificity and precision. With ensemble learning, age, ICU history within 1 week, and respiratory rate (BF) were the top three compelling risk factors affecting mortality due to HF. To improve the explainability of the AI models, Shapley Additive Explanations methods were also conducted.Conclusion: Exploring HF mortality and its patterns related to clinical risk factors by machine learning models can help physicians make appropriate decisions when monitoring HF patients’ health quality in the hospital.Keywords: mortality, risk factor, cardiovascular disease, multivariate statistical analysis, machine learning, artificial intelligence

Jérémie Thereaux, MD, PhD, Mohammed Bennani, PhD, Jean Khemis, MD et al.

Objective:. This study compared the effectiveness of 4 main revisional bariatric surgery (RBS) sequences after sleeve gastrectomy (SG) and adjustable gastric banding (AGB), on the reimbursement of antidiabetic treatments in France. Background:. Few large-scale prospective cohort studies have assessed the changes in antidiabetic treatments after RBS. Method:. This nationwide observational population-based cohort study analyzed data from the French National Health Insurance Database. All patients who underwent primary SG and AGB in France between January 2012 and December 2014 were included and followed up until December 31, 2020. The changes in categories and costs of reimbursed antidiabetic treatments across different RBS sequences were assessed (presented as follows: bariatric surgery (BS)-RBS). Results:. Among the 107,088 patients who underwent BS, 6396 underwent RBS, 2400 SG-GBP (SG converted to gastric bypass [GBP] during follow-up), 2277 AGB-SG, 1173 AGB-GBP, and 546 SG-SG. Pre-RBS insulin was used in 10 (2.9%), 4 (0.9%), 8 (2.4%), and 10 (2.6%) patients, respectively. Two years after RBS, the treatment discontinuation or decrease (the change of treatment to a lighter one category rates [eg, insulin to bi/tritherapy]) was 47%, 47%, 49%, and 34%, respectively. Four years after RBS, the median annual cost per patient compared with baseline was lower (P < 0.01) for all sequences, except SG-SG (P = 0.24). The most notable effect concerned AGB-GBP (median of more than 220 euros to 0). Conclusions:. This study demonstrated the positive impact of RBS over a 4-year follow-up period on antidiabetic treatments reimbursement, through the reduction or discontinuation of treatments and a significant decrease in costs per patient.

Luca De Mori, Pietro Millossovich, Rui Zhu et al.

The analysis of residual life expectancy evolution at retirement age holds great importance for life insurers and pension schemes. Over the last 30 years, numerous models for forecasting mortality have been introduced, and those that allow us to predict the mortality of two or more related populations simultaneously are particularly important. Indeed, these models, in addition to improving the forecasting accuracy overall, enable evaluation of the basis risk in index-based longevity risk transfer deals. This paper implements and compares several model-averaging approaches in a two-population context. These approaches generate predictions for life expectancy and the Gini index by averaging the forecasts obtained using a set of two-population models. In order to evaluate the eventual gain of model-averaging approaches for mortality forecasting, we quantitatively compare their performance to that of the individual two-population models using a large sample of different countries and periods. The results show that, overall, model-averaging approaches are superior both in terms of mean absolute forecasting error and interval forecast accuracy.

Xiaona Li, Dongping Ma, Zhiqiang Feng et al.

BackgroundMultiple Chronic Diseases (MCD) are the co-occurrence of two or more chronic conditions within an individual. Compared to patients with a single chronic disease, those with MCD face challenges related to polypharmacy, which increases the risk of adverse drug events, side effects, and drug–drug interactions. Understanding the specific medication preferences of patients with MCD is crucial to optimize treatment plans and enhance treatment safety.ObjectiveThis study aims to evaluate the medication preferences among patients with multiple chronic diseases in rural areas of an eastern province of China.MethodsA discrete choice experiment (DCE) was used to measure patients’ medication preferences. According to literature research, expert panel discussions, and in-depth patient interviews, we identified six attributes: monthly out-of-pocket cost, onset speed of action, adverse effects, whether it is covered by health insurance, origin of medications, and types of medications. The conditional logit models (CLM) and mixed logit models (MIXL) were used to evaluate the choice data. Willingness to pay (WTP) was used to reflect the monetary value that patients were willing to pay or receive reimbursement after changes in different attribute levels.ResultsA total of 956 respondents were included in the analysis. Of which, 68.62% were female, with an average age of 68 years, and 65.89% had a Body Mass Index (BMI) greater than or equal to 24. Statistical significance was observed for all attributes (p &lt; 0.001). The preferred medication for patients encompassed low monthly out-of-pocket costs, rapid onset of action, rare adverse effects, and a preference for Western medicine, health insurance-covered medication and domestic medication. The onset speed of action was a primary consideration for patients, who demonstrated a willingness to pay an additional CNY151.37 per month for a medication with a rapid onset of action.ConclusionRural patients with multiple chronic diseases preferred medications with rapid onset, rare adverse, Western medications, domestic medication, and health insurance-covered medication. Medical staff can effectively combine the Health Belief Model (HBM) to help patients with multiple chronic diseases improve their confidence and understanding of medication selection, to improve their health management.

Oscar Herrera-Restrepo, Marta Kwiatkowska, Samuel Huse et al.

Invasive meningococcal disease (IMD) is a life-threatening yet vaccine-preventable disease, with vaccines approved and recommended in the United States by the Centers for Disease Control and Prevention. This study assessed complications, mortality, healthcare resource utilization (HCRU), and healthcare costs among a sample of commercially-insured individuals living in the United States who experienced IMD. We used retrospective data from large claims databases limited to individuals with IMD covered by commercial health plans between January 2010–March 2022. Health outcomes, HCRU, and healthcare costs were analyzed during the acute (index date to 30 days post-hospital discharge) and post-acute (end of acute phase to end of follow-up period) phases. Among 618 IMD cases identified, the most common acute phase complications were severe brain damage, renal failure, and autoimmune disease. The most common post-acute phase complications were autoimmune disease, arthralgia, and renal failure. Acute phase HCRU ranged from 72.7 (95% confidence interval [CI] 19.81–186.12) intensive care unit (ICU) stays to 12,102.9 (95% CI 11,201.07–13,058.00) surgeries per 1,000 patient-years. Post-acute phase HCRU ranged from 3.6 (95% CI 1.18–8.50) ICU stays to 7,808.3 (95% CI 7,661.22–7,957.54) specialty physician visits per 1,000 patient-years. Patients with IMD incurred average healthcare costs of $60,866.23 and $145,883.65 during the acute and post-acute phases, respectively. Negative health outcomes and high HCRU and costs were observed among commercially-insured patients with IMD. Our findings suggest that IMD immunization efforts and healthcare interventions targeting education on vaccine recommendations to healthcare providers and patients could help prevent IMD and reduce disease burden.

Buhl R, Wilke T, Picker N et al.

Roland Buhl,1 Thomas Wilke,2 Nils Picker,3 Olaf Schmidt,4 Marlene Hechtner,5 Anke Kondla,5 Ulf Maywald,6 Claus F Vogelmeier7 1Pulmonary Department, Mainz University Hospital, Mainz, Germany; 2IPAM e.V, Wismar, Germany; 3Cytel Inc - Ingress-Health HWM GmbH, Wismar, Germany; 4Pulmonary Group Practice, Koblenz, Germany; 5Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim, Germany; 6AOK PLUS, Dresden, Germany; 7Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg (UMR), Member of the German Center for Lung Research (DZL), Marburg, GermanyCorrespondence: Roland Buhl, Medizinische Klinik und Poliklinik - Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, Mainz, 55131, Germany, Tel +49 6131 17 7271, Email roland.buhl@unimedizin-mainz.dePurpose: This study aimed to describe the real-world treatment of German incident COPD patients, compare that treatment with clinical guidelines, and provide insight into disease development after incident diagnosis. In addition, the economic burden of the disease by assessing COPD-related healthcare costs was described.Patients and Methods: Based on a German claims dataset, continuously insured individuals (04/2014-03/2019) aged 40 years or older with at least two incident pulmonologist’s diagnoses or one inpatient diagnosis of COPD (ICD-10-GM code J44.-; no respective diagnosis in a 12-month baseline period) were selected. Treatment patterns after incident diagnosis considering inhaled maintenance therapies identified by ATC codes (outpatient prescriptions) were analyzed. Prescription patterns were compared with recommendations of German COPD treatment guidelines. Severe exacerbations were assessed as hospitalizations with main diagnosis ICD-10-GM code J44.1. COPD-associated costs from the perspective of the health insurance fund AOK PLUS were calculated per patient-year (PY).Results: The sample comprised 17,464 incident COPD patients with a mean age of 71.5 years. 58.9% were male and the mean Charlson-Comorbidity-Index was 5.3. During follow-up (median: 2.0 years), 57.1% of the patients received at least one prescription of an inhaled maintenance therapy, whereas 42.9% did not. Among treated patients, 35.2% started their treatment with LABA/LAMA, 25.3% with LAMA monotherapy, 16.2% with LABA/ICS, and 7.8% with LABA/LAMA/ICS therapy. Within four weeks after initial diagnosis, ICS-containing therapies were prescribed in 14.1% of patients. Of all patients with a prescribed triple therapy, 68.9% had no corresponding exacerbation history documented. On average, 0.16 severe exacerbations and 0.19 COPD-related hospitalizations were observed per PY during available follow-up. Direct COPD-related costs were 3,693 €/PY, with COPD-related hospitalizations being responsible for about 79.2% of these costs.Conclusion: Long-acting bronchodilators are the mainstay of pharmacological treatment of incident COPD patients in Germany, in line with guideline recommendations. Yet, a considerable proportion of incident COPD patients did not receive any inhaled maintenance therapy.Keywords: COPD, real-world treatment, exacerbation frequency, healthcare costs

Gabrielle LeBlanc, Inkoo Lee, Henry Carretta et al.

Purpose: To analyze the extent to which rural-urban differences in breast cancer stage at diagnosis are explained by factors including age, race, tumor grade, receptor status, and insurance status. Methods: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 database, analysis was performed using data from women aged 50?74 diagnosed with breast cancer between the years 2013 and 2016. Patient rurality of residence was coded according to SEER's Rural-Urban Continuum Code 2013: Large Urban (RUCC 1), Small Urban (RUCC 2,3), and Rural (RUCC 4,5,6,7,8,9). Stage at diagnosis was coded according to SEER's Combined Summary Stage 2000 (2004+) criteria: Localized (0,1), Regional (2,3,4,5), and Distant (7). Descriptive statistics were analyzed, and variations were tested for across rural-urban categories using Kruskall?Wallis and Kendall's tau-b tests. Additionally, odds ratios (ORs) and 95% confidence intervals for the three ordinal levels of rural-urban residence were calculated while adjusting for other independent variables using ordinal logistic regression. Results: The rural residence category showed the largest proportion of women diagnosed with distant stage breast cancer. Additionally, we determined that patients with residence in both large and small urban areas had statistically significantly lower odds of higher stage diagnosis compared to rural patients even after controlling for age, race, tumor grade, receptor status, and insurance status. Conclusions: Rural women with breast cancer show small but statistically significant disparities in stage-at-diagnosis. Further research is needed to understand local area variation in these disparities across a wide range of rural communities, and to identify the most effective interventions to eliminate these disparities.

Juhee Park, Kyeongjun Moon, Dong-Sook Kim

BackgroundThe burden of care continues to rise considerably worldwide and the challenge of diversity in cancer research has become important. We aimed to examine trends of cancer care utilization and anti-cancer medication among patients with six solid cancers (gastric, colorectal, liver, lung, breast, and prostate cancer) in South Korea.MethodsThis study analyzed patients diagnosed with six types of solid cancer from 2007 to 2019 using data from the National Health Insurance claims database. We analyzed the total number of cancer cases, each patient’s length of stay (LOS) in a hospital, the number of outpatient physician visits, total medical care costs, total out-of-pocket (OOP) costs, and expenditures on anti-cancer drugs.ResultsUtilization of healthcare services and spending on cancer care including anti-cancer drugs both increased in the 13-year study period. The average LOS was the highest for colorectal cancer patients at 43.5 days, and breast cancer patients had the highest average number of physician visits at 11.8. Breast cancer patients had the highest total medical costs (USD 923 million), anti-cancer drug spending (USD 156 million), and the largest increase (5 times) over the 13-year period. The anti-cancer drugs with the largest market shares were ramucirumab for gastric cancer; oxaliplatin for colorectal cancer; sorafenib for liver cancer; pembrolizumab, nivolumab, for lung cancer; trastuzumab for breast cancer; and bicalutamide for prostate cancer.ConclusionThis study was a large-scale analysis from a nationally representative database of the total population. The study also shows the pattern of cancer care in an Asian country and can provide implications for future cancer research.

Andrey Reshetnikov, Nadezhda Prisyazhnaya, Florian Steger et al.

The coronavirus pandemic has raised serious questions about the need to properly inform residents of large cities about the rules of hygiene, behavior in self-isolation, and maintaining health. This study aimed to identify in more detail the sources of information and to assess the levels of awareness and knowledge of the inhabitants of a typical metropolis about coronavirus infection to further search for ways to improve health information during pandemics. This research has a questionnaire survey design. Data from 478 adult Muscovites were collected on 20–25 March 2020 by the Institute of Social Sciences of Sechenov University. The aim of this study was to study the level of awareness in preventing the spread of infection and peculiarities in the perceptions of residents of the city of Moscow toward the large-scale social changes associated with the COVID-19 pandemic as well as their impact on the way of life, social relations, lifestyle, and ideas about the future of the population. This article presents the results of a medical and sociological survey of residents of Moscow implemented at the beginning of the spread of coronavirus infection in the country, which showed the awareness of residents of Moscow regarding the problem of the spread of coronavirus and the prevention of infection as well as a high level of anxiety and the pessimistic expectations of respondents regarding the consequences of the COVID-19 pandemic for the state, society, and people. At the same time, the fears of the survey participants involved both immediate risks of the disease and a wide range of socioeconomic problems from near and distant perspectives.

Behzad Karami Matin, Ali Kazemi Karyani, Shahin Soltani et al.

Objective: Down syndrome or trisomy 21 is one of the most common human chromosomal disorders that affect cognitive functions, communication and behavioral skills. At the macro level, various factors can contribute to the Down syndrome prevalence and mortality. This study aimed to investigate the association of health system functions with Down syndrome prevalence and mortality worldwide. Materials & Methods: The study was a cross-sectional study conducted based on the secondary analysis of existing data in 2019. Data from 202 countries in six different regions (African Region [AFRO], Eastern Mediterranean Region [EMRO], European Region [EURO], South-East Asia Region [SEARO], Western Pacific Region [WPRO], and Pan American Health Organization [PAHO]) were included in the study. Data were extracted from the World Health Organization (WHO), the World Bank and the Institute for Health Metrics and Evaluation databases. The adjusted linear regression analysis was used to examine the association between health system-related factors with prevalence of, and death due to Down syndrome as the outcome variables. In the present study, two functions of health financing (domestic general government health expenditure [GGHE-D] per capita in PPP [purchasing power parity] int$, domestic private health expenditure [PHE-D] per capita in PPP int$, external health expenditure [EXT] per capita in PPP int$) and health system resources (nurse and midwifery personnel, generalist medical practitioners [GMP], specialist medical practitioners [SMP], pharmacists, dentists, physiotherapists) were included in the study as independent variables. We used the Stata software version 14 to analyze  Results: Africa and low-income countries had the highest deaths due to Down syndrome. On the other side, Europe and high-income countries had the highest prevalence of Down syndrome worldwide. According to the available data, Iran had a lower prevalence (29.31 vs 38.44 per 100,000 population) and higher deaths (0.34 vs 0.32 per 100,000 population) compared to high- income countries. The 20-year trend of prevalence of, and deaths due to Down syndrome in Iran has always been lower and higher than high-income countries, respectively. Linear regression analysis showed that GGHE-D per capita (β=0.385, P<0.001) and PHE-D per capita (β=0.354, P=0.02) could predict the prevalence of Down syndrome significantly in the study countries. On the other hand, nurse and midwifery personnel (β=-0.607, P=0.014) and number of SMP (β=0.420, P=0.025) were associated with increased deaths from Down syndrome in the included countries.  Conclusion: Our findings showed GGHE-D and PHE-D are associated with a higher prevalence of Down syndrome in health systems.  On the other hand, health system resources (nurses and SMP) were the main predictors of death due to Down syndrome in the included countries. International organizations and governments need to monitor and improve the equitable access of vulnerable groups to health services in low-income countries.  Improving health insurance coverage and equitable distribution of health resources is suggested to reduce deaths due to Down syndrome in Iran.

Hande Aksöz Yılmaz

This study investigates the effect of immigration and foreign direct investment on trade within the framework of factor mobility. Hence, we used annual data, spanning the period of 2000–2018, and immigration flows to Turkey’s major trade partners (Germany, France, Italy, UK, and the United States). The inward foreign direct investment flows to Turkey from these countries. However, exchange rates, foreign employment, globalization index, and political stability index variables affect trade. The findings show that migration flows from Turkey to five countries and have more impact on trade, compared to inward foreign direct investment to Turkey overthe period of 2000–2018. Furthermore, when the fundamental assumptions of traditional foreign trade theories are ignored, parallel results are obtained, indicating that factor movements and trade are complementary.

Johannes Geyer

<span class="fontstyle0">The comparison of long-term care (LTC) expenditures is a difficult task. National LTC systems differ widely in terms of eligibility criteria, level of benefits, institutional variety and regional heterogeneity. In this commentary I will first give some general remarks on cross country comparisons. Then I discuss the role of the informal sector which is the most important pillar of all LTC systems. I conclude with some background on current developments in Germany. Different from Japan Germany is extending its LTC insurance instead of containing costs.</span>

Wisnu Kumala, Yaswirman Yaswirman, Ulfanora Ulfanora

There is a tug of authority in resolving insurance disputes outside the court between the Consumer Dispute Settlement Agency (BPSK) based on Law Nomor 8 of 1999 concerning Consumer Protection with Alternative Dispute Resolution Institutions (LAPS) based on Financial Services Authority Regulation Number 1/POJK.07/2014. This encourages the author to conduct legal research in order to determine the authority of BPSK in resolving insurance disputes as well as the legal consequences of the decision after the issuance of the Financial Services Authority Regulation Number 1/POJK.07/2014 using the statutory approach. This legal research results in the finding that BPSK is still authorized to settle insurance disputes following the issuance of the Financial Services Authority Regulation Number 1/POJK.07/2014, this is based on the provisions of the Lex superior derogat legi inferiori principle. Then there is no legal effect on the BPSK decision after the issuance of the Financial Services Authority Regulation. This is because BPSK's decision has been based on Law Number 8 of 1999 concerning Consumer Protection, whose position is higher than the Regulation of the Financial Services Authority. So there is no need for BPSK to follow the provisions of the regulations whose hierarchy of legislation is lower than the Consumer Protection Act. Therefore BPSK's decision is "final and binding" as explained in Article 54 paragraph 3 of the Consumer Protection Act.

Won-Sep Kim, Hee-Joon Bae, Hyun-Haeng Lee et al.

Objective To investigate the post-stroke rehabilitation status according to stroke severity using the database of the Korean Health Insurance Review and Assessment Service. Methods The data of patients admitted to the neurology departments of 12 hospitals within 7 days of onset of ischemic stroke were collected. A total of 2,895 patients hospitalized between November 2010 and December 2011 were included. The patients were classified into three groups according to their initial National Institutes of Health Stroke Scale (NIHSS) scores (mild, ≤5; moderate, >5 and ≤13; and severe, >13). Length of hospital stay (LoS) with rehabilitation, NIHSS score after acute care, and scores on modified Rankin Scale (mRS) were examined at 1 year post-stroke according to stroke severity and ongoing rehabilitation. Results The total LoS for ongoing rehabilitation significantly increased with stroke severity (mild, 91.66±149.70; moderate, 197.26±241.93; severe, 263.50±275.75 days; p<0.01). However, the proportion of LoS with ongoing rehabilitation to the total LoS tended to decline with increasing stroke severity (mild, 77.93±29.50, p<0.01; moderate, 71.83±32.13; severe, 62.29±37.19). The home discharge rate of the group that underwent continuous inpatient rehabilitation was significantly higher in patients with moderate and severe stroke, respectively (14.2% vs. 0.0%, p<0.001; 7.4% vs. 0.0%, p=0.032). Conclusion This study showed that intermittent rehabilitation was often provided after acute care, whereas ongoing rehabilitation positively affected rate of home discharge in patients with moderate and severe stroke in Korea. These results represent evidence for improving the healthcare system to promote adequate rehabilitation in the future.

Milan Počuča, Zdravko Petrović, Dragan Mrkšić

Damage in agricultural production can be crucial for the economy of a state, especially in countries where agricultural production prevails in the gross national income, as it is the case with Serbia. However, it is equally important that our agricultural producers manage incomes and expenditures in an efficient manner and optimize profit per surface unit, which is the basis of their business. Insurance plays an important part in the protection of the income statement of every agricultural producer as insurance costs are at the level of 1.5% to 2% on average of the production value, i.e. they are very low and saving on insurance could lead to the loss of the total yield and consequently total profit. However, agricultural insurance in Serbia is not developed enough. The states attempt to boost insurance development amounts to insurance subsidies, which, in the period of the implementation of this regulation, i.e. since 2006, has raised awareness of the need of such a type of protection of agricultural producers.

Maia Sieverding, Cynthia Onyango, Lauren Suchman

<h4>Background</h4>Incorporating private healthcare providers into social health insurance schemes is an important means towards achieving universal health coverage in low and middle income countries. However, little research has been conducted about why private providers choose to participate in social health insurance systems in such contexts, or their experiences with these systems. We explored private providers' perceptions of and experiences with participation in two different social health insurance schemes in Sub-Saharan Africa-the National Health Insurance Scheme (NHIS) in Ghana and the National Hospital Insurance Fund (NHIF) in Kenya.<h4>Methods</h4>In-depth interviews were held with providers working at 79 facilities of varying sizes in three regions of Kenya (N = 52) and three regions of Ghana (N = 27). Most providers were members of a social franchise network. Interviews covered providers' reasons for (non) enrollment in the health insurance system, their experiences with the accreditation process, and benefits and challenges with the system. Interviews were coded in Atlas.ti using an open coding approach and analyzed thematically.<h4>Results</h4>Most providers in Ghana were NHIS-accredited and perceived accreditation to be essential to their businesses, despite challenges they encountered due to long delays in claims reimbursement. In Kenya, fewer than half of providers were NHIF-accredited and several said that their clientele were not NHIF enrolled. Understanding of how the NHIF functioned was generally low. The lengthy and cumbersome accreditation process also emerged as a major barrier to providers' participation in the NHIF in Kenya, but the NHIS accreditation process was not a major concern for providers in Ghana.<h4>Conclusions</h4>In expanding social health insurance, coordinated efforts are needed to increase coverage rates among underserved populations while also accrediting the private providers who serve those populations. Market pressure was a key force driving providers to gain and maintain accreditation in both countries. Developing mechanisms to engage private providers as stakeholders in social health insurance schemes is important to incentivizing their participation and addressing their concerns.

An Chen, Filip Uzelac

This paper compares two different types of private retirement plans from the perspective of a representative beneficiary: a defined benefit (DB) and a defined contribution (DC) plan. While salary risk is the main common risk factor in DB and DC pension plans, one of the key differences is that DB plans carry portability risks, whereas DC plans bear asset price risk. We model these tradeoffs explicitly in this paper and compare these two plans in a utility-based framework. Our numerical analysis focuses on answering the question of when the beneficiary is indifferent between the DB and DC plan. Most of our results confirm the findings in the existing literature, among which, e.g., portability losses considerably reduce the relative attractiveness of the DB plan. However, we also find that the attractiveness of the DB plan can decrease in the level of risk aversion, which is inconsistent with the existing literature.

Anja Takla, Ole Wichmann, Thorsten Rieck et al.

Objective We aimed to quantify progress towards measles elimination in Germany from 2007 to 2011 and to estimate any potential underreporting over this period. Methods We determined the annual incidence of notified cases of measles – for each year – in northern, western, eastern and southern Germany and across the whole country. We then used measles-related health insurance claims to estimate the corresponding incidence. Findings In each year between 2007 and 2011, there were 6.9–19.6 (mean: 10.8) notified cases of measles per million population. Incidence decreased with age and showed geographical variation, with highest mean incidence – 20.3 cases per million – in southern Germany. Over the study period, incidence decreased by 10% (incidence rate ratio, IRR: 0.90; 95% confidence interval, CI: 0.85–0.95) per year in western Germany but increased by 77% (IRR: 1.77; 95% CI: 1.62–1.93) per year in eastern Germany. Although the estimated incidence of measles based on insurance claims showed similar trends, these estimates were 2.0- to 4.8-fold higher than the incidence of notified cases. Comparisons between the data sets indicated that the underreporting increased with age and was generally less in years when measles incidence was high than in low-incidence years. Conclusion Germany is still far from achieving measles elimination. There is substantial regional variation in measles epidemiology and, therefore, a need for region-specific interventions. Our analysis indicates underreporting in the routine surveillance system between 2007 and 2011, especially among adults.

Takamura K, Okayama M, Takeshima T et al.

Kazuhiro Takamura,1 Masanobu Okayama,2 Taro Takeshima,2 Shinji Fujiwara,3 Masanori Harada,4 Junichi Murakami,5 Masahiko Eto,6 Eiji Kajii21Department of Community Medicine, Obstetrics and Gynecology, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan; 2Division of Community and Family Medicine, Center for Community Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan; 3Mima City National Health Insurance Koyadaira Clinic, Mima, Tokushima, Japan; 4Department of Support of Rural Health Care, Yamaguchi Grand Medical Center, Hofu, Yamaguchi, Japan; 5Division of Chest Surgery, Department of Surgery and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan; 6Department of Internal Medicine, Wakuya Medical and Welfare Center, Wakuya, Miyagi, JapanPurpose: A salt preference questionnaire may be a convenient and cost-effective method for predicting salt intake; however, the influence of salt preference on daily salt intake is unclear. This study aimed at revealing the effectiveness of the salt preference question in determining the daily salt intake in primary care outpatients.Patients and methods: This cross-sectional study included 1,075 outpatients (men, n=436, 40.6%) at six primary care institutions in Japan. Primary outcomes included a salty food preference assessed by using one question and a daily salt intake, assessed using early morning second urine samples. Multivariate analyses determined the relationships between the salt intake and the two salt preference levels.Results: The mean age was 67.6&plusmn;14.6 years, and 594 (55.3%) preferred salty foods. The daily salt intake was 12.3&plusmn;4.0 g per day and 11.4&plusmn;3.7 g per day in the salt preference and nonsalt preference groups, respectively (P&lt;0.001). A salt intake &lt;10 g per day was consumed by 169 (28.5%) and 181 (37.6%) patients (P=0.001), respectively, and &lt;6 g salt per day was consumed by 28 (4.7%) and 26 (5.4%) patients (P=0.606), respectively. The patients who preferred salty foods consumed a significantly larger amount of salt per day than those who did not prefer salty foods (&beta; coefficient, 0.621; 95% confidence interval [CI], 0.146&ndash;1.095). There was no difference in the number of patients who consumed &lt;10 g salt per day (adjusted odds ratio [ad-OR], 1.29; 95% CI, 0.99&ndash;1.69) or &lt;6 g salt per day (ad-OR, 1.39; 0.90&ndash;1.69) between the groups.Conclusion: Preference for salty foods was positively associated with daily salt intake. However, daily salt intake was not always appropriate, even in the patients who did not prefer salty foods. Behavioral interventions for salt restriction after an assessment of daily salt intake are necessary for primary care patients, regardless of their preference for salty foods.Keywords: salt preference, daily salt intake, outpatients, primary care, salt restriction, spot urine method