Naoko Otsuki, Ryohei Yamamoto, Tomoaki Mameno
et al.
Abstract Background Although previous studies have reported associations between the number of teeth and all-cause mortality, the results vary depending on the tooth condition. Few previous studies have focused on the most effective method of counting the number of teeth to predict all-cause mortality. This study aimed to identify an effective method for counting the number of teeth according to their condition in order to predict all-cause mortality. Methods This cohort study used data from the Oral Health Screening to Assess Keys of Aging Well (OHSAKA) study and linked public dental check-ups and healthcare administrative datasets in Japan from 2018 to 2020. A total of 190,282 participants aged 75 years or older who underwent public dental checkups in Japan were evaluated for the study. The exposure in this study was the number of teeth and their condition, excluding the third molars. The outcome measure was all-cause mortality using the National Health Insurance Database of Japan. Results The median observational period was 3.4 years (interquartile range, 2.8–3.8), and all-cause mortality was observed in 9,713 (12.0%) men and 6,242 (5.7%) women. Adjusted Cox proportional hazard models revealed a dose-dependent association between sound and filled teeth and the all-cause mortality (adjusted hazard ratios [95% confidence intervals] of 0, 1–5, 6–10, 11–15, 16–20, and ≥ 21 teeth for men: 1.74 [1.62, 1.87], 1.51 [1.41, 1.61], 1.42 [1.33, 1.51], 1.38 [1.29, 1.47], 1.15 [1.08, 1.22], and 1.00 [reference], respectively, for women: 1.69 [1.55, 1.85], 1.35 [1.24, 1.48], 1.24 [1.14, 1.34], 1.21 [1.12, 1.31], 1.17 [1.09, 1.26], and 1.00 [reference], respectively). The Net Reclassification Improvement of the sound + filled + decayed teeth count model decreased compared to that of the sound + filled teeth count model in both men and women. Conclusions This study clarified the deleterious and beneficial associations between decayed and filled teeth and all-cause mortality. The total number of sound and filled teeth predicted all-cause mortality more accurately than the number of sound teeth alone, or the number of sound, filled, and decayed teeth combined.
Said S. A. Khamis, Ahmed Ragheeb Tawfeek, Mohammed Fathy Ragab
et al.
Abstract Background Recent HD systems have moved from pre-defined dialysate flow rates (e.g. 300, 500, 800 mL/min) to an individual setting, or an automatic adjustment with a fixed factor of the dialysate flow to the blood flow. Both allows more flexibility of choosing the appropriate dialysate flow as an optimal adjustment to the current blood flow. Aim of the work To study the possible effects of using autoflow factor function on hemodialysis (HD) efficacy in regular hemodialysis patients. Methods A prospective cross section study included 55 ESRD patients on hemodialysis and conducted in hemodialysis unit in Menoufia university hospital. Results There was no statistically significant difference between the dialysate flow rate 500 mL/min and auto Flow factor regarding the Kt/V (p = 0.068). Conclusion The present study demonstrates that the use of the Auto Flow Factor Function does not result in a statistically significant difference in dialysis efficacy compared to a fixed dialysate flow rate of 500 mL/min. Given the potential for dialysate and energy savings, the implementation of Auto Flow may represent a step toward environmentally sustainable dialysis without compromising patient care.
BackgroundPolicy pilots and policy diffusion are important tools for national governance and policy innovation in China. Long-term care insurance (LTCI) offers a potential solution to the challenges posed by the aging population. Currently, the pilot program for the LTCI system in China has gone through two phases, but a unified national policy framework has yet to be established. Therefore, the outcomes of the policy pilots and the diffusion process of this policy warrant further exploration.MethodBased on the perspective of policy diffusion, this study employs textual analysis and applies the Policy Modeling Consistency (PMC) index model to evaluate the quality and consistency of LTCI policies. A quantitative evaluation is conducted on 29 LTCI policies from two groups of pilot cities in China. The characteristics of policy diffusion are analyzed from both temporal and spatial dimensions.Conclusion(1) According to the PMC index results, LTCI policies of 25 cities achieved an excellent level, 4 cities reached an acceptable level, and there were no substandard policies among the 29 pilot cities. The overall consistency of LTCI policies in the first batch of pilot cities in China is higher than that in the second batch, with PMC index of 6.61 and 6.23. The LTCI policy still faces many challenges, such as limited funding sources and a narrow scope of care services. (2) The diffusion of LTCI policy across different regions and batches has the following characteristics: the diffusion of LTCI policy has followed an “M-shaped” curve over time. In terms of spatial diffusion, there is an interaction between spatial proximity and social proximity effects. In terms of diffusion pathways, there is a combined effect of vertical and horizontal diffusion, reflecting a hierarchical diffusion pattern.DiscussionThis paper constructs a new analytical framework for studying policy diffusion. Based on the analysis of policy texts using the PMC model, we focus on the analysis of policy quality and consistency to the diffusion characteristics and exploring the underlying reasons for the diffusion of the LTCI policies. This extends the research of LTCI policy from traditional qualitative analysis to the quantitative research domain.
Abstract Background According to Israel's National Health Insurance Law (1994), the Ministry of Health is responsible for the provision of health services in the country including physiotherapy services; moreover, the Special Education Law (1988), stipulates that physiotherapy services for children with motor disabilities, as well as other allied health services, are provided by the Ministry of Education in educational settings. Thus, children with motor disabilities are entitled PT services under two different laws by two different ministries. Method To describe the physiotherapy services for children with motor disabilities and examine how policymakers view these services, we conducted a qualitative study including in-depth semi-structured interviews with 10 policymakers from the Ministry of Health and the Ministry of Education, and the national directors of physiotherapy services from three of the four health maintenance organizations in Israel. Results Study results indicate that there is an array of physiotherapy services and providers. Despite the regulation of these services for children with motor disabilities, uncertainty and lack of knowledge were found about various issues. Therefore, the thematic analysis was structured around four descriptive questions: Where do the children receive physiotherapy? Who is eligible for physiotherapy treatment and who receives treatment? What interventions do children with motor disabilities receive? Who provides therapy for children with motor disabilities? Conclusions Policymakers are dubious regarding the provision of these services, questioning whether children with motor disabilities receive physiotherapy services according to their needs. In addition, the abundance of suppliers does not necessarily improve the quality of services provided to children with motor disabilities, which may ultimately harm their developmental potential.
Purpose This study aimed to determine the risk of incidence, prevalence, survival, and death risk for Marfan syndrome (MFS) in Korea. Methods MFS (10th revision of the International Statistical Classification of Diseases [ICD-10] code: Q87.4) data were collected from the Korea National Health Insurance Service between 2006 and 2017. Simple and multiple Cox proportional hazards analyses were performed. The death data of Koreans from 2006 to 2018 were used. Results The mean age of patients with MFS was 27.2± 16.8 years, 26.5± 15.9 years for males and 28.2± 18.1 years for females (P < 0.01), and the proportion of males was 59.5%. The age-standardized incidence and prevalence in 2017 were 0.51 and 5.70 per 100,000 persons, respectively. The 10-year survival rate was 92.7%. Adjusted hazard ratio increased significantly with age, male sex, heart failure, ischemic stroke, hemorrhagic stroke, chronic kidney disease, malignant neoplasm, aortic dissection, and abdominal aortic aneurysm. Conclusion Although the overall 10-year survival rate of MFS was over 90%, the adjusted hazard ratio was significantly higher in the older age group, male sex, and individuals with heart failure, stroke, chronic kidney disease, malignant neoplasm, aortic dissection, and abdominal aortic aneurysm. These results suggest the need for meticulous surveillance of aortopathy in patients with MFS, as it may portend a worse prognosis in aortic dissection and aneurysm, and in older age groups with MFS.
Nowadays, factors such as the ageing of the population and the prolongation of life expectancy make it mandatory to create effective social policies by considering the health and care needs of societies. This study evaluates research on long-term care insurance, which is an important determinant of social welfare, through bibliometric analysis, a quantitative research technique. On 25.08.2023, 1497 results were obtained by searching the concept of "long-term care insurance" in the Web of Science database. Because of the analysis, it was observed that the studies on long-term care insurance were distributed between 1984 and 2023. Among 112 different research fields, it was concluded that the most studies were conducted in the field of Gereontology (n=339). "Gerontologist" was the journal that published the highest number of studies (n=76) on long-term care. The National Centre for Geriatrics Gerontology published the most studies (n=103); Ichiro Tsuji is the author of the most studies with 53 publications. The report "2018 Alzheimer’s disease facts and figures" is the most cited study. The study titled “Care-Needs Certification in Long-Term Care Insurance System of Japan”, carried out by Takako Tsutsui and Naoko Muramatsu (2005) independently of institutions, has the most citations. "Long-term care insurance" (n=332), "long-term care" (n=225) and "Japan" (n=104) are among the most frequently used keywords.
Industrial relations, Social insurance. Social security. Pension
Han Su, Hilaire J Thompson, Karl Cristie Figuracion
et al.
Financial toxicity is common in individuals with COVID-19 and Long COVID. However, the extent of financial toxicity experienced, in comparison to other common comorbidities, is uncertain. Contributing factors exacerbating financial challenges in Long COVID are also unclear. These knowledge gaps are addressed via a cross-sectional analysis utilizing data from the 2022 National Health Interview Survey (NHIS), a representative sample drawn from the United States. COVID-19 cases were identified through self-reported positive testing or physician diagnoses. Long COVID was defined as experiencing COVID-19-related symptoms for more than three months. Comorbidity was assessed based on self-reported diagnoses of ten doctor-diagnosed conditions (Yes/No). Financial toxicity was defined as having difficulty paying medical bills, cost-related medication nonadherence, delaying healthcare due to cost, and/or not obtained healthcare due to cost. A total of 27,492 NHIS 2022 respondents were included in our analysis, representing 253 million U.S. adults. In multivariable logistic regression models, adults with Long COVID (excluding respondents with COVID-19 but not Long COVID), showed increased financial toxicity compared to those with other comorbidities, such as epilepsy (OR [95% CI]: 1.69 [1.22, 2.33]), dementia (1.51 [1.01, 2.25]), cancer (1.43 [1.19, 1.71]) or respiratory/cardiovascular conditions (1.18 [1.00, 1.40]/1.23 [1.02, 1.47]). Long COVID-related financial toxicity was associated with female sex, age <65 years, lack of medical insurance, current paid employment, residence region, food insecurity, fatigue, mild to severe depression symptoms experienced during the survey completion, visits to hospital emergency rooms, presence of arthritis, cardiovascular or respiratory conditions, and social activity limitations. In conclusion, American adults with Long COVID, but not those who had prior COVID-19 infection without Long COVID, exhibited a higher prevalence of financial toxicity compared to individuals with common comorbidities. Vulnerable populations were at greater risk for financial toxicity. These findings emphasize the importance of evaluating strategies to reduce economic burden and increase awareness of the effect of Long COVID-related financial toxicity on patient's healthcare and health status.
Dadi Adriana, Hartoyo Hartoyo, Rizal Syarief
et al.
Based on the results of situational analysis, problematic situations, strategies, and the proposed model as explained above, several conclusions can be drawn. The high number of Muslim people in Indonesia encourages companies to innovate in creating new products that are easier for the public to understand, especially related to Sharia insurance. The existing condition of the insurance industry is driven by the real growth trend of Sharia insurance customers, which can be used as a measure of industry growth. When compared with other countries, there are similarities and differences between Sharia and conventional insurance governance. This can be used as a comparative reference to optimize the management of the Sharia insurance industry. Based on the results of the situation analysis, it is known that the current condition of the Sharia insurance industry is not optimal because there has been no serious effort from the regulator to integrate all potential from upstream to downstream in all elements of the Sharia insurance industry. From the results of the interview analysis, it was revealed that the strategy considered to be the most effective and the main priority in developing the Sharia insurance industry is increasing human resource competency through intensive and continuous training. This aims to overcome the shortage of professional human resources in the fields of insurance and sharia economics while ensuring quality improvement.
AbstractThis study examines natural disasters’ short-run and long-run effects on economic growth. We analysed insurance’s short-run and long-run role in the natural disaster-economic growth nexus using 48 African countries from 2000 to 2020. Using a two-step system GMM, the study revealed that natural disasters have a short-term detrimental effect and a favourable long-term impact on economic growth. Regarding the role of insurance in the relationship between natural disasters and economic growth, it should be noted that while insurance and those affected have a positive complementary effect on economic growth in the short run, the long-term effects of insurance and natural disasters on economic growth are negligible. Therefore, regulators must enforce periodic high regulatory capital requirements to ensure the financial stability of insurance markets, especially the non-life market in Africa, and to enable insurers to absorb the unforeseen shocks from natural disasters in Africa. Also, regulators should create insurance coverage awareness through insurance education to promote insurance development and help reduce individuals’ and businesses’ financial losses upon the occurrence of natural disasters.
The importance of Environmental, Social, and Governance (ESG) aspects in investment decisions has grown significantly in today’s volatile financial market. This study aims to answer the important question of whether investing in ESG-compliant companies is a better option for investors in both developed and emerging markets. This study assesses ESG investment performance in diverse regions, focusing on developed markets with high GDP, specifically the USA, Germany, and Japan, alongside emerging nations, India, Brazil, and China. We compare ESG indices against respective broad market indices, all comprising large and mid-cap stocks. This study employs a variety of risk-adjusted criteria to systematically compare the performance of ESG indices against broad market indices. The evaluation also delves into downside volatility, a crucial factor for portfolio growth. It also explores how news events impact ESG and market indices in developed and emerging economies using the EGARCH model. The findings show that, daily, there is no significant difference in returns between ESG and conventional indices. However, when assessing one-year rolling returns, ESG indices outperform the overall market indices in all countries except Brazil, exhibiting positive alpha and offering better risk-adjusted returns. ESG portfolios also provide more downside risk protection, with higher upside beta than downside beta in most countries (except the USA and India). Furthermore, negative news has a milder impact on the volatility of ESG indices in all of the studied countries except for Germany. This suggests that designing a portfolio based on ESG-compliant companies could be a prudent choice for investors, as it yields relatively better risk-adjusted returns compared to the respective market indices. Furthermore, there is insufficient evidence to definitively establish that the performance of ESG indices varies significantly between developed and emerging markets.
Oleksandr Kocharian, Nataliia Barinova, Sergey A. Barinov
In Ukraine, important processes are underway to identify those areas of psychotherapy that deserve official recognition by law. The official recognition of psychotherapeutic methods and techniques is associated with the fact that they are recognized as clinically and statistically effective. Such psychotherapy is reimbursed by insurance and is actively promoted in training courses, often "at the expense of other methods of psychotherapy." The psychotherapeutic procedure itself is becoming more and more standardized and impersonal, conforming to a protocol. The fate of client-centered and experiential psychotherapy (PCE-therapy) is not so easy in the world: evidence of its effectiveness is not reflected in the NICE (National Center for Collaboration in Mental Health) guidelines for depression and schizophrenia, which to some extent determine health policy. Therefore, there are widespread prejudices about the ineffectiveness of this type of therapy: it is not effective for severe mental illness, crisis states, specific phobias and traumas, behavioral problems, for those clients who need a directive approach, for assessing and diagnosing clients, etc. The article presents specific studies of the effectiveness of client-centered and experiential psychotherapy for specific symptoms (anxiety, depression, schizophrenia, borderline personality disorders, and some somatic disorders), as well as data from a meta-analysis of the effectiveness of client-centered and experiential therapy. PCE-therapy proved to be highly effective according to the criteria: "before-after" treatment; 2) "treatment-no treatment"; 3) "comparison with other types of psychotherapy" - the data obtained are generally statistically and clinically equivalent in terms of effectiveness to other methods of psychotherapy. PCE therapy proved to be the most effective in the following cases: interpersonal problems, self-harming behavior, coping with chronic somatic diseases, psychosis. It turned out that cognitive behavioral therapy (CBT) has mixed benefits compared to PCE therapy. However, Elliott et al. note that, firstly, these "studies were mostly performed by CBT therapists" and, secondly, "low-quality versions of PCE therapy were used as comparison conditions". The most effective methods of PCE therapy were EFT and PCT. A list of approaches included in PCA-therapy is given, and their general characteristics are given.
Koki Ibayashi, Yoshihisa Fujino, Masakazu Mimaki
et al.
Background: To provide a better healthcare system for patients with mitochondrial diseases, it is important to understand the basic epidemiology of these conditions, including the number of patients affected. However, little information about them has appeared in Japan to date. Methods: To gather data of patients with mitochondrial diseases, we estimated the number of patients with mitochondrial diseases from April 2018 through March 2019 using a national Japanese health care claims database, the National Database (NDB). Further, we calculated the prevalence of patients, and sex ratio, age class, and geographical distribution. Results: From April 2018 through March 2019, the number of patients with mitochondrial diseases was 3,629, and the prevalence was 2.9 (95% confidence interval [CI], 2.8–3.0) per 100,000 general population. The ratio of females and males was 53 to 47, and the most frequent age class was 40–49 years old. Tokyo had the greatest number of patients with mitochondrial diseases, at 477, whereas Yamanashi had the fewest, at 13. Kagoshima had the highest prevalence of patients with mitochondrial diseases, 8.4 (95% CI, 7.1–10.0) per 100,000 population, whereas Yamanashi had the lowest, 1.6 (95% CI, 0.8–2.7). Conclusion: The number of patients with mitochondrial diseases estimated by this study, 3,269, was more than double that indicated by the Japanese government. This result may imply that about half of all patients are overlooked for reasons such as low severity of illness, suggesting that the Japanese healthcare system needs to provide additional support for these patients.
Yitong (Alice) Gao, Elizabeth E. Krans, Qingwen Chen
et al.
Introduction: Risk factors and treatment rates for substance use disorders (SUDs) differ by sex. Females often have greater childcare and household responsibilities than males, which may inhibit SUD treatment. We examined how SUD, medication for opioid use disorder (MOUD) receipt, and overdose rates differ by sex among parents with young children (<5 years). Methods: Using deidentified national administrative healthcare data from Optum’s Clinformatics® Data Mart Database version 8.1 (2007–2021), we identified parents aged 26–64 continuously enrolled in commercial insurance for ≥ 30 days and linked to ≥ 1 dependent child < 5 years from January 1, 2016-February 29, 2020. We used generalized estimating equations to estimate the average predicted prevalence of SUD diagnosis, MOUD receipt after opioid use disorder (OUD) diagnosis, and overdose by parent sex in any month, adjusting for age, race/ethnicity, state of residence, enrollment month, and mental health conditions. Results: From 2016 to 2020, there were 2,241,795 parents with a dependent child < 5 years, including 1,155,252 (51.5%) females and 1,086,543 (48.5%) males. Male parents had a higher average predicted prevalence of an SUD diagnosis (11.1% [11, 11.16]) than female parents (5.5% [5.48, 5.58]). Among parents with OUD, the average predicted prevalence of receiving MOUD was 27.4% [26.1, 28.63] among male and 19.7% [18.34, 21.04] among female parents, with no difference in overdose rates by sex. Conclusion: Female parents are less likely to be diagnosed with an SUD or receive MOUD than male parents. Removing policies that criminalize parental SUD and addressing childcare-related barriers may improve SUD identification and treatment.
Psychology, Social pathology. Social and public welfare. Criminology
IntroductionThis study was conducted to investigate changes and new trends over the past 6 years by analyzing the current status of precocious puberty (PP) treatment and treatment costs in Korea between 2016 and 2021.Materials and methodsAnnual and monthly number of patients diagnosed with PP from 2016 to 2021 were reviewed using the data from Healthcare Bigdata Hub. Annual medical insurance expenses for the treatment of PP were also reviewed. The data were compared by the gender of the patients.ResultsThe number of patients diagnosed with PP rose from 86,352 in 2016 to 166,645 in 2021, while medical expenses rose from KRW 64,111,689,000 in 2016 to KRW 134,642,100,000 in 2021. The percentage of male PP patients increased from 9.21% in 2016 to 19.55% in 2021.ConclusionIncreasing numbers of Korean patients diagnosed with PP. Consistent with the situation in other countries, the rapid increase in the number of cases since April 2020 appears to be a result of the COVID-19 pandemic. In Korea, this is considered a nationwide phenomenon. Also on the rise is the incidence of PP in males, which appears to be due to an increased awareness of the phenomenon. Further investigations are required to determine the possible causes in increasing prevalence of PP.
Mohammad Javad Kabir, Alireza Heidari, Zahra Khatirnamani
et al.
Background and objectives Health system services are not reliable without quality assessment. It is important to explore gaps between standard services and existing situation to improve the quality of health system. His study aimed at studding the quality assessment of electronic referral system in one of the major provinces of Iran. Material and Methods This study was a cross-sectional study utilizing SERVQUAL model. The population comprised 3 groups totaling approximately 11,004 people. The sample size allocated to each city was determined in view of the ratio of patients. A sample of 384 patients who used electronic referral service at level 2 and revived outpatient services constructed the population of study. The data were collected through a two-part questionnaire. The validity of the questionnaire was confirmed by 10 experts including senior and mid-level managers and medical science university faculty members. The questionnaire assessed demographic data and the patients' perceptions and expectations. Data was analyzed using descriptive statistics and analytical statistics such as nonparametric mean comparison tests, in view of the normality assumption,) including Wilcoxon test, Mann-Whitney and Kruskal-Wallis. Spearman correlation test was used to determine the intensity of correlation between the study variables. The significance level of all tests was considered 0.05. Results There were identified gaps throughout all dimensions of health service among the studied clinics (P <0.001). The highest gap was observed in the empathy dimension (0.57) and the lowest gap was observed in the tangible dimension (-0.38). The gap between the services provided to patients was different in terms of guarantee, gender (P = 0.005), empathy , level of education (P = 0.028) and reliability based on the city vise (P = 0.028). Conclusion In the hospitals implementing the electronic referral system in Golestan province, there is a gap in all dimensions and it indicates that in none of the dimensions, the expectations of the recipients have not been fully met. Extended Abstract Background and Objectives Quality assessment is doubly important in the health sector, compared to other sectors, due to the sensitivity of services provided in this area. This study was conducted to investigate the gap in the quality of medical services provided in hospitals implementing electronic referral system in Golestan province, using SERVQUAL model. Material and Methods In this cross-sectional study, 384 patients were selected through stratified random sampling with allocation proportionate to each city’s population. These patients were referred to level 2 in the frame of electronic referral system and received outpatient services by a specialist physician in the clinics of hospitals implementing the electronic referral system in Golestan province in 2019. This study was conducted in the cities of Bandar-e-Turkmen, Aq-Qala and Aliabad-e-Katoul, where the electronic health referral system had been fully. The population comprised 3 groups totaling approximately 11,004 people. The sample size allocated to each city was determined in view of the ratio of patients referred to level 2 in each city. Accordingly, the sample size selected included 84 subjects from Bandar-e-Turkmen City, 203 from AqQala is 203, and 115 from Aliabad. Having referred to these centers, we collected, from the patient registration office, the record of the patients whose family physician had referred them to level 2 and who had received the desired services. Then, the subjects were systematically and randomly selected according to the referral code registered in the system and the patient list. The data were collected through a two-part questionnaire. The first part of the questionnaire revolved around demographic variables, including age, sex, marital status, level of education, occupation and clinical and medical characteristics such as the number of visits to this clinic, type of disease and type of patients' insurance. The second part of the questionnaire assessed the patients' perceptions and expectations by 30 questions which were similar in content and number but different in wording. In this study, the validity of the questionnaire was confirmed by 10 experts including senior and mid-level managers and faculty members of Golestan University of Medical Sciences. Cronbach's alpha coefficient was calculated to determine the overall reliability of the questionnaire. The data were analyzed using SPSS software version 23. The data were analyzed descriptively through tables, number, frequency percentage for qualitative data, and Mean and Standard Deviation for quantitative data. In addition, we employed analytical statistics such as nonparametric mean comparison tests, in view of the normality assumption,) including Wilcoxon test, Mann-Whitney and Kruskal-Wallis and also Spearman correlation test to determine the intensity of correlation between the study variables. In the present study, the significance level of all tests was considered 0.05. Results Out of a total of 402 patients studied, information on only 384 patients was fully recorded (response rate 95.5%). The majority of subjects were female (74.5%), married (81.5%), high school graduate (24.9%), housewife (64.9%). The mean age of the patients was 37.17 ± 14.54 years, so that 62.4% of the subjects fell in the age bracket of 30-60 years. 53.6% of the patients had referred to the center more than once. 56.2% had rural insurance and the highest number of referrals had been made to gynaecologist (21.4%). The relationship between expectations and perceptions of service quality in all dimensions was statistically significant (P < 0.001). The results of Wilcoxon test showed that the gap between the patients' expectations and perceptions with a 95% probability was significant (P<0.001) in all three cities and among all patients., found that. That is, there was a difference between the patients' expectations of service quality and their perceptions in the whole sample. The highest mean score in the expectations section was related to the guarantee and confidence dimension (4.49) and it was related to the tangible dimension in the perceptions section (4.10) is) while the lowest score is in the expectations and perceptions section related to the empathy dimension (4.34 and respectively. 77.3). After calculating the difference between the mean scores of perceptions and expectations, in all dimensions, the level of the patients' expectations of services was found higher than the level of perceptions with a negative gap. The largest gap in service quality was related to the empathy dimension (-0.57) and the lowest quality service gap was related to the tangible dimension (-0.38). There was no significant relationship between service quality gap and age groups, marital status, occupation groups, number of visits, type of insurance and type of illness (P> 0.05). But the gap in service quality was significantly associated with the patients' gender (P = 0.005) and education level (P = 0.028). So that the biggest gap was related to women and illiterate people. Also, the quality gap was different according to the city (P = 0.028), with the largest gap related to Aq-Qala city. Conclusion The results showed that the studied hospitals could not meet the expectations of the patients in any of the five components of service quality, with the perceived quality always lagging behind the expected quality. This highlights need to improve the quality of services through paying more attention to people in the community in order to deliver committed services reliably, accurately and correctly in a timely manner, as well as, enhancing the knowledge, etiquette and ability of employees to build trust and confidence in customers. Since at the time of the study, only three cities, Bandar-e-Turkmen, Aq-Qala and Aliabad-e-Katoul, were implementing an electronic referral system, it was not possible to study other cities in this field and the statistical population was outpatients from level 1 to level 2. A wider study should be conducted at the provincial level to include all referrals to family physicians at level one and all inpatient and outpatient referrals. In addition, the SERVQUAL questionnaire does not cover all the expectations, perceptions and beliefs of patients, so the use of qualitative study methods along with quantitative methods in future studies could provide a better understanding of the issue of quality. Practical implications of research According to the results of this study, it is suggested that officials and providers of health services should prioritize:- Continuous improvement and evaluation of service quality in planning;- Equipping medical centers with efficient and new equipment;- Providing services at the promised time and in the shortest time to clients;- Availability of staff and service providers when patients are referred;- Familiarity with the knowledge and skills of the day to meet the needs of clients and- Understanding the values and emotions of clients Ethical considerations study protocol, with the number IR.GOUMS.REC.1397.289, was ethically approved by the Research Ethics committee of Golestan University of Medical Sciences. At the time of data collection, respondents were assured that their information would remain confidential and the questionnaire was completed anonymously. Meanwhile, those who did not want to participate in the study were excluded from the study. Conflict of interest The authors state that there is no conflict of interest in the present study. Acknowledgement The Vice Chancellor for Research and Technology of Golestan University of Medical Sciences and the Research Center for Health Management and Social Development for approving the research plan with code 110602 and the assistance of officials and staff of selected hospitals in conducting this research plan are appreciated.
Environmental, social and governance criteria (ESG) are considered to be the main factors in measuring the sustainability and ethical impact of companies. This article focuses on comparing the ability of insurance companies to use an ESG-driven approach to managing their sustainable development. The study is conducted using comparative analysis, statistical analysis, and a case study method. The study compares six ESG Ratings on four main criteria (dependent variables, independent variables, scale type, sample), that allows choosing the most appropriate rating for the analysis of insurance companies. As a result, 156 insurance companies are compared by the level of ESG risk (low ESG risk – 24 companies, medium ESG risk – 111 companies, high ESG risk – 21 companies) and by geographical affiliation (26 countries) using descriptive statistics. The assessment of effectiveness of the ESG-driven approach to managing sustainable development of insurance companies is carried out on the example of 16 companies by comparing their non-financial reporting (the sample is selected based on of the annual report for 2019-2020). The study identifies the most common guidelines for report development, as well as components of the ESG-driven approach: environmental (waste and pollution, climate change, energy efficiency), social (workforce and diversity, customer engagement, communities), governance (code and values, reporting, risk management). The study systematizes the best practices of insurance companies for applying the ESG-driven approach to manage their sustainable development and highlights the need for insurance companies to improve their reporting and disclosure practices related to the development of the ESG-driven approach. AcknowledgmentComments from the Editor and anonymous referees have been gratefully acknowledged.
This study investigates the features of the development of the discriminant model of diagnostics of the socio-economic potential of health insurance, and the trends in the medical insurance system development in Ukraine. This study uses logistic, statistical and normative methods to assess of the socio-economic potential of health insurance in Ukraine from 2010 to 2017. The empirical result shows that the block assessment of the financial potential of health insurance gives the complete information on the dynamics of individual indicators and trends of the branch. The need for assessment of the socio-economic potential of health insurance in order to improve the efficiency of the public financial management of the health care finance system and the insurance market regulation has been justified.