Hasil untuk "Insurance"

Oleksandr Voitko, Dmytro Rybak, Maksym Samsonenko et al.

Мета роботи. Проведення аналізу іноземного та вітчизняного досвіду організації підготовки управлінь армійських корпусів. Метод дослідження. Методи аналізу, узагальнення, дедукції. Результати дослідження. Проведено аналіз стану організації системи підготовки управлінь (штабів) армійських корпусів за іноземними та вітчизняними публікаціями, викладено спільність етапів підготовки, особливості індивідуальної підготовки фахівців на L-курсах та узагальнено об’єктивні причини розбіжностей окремих питань організації їх оперативної підготовки. Теоретична цінність дослідження. Матеріали статті можуть бути корисними службовим особам органів військового управління різних рівнів підпорядкованості, а також науковцям і дослідникам у галузі застосування, управління та розвитку Збройних Сил України.

Viktor Koval, Dzintra Atstāja, Nadiia Shmygol et al.

This study examines methods for assessing the risks of energy systems that supply urban areas based on an integrated approach in which a qualitative assessment takes into account internal and external impacts as an element of a multifactorial analysis. A risk matrix is offered for risk assessment, which was built for energy infrastructure facilities and takes into account the features of the functioning of energy equipment which is potentially dangerous due to the probability of failures on a five-point scale and the possible degree of severity of the consequences due to the possibility of restoring the systems. The study proposes two statistical models for the assessment of reliability parameters before the onset of a critical situation and calculations after a critical event, i.e., the probability of the restoration or adaptation of the energy system object being analyzed and the degree of such restoration. This approach allows for the consideration of risks, taking into account both the technical condition of power equipment and environmental aspects, including their mutual influence, for sustainable management. This approach evaluates the energy system’s failure intensity and recovery probability based on the parameters developed to assess the system functionality and resilience effectively. A risk assessment using reliability parameters based on maximum likelihood estimation (MLE) showed that when sampling statistical data with a total number of n = 10, the accuracy of risk assessment according to indicator parameters increases by 15%, which is especially relevant for the potential safety of urban energy systems. A list of threats is proposed for the multifactorial risk analysis of an energy company based on an expert assessment of their likelihood and consequences. The constructed risk matrix reduces the level of threat, which helps to increase the efficiency of risk management both at the stages of planning and forecasting and during operation, including the management of socio-economic consequences.

Adriano Hyeda, Élide Sbardellotto Mariano da Costa, Sérgio Candido Kowalski

Abstract Background Disability insurance represents a significant economic burden within Brazil’s social security system, yet long-term cost trends across disease groups remain understudied, hindering informed prevention and management strategies. Hospital costs, which account for approximately 40% of direct healthcare expenses, were selected as a comparative reference to contextualize the economic burden of disability insurance. Objective This study analyzes long-term cost trends of newly granted disability insurance by disease groups in Brazil, comparing them to public health system hospitalization expenses. Method This ecological time series study applied the inflection point regression model and Annual Average Percentage Change (AAPC) analysis, utilizing open-access federal government datasets. Annual rates and costs of disability insurance and hospitalizations were examined, categorized by International Classification of Diseases, 10th Revision (ICD-10) groups, and standardized per insured individuals and the general population. Results Between 2010 and 2019, the rate of temporary disability insurance granted (406 per 10,000 insureds) was 94% higher than permanent disability insurance (24 per 10,000), with women showing slightly higher rates but men incurring higher costs. The overall annual average rate of granted disability insurance (430 per 10,000 insureds) and its costs (BRL 5,084 per 100 insureds) were lower than those of hospitalizations (525 per 10,000 and BRL 5,870 per 100 Brazilians, respectively). Disabilities due to injuries, musculoskeletal disorders, and mental health problems had the highest rates (126, 89, and 40 per 10,000 insureds, respectively) and costs (BRL 1,455, 1,076, and 533 per 100 insureds, respectively). Neoplasms showed the only increasing trend in granted rates (AAPC 2.5%). The cost growth of granted disability insurance (AAPC 6.2%) was twice that of hospitalization costs (AAPC 2.9%), with disability insurance costs surpassing hospitalization expenses by 2018. Although most disease groups exhibited stable or declining trends in granted rates, costs increased across nearly all conditions. Conclusion The rising costs of disability insurance in Brazil highlight the growing economic burden of non-medical expenses and the need for evidence-based policies focused on prevention, management, and the sustainability of the social security system.

Gabriela Mădălina Oprică, Denis Mihaela Panaitescu, Brînduşa Elena Lixandru et al.

The medical sector is one of the biggest consumers of single-use materials, and while the insurance of sterile media is non-negotiable, the environmental aspect is a chronic problem. Nanocellulose (NC) is one of the safest and most promising materials that can be used in medical applications due to its valuable properties like biocompatibility and biodegradability, along with its good mechanical properties and high water uptake capacity. However, NC has no bactericidal activity, which is a critical need for the effective prevention of infections in chronic diabetic wound dressing applications. Therefore, in this work, a natural product, propolis extract (PE), was used as an antibacterial agent, in different amounts, together with NC to obtain sponge-like structures (NC/PE). The scanning electron microscope (SEM) images showed well-impregnated cellulose fibers and a more compact structure with the addition of PE. According to the thermogravimetric analysis (TGA), the samples containing PE underwent thermal degradation before the unmodified NC due to the presence of volatile compounds in the extract. However, the peak degradation temperature in the first derivative thermogravimetric curves was higher for all the sponges containing PE when compared to the unmodified NC. The antibacterial efficacy of the samples was tested against <i>Staphylococcus aureus</i>, <i>Pseudomonas aeruginosa</i>, and <i>Escherichia coli</i>, as well as on two clinically resistant isolates. The samples completely inhibited the development of <i>Staphylococcus aureus</i>, and <i>Pseudomonas aeruginosa</i> was partially inhibited, while <i>Escherichia coli</i> was resistant to the PE action. Considering the physical and biological properties along with the environmental and economic benefits, the development of an NC/PE wound dressing seems promising.

Аndrii Bochkovskyi, Nаtalia Sapozhnikova, Tetiana Kurska

Мета роботи: удосконалити методичне забезпечення процесу оцінки професійних ризиків в системах управління цивільною безпекою підприємств відповідно до рекомендацій IEC/ ISO 31010:2019 та ISO 31000:2018. Метод дослідження: аналіз науково-технічної літератури та міжнародних нормативно-правових документів щодо оцінювання професійних ризиків в системах управління цивільною безпекою підприємств, установ та організацій – для визначення напрямів удосконалення методичного забезпечення стандартів IEC/ ISO 31010:2019, ISO 31000:2018; ймовірнісно-статистичні методи та теорія марковських процесів – для удосконалення методичного забезпечення процедури Plan та принципів функціонування процесу PDCA в сфері охорони праці. Результати дослідження: Запропоновано до застосування методичне забезпечення для етапів визначення обсягу ресурсів та оцінювання ризиків, що дозволяє забезпечити можливість об’єктивної реалізації процедури Plan. Запропоновано до застосування в рамках IEC/ISO 31010:2019 методичне забезпечення дозволяє визначати, відповідно: оптимальний обсяг ресурсів на розробку, впровадження та забезпечення функціонування комплексу заходів і засобів з охорони праці при обмеженні на встановлений організацією (прийнятний) рівень ризику; ймовірності отримання працівником виробничої травми у випадковий період часу, перевищення рівня накопичення в організмі працівника впливу ШВФ нормованих значень та інші показники професійної безпеки. Практична цінність дослідження: отримані результати можуть бути використані для удосконалення рекомендацій міжнародних стандартів IEC/ ISO 31010:2019, ISO 31000:2018. Оригінальність: За результатами проведеного дослідження запропоновано до застосування методику для реалізації етапу визначення обсягу ресурсів процедури Plan, а також удосконалену методику оцінки професійних ризиків згідно рекомендацій IEC/ ISO 31010:2019 та ISO 31000:2018. Обмеження дослідження: Запропоновані методичні підходи для оцінювання професійних ризиків в системах управління цивільною безпекою підприємств адаптовані до рекомендацій стандарту IEC/ ISO 31010:2019. Тип статті: теоретичний.

Dingwei Dai, Ali Samiian, Joaquim Fernandes et al.

# Background Essential tremor (ET), the most common movement disorder, often impairs patients’ ability to perform activities of daily living, mental health, and quality of life. # Objectives To assess comorbidities, psychiatric disorders, healthcare resource utilization (HCRU), and costs among patients with ET compared with patients without ET. # Methods This retrospective observational study was conducted using a large US administrative claims database. Patients with ET were identified during the study period (1/1/2017–12/31/2019). The earliest claim date with ET diagnosis was identified as the index date. An index date was assigned randomly for each non-ET patient. Patients had to be at least 22 years old and be enrolled in the health plan for at least 6 months before and at least 12 months after the index date. Patients with and those without ET were matched 1:1 on age, gender, payer type, and first 3 digits of their ZIP code. Comorbidities were assessed using data within 6 months prior to the index date. Psychiatric disorders, HCRU, and costs were examined using data within 12 months after the index date. # Results The mean (SD) age of ET patients (n = 5286) was 70.8 (11.8) years, 49.1% were female, and 82.9% were Medicare Advantage members. In the 12 months following the index date, 26.0% of patients had no insurance claims for ET-related pharmacotherapy or invasive therapies. Patients with ET had a higher number of comorbidities than non-ET patients (5.3 \[3.2\] vs 4.0 \[3.3\]); a higher prevalence of psychiatric disorders (depression: 25.6% vs 15.3%; adjusted odds ratio (AOR) \[95% CI\], 1.56 \[1.41-1.73\]; anxiety: 27.7% vs 15.5%, AOR: 1.78 \[1.61-1.96\]); and higher total healthcare costs: $17&#8239;560 \[$39&#8239;972\] vs $13&#8239;237 \[$27&#8239;098\], adjusted cost ratio \[95% CI\]: 1.11 \[1.06-1.16\]; all _P_<.0001. # Discussion Highly prevalent multiple comorbidities and psychiatric disorders should be considered in the context of clinical decision-making to optimize ET management. # Conclusions This study represents the largest observational study to report ET disease and economic burdens in a real-world setting. The data demonstrate increased comorbidity, mental health, and healthcare cost burdens among ET patients compared with matched non-ET patients. These findings underscore the need for innovative care for this complex population.

Kyoung Ho Roh, Heun Choi, HeeKyoung Choi et al.

Background: Due to the COVID-19 pandemic, from 2020, many pharmaceutical companies have developed vaccines. To determine the efficacy of AstraZeneca’s and Pfizer’s vaccines, which were the first and second vaccines to be approved in Korea, respectively, we developed a method to measure their antibody-generating efficacies using immunology analyzers and a rapid antibody test available in Korea. Methods: The antibody-stimulating efficacies of the Pfizer and AstraZeneca vaccines were evaluated using Centaur. XPT SARS-CoV-2 (Siemens Healthineers, Germany), Elecsys. Anti-SARS-CoV-2 S (Roche Diagnostics, Germany), and STANDARD F SARS-CoV-2 nAb FIA (SD Biosensor, Korea). Healthcare workers were enrolled in two groups: the Pfizer (121) and AstraZeneca (117) groups. Antibody levels were measured pre-vaccination, three weeks after vaccination, and 16 weeks after vaccination. Results: The Pfizer group comprised 41 males and 80 females, while the AstraZeneca group comprised 38 males and 79 females. Antibody results were analyzed after excluding four individuals who had recovered from COVID-19. Between weeks 3 and 16, there was no significant difference (P= 0.5, 1.0) between the results of the Roche and Siemens antibody tests in the Pfizer vaccine group. However, the SD biosensor results comparing with the Roche and Siemens antibody tests at three weeks after the initial vaccination showed a significant difference (P < 0.0001). Analysis of the Roche antibody test results before, at three weeks, and at 16 weeks after the administration of the Pfizer and AstraZeneca vaccines revealed a statistically significant difference between before and at three weeks after the first injection (P < 0.0001). After two doses of the Pfizer and AstraZeneca vaccines, antibody formation was above the 90th percentile of the measurement range in all subjects.

Abdülkadir Şenkal

The Great Transformation, published in 1944 by Karl Polanyi, brought a new dimension to the relationship between market, state, and welfare. Polanyi considered the relation between markets and societies as a central feature of any social order; according to him, while the market destabilizes society, the commodification of labor, land, and money creates a reaction or “counter-movement.” For this reason, he describes market society as being a dominant principle for social organization. Social relations are embedded within the economic system instead of the economy being embedded in social relations. Polanyi also claims that market society is a political and social construct rather than a natural phenomenon. Yet, the rapid growth of government bureaucracy and interference in the private sphere has challenged many traditional notions related to the nature of capitalist society, especially since the 1940s. Therefore, the state plays an important role in both the establishment and regulation of the private market economy. This article proposes an interpretation, in the context of the contemporary welfare state based on Polanyi’s The Great Transformation, which discusses the distinction between market, welfare, and labor. The institutions, that once contributed to embedding the market economy within society, now play an important role in situations that have potential consequences for those seeking help from the welfare state.

Antje Fischer-Rosinský, Anna Slagman, Ryan King et al.

Introduction: The crowding of emergency departments (ED) has been a growing problem for years, putting the care of critically ill patients increasingly at risk. The INDEED project's overall aim is to get a better understanding of ED utilization and to evaluate corresponding primary health care use patterns before and after an ED visit while driving forward processes and methods of cross-sectoral data merging. We aim to identify adequate utilization of EDs and potentially avoidable patient contacts as well as subgroups and clusters of patients with similar care profiles.Methods: INDEED is a joint endeavor bringing together research institutions and hospitals with EDs in Germany. It is headed by the Charité–Universitätsmedizin Berlin, collaborating with Otto von Guericke University Magdeburg, Technische Universität Berlin, the Central Research Institute of Ambulatory/Outpatient Health Care in Germany (Zi), and the AOK Research Institute as part of the Federal Association of AOK, as well as experts in the technological, legal, and regulatory aspects of medical research (TMF). The Institute for Information Technology (OFFIS) was involved as the trusted third party of the project. INDEED is a retrospective study of approximately 400,000 adult patients with statutory health insurance who visited the ED of one of 16 participating hospitals in 2016. The routine hospital data contain information about treatment in the ED and, if applicable, about the subsequent hospital stay. After merging the patients' hospital data from 2016 with their outpatient billing data from 2 years before to 1 year after the ED visit (years 2014–2017), a harmonized dataset will be generated for data analyses. Due to the complex data protection challenges involved, first results will be available in 2021.Discussion: INDEED will provide knowledge on extracting and harmonizing large scale data from varying routine ED and hospital information systems in Germany. Merging these data with the corresponding outpatient care data of patients offers the opportunity to characterize the patient's treatment in outpatient care before and after ED use. With this knowledge, appropriate interventions may be developed to ensure adequate patient care and to avoid adverse events such as ED crowding.

Maiju K. Marttinen, Hannu Kautiainen, Maija Haanpää et al.

Abstract Background Pain is a frequent and inevitable factor affecting the quality of life among older people. Several studies have highlighted the ineffectiveness of treating chronic pain among the aged population, and little is known about the prevalence of analgesics administration among community-dwelling older adults. The objective was to examine older adults’ prescription analgesic purchases in relation to SF-36 pain in a population-based setting. Methods One thousand four hundred twenty community-dwelling citizens aged 62–86 years self-reported SF-36 bodily pain (pain intensity and pain-related interference) scores for the previous 4 weeks. The Social Insurance Institution of Finland register data on analgesic purchases for 6 months prior to and 6 months after the questionnaire data collection were considered. Special interest was focused on factors related to opioid purchases. Results Of all participants, 84% had purchased prescription analgesics during 1 year. NSAIDs were most frequently purchased (77%), while 41% had purchased paracetamol, 32% opioids, 17% gabapentinoids, and 7% tricyclic antidepressants. Age made no marked difference in purchasing prevalence. The number of morbidities was independently associated with analgesic purchases in all subjects and metabolic syndrome also with opioid purchases in subjects who had not reported any pain. Discussion Substantial NSAID and opioid purchases emerged. The importance of proper pain assessment and individual deliberation in terms of analgesic contraindications and pain quality, as well as non-pharmacological pain management, need to be highlighted in order to optimize older adults’ pain management.

Oksana Okhrimenko, Iryna Manaienko

Insurers’ understanding of reputation importance is a key factor of their successful performance at the market. It particularly concerns life insurance sector, which has a significant development potential in Ukraine.The article aims at deepening scientific and practical essentials concerning the formation of life insurance companies’ reputation in conditions of market competition aggravation and insurance market conjuncture volatility.Based on ranking assessments used in Ukraine (Insurance Top, Mind, “My insurance agent” and the ranking of the corporate reputation management quality “REPUTATIONAL ACTIVists”), the need for ensuring the insurers’ reputation stability in conditions of acute competition at the market was substantiated. The results of financial statements analysis and corporate governance reporting of insurance companies ASKA-LIFE, TAS, KD Life, PZU Ukraine, UNIQA Life, MetLife were presented. It was substantiated that, within studying the life insurance companies’ reputation, along with main financial indicators, there is a need to analyze in details such indicators as insurance premiums and investment income for one insured from savings life insurance, average payments, current accounts payable, etc.It was proved that for reputation capital development, it is worth strengthening the role of corporate social responsibility, and to consider insurance companies’ assessment on the part of clients and employees who are brand advocates and affect the companies’ reputation formation.

hager ahmed fahmi

The smart health card has many services that the identity card cannot accommodate such as: the sick history of citizens - dispensing drugs - allergies to certain drugs ... etc, and the smart health card is provided by governments, companies or medical associations for certain fees to provide health insurance service easily And quickly with the reduction of waste of time and expenses and facilitate the medical team based on the treatment of the person to know the history of patients to be examined in terms of drugs, quantity and duration of abuse.In most countries of the world, citizens carry an important name (smart card), which replaces the identity card - this card carries all the information about any citizen living in the country such as address and social insurance number and health, and carry a ration card or food support (as happens in the states United) or not? Does it apply to private or public health insurance, the name of his parents, his property, his marital status, the name of his wife and children? Does he pay his taxes or not? In the event of an accident, the person is directed to the hospital which allows treatment, other medicines, accommodation, etc.As well as to the card under study can be used other uses such as Arabic license and Tamuni cards which can integrate more than one service and function in this card and thus provide the production of more than one card in one card uses all uses, as once entered to the database shows all the data of the person Of sick history, salary, license and other uses.

Jani Takatalo, Jari Ylinen, Tuomo Pienimäki et al.

Abstract Background The thoracic spine (TS) has been neglected in the study of the spine despite its essential role in the stability and posture of the entire spinal complex. Therefore, there is an inevitable need to investigate the reproducibility of different thoracic spinal posture measures used in subjects with TS pain. Methods Thirty-two subjects (16 females and 16 males, mean age 39 years) were evaluated by two physiotherapists on the same day to gauge inter-rater reliability and on two consecutive days to gauge intra-rater reliability. TS posture was assessed by observation, and thoracic spine mobility was measured by manual assessment of segmental flexion and extension mobility in a seated position. Additionally, posterior-to-anterior accessory mobility in a prone position was assessed manually. Moreover, cervicothoracic flexion in a seated position, thoracic posture, and thoracic flexion and extension mobility in a standing position were assessed with a tape measure, and flexion and extension mobility in a seated position and TS posture in seated and standing positions were measured with an inclinometer. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), mean difference (MD), Bland-Altman (B&A) plot features and coefficient of repeatability (CR) were calculated. Results The mean and standard deviation (SD) of the duration of TS pain was 22 (SD 45) months, with the intensity of pain being rated at 27 (SD 21) mm on a visual analogue scale (VAS). Intra-rater reliability was very strong (ICC ≥ 0.80) for the evaluation of seated and standing upper TS posture, standing whole TS posture and seated lower TS posture with an inclinometer. Moreover, TS posture evaluation with a measuring tape, posture inspection in a seated position, and manual assessment of segmental extension were found to have very strong intra-rater reliability. Inter-rater reliability was very strong for inclinometer measurements of standing and seated upper TS posture as well as standing whole TS posture. Conclusion Intra-rater reliability was higher than inter-rater reliability in most of the evaluated measurements. Overall, posture measurements with an inclinometer were more reliable than mobility measurements with the same instrument. The manual assessments can be used reliably when same evaluator performs the examination. Trial registration Clinical Trials, NCT01884818. Registered 24 June 2013, https://clinicaltrials.gov/ct2/show/NCT01884818?cond=thoracic+spine&cntry=FI&rank=1

Hung M, Li W, Hon ES et al.

Man Hung,1&ndash; 5 Wei Li,2 Eric S Hon,6 Sharon Su,1 Weicong Su,7 Yao He,8 Xiaoming Sheng,9 Richard Holubkov,10 Martin S Lipsky1 1Roseman University of Health Sciences, College of Dental Medicine, South Jordan, UT, USA; 2University of Utah, Department of Family and Preventive Medicine, Salt Lake City, UT, USA; 3University of Utah, Department of Orthopaedics, Salt Lake City, UT, USA; 4University of Utah, School of Business, Salt Lake City, UT, USA; 5George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, USA; 6University of Chicago, Department of Economics, Chicago, IL, USA; 7University of Utah, Department of Mathematics, Salt Lake City, UT, USA; 8University of Utah Alzheimer&rsquo;s Center, Salt Lake City, UT, USA; 9University of Utah, College of Nursing, Salt Lake City, UT, USA; 10University of Utah, Department of Pediatrics, Salt Lake City, UT, USACorrespondence: Man HungRoseman University of Health Sciences College of Dental Medicine, 10894 S. River Front Parkway, South Jordan, UT 84095, USATel +1801-878-1270Email mhung@roseman.eduIntroduction: It is unknown whether patients admitted for all-cause dental conditions (ACDC) are at high risk for hospital readmission, or what are the risk factors for dental hospital readmission.Objective: We examined the prevalence of, and risk factors associated with, 30-day hospital readmission for patients with an all-cause dental admission. We applied artificial intelligence to develop machine learning (ML) algorithms to predict patients at risk of 30-day hospital readmission.Methods: This study used data extracted from the 2013 Nationwide Readmissions Database (NRD). There were a total of 11,341 cases for all-cause index admission for dental patients admitted to the hospitals. Descriptive statistics were used to analyze patient characteristics. This study applied five techniques to build risk prediction models and to identify risk factors. Model performance was evaluated using area under the receiver operating characteristic curve (AUC), and accuracy, sensitivity, specificity and precision.Results: There were 11% of patients admitted for ACDC readmitted within 30 days of hospital discharge. On average, the total charge per patient was $131,004 for those with 30-day readmission (n=1254) and $69,750 for those without readmission (n=10,087). Factors significantly associated with 30-day hospital readmission included total charges, number of diagnoses, age, number of chronic conditions, length of hospital stays, number of procedures, Medicare insurance and Medicaid insurance, and severity of illness. Model performance from all methods was similar with the artificial neural network showing the highest AUC of 0.739.Conclusion: Our results demonstrate that readmission after hospitalization with ACDC is fairly common. If one-third of the 30-day readmission cases can be avoided, there is a potential annual saving of over $25 million among the twenty-one states represented in the NRD. The ML algorithms can predict hospital readmission in dental patients and should be further tested to aid the reduction of hospital readmission and enhancement of patient-centered care.Keywords: machine learning, dentistry, quality improvement, risk prediction, healthcare policy, precision medicine

Rasoulian Mohsen, Ghannadi Ali Akhavan, Nojoomi Alireza

In the contemporary world, the insurance industry is considered one of the crucial factors of the development and progress of countries, and the insurance condition is an indicator of this phenomenon. The aim of the study is to assess risk taking of insurance companies from the perspective of senior managers and experts. The methods of research are questionnaire and interview with experts and senior managers of life insurance of active insurance companies in the city of Tehran using random sampling. In the present study, among 60 senior managers and experts, descriptive statistics in the field of demography such as gender, background, and educational level of respondents have been studied, and then they have been asked for the confirmation and rejection of statistical assumptions in the form of known criteria and opinions of experts and decision-makers. To prioritise the factors from the hierarchical analysis process for factor ranking, the results have indicated that inflation, governmental policies and lack of expertise are the major factors affecting risk taking in the industry of life insurance.

In Sung Cho, Ye Rin Chae, Ji Hyeon Kim et al.

Abstract Background Aspirin has been considered to be beneficial in preventing cardiovascular diseases and cancer. Several pharmaco-epidemiology cohort studies have shown protective effects of aspirin on diseases using various statistical methods, with the Cox regression model being the most commonly used approach. However, there are some inherent limitations to the conventional Cox regression approach such as guarantee-time bias, resulting in an overestimation of the drug effect. To overcome such limitations, alternative approaches, such as the time-dependent Cox model and landmark methods have been proposed. This study aimed to compare the performance of three methods: Cox regression, time-dependent Cox model and landmark method with different landmark times in order to address the problem of guarantee-time bias. Methods Through statistical modeling and simulation studies, the performance of the above three methods were assessed in terms of type I error, bias, power, and mean squared error (MSE). In addition, the three statistical approaches were applied to a real data example from the Korean National Health Insurance Database. Effect of cumulative rosiglitazone dose on the risk of hepatocellular carcinoma was used as an example for illustration. Results In the simulated data, time-dependent Cox regression outperformed the landmark method in terms of bias and mean squared error but the type I error rates were similar. The results from real-data example showed the same patterns as the simulation findings. Conclusions While both time-dependent Cox regression model and landmark analysis are useful in resolving the problem of guarantee-time bias, time-dependent Cox regression is the most appropriate method for analyzing cumulative dose effects in pharmaco-epidemiological studies.

Furaha August, Andrea B. Pembe, Edmund Kayombo et al.

Background: Birth preparedness and complication readiness (BP/CR) strategies are aimed at reducing delays in seeking, reaching, and receiving care. Counselling on birth preparedness is provided during antenatal care visits. However, it is not clear why birth preparedness messages do not translate to utilisation of facility delivery. This study explores the perceptions, experiences, and challenges the community faces on BP/CR. Design: A qualitative study design using Focused Group Discussions was conducted. Twelve focus group discussions were held with four separate groups: young men and women and older men and women in a rural community in Tanzania. Qualitative content analysis was used to analyse the data. Results: The community members expressed a perceived need to prepare for childbirth. They were aware of the importance to attend the antenatal clinics, relied on family support for practical and financial preparations such as saving money for costs related to delivery, moving closer to the nearest hospital, and also to use traditional herbs, in favour of a positive outcome. Community recognised that pregnancy and childbirth complications are preferably treated at hospital. Facility delivery was preferred; however, certain factors including stigma on unmarried women and transportation were identified as hindering birth preparedness and hence utilisation of skilled care. Challenges were related to the consequences of poverty, though the maternal health care should be free, they perceived difficulties due to informal user fees. Conclusions: This study revealed community perceptions that were in favour of using skilled care in BP/CR. However, issues related to inability to prepare in advance hinder the realisation of the intention to use skilled care. It is important to innovate how the community reinforces BP/CR, such as using insurance schemes, using community health funds, and providing information on other birth preparedness messages via community health workers.

Fadi Abdelmuniem Abdelfattah, Muhammad Sabbir Rahman, Mohamad Osman

<p><strong>Purpose:</strong> This research aim to investigate the influence of service quality attributes towards customers’ loyalty on health insurance products. In addition, this research also tested the mediation role of perceived value in between service quality and customers’ loyalty on health insurance products.</p> <p><strong>Design/methodology/approach:</strong> Based on the literature review, this research developed a conceptual model of customers loyalty embedded with service quality and perceived value. The study surveyed 342 healthcare insurance customers. Apart from assessing the reliability and validity of the constructs through confirmatory factor analysis, this research also used structural equation modelling (SEM) approach to test the proposed hypothesis.</p> <p><strong>Findings:</strong> The results from the inferential statistics revealed that the healthcare insurance customers are highly influenced by service quality followed by the perceived value in reaching their loyalty towards a particular health insurance service provider.</p> <p><strong>Research limitations/implications:</strong> The sample for this study is based on health insurance customers only and it is suggested that future studies enlarge the scope to include others type of customers of different insurance products.</p> <p><strong>Practical implications:</strong> In order to encourage the customers to more loyal towards their service providers, this research will add value for the mangers to understand the items of service quality and considering the perceived value of the target customers in order to optimize their loyalty. As whole, the outcome of this research will assist managers for better understanding of the customers’ loyalty antecedents under the perspective of healthcare insurance products.</p> <p><strong>Originality/value:</strong> This paper has tried to provide a comprehensive understanding about customers’ loyalty under the perspective of service quality and perceived values context in the Malaysian health care insurance industry. Since there was a lack of such research in Malaysian health insurance context, this research can provide theoretical contribution and managerial basis for future researches as well as implications for the managers. Yet, till now research in this sector under Malaysian context do not appear adequately to take into account service quality, perceived values and customers loyalty factors.</p>

Patrick Stephen W, Freed Gary L

<p>Abstract</p> <p>Background</p> <p>From its inception, Medicaid was aimed at providing insurance coverage for low income children, elderly, and disabled. Since this time, children have become a smaller proportion of the US population and Medicaid has expanded to additional eligibility groups. We sought to evaluate relative growth in spending in the Medicaid program between children and adults from 1991-2005. We hypothesize that this shifting demographic will result in fewer resources being allocated to children in the Medicaid program.</p> <p>Methods</p> <p>We utilized retrospective enrollment and expenditure data for children, adults and the elderly from 1991 to 2005 for both Medicaid and Children’s Health Insurance Program Medicaid expansion programs. Data were obtained from the Centers for Medicare and Medicaid Services using their Medicaid Statistical Information System.</p> <p>Results</p> <p>From 1991 to 2005, the number of enrollees increased by 83% to 58.7 million. This includes increases of 33% for children, 100% for adults and 50% for the elderly. Concurrently, total expenditures nationwide rose 150% to $273 billion. Expenditures for children increased from $23.4 to $65.7 billion, adults from $46.2 to $123.6 billion, and elderly from $39.2 to $71.3 billion. From 1999 to 2005, Medicaid spending on long-term care increased by 31% to $84.3 billion. Expenditures on the disabled grew by 61% to $119 billion. In total, the disabled account for 43% and long-term care 31%, of the total Medicaid budget.</p> <p>Conclusion</p> <p>Our study did not find an absolute decrease in the overall resources being directed toward children. However, increased spending on adults on a per-capita and absolute basis, particularly disabled adults, is responsible for much of the growth in spending over the past 15 years. Medicaid expenditures have grown faster than inflation and overall national health expenditures. A national strategy is needed to ensure adequate coverage for Medicaid recipients while dealing with the ongoing constraints of state and federal budgets.</p>

M. Brennan, R. Solanki