Hasil untuk "Insurance"

John B. Bryant

J. Currie, J. Gruber

David M. Cutler, J. Gruber

Dean Yang, Hwajung Choi

X. Giné, Dean Yang, Dean Yang

The adoption of new agricultural technologies may be discouraged because of their inherent riskiness. This study implemented a randomized field experiment to ask whether the provision of insurance against a major source of production risk induces farmers to take out loans to invest in a new crop variety. The study sample was composed of roughly 800 maize and groundnut farmers in Malawi, where by far the dominant source of production risk is the level of rainfall. We randomly selected half of the farmers to be offered credit to purchase high-yielding hybrid maize and improved groundnut seeds for planting in the November 2006 crop season. The other half of the farmers were offered a similar credit package but were also required to purchase (at actuarially fair rates) a weather insurance policy that partially or fully forgave the loan in the event of poor rainfall. Surprisingly, take up was lower by 13 percentage points among farmers offered insurance with the loan. Take-up was 33.0 percent for farmers who were offered the uninsured loan. There is suggestive evidence that the reduced take-up of the insured loan was due to the high cognitive cost of evaluating the insurance: insured loan take-up was positively correlated with farmer education levels. By contrast, the take-up of the uninsured loan was uncorrelated with farmer education.

Elizabeth E. Ward, M. Halpern, N. Schrag et al.

Advances in the prevention, early detection, and treatment of cancer have resulted in an almost 14% decrease in the death rates from all cancers combined from 1991 to 2004 in the overall US population, with remarkable declines in mortality for the top 3 causes of cancer death in men (lung, colorectal, and prostate cancer) and 2 of the top 3 cancers in women (breast and colorectal cancer). However, not all segments of the population have benefited equally from this progress, and evidence suggests that some of these differences are related to lack of access to health care. Lack of adequate health insurance appears to be a critical barrier to receipt of appropriate health care services. This article provides an overview of systems of health insurance in the United States, demographic and socioeconomic characteristics associated with health insurance coverage, and economic burdens related to health care among individuals and families. This article also presents data on the association between health insurance status and screening, stage at diagnosis, and survival for breast and colorectal cancer based on analyses of the National Health Interview Survey and the National Cancer Data Base. Although this article focuses on associations between health insurance and cancer care utilization and outcomes, it is important to recognize that barriers to receipt of optimal cancer care are complex and involve patient‐level, provider, and health system factors. Evidence presented in this paper suggests that addressing insurance and cost‐related barriers to care is a critical component of efforts to ensure that all Americans are able to share in the progress that can be achieved by access to high‐quality cancer prevention, early detection, and treatment services.

Ker-Tah Hsu

M. Weitzman

A critical issue in climate-change economics is the specification of the so-called "damages function" and its interaction with the unknown uncertainty of catastrophic outcomes. This paper asks how much we might be misled by our economic assessment of climate change when we employ a conventional quadratic damages function and/or a thin-tailed probability distribution for extreme temperatures. The paper gives some numerical examples of the indirect value of various GHG concentration targets as insurance against catastrophic climate-change temperatures and damages. These numerical examples suggest that we might be underestimating considerably the welfare losses from uncertainty by using a quadratic damages function and/or a thin-tailed temperature distribution. In these examples, the primary reason for keeping GHG levels down is to insure against high-temperature catastrophic climate risks.

R. Boháček, Hugo Rodr ´ iguez

Lorraine Poncet, Noémie Roland, Romain Fortuna et al.

Summary: Background: A decrease in oral contraceptive use, newly available methods, and the emerging role of midwives suggested meaningful changes in contraception use in France. With two repeated cross-sectional studies, we aimed to describe contraception use in France in 2012 and 2022, in the total population and across age groups. Methods: Using the French National Health Data System (SNDS) covering 99% of the population, we identified reimbursed contraceptive use in women 15–49 years in January 2012 and 2022: combined oral contraceptives (COC), progestogen-only pill (POP), injectable progestogen, copper intrauterine device (Cu-IUD), levonorgestrel-releasing intrauterine devices (LNG-IUD), implants, sterilization. Number of users, socio-demographic characteristics and healthcare providers were assessed. Sales data accounted for non-reimbursed OC. Findings: Amid stable prevalence of contraception use (6.67 million users in 01/2012 and 6.73 in 01/2022, or 47%–46% of women aged 15–49 years), COC use decreased by a third from 54% (n = 3,602,803) to 35% of users (n = 2,370,205) while remaining the most popular method. POP and Cu-IUD use doubled, up to 19% (n = 1,293,073) and 21% of users (n = 1,428,837) users, respectively. IUD and POP have become leading methods in women 30–39 years, concerning 44% of users (n = 951,649) and 20% of users (n = 428,138) of users, respectively, while 50% of women ≥40 years (n = 1,051,066) used IUD. From <0.5% in 2012 (n = 16,154), midwives prescriptions reached 13% (n = 859,819) of total prescriptions in 2022. Social disparities in IUD use grew. Interpretation: Our findings displayed profound changes over ten years towards more hormone-free contraceptive methods. Funding: The French National Health Insurance Fund (Cnam) and the French National Agency for Medicines and Health Products Safety (ANSM) via the Scientific Interest Group EPI-PHARE.

Qunjun Yu, Ya He, Luyan Li et al.

BackgroundAchieving universal health coverage remains a global health priority. Understanding factors that influence individuals' willingness to enroll in basic medical insurance is essential for system sustainability.ObjectivesThis study aims to examine the impact of policy awareness and institutional trust on the willingness of urban and rural residents to enroll in the Urban and Rural Residents Basic Medical Insurance (URRBMI), with implications for policy refinement. The goal is to improve the precision of policy implementation and encourage broader insurance enrollment, supporting system sustainability.MethodsA survey of 563 residents was conducted in a county of Yunnan Province, China. Descriptive analysis of respondent demographics was followed by multiple linear regression, using policy awareness, policy expectation and institutional trust as independent variables, and demographics as control variables, to identify significant factors affecting enrollment willingness.ResultsThe results of the survey showed that 87.4% of respondents were enrolled in the URRBMI. The regression model, with an adjusted R2 of 0.322, showed policy awareness (coefficient = 0.243, P &lt; 0.001) and institutional trust (coefficient = 0.354, P &lt; 0.001) significantly and positively influenced enrollment willingness. Age and annual household income were also significant factors.ConclusionPolicy awareness and institutional trust are key determinants of enrollment willingness, with age and income playing roles. Policy education and communication should be refined, leveraging big data for targeted outreach and flexible payment options to enhance enrollment and system sustainability.

Olivia Emelie Engström, Hisayo Katsui, Lieketseng Ned

People who sustain traumatic brain injuries (TBIs) often experience unmet rehabilitation needs. The aim of our research was to explore how the invisible aspects of traumatic brain injury affect the experiences of survivors of TBI in accessing the necessary medical, social, and financial assistance. Using Giorgi’s descriptive phenomenological inquiry, we purposefully sampled 11 participants who had experienced TBI when aged 13–27 for interviews. The time since their injuries ranged from 7 to 37 years. Three key themes emerged: (1) lack of knowledge and guidance in medical services, (2) lack of social service assistance, and (3) battles with insurance companies. Our findings show that, due to the hidden nature of TBI-related disabilities and a general lack of societal knowledge about TBI outcomes, survivors face significant difficulties in accessing essential medical, social, and financial services. This study underscores the critical need to address the challenges faced by youth survivors of TBI, as their injuries occur during a pivotal developmental phase when they are developing psychosocial skills, pursuing education, and transitioning into the workforce. Delays or lack of proper medical, social, and financial support hinder rehabilitation and the successful reintegration of these youth into society.

Svenja Schlachter, Sophia Helen Adam, Maximilian Baxendale et al.

Abstract Background There is a vicious cycle between unemployment and mental health issues. Unemployed individuals with mental health issues require individualized support at multiple levels in order to promote their mental health, and obtain and retain employment. The 3for1-intervention program aims to provide such support with three components (short-term psychotherapy, job coaching based on the Individual Placement and Support approach, and peer support). This study protocol outlines how the effectiveness of this three-component intervention program in terms of re-employment, mental health, and psychosocial outcomes will be evaluated. Methods The 3for1-intervention program will be evaluated with a non-randomized controlled trial design in a multi-center study. 500 eligible participants aged between 18 and 60 years from six job centers in Southern Germany will be allocated to a control group or an intervention group. Allocation is time-based, with the control group being recruited first, followed by recruitment of the intervention group. The control group will receive treatment as usual, whereas the intervention group will receive treatment as usual as well as access to the three intervention components over a period of 12 months. Assessment will be conducted at baseline (t0), and 12 (t1) and 18 (t3) months later. The primary outcome will be the proportion of participants who are in employment subject to social insurance contributions at t1. Differences between control and intervention group will be tested with logistic regression analysis, controlling for relevant covariates. Analyses of secondary outcomes will relate to group differences regarding re-employment, health and well-being, social integration, help-seeking, and self-stigma at t1 and t2, applying logistic regression analysis or analysis of covariance. Additionally, usage of health services will be measured to evaluate the intervention program’s cost effectiveness. Discussion The 3for1-intervention aims to improve employability and mental health outcomes of a vulnerable population with high need for assistance. Improvements for this population would benefit the German welfare state as well. This study could provide valuable insights into the feasibility, implementation, and sustainability of this individualized, multi-level support program within German job centers. Trial registration This trial is registered with the German Clinical Trials Register: DRKS00029002 (registered on 11 May 2022).

Li Wang, Li Wang, Ruiguang Zhang et al.

ObjectiveThe aims of this survey were to investigate the public awareness of drug clinical trials (DCTs) and willingness to participate the DCTs, and provide references for propaganda and science popularization of DCTs.MethodsA self-designed questionnaire named “an online survey questionnaire on public awareness of DCTs” was used to conduct an online survey from January to March 2022. The demographic characteristics and the response of participants to the awareness and willingness to participate the DCTs were collected. The factors affecting the public awareness of DCTs were analyzed by single factor and binary logistic regression analysis.ResultsOne thousand three hundred eighty valid questionnaires were collected, and the respondents’ awareness rate of DCTs was 61.1%. Thirteen demographic characteristics including age, gender, education, occupation, work fields, household type, marital status, city type, income, medical insurance, medical expenditure, pressure to seek medical care, financial pressure, both significantly affected the qualified rate of participants’ awareness of DCTs (p &lt; 0.001) by single factor analysis. Binary logistic regression analysis indicated that education level, work fields, city type, medical insurance, and medical expenditure affected independently the participants’ awareness rate of DCTs (p &lt; 0.001). 52.9% of the participants were willing to take part in DCTs. “to promote medical progress” (54.4%) or “believe doctors” (31.1%) were the most frequent reasons for subjects participating in DCTs.ConclusionThe public awareness rate of DCTs and the willingness to participate in drug clinical were significantly affected by the demographic characteristics of subjects. Thus, targeting the needs of the public, propaganda, and science popularization of DCTs should be carried out and served public health.

L. Mehl-Madrona

Introduction Acupuncture has long been used in treating anxiety, and a literature exists on its effectiveness. However, acupuncture is rarely covered by government insurance (Medicaid or Medicare) or even by many commercial insurance carriers in the United States, making it inaccessible to those who cannot pay separately. Objectives We asked if adding acupuncture to an anxiety group would improve outcome. Methods We provided acupuncture during group psychotherapy for anxiety as a non-billable service. This was feasible since patients were already being billed for group psychotherapy. A physician and a social work intern led the group. At the start of the group, the physician went around the circle of group members and inserted acupuncture needles, using points in the ears, head, hands, feet, and, in the summer, arms and lower legs). The size of the group ranged from 4 to 12 people. We used Battlefield auricular points, the four gates (Large Intestine 4 and Liver 3, bilaterally), and GV24, GV29, Ht7, and Sp6. Sometimes, other points were added for other symptoms (back pain, neck pain, etc.) People sometimes joined the group without anxiety as a core problem in getting access to acupuncture. A core group of patients formed who came weekly while others came and went. The Hamilton Anxiety Scale measured anxiety after treatments 4, 8, and 12. The group lasted 90 minutes and consisted of mindfulness training, guided imagery, and CBT for anxiety. All patients met the criteria for generalized anxiety disorder. The t-test procedure was used to compare the differences between the means for the two groups. Results Thirty-five patients received acupuncture, while another 55 patients attended the group and did not elect to receive acupuncture. All patients were covered by MaineCare health insurance, Maine’s version of Medicaid. All patients had multiple other medical problems, which was why they were referred to the group. Seventy percent of the patients were women, and 30% were men. The average age was 40.1 years. Anxiety ratings on the Hamilton Anxiety Scale decreased by the last time measured for those not receiving acupuncture by an average of 5.17 points (S.D. 2.9; n = 55). Anxiety ratings for those receiving acupuncture decreased by an average of 7.19 points (S.D. 2.5, n = 35). The difference of the means was -2.02 (S.E. 0.595; 95% CI = -2.203 to -0.837; t = -3.394; p = 0.001). Headaches, shoulder pains, and upper back pain also decreased. Patients reported high levels of benefit from the acupuncture and encouraged other patients to continue to come and try the acupuncture. Usually, the needles could be placed within the first third of the group. Conclusions Acupuncture improved anxiety ratings for people in group psychotherapy for anxiety over group alone, though the possibility of a placebo effect cannot be eliminated. Patients chose acupuncture, which could also present a potential bias. Disclosure of Interest None Declared

Alberto Ranavolo, Arash Ajoudani, Vincent Bonnet et al.

Afiba Manza-A Agovi, Caitlin T. Thompson, Kevin J. Craten et al.

Abstract Background Long-acting injectable cabotegravir plus rilpivirine (LAI CAB/RPV) has several potential benefits over daily oral formulations for HIV treatment, including the potential to facilitate long-term adherence and reduce pill fatigue. We aimed to assess facilitators of and barriers to LAI CAB/RPV implementation and delivery through the perspectives of physicians and clinical staff, and the experiences of LAI CAB/RPV use among people living with HIV (PLWH) at a Ryan-White supported safety-net clinic in North Texas. Methods We conducted semi-structured interviews with recruited clinic staff (physicians, nurses, and support staff) involved with LAI CAB/RPV implementation and PLWH who switched to LAI CAB/RPV and consented to participate in individual interviews. Data were collected from July to October 2023. Our interview guide was informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM), and Proctor Implementation Outcomes frameworks. Qualitative data were analyzed using a rapid qualitative analysis approach to summarize key themes. Results We recruited and interviewed 15 PLWH who transitioned to LAI CAB/RPV and 11 clinic staff serving these patients. PLWH conveyed that emotional and informational support from family or a trusted clinician influenced their decision to switch to LAI CAB/RPV. PLWH also reported that injectable treatment was more effective, convenient, and acceptable than oral antiretroviral therapy. Clinic staff and physicians reported that staff training, pharmacist-led medication switches, flexible appointments, refrigeration space and designated room for injection delivery facilitated implementation. Clinic staff cited medication costs, understaffing, insurance prior authorization requirements, and lack of medication access through state drug assistance programs as critical barriers. Conclusions Our study offers insights into real-world experiences with LAI usage from the patient perspective and identifies potential strategies to promote LAI CAB/RPV uptake. The barriers to and facilitators of LAI CAB/RPV program implementation reported by clinic staff in our study may be useful for informing strategies to optimize LAI CAB/RPV programs.

Ashia M. Hackett, Christopher O. Adereti, Ariel P. Walker et al.

Racial and socioeconomic health disparities are well documented in the literature. This study examined patient demographics, including socioeconomic status (SES), among individuals presenting with aneurysmal subarachnoid hemorrhage (aSAH) and unruptured intracranial aneurysm (UIA) to identify factors associated with aSAH presentation. A retrospective assessment was conducted of all patients with aSAH and UIA who presented to a large-volume cerebrovascular center and underwent microsurgical treatment from January 2014 through July 2019. Race and ethnicity, insurance type, and SES data were collected for each patient. Comparative analysis of the aSAH and UIA groups was conducted. Logistic regression models were also employed to predict the likelihood of aSAH presentation based on demographic and socioeconomic factors. A total of 640 patients were included (aSAH group, 251; UIA group, 389). Significant associations were observed between race and ethnicity, SES, insurance type, and aneurysm rupture. Non-White race or ethnicity, lower SES, and having public or no insurance were associated with increased odds of aSAH presentation. The aSAH group had poorer functional outcomes and higher mortality rates than the UIA group. Patients who are non-White, have low SES, and have public or no insurance were disproportionately affected by aSAH, which is historically associated with poorer functional outcomes.

Ho-Sheng Lee, Yu-Feng Wei, Chin-Chung Shu

Background: The coexistence of lung cancer and tuberculosis is not rare. Rifamycin plays a pivotal role in anti-tuberculosis therapy. However, its potential impact on the liver metabolism of oncology drugs raises concerns. We performed this study to explore whether Rifamycin affects the survival of patients with tuberculosis and lung cancer. Methods: Drawing from the Taiwan National Health Insurance Research Database, we identified patients diagnosed with concurrent lung cancer and tuberculosis between 2000 and 2014. Patients were categorized based on whether they underwent rifamycin-inclusive or rifamycin-exempt anti-tuberculosis therapy. Subsequently, we paired them at a 1:1 ratio and evaluated the mortality risk over a two-year span. Results: Out of the study participants, 1558 (81.4%) received rifamycin-based anti-tuberculosis therapy, while 356 (18.6%) underwent a rifamycin-free regimen. Analysis revealed no marked variance in the biennial mortality rate between the groups (adjusted hazard ratio: 1.33, 95% confidence interval 0.93–1.90, <i>p</i> = 0.1238). When focusing on the matched sets comprising 127 individuals in each group, the data did not indicate a significant link between rifamycin and a heightened two-year mortality risk (adjusted hazard ratio: 1.00, 95% confidence interval 0.86–1.18, <i>p</i> = 0.9538). Conclusions: For individuals with concomitant lung cancer and tuberculosis, rifamycin’s administration did not adversely influence two-year survival. Thus, rifamycin-containing anti-TB regimens should be prescribed for the indicated patients.

Aviva Aron-Dine, L. Einav, Amy Finkelstein