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Due to the increasing cost of health insurance, for decades, many countries have endeavored to constrain the cost of insurance by utilizing a DRG payment system. In most cases, under the DRG payment system, hospitals cannot exactly know which DRG code inpatients are until they are discharged. This paper focuses on the prediction of what DRG code appendectomy patients will be classified with when they are admitted to hospital. We utilize two models (or classifiers) constructed using the C4.5 algorithm and back-propagation neural network (BPN). We conducted experiments with the data collected from two hospitals. The results show that the accuracies of these two classification models can be up to 97.84% and 98.70%, respectively. According to the predicted DRG code, hospitals can effectively arrange medical resources with certainty, then, in turn, improve the quality of the medical care patients receive. [ABSTRACT FROM AUTHOR]

The Philippines is a source of labor for many countries. Roughly 10 million overseas Filipinos are working and living outside of the Philippines. This paper examines the association between sociodemographic characteristics (sex, age, educational level, and income) and self-rated physical and mental health, access to healthcare, and health habits among immigrant Filipinos living in Santa Cruz de Tenerife, Spain. Through convenience sampling, Filipino migrants (n = 103) aged 18 years and above participated in the online survey between October 2022 and March 2023. The data were analyzed using descriptive statistical analysis and chi-square. Almost all respondents self-rated their health as excellent and very good. Female respondents are more affected by mental health. Most are enrolled in the Universal Health System of Spain (public insurance). There is more utilization of private health insurance among respondents aged 60 years and above and high-wage earners. Cigarette smoking and alcohol drinking are associated with males. More than half of the respondents perform weekly exercise occasionally or never. These findings suggest a potential need for targeted interventions with an emphasis on the practice of preventive health and the promotion of healthy lifestyles, especially among financially disadvantaged migrants with lesser health access. [ABSTRACT FROM AUTHOR]

Nurses are at high risk of burnout and subsequent mental health concerns due to problems with overstaffing, immense workload volume, and personal health risks associated with the job. Effective mental health treatments are available but potential barriers to receiving care may prevent nurses from benefiting. The Emotional Health and Well-Being Clinic (EHWC) at Houston Methodist is an outpatient mental health clinic offering therapy and medication management services for employees and employee dependents of our institution. The EHWC is uniquely positioned to observe how nurses utilize mental health services and to address barriers to effective care for this vital group of healthcare professionals. This paper provides descriptive data on the utilization of mental health services by nurses in the EHWC and a discussion of possible challenges faced by this group when seeking care. Based on these data, we propose potential solutions to ensure that nurses can achieve maximum benefit from outpatient mental health services. [ABSTRACT FROM AUTHOR]

People's health is a necessary condition for the country's prosperity. Under the background of the COVID-19 pandemic and frequent natural disasters, exploring the spatial and temporal distribution, regional differences and convergence of China's provincial public health level is of great significance to promoting the coordinated development of China's regional public health and achieving the strategic goal of a "healthy China". Based on China's provincial panel data from 2009 to 2020, this paper constructs an evaluation index system for China's public health level from five dimensions: the popularization of a healthy life, optimization of health services, improvement of health insurance, construction of a healthy environment, and development of a health industry. In this paper, the entropy method, Dagum Gini coefficient, Kernel density function and spatial econometric model are used to analyze the spatiotemporal distribution, regional differences, dynamic evolution and convergence of China's public health level since the new medical reform. The study found that, first, China's public health level is generally low, structural contradictions are prominent and the construction of a healthy environment has become a shortcoming hindering the improvement of China's public health level since the new medical reform. The public health level of the four major regions showed a spatial distribution pattern of "high in the eastern, low in the northeastern, central and western" areas. Second, the overall Gini coefficient of China's public health level showed a "V-shaped" trend of first decreasing and then rising, but the overall decrease was greater than the increase, among which the regional difference was the main source of regional differences in China's public health level, but its contribution rate showed a downward trend. Third, except for the basic maintenance of a healthy environment, the Kernel density curves of China's public health level and its sub-dimensions have shifted to the right to a certain extent, and there is no polarization phenomenon. Finally, the level of public health in China has a significant spatial correlation. Except for the northeast region, the growth rate of low-level public health provinces in China and the other three major regions is higher than that of high-level public health provinces, showing a certain convergence trend. In addition, the impact of economic development, financial pressure, and urbanization on the convergence of public health levels in the four major regions is significantly heterogeneous. [ABSTRACT FROM AUTHOR]

Colombia has extensive laws prohibiting discrimination against sexual minority people. However, violence and discrimination toward sexual minorities are still frequent. While a growing body of research shows that sexual minority people experience elevated rates of discrimination and domestic abuse globally, little research has been conducted on these issues affecting sexual minorities in Colombia specifically. Using minority stress theory as a conceptual framework, this paper aims to fill this gap by examining the prevalence of experiencing intimate partner violence (IPV) and witnessed discrimination and the relationship of these stressors to self-reported health among a national sample of sexual minority Colombians. We found that bisexual individuals experienced higher rates of physical and sexual IPV, compared to lesbian and gay individuals. Additionally, sexual minority Colombians who experienced IPV and witnessed discrimination were more likely to report having poorer health, compared to those who had not. We discuss the implications of our findings for future research and clinicians working with sexual minority clients. [ABSTRACT FROM AUTHOR]

German health insurance companies increasingly strive to position themselves as health partners to their customers to improve customers' health and contain costs. However, there is uncertainty about customers' preferences for health services offered by health insurance companies. Therefore, this paper studies consumer preferences for health services that are or could be provided by health insurance companies in Germany. An online survey was conducted using two stated preference techniques to collect and analyze the data (namely, rating and ranking of health services considered by insurance companies). A sample of 880 German health insurance customers between 18 and 65 years old filled out the online questionnaire, of which 860 submitted complete responses. Ordinal logistic regression analysis was used for the rating and ranking. Preliminary examinations, care management, and health programs were the three health services most important to the respondents. The results suggest that people want their health insurance to support them with preventive health services that offer direct therapeutic value and not just informational, economic, access-related, or convenience-related benefits. These preferences for health services are homogeneous for most subgroups of the population, implying that health insurance companies could consider an overall strategy to address these preferences for all clients by focusing on the important health services. [ABSTRACT FROM AUTHOR]

Eliminating poverty due to illness is an important way for China to pursue common prosperity. The high medical expenditure caused by the aging population has brought severe challenges to governments and families of all countries, especially in China, where the entire population has just been lifted out of poverty in 2020 and then hit by COVID-19. How to prevent the possible return of poor boundary families to poverty in China has become a difficult research topic. Based on the latest data from the China Health and Retirement Longitudinal Survey, this paper discusses the poverty reduction effect of medical insurance on middle-aged and elderly families from the absolute index and relative index. Medical insurance had a poverty reduction effect on middle-aged and elderly families, especially the poor boundary families. For example, people who participated in medical insurance reduced their financial burden by 2.36% for middle-aged and older families compared to people who did not participate in medical insurance. Furthermore, the poverty reduction effect had heterogeneity in gender and age. This research brings some policy implications. For example, the government should give more protection to vulnerable groups such as the elderly and low-income families and improve the fairness and effectiveness of the medical insurance system. [ABSTRACT FROM AUTHOR]

This paper discusses the Topp-Leone-G power series class of distributions. The greatest attention is paid to the investigation of intrinsic characteristic "saturation" to the horizontal asymptote in the Hausdorff sense. Some estimates for the value of the Hausdorff distance are obtained. We present a new family of recurrence generated adaptive functions with corresponding applications. The usefulness of the obtained results is demonstrated in a simulation study of some real data sets from the medical sector and insurance. Some suitable software modules within the programming environment CAS MATHEMATICA are proposed. [ABSTRACT FROM AUTHOR]

Applying the behavioral model of health services utilization to data from the United States, this study examined immigrant children's use of physician and dentist visits, hospital care, and prescribed medication. We employed data describing 9759 immigrant parents and children who participated in 2021's National Survey of Children's Health. Logistic regression results negatively linked physician visits to child health, child age, Asian children, fathers, lower parent education, lower family income, uninsured children, and parent's U.S. residence under 5 years. Dentist visits were positively associated with child age, girls, Hispanic children, parent education, family income, public/private health insurance coverage, and U.S.-born children, but such use was associated negatively with Asian children. Hospital use was positively associated with poor child health, Black children, children of "other" race/ethnicity, younger parent age, enrolled in health insurance, and parent's U.S. residence under 5 years. The use of prescribed medication was negatively associated with Asian children, younger child age, lower parent education, uninsured child, and lack of English proficiency. The paper's conclusion suggests policymakers expand Medicaid and CHIP eligibility among immigrant children and suggests community education to foster awareness of children's physical and oral health needs and of Medicaid, CHIP, and prescription assistance programs. The conclusion calls for healthcare providers and social workers to accommodate and respect immigrants' traditional health-related beliefs, showing cultural competence. [ABSTRACT FROM AUTHOR]

The high volatility in financial markets, together with the ultra-low interest rates environment and the increased expectation of life, constitute serious threats for providers of long-term investment guarantees and lifelong benefits. The paper by [3] ([3]) addresses the problem of approximating the future value distribution of a large and heterogeneous life insurance portfolio by proposing two regression-based methodologies: the former is an extension of the well-known least squares Monte Carlo approach; the latter is grounded on the class of generalized beta distribution of the second kind. Then, a more accurate assessment of these risks enables enlargement of the insurance portfolios and to keep premiums at reasonable levels. [Extracted from the article]

The scope and ambitions of biomedical institutions worldwide currently working toward the integration of personalized medicine (PM) require recognizing the potential profound impact on regulatory standards and on the economic functioning and financing of healthcare. Against this background, researchers and policymakers must manage the arising challenges for the healthcare systems. In this paper we study the literature related to the consequences of PM on health insurance and care systems. Using the PRISMA research protocol, we search the existing body of literature and analyze publications dealing with insurance (419 papers) in the field of PM. After a detailed reading of the 52 studies included in our analysis, we synthesize challenges in three fields that must be addressed to avoid hindering the implantation of PM. The key issues that we highlight concern (1) a lack of clear and consistent data on the economic relevance of PM, (2) a value-oriented and cost-efficient definition of reimbursement thresholds, (3) the implementation of PM in the prevailing healthcare system. In the meantime, we provide several solutions to these concerns; we present (a) risk-sharing contracts that can deal with the emerging coverage challenges, (b) criteria that could constitute future reimbursement thresholds and (c) examples of successful implementations of PM into healthcare systems. Our findings are relevant for policymakers and health insurance companies for redefining the guidelines for the healthcare schemes of the future. [ABSTRACT FROM AUTHOR]

Concerns about the moral hazards and usage of universal health insurance require examination. This study aimed to analyze changes in lifestyle, metabolic syndrome-related health status, and individuals' tendency to use healthcare services according to changes in the eligibility status of medical aid recipients. This paper reports a retrospective cohort study that involved analyzing data from 2366 medical aid recipients aged 40 years or older who underwent national health screenings in 2012 and 2014. Of the recipients, 1606 participants continued to be eligible for medical aid (the "maintained" group) and 760 changed from being medical aid recipients to National Health Insurance (NHI) enrollees (the "changed" group). Compared to the "changed" group, the "maintained" group was less likely to quit smoking, more likely to begin smoking, less likely to reduce binge drinking to moderate drinking, and had a significant increase in blood glucose and waist circumference. Annual total medical expenses also increased significantly in the "maintained" group. Since the mere strengthening of healthcare coverage may lead to moral hazards and the failure to link individuals' tendency to use healthcare services and outcomes, establishing mechanisms is necessary to educate people about the health-related outcomes of maintaining a healthy lifestyle and ensure the appropriate use of healthcare services. [ABSTRACT FROM AUTHOR]

This paper investigates the optimal private health insurance contract design problem, considering the joint interests of a policyholder and an insurer. Both the policyholder and the insurer jointly determine the premium of private health insurance. In order to better reflect reality, the illness expenditure is modelled by an extended compound Poisson process depending on health status. Under the mean–variance criterion and by applying dynamic programming, control theory, and leader–follower game techniques, analytically time-consistent private health insurance strategies are derived, optimal private health insurance contracts are designed, and their implications toward insurance are analysed. Finally, we perform numerical experiments assuming that the policyholder and the insurer calculate their wealth every year and they deposit their disposable income into the Bank of China with the interest rate being r = 0.021 . The values of other model parameters are set by referring to the data in the related literature. We find that the worse the policyholder's health, the higher the premium that they pay for private health insurance, and buying private health insurance can effectively reduce the policyholder's economic losses caused by illnesses. [ABSTRACT FROM AUTHOR]

Simple Summary: The investigation of cancer disparities is of major importance. In this paper, we address this issue through the occupational point of view, trying to capture how work and its related factors impact on cancer inequalities. The data we provide may increase awareness relevant to cancer control, and stimulate further studies aimed at the identification of the occupational determinants of cancer disparities and the quantification of their role. Cancer occurrence is characterized globally by profound socioeconomic differences. Occupation is a fundamental component of socioeconomic status. In this review, we discuss the role of occupation as a determinant of cancer disparities. First, we address the issue of participation in cancer screening programs based on income, health insurance, occupational status and job title. Second, we review the role of occupation in contributing to disparities by acting as a mediator between cancer and (i) education and (ii) race/ethnicity. Lastly, we analyze data from a multicenter case−control study of lung cancer to calculate the mediating role of occupational exposure to diesel exhaust, silica and welding fumes in the association between education and lung cancer. By addressing the complex paths from occupation to cancer inequalities from multiple points of view, we provide evidence that occupational-related characteristics, such as income, health insurance, unemployment and hazardous exposures impinge on cancer control and outcomes. The increasing awareness of these aspects is fundamental and should lead to public health interventions to avoid inequalities rising from occupational factors. [ABSTRACT FROM AUTHOR]

In many countries around the world, demographic and civilization changes have brought about the phenomenon of aging societies. This phenomenon affects the economy, especially the pension and health care systems, causing difficulties in their financing. The implementation of a policy that would effectively manage the problem of the longevity risk is thus required. Using housing resources and private health insurance to improve retirees' living standards may serve this purpose. The instruments we propose comprise two variants of contracts: the first for a marriage, the second for an individual client. We analysed the cash flow in both the cases. The results suggest that the amount of cash flows related to reverse equity and dread disease insurance benefits depends on the spouse's economic status, age, and health conditions. The benefits of the two variants of the contract vary. This paper examines numerous strategies for selecting the type of the contract, taking into consideration the abovementioned factors. [ABSTRACT FROM AUTHOR]

Simple Summary: Breast cancer is a leading cause of death in women in the United States. However, there exist inequalities in outcomes of breast cancer and medically underserved populations by race, insurance status, educational background, and geography. Here, we present efforts by the Siteman Cancer Center to address disparities over the past 15+ years. As an academic center, we have partnered with community organizations to help support patients and reduce barriers to receiving care. We also ran a mobile van to offer mammograms to women living in both urban and rural areas of Missouri. These efforts resulted in earlier detection of breast cancer and increased use of mammograms. The mammography van managed to reach mostly poor, uninsured, or underinsured women with limited educational backgrounds. This work demonstrates the potential for collaborations between academic and community partners to improve community health outcomes. Community-based participatory strategies are a promising approach to addressing disparities in community health outcomes. This paper details the efforts of Siteman Cancer Center to achieve breast health equity over the past 15+ years. We begin by describing the activities and successes arising from our breast health community partnerships including identifying priorities, developing recommendations, and implementing patient navigation services to advance breast health. This system-wide coordinated navigation approach that includes primary and specialty care providers helped to increase potential impact on reducing breast health disparities by expediting care, increasing care efficiency, and standardizing referral procedures across systems for all women including those who are uninsured and underinsured. We also discuss a mobile mammography unit that has been deployed to serve women living in both urban and rural regions. The van reached a particularly vulnerable population that was mostly poor, uninsured, and with limited educational backgrounds regardless of their zip code of service. This work shows that collaborations between academic and community partners have resulted in decreased late stage at diagnosis and improved access to mammography. Furthermore, we offer lessons learned and recommendations that may be applicable to other communities. [ABSTRACT FROM AUTHOR]

Rapidly rising medical expenses can be controlled by a well-designed medical insurance payment system with the ability to ensure the stability and development of medical insurance funds. At present, China is in the stage of exploring the reform of the medical insurance payment system. One of the significant tasks is to establish an appropriate reimbursement model for disease treatment expenses, so as to meet the needs of patients for medical services. In this paper, we propose a case-mixed decision tree method that considers the homogeneity within the same case subgroup as well as the heterogeneity between different case subgroups. The optimal case mix is determined by maximizing the inter-group difference and minimizing the intra-group difference. In order to handle the instability of the tree-based method with a small amount of data, we propose a multi-model ensemble decision tree method. This method first extracts and merges the inherent rules of the data by the stacking-based ensemble learning method, then generates a new sample set by aggregating the original data with the additional samples obtained by applying these rules, and finally trains the case-mix decision tree with the augmented dataset. The proposed method ensures the interpretability of the grouping rules and the stability of the grouping at the same time. The experimental results on real-world data demonstrate that our case-mix method can provide reasonable medical insurance payment standards and the appropriate medical insurance compensation payment for different patient groups. [ABSTRACT FROM AUTHOR]

Social accountability is an important strategy towards ensuring that political leaders and actors implement the right policies in the interest of the entire society. In 2007, a community-based health insurance programme was implemented in selected rural communities in Kwara State, Nigeria, through collaboration between the Dutch Health Insurance Fund, PharmAccess Foundation, the Kwara State Government, and Hygeia Nigeria Limited to provide access to basic healthcare for the people. After operating for 9 years, the programme stopped in 2016. This paper describes how social and political accountability shaped the introduction, functioning, and stoppage of the CBHI programme. The study adopted a qualitative approach for data collection, particularly in-depth (n = 22) and key informant interviews (n = 32). Findings indicate that the community-based health insurance programme was proposed by the foreign agency and that the state government was instrumental in the stoppage of the programme. Also, the change in government (via voting against a political bloc that had been in power since 2003) in Kwara State during the 2019 general elections was among the accountability measures employed by the citizenry in reaction to the stoppage of the Community-Based Health Insurance programme. The implication of this is that the current government, expectedly, will not only draw up a more robust healthcare policy for implementation but will also ensure that the people are carried along through adequate social and political accountability mechanisms. [ABSTRACT FROM AUTHOR]

This paper presents a method for estimating the average treatment effects (ATE) of an exponential endogenous switching model where the coefficients of covariates in the structural equation are random and correlated with the binary treatment variable. The estimating equations are derived under some mild identifying assumptions. We find that the ATE is identified, although each coefficient in the structural model may not be. Tests assessing the endogeneity of treatment and for model selection are provided. Monte Carlo simulations show that, in large samples, the proposed estimator has a smaller bias and a larger variance than the methods that do not take the random coefficients into account. This is applied to health insurance data of Oregon. [ABSTRACT FROM AUTHOR]

To enhance the vaccination rate of adolescents against HPV, understanding their current vaccination intentions and identifying the factors that influence their decision to vaccinate are imperative. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to search for relative literature. Five electronic databases (CINAHL, PubMed, Web of science, Research Information Sharing Service (RISS) and Korea Citation Index (KCI)) were searched from 2007 to 2022, and 19 studies were selected for final review. The Mixed Methods Assessment Tool (MMAT) was used as a critical appraisal tool to evaluate the quality for various types of research designs. This integrative review revealed three themes, including facilitators (personal characteristics and environmental factors), barriers (lack of awareness and knowledge about HPV, concerns about side effects, and the burden of costs), and ways to increase vaccination uptake (knowledge promotion and HPV vaccines coverage by public insurance). To encourage HPV vaccine uptake, it is essential to enhance public knowledge, create compelling advertisements, and ensure that the vaccines are covered by public insurance. Moreover, providing educational programs that emphasize the effectiveness and significance of HPV vaccines to adults who can influence the vaccination decisions of adolescents is vital. [ABSTRACT FROM AUTHOR]

The paper presents a novel methodology based on machine learning to optimize medical benefits in healthcare settings, i.e., corporate, private, public or statutory. The optimization is applied to design healthcare insurance packages based on the employee healthcare record. Moreover, with the advancement in the insurance industry, it is rapidly adapting mathematical and machine learning models to enhance insurance services like funds prediction, customer management and get better revenue from their businesses. However, conventional computing insurance packages and premium methods are time-consuming, designation specific, and not cost-effective. During the design of insurance packages, an employee's needs should be given more importance than his/her designation or position in an organization. The design of insurance packages in healthcare is a non-trivial task due to the employees' changing healthcare needs; therefore, using the proposed technique employees can be moved from their existing package to another depending upon his/her need. This provides the motivation to propose a methodology in which we applied machine learning concepts for designing need-based health insurance packages rather than professional tagging. By the design of need-based packages, medical benefit optimization which is the core goal of our proposed methodology is effectively achieved. Our proposed methodology derives insurance packages that are need-based and optimal based on our defined criteria. We achieved this by first applying the clustering technique to historical medical records. Subsequently, medical benefit optimization is achieved from these packages by applying a probability distribution model on five years employees' insurance records. The designed technique is validated on real employees' insurance records from a large enterprise.The proposed design provides 25% optimization on medical benefit amount compared to current medical benefits amount therefore, gives better healthcare to all the employees. [ABSTRACT FROM AUTHOR]

The paper describes the medical data personalization problem by determining the individual characteristics needed to predict the number of days a patient spends in a hospital. The mathematical problem of patient information analysis is formalized, which will help identify critical personal characteristics based on conditioned space analysis. The condition space is given in cube form as a reflection of the functional relationship of the general parameters to the studied object. The dataset consists of 51 instances, and ten parameters are processed using different clustering and regression models. Days in hospital is the target variable. A condition space cube is formed based on clustering analysis and features selection. In this manner, a hierarchical predictor based on clustering and an ensemble of weak regressors is built. The quality of the developed hierarchical predictor for Root Mean Squared Error metric is 1.47 times better than the best weak predictor (perceptron with 12 units in a single hidden layer). [ABSTRACT FROM AUTHOR]

Over the past few decades, healthcare expenditures in the United States have increased due to a variety of different factors. Depending on their insurance plans, Americans have varying levels of health insurance coverage and may need to make co-payments or pay fully for specific health services. According to multiple studies, health insurance does appear to increase the utilization of healthcare services, except emergency services. Demographic factors such as age, citizenship, and race/ethnicity, as well as the type of health service demanded, all appear to influence the consumption of healthcare in the United States. However, many existing studies conducted in this area are not experimental or randomized, which may result in a lack of validity of the estimated relationship between insurance and healthcare utilization due to confounding variables. A new experimental study, similar to the RAND HIE study, is needed to provide insight into the current relationships between insurance and healthcare utilization, taking into consideration changes in legislation. [ABSTRACT FROM AUTHOR]

Background/Objectives: In 2022, 17.3% of US households with children experienced food insecurity (FI). The objective of this study was to examine pediatric clinicians' FI screening and management immediately following the release of the American Academy of Pediatrics (AAP) 2015 FI Policy Statement. Methods: Data were collected in 2016 from 85 primary care pediatric clinicians via an online survey of clinicians in the Washington, DC metropolitan area. Descriptive statistics were calculated using univariate/bivariate analyses. Fisher's exact test and Chi-square tests were used to explore the association between FI screening, health insurance, and clinician demographics. Results: Sixty-six percent of clinicians indicated that they infrequently screened for FI. Only 13% of clinicians used a standardized FI screening tool. Forty-five percent of clinicians screened for FI only when they perceived an acute concern. About 70% of them screened for FI when a patient presented with poor weight gain or was underweight. Conclusions: Immediately after the release of the AAP Policy Statement, it was found that few pediatric clinicians appropriately and frequently screened for FI in our regional sample. Our data emphasize the common misconceptions held by clinicians around FI and the necessity to incorporate training that underscores the invisibility of FI along with effective techniques to screen and intervene. [ABSTRACT FROM AUTHOR]

In the aftermath of the COVID-19 pandemic, people are gradually realizing that urban community resilience is pivotal for effectively managing public health emergencies. This study employed grounded theory to establish a theoretical framework for epidemic resilience of urban communities (ERUC) in the post-pandemic era. Subsequently, the decision-making trial and evaluation laboratory (DEMATEL)-interpretive structural modeling (ISM) method is utilized to discern the significance and hierarchical interrelations among influencing factors. The findings delineate that 14 determinants shaping ERUC are organized into five distinct tiers. Notably, nine determinants emerge as principal: vulnerable group; educational attainment; risk perception; medical insurance coverage; communal norms; community emergency response; community services; resident participation; and government efficacy. Among these, the vulnerable group and government efficiency are identified as foundational factors, while medical insurance coverage, resident participation, and community infrastructure are identified as direct influences. [ABSTRACT FROM AUTHOR]

Background: The disparities in healthcare access due to varying insurance coverage significantly impact hospital outcomes, yet what is unclear is the role of insurance in providing care once the patient is in the hospital for a preventable admission, particularly in a weak gatekeeping environment. This study aimed to investigate the association between insurance types and readmission rates, healthcare expenditures, and length of hospital stay among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Methods: This retrospective observational study utilized hospitalization data collected from the Nanhai District, Foshan City, between 2016 and 2020. Generalized linear models (GLMs) were employed to analyze the relationship between medical insurance types and readmission rates, lengths of hospital stay, total medical expenses, out-of-pocket expenses, and insurance-covered expenses. Results: A total of 185,384 records were included. Among these, the participants covered by urban employee basic medical insurance (UEBMI) with 44,415 records and urban and rural resident basic medical insurance (URRBMI) with 80,752 records generally experienced more favorable outcomes compared to self-pay patients. Specifically, they had lower readmission rates (OR = 0.57, 95% CI: 0.36 to 0.90; OR = 0.59, 95% CI: 0.42 to 0.84) and reduced out-of-pocket expenses (β = −0.54, 95% CI: −0.94 to −0.14; β = −0.41, 95% CI: −0.78 to −0.05). However, they also experienced slightly longer lengths of hospital stay (IRR = 1.08, 95% CI: 1.03 to 1.14; IRR = 1.11, 95% CI: 1.04 to 1.18) and higher total medical expenses (β = 0.26, 95% CI: 0.09 to 0.44; β = 0.25, 95% CI: 0.10 to 0.40). Conclusions: This study found that different types of health insurance were associated with varying clinical outcomes among patients with chronic ambulatory care sensitive conditions (ACSCs) in China. Since the hospitalization of these patients was initially avoidable, disparities in readmission rates, lengths of hospital stay, and medical expenses among avoidable inpatient cases exacerbated the health gap between different insurance types. Addressing the disparities among different types of insurance can help reduce unplanned hospitalizations and promote health equity. [ABSTRACT FROM AUTHOR]

Background: Mental and behavioral disorders significantly impair psychophysical functioning, leading to challenges in daily activities. The increasing recognition of the importance of mental health in global development goals has resulted in its inclusion in the United Nations' Sustainable Development Goals. The burden of mental disorders has grown worldwide due to demographic changes, with substantial economic and social impacts. Objective: This study aimed to examine the indirect costs of mental disorders in Poland by analyzing the expenditures by the Social Insurance Institution (ZUS) on work incapacity benefits and disability pensions from 2012 to 2023. The goal was to identify trends, dependencies, and the economic impact of policy changes. Material and Methods: Data were collected from ZUS reports on annual expenditures for work incapacity benefits and disability pensions. Advanced statistical methods, including linear regression and Pearson correlation, were employed to analyze trends and relationships. Student's t-tests assessed the statistical significance of the observed trends. Results: The expenditures on benefits for work incapacity due to mental disorders increased significantly over the past decade, particularly from 2020 to 2023, partly due to the COVID-19 pandemic. Short-term absenteeism due to mental disorders accounted for 10.5% of the total sick leave days. A strong positive correlation was found between years and benefit expenditures. Conversely, the disability pension expenditures exhibited a downward trend, potentially reflecting improvements in public health or policy changes. Conclusions: The significant increase in expenditures on benefits related to mental disorders may reflect greater awareness, improved diagnostics, and the impact of the COVID-19 pandemic. In contrast, the decline in disability pension expenditures could suggest improved mental health or effective policy measures. However, it is important to emphasize that the presented data are not the only factor influencing this situation. Multiple variables, including societal, economic, and healthcare system changes, contribute to these trends. Therefore, further research is necessary to fully understand the underlying causes and to guide effective policy development. Regular monitoring and continued investment in mental health are essential to managing indirect costs such as absenteeism and presenteeism efficiently. [ABSTRACT FROM AUTHOR]

This paper describes the present Japanese oral healthcare system and outlines the future challenges and perspectives for Japan. Japan has developed a system for providing high-quality and appropriate health care efficiently through a universal health insurance system which has been in operation since 1961. This health insurance covers most restorative, prosthetic and oral surgery treatment. Therefore, all people can receive dental treatment at a relatively low cost, with the same fees applying throughout the nation. In Japan, public oral health services are provided by the local governments according to the life stage of their populations. These services are mainly conducted by private dental practitioners under contracts with local governments. National oral health data shows that the oral health of the Japanese population has improved over the last several decades. Future challenges and perspectives for Japanese dentistry include: tackling the regional differences in oral health, decreasing the cost of health expenditure, establishment of sustainable emergency oral healthcare services in times of disaster, and the development a new tele-dental system for remote areas without access to dental professionals. [ABSTRACT FROM AUTHOR]

The relevance of critical illness coverage and life insurance in cause-specific mortality conditions is increasing in many industrialized countries. Specific conditions on the illness and on death event, providing cheapest premiums for the insureds and lower obligations for the insurers, constitute interesting products in an insurance market looking to offer appealing products. On the other hand, the systematic improvement in longevity gives rise to a market with agents getting increasingly older, and the insurer pays attention to this trend. There are financial contracts joined with insurance coverage, and this particularly happens in the case of the so-called insured loan. Insured loans are financial contracts often proposed together with a term life insurance in order to cover the lender and the heirs against the borrower's death event within the loan duration. This paper explores new insurance products that, linked to an insured loan, are founded on specific illness hypotheses and/or cause-specific mortality. The aim is to value how much the insurance costs lighten with respect to the traditional term insurance. The authors project cause-specific mortality rates and specific diagnosis rates, in this last case overcoming the discontinuities in the data. The new contractual schemes are priced. Numerical applications also show, with several graphs, the rates projection procedure and plenty of tables report the premiums in the new proposed contractual forms. The complete amortization schedule closes the work. [ABSTRACT FROM AUTHOR]

Introduction: Providing health insurance to the poor has become a standard policy response to health disparities between the poor and the non-poor. It is often assumed that if the poor people are given health insurance, they will use preventative care, which will prevent more expensive emergency visits and inpatient hospitalization, and in turn, it will save healthcare cost in the long run. This paper presents the findings from our study in California about what happens to the poor when they are given health insurance. The purpose of the study was to understand how the healthcare system in California treats the poor patients differently than the non-poor. Method: Using multivariate logistic regressions, this study analyzed a large patient discharge data (PDD) from the California Office of Statewide Planning and Development (OSHPD) for eight counties in the Central Valley California (N = 423,640). First, utilizing International Classification of Diseases (ICD 10) as diagnostic criteria, mental-health vs. non-mental health hospitalization rates were estimated. Second, health insurance status was used as a proxy measure of poverty of the patients. Using chi-Square, the probability of hospitalization for mental health services was estimated based on their insurance types. Finally, using step-wise logistic regression, the odds of mental health hospitalization was estimated conditional on individual characteristics, health insurance types, and geographic characteristics. Findings: When the poor people were given health insurance, they were three times more likely to be hospitalized for mental health services than the non-poor. The more than three-fold variation in mental health hospitalization was not driven by demographic or geographic characteristics. The findings are new and have important implications for the healthcare policies for the poor. Further studies are needed to understand the extent to which the disproportionately high rate of mental health hospitalizations of the poor are driven by the provider-induced needs. [ABSTRACT FROM AUTHOR]

Access to online medical records (OMRs) can help enhance cancer patient engagement and improve their health outcomes. This study investigates disparities in OMR access among cancer survivors and examines the association between OMR access and health perceptions. We conducted a cross-sectional analysis using data from the National Cancer Institute's Health Information National Trends Survey (HINTS) from 2017 to 2022. The sample included 4713 cancer survivors. We employed regression analysis to assess the associations between the different factors. Overall, 18.78% of participants accessed their OMRs once or twice, while 36.69% accessed them three times or more. Gender minority groups (β = −0.0038, p = 0.01), older adults (β = −0.1126, p < 0.001), and racial minority groups (β = −0.059, p < 0.001) were less likely to access their OMRs. Additionally, higher education levels (β = 0.274, p < 0.001), insurance coverage (β = 0.365, p < 0.001), and higher incomes (β = 0.115, p < 0.001) were associated with increased OMR access. Positive health perceptions were significantly associated with OMR usage, including perceived good health (β = 0.148, p < 0.001), quality of care (β = 0.15, p = 0.026), and self-efficacy (β = 0.178, p = 0.002). Disparities in OMR access among cancer survivors are influenced by socio-economic factors and health perceptions. Interventions targeting vulnerable groups, enhancing digital health literacy, and improving health perceptions could promote equitable OMR usage. [ABSTRACT FROM AUTHOR]

We explored the outcomes and challenges encountered during a 12-year collaborative development endeavor in Tanzania, focused on enhancing the healthcare system. The Health Promotion and System Strengthening (HPSS) project, supported by the Swiss Government and implemented by the Swiss Tropical and Public Health Institute (Swiss TPH) from 2011 to 2023, aimed to strengthen various aspects of Tanzania's healthcare landscape. This included reforms in health insurance through the improved Community Health Fund (iCHF), the establishment of a public–private partnership to optimize the health commodity supply chain via a Prime Vendor System (Jazia PVS), the implementation of health technology management innovations, and the facilitation of participatory community and school health promotion initiatives. Operating in a multisectoral, interdisciplinary, and systemic manner, the HPSS project employed a variety of interconnected strategies, focusing on key entry points within the Tanzanian health system, starting from district level to national policies. These efforts followed a three-stages approach to reach a sustainable adoption of the innovations, going through the process of service and product innovation, integration into service delivery systems, and finally their adoption in the respective institutional policies. Each stage presented distinct frameworks and challenges, detailed in this article. The development of innovative concepts was complemented by capacity building through on-the-job training, establishment of new accredited training programs for pre-service trainings, and the development of new IT systems integrated into the governmental IT environment, as well as efforts to improve transparency, accountability, and governance. Activities in these fields were guided by operational research, following the translational approach of Swiss TPH to go from innovation and validation to application. The example of the HPSS project highlights the cycle of developing and testing innovations at the community and district level, followed by endeavoring national-level integration and policy adjustments, consequently resulting in improved service delivery at the district and community level. [ABSTRACT FROM AUTHOR]

Background/Objectives: Benign paroxysmal positional vertigo (BPPV) is the most common cause of recurrent vertigo and the most common peripheral vestibular disorder. It is characterized by intense vertigo triggered by head and position changes. This study investigates the risk of subsequent injury in BPPV patients and the effects of treatment. Methods: A population-based retrospective cohort study was conducted using data from the Longitudinal Health Insurance Database 2005 in Taiwan. Patients with and without BPPV were identified between 2000 and 2017. The study outcomes were diagnoses of all-cause injuries. The Kaplan–Meier method determined the cumulative incidence rates of injury in both cohorts, and a log-rank test analyzed the differences. Cox proportional hazard models calculated each cohort's 18-year hazard ratios (HRs). Results: We enrolled 50,675 patients with newly diagnosed BPPV and 202,700 matched individuals without BPPV. During follow-up, 47,636 patients were diagnosed with injuries (13,215 from the BPPV cohort and 34,421 from the non-BPPV cohort). The adjusted HR for injury in BPPV patients was 2.63 (95% CI, 2.49–2.88). Subgroup analysis showed an increased incidence of unintentional and intentional injuries in BPPV patients (aHR 2.86; 95% CI, 2.70–3.13 and 1.10; 95% CI, 1.04–1.21, respectively). A positive dose–response relationship was observed with increasing BPPV diagnoses. Treatment with canalith repositioning therapy (CRT) or medications reduced the risk of injury slightly but not significantly (aHR, 0.78; 95% CI, 0.37–1.29, 0.88; 95% CI, 0.40–1.40, respectively). Conclusions: BPPV is independently associated with an increased risk of injuries. CRT or medications have limited effects on mitigating this risk. Physicians should advise BPPV patients to take precautions to prevent injuries even after treatment. [ABSTRACT FROM AUTHOR]

The optimal strategy for the microelimination of HCV within community settings remains ambiguous. We evaluated the percentage of participants who achieved linkage to care (LTC) following the conclusion of a screening campaign and examined the diverse factors influencing LTC among these individuals. The effectiveness of recall intervention for the non-LTC population and its barriers were analyzed. We initiated an HCV patient recall program to identify HCV participants who might not be treated after the HCV screening campaign. The program staff recalled HCV participants who were lost to follow-up via telephone from March 2019 to June 2019. They were informed of HCV treatment's importance, efficacy, availability, and safety. Among 185 participants infected with HCV, 109 (58.9%) obtained LTC. Compared with those who had LTC, those without LTC were older, had lower education levels, were less aware of their HCV infection, less frequently lived in urban areas, and had less health insurance. At the end of the recall program, 125 (67.6%) persons had linkage to care. The proportion of LTC increased by 8.7%. In total, 119 persons had an HCV RNA test, and 82 (68.9%) had viremia. Of the 82 patients with viremia, 78 (95.1%) received antiviral therapy, and 76 (97.4%) achieved a sustained virological response. After a community screening campaign, 59% of participants with anti-HCV-positive tests had LTC. The recall program increased this by 9%. However, 32% of HCV participants still could not be linked to care. Outreach care for non-LTC patients is a method worth trying in order to achieve the microelimination of HCV in rural communities. [ABSTRACT FROM AUTHOR]

The current research, guided by the intersectionality theory and the Institute of Medicine's healthcare access model, explored the determinants of preventive care utilization within the Asian American community. Analyzing data from the Asian American Quality of Life Survey (with a sample size of 2535), logistic regression models were employed, incorporating various factors: demographic variables, immigration-related variables, health and access, and patient–provider relationship. Results revealed that longer stays in the U.S., having health insurance coverage, having a usual source of care, and higher satisfaction levels with prior healthcare services were associated with increased odds of utilizing preventive healthcare. These findings contribute to our comprehension of preventive care utilization among Asian Americans and offer practical insights for targeted interventions in social work and public health and strategic healthcare planning. [ABSTRACT FROM AUTHOR]

Under the backdrop of global aging, the escalating number of elderly individuals in poor health poses a growing social burden and impacts economic development and social stability. A fundamental question arises as to whether the advancements of digital finance (DF) can effectively enhance the physical health of the elderly. This study aims to investigate the impact of DF on the physical health of the elderly by utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) conducted in 2013, 2015, and 2018. The results reveal a significant positive impact of DF on enhancing the physical health of the elderly. Furthermore, the study demonstrates that this impact is particularly pronounced among the elderly with higher educational attainment, stronger intergenerational links, and those residing in central cities. A mechanism analysis further reveals that DF contributes to improving the physical health of the elderly by augmenting household disposable income, alleviating liquidity constraints, and enhancing the utilization of medical services. These findings offer valuable insights for the future development of DF and the implementation of policies promoting healthy aging and active aging. [ABSTRACT FROM AUTHOR]

Strokes remain a leading cause of death and disability worldwide. The STROKE OWL study evaluated a novel case management approach for patients with stroke (modified Rankin Scale 0–4) or transient ischemic attack (TIA) who received support across healthcare settings and secondary prevention training from case managers for one year. The primary aim of this quasi-experimental study was a reduction in stroke recurrence. Here, we report the results of a health economic analysis of the STROKE OWL study, conducted in accordance with CHEERS guidelines. The calculations were based on claims data of cooperating statutory health insurance companies. In addition to a regression analysis for cost comparison, the incremental cost-effectiveness ratio was determined, and a probabilistic sensitivity analysis was carried out. In total, 1167 patients per group were included in the analysis. The intervention group incurred 32.3% higher direct costs (p < 0.001) than the control group. With a difference of EUR 1384.78 (95% CI: [1.2384–1.4143], p < 0.0001) and a 5.32% increase in hazards for the intervention group (HR = 1.0532, 95% CI: [0.7869–1.4096], p = 0.7274) resulting in an ICER of EUR 260.30, we found that the case management intervention dominated in the total stroke population, even for an arbitrarily high willingness to pay. In the TIA subgroup, however, the intervention was cost-effective even for a low willingness to pay. Our results are limited by small samples for both TIA and severe stroke patients and by claims data heterogeneity for some cost components, which had to be excluded from the analysis. Future research should investigate the cost-effectiveness of case management interventions for both severe stroke and TIA populations using appropriate data. [ABSTRACT FROM AUTHOR]

The purpose of this study was to explore the determinants of risk literacy among university students in the United States by utilizing the Berlin Numeracy Test. Risk literacy skills are essential for decision-making and communication of risks, but few studies consider university students. This study aims to evaluate the association of sociodemographic factors with individual risk literacy levels. An observational cross-sectional survey study was used with a convenience sample of 184 undergraduate and graduate university students. Statistical analysis revealed significant differences for demographics at risk for negative outcomes associated with lower risk literacy. For this group of students, the majority had below-average numeracy. These findings can guide healthcare professionals to focus on college-age individuals with low-risk literacy scores to enhance patient understanding, facilitate communication, and promote healthier behaviors. [ABSTRACT FROM AUTHOR]

Medicare is one of the largest federal social insurance programs in the United States and the secondary payer for Medicare beneficiaries covered by employer-provided health insurance (EPHI). However, an increasing number of individuals are delaying their Medicare enrollment when they first become eligible at age 65. Using administrative data from the Medicare Current Beneficiary Survey (MCBS), this paper estimates the effects of EPHI, employment, and delays in Medicare enrollment on Medicare costs. Given the administrative nature of the data, we are able to disentangle and estimate the Medicare as secondary payer (MSP) effect and the work effects on Medicare costs, as well as to construct delay enrollment indicators. Using Heckman's sample selection model, we estimate that MSP and being employed are associated with a lower probability of observing positive Medicare spending and a lower level of Medicare spending. This paper quantifies annual savings of $5.37 billion from MSP and being employed. Delays in Medicare enrollment generate additional annual savings of $10.17 billion. Owing to the links between employment, health insurance coverage, and Medicare costs presented in this research, our findings may be of interest to policy makers who should take into account the consequences of reforms on the Medicare system. [ABSTRACT FROM AUTHOR]

(1) Background: Social isolation, which has numerous adverse effects on health status, is prevalent among cancer patients. This review proposes to identify the influencing factors of social isolation among cancer patients. (2) Methods: Articles published in English or Chinese from six electronic databases before December 2023 were identified via a systematic search. A manual search was also performed. (3) Results: Twenty-eight studies were identified in this systematic review. The factors associated with social isolation can be summarized into the following categories: demographic characteristics, having cancer, health status, coping, social support and social interaction. Despite the heterogeneity, 20 factors were significantly associated with social isolation, including age, gender, comorbidity burden, education level, residence, medical insurance, occupation status, personality, race, smoking status, having children, not living alone, household income level, marital status, the role of primary caregiver, physical health status, mental health status, social health status, coping styles, and the level of social support and social interaction. (4) Conclusions: The systematic review showed that cancer patients' social isolation was influenced by their demographic characteristics, cancer-related factors, physical condition, psychological status, social health status, coping styles, and level of social support and social interaction. In addition, future group intervention could be considered to improve social isolation. [ABSTRACT FROM AUTHOR]

Investigating the factors that influence individual decisions to participate in social health insurance is an essential component of constructing a multi-tiered, comprehensive social health insurance system, and religious beliefs may constitute an important potential factor. Utilising data from the China General Social Survey (CGSS), this study has developed a comprehensive explanatory framework encompassing both macro- and micro-level analyses to ascertain the impact of religious beliefs on individual decisions to participate in social health insurance through quantitative methods. The findings indicate that religious beliefs significantly diminish the likelihood of individuals participating in social health insurance, and the influence varies among different types of religions; endogeneity and robustness tests offer robust support for these conclusions. With respect to heterogeneity, the influence of religious beliefs on the decision to participate in social health insurance exhibits differentiation across dimensions such as educational attainment, social trust levels, income levels, and self-rated health statuses. Furthermore, the social interaction effect and the employment opportunity effect are identified as potential mechanisms driving this influence. [ABSTRACT FROM AUTHOR]

Background and Objective: The aim of this study was to analyze trends in surgical and non-surgical service utilization for common shoulder disorders in Korea from 2010 to 2019. Methods and Materials: This retrospective, cross-sectional, descriptive study utilized National Patient Sample data from the Health Insurance and Review Assessment Service (HIRA) of Korea. These data constitute a 2% sample out of the entire Korean population and include data for a variety of parameters instrumental for health care research. Patients with at least one medical service use for rotator cuff syndrome or tear, impingement syndrome, or adhesive capsulitis between January 2010 and December 2019 were included. Trends in healthcare utilization by disorder type, patient demographics, seasonal service use, and treatment details were examined. Results: There was an upward trend in the total number of patients and costs for shoulder disorders, from 35,798 patients and USD 5,485,196 in 2010 to 42,558 and USD 11,522,543 in 2019, respectively. The number of patients aged ≥60 and hospital visits increased. March had the highest number of claims. Physical therapy was the most common non-surgical procedure, while nerve block claims more than doubled. Opioid prescription rates also tripled. Surgical treatments were dominated by shoulder rotator cuff repair and acromioplasty. Conclusions: There was a significant increase in healthcare utilization for shoulder disorders, marked by rising costs and patient numbers. The use of nerve blocks and opioids notably increased. These data are valuable for clinicians, researchers, and policymakers. [ABSTRACT FROM AUTHOR]

Background and Objectives: Few studies have investigated the socioeconomic factors associated with retear after rotator cuff repair. This study aimed to identify the risk factors, including socioeconomic factors, for rotator cuff retear in patients who underwent arthroscopic rotator cuff repair. Materials and Methods: This retrospective study included 723 patients diagnosed with full-thickness rotator cuff tears who underwent arthroscopic rotator cuff repair from March 2010 to March 2021. The outcome variable was rotator cuff retear observed on postoperative magnetic resonance imaging or ultrasonography. Sex, age, obesity, diabetes, symptom duration, and tear size were the independent variables. Socioeconomic variables included occupation, educational level, type of medical insurance, and area of residence. We compared patients with and without retear and estimated the effects of the independent factors on retear risk. Results: The mean age of the patients, symptom duration, and tear size were 62.4 ± 8.0 years, 1.8 ± 1.7 years, and 21.8 ± 12.5 mm, respectively. The age, type of medical insurance, diabetes, tear size, and symptom duration differed significantly between patients with and without retearing (p < 0.05). Age, occupation, type of medical insurance, diabetes, initial tear size, and symptom duration significantly affected the risk of retear. Patients who performed manual labor had a significantly higher retear rate (p = 0.005; OR, 1.95; 95% CI, 1.23–3.11). The highest retear risk was seen in patients with Medicaid insurance (p < 0.001; OR, 4.34; 95% CI, 2.09–9.02). Conclusions: Age, initial tear size, and symptom duration significantly affect retear risk after arthroscopic rotator cuff repair. Occupation and type of medical insurance were also risk factors for retear. Socioeconomically vulnerable patients may be at a greater risk of retear. Proactive efforts are required to expand early access to medical care. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is a leading cause of global mortality. While recent reports suggest potential connections between CKD and chronic rhinosinusitis (CRS), further research is needed to elucidate the direct association between CKD and CRS. This study investigated the association between CKD and CRS using data from the Korean National Health Insurance Service Health Screening Cohort. Participants were recruited according to medical claim codes, and individuals with CKD were matched in a 1:4 ratio with the control group. Covariates, such as demographics, health-related data, and medical history were used. The incidence rates and hazard ratio of CRS were analyzed. A further analysis was performed based on the presence of nasal polyps. Among the 514,866 participants, 16,644 patients with CKD and 66,576 matched controls were included in the analysis. The CKD group demonstrated a higher incidence of CRS than the controls: 18.30 versus 13.10 per 10,000 person-years. The CKD group demonstrated a higher risk of CRS than the control group (1.28 adjusted hazard ratio). In additional analyses, the CKD group did not exhibit a statistically significant correlation for the development of CRS with nasal polyps. This study suggests that CKD is associated with an increased risk for CRS. [ABSTRACT FROM AUTHOR]

We propose a method for fitting transition intensities to a sufficiently large set of trajectories of a continuous-time non-homogeneous Markov chain with a finite state space. Starting with simulated data computed with Gompertz–Makeham transition intensities, we apply the proposed method to fit piecewise linear intensities and then compare the transition probabilities corresponding to both the Gompertz–Makeham transition intensities and the fitted piecewise linear intensities; the main comparison result is that the order of magnitude of the average fitting error per unit time—chosen as a year—is always less than 1%, thus validating the methodology proposed. [ABSTRACT FROM AUTHOR]

In recent years, the number of fraud cases in basic medical insurance has increased dramatically. We need to use a more efficient method to identify the fraudulent users. Therefore, we deploy the cloud edge algorithm with lower latency to improve the security and enforceability in the operation process. In this paper, a new feature extraction method and model fusion technology are proposed to solve the problem of basic medical insurance fraud identification. The feature second-level extraction algorithm proposed in this paper can effectively extract important features and improve the prediction accuracy of subsequent algorithms. In order to solve the problem of unbalanced simulation allocation in the medical insurance fraud identification scenario, a sample division method based on the idea of sample proportion equilibrium is proposed. Based on the above methods of feature extraction and sample division, a new training and fitting model fusion algorithm (tree hybrid bagging, THBagging) is proposed. This method makes full use of the balanced idea of the tree model algorithm based on Boosting to fuse, and finally achieves the effect of improving the accuracy of basic medical insurance fraud identification. [ABSTRACT FROM AUTHOR]

(1) Background: Linear immunoglobulin A bullous dermatosis (LABD) is a rare autoimmune, subepidermal blistering disease, characterized by linear IgA deposits along the epidermal basement membrane. LABD is idiopathic and is associated with medication and systemic autoimmune diseases. (2) Methods: We investigated the demographic characteristics, disease course, causative agents, and associated diseases in Korean patients with LABD. The Korean Health Insurance Review and Assessment Service database was used to obtain data. We identified 670 LABD cases between 2010 and 2022. (3) Results: The annual incidence of LABD was 1.3 per 100,000 persons, with a higher prevalence in individuals ≥60 years old. The patients were treated with dapsone for 30.7 ± 56.7 days, had 1.3 ± 0.7 hospital visits, and were hospitalized for 19.8 ± 19.7 days. Risk factors, including malignancy, commonly preceded LABD. Antibiotic use, specifically vancomycin and third-generation cephalosporins, was a risk factor. The mean age of LABD diagnosis was 55.9 ± 21.7 years. (4) Conclusion: This is the first published study to assess a nationwide cohort for LABD. The incidence of LABD was higher than that in other studies. Most case reports have linked LABD with the administration of specific antibiotics; however, this study shows there were more associations with other conditions. [ABSTRACT FROM AUTHOR]

Background and Objectives: Soft tissue sarcomas represent a heterogeneous group of malignant mesenchymal tissues. Despite their low prevalence, soft tissue sarcomas present clinical challenges for orthopedic surgeons owing to their aggressive nature, and perioperative wound infections. However, the low prevalence of soft tissue sarcomas has hindered the availability of large-scale studies. This study aimed to analyze wound infections after wide resection in patients with soft tissue sarcomas by employing big data analytics from the Hub of the Health Insurance Review and Assessment Service (HIRA). Materials and Methods: Patients who underwent wide excision of soft tissue sarcomas between 2010 and 2021 were included. Data were collected from the HIRA database of approximately 50 million individuals' information in the Republic of Korea. The data collected included demographic information, diagnoses, prescribed medications, and surgical procedures. Random forest has been used to analyze the major associated determinants. A total of 10,906 observations with complete data were divided into training and validation sets in an 80:20 ratio (8773 vs. 2193 cases). Random forest permutation importance was employed to identify the major predictors of infection and Shapley Additive Explanations (SHAP) values were derived to analyze the directions of associations with predictors. Results: A total of 10,969 patients who underwent wide excision of soft tissue sarcomas were included. Among the study population, 886 (8.08%) patients had post-operative infections requiring surgery. The overall transfusion rate for wide excision was 20.67% (2267 patients). Risk factors among the comorbidities of each patient with wound infection were analyzed and dependence plots of individual features were visualized. The transfusion dependence plot reveals a distinctive pattern, with SHAP values displaying a negative trend for individuals without blood transfusions and a positive trend for those who received blood transfusions, emphasizing the substantial impact of blood transfusions on the likelihood of wound infection. Conclusions: Using the machine learning random forest model and the SHAP values, the perioperative transfusion, male sex, old age, and low SES were important features of wound infection in soft-tissue sarcoma patients. [ABSTRACT FROM AUTHOR]

The existing literature has considered accountable care organizations (ACOs) as whole entities, neglecting potentially important variations in the characteristics and experiences of the individual practice sites that comprise them. In this observational cross-sectional study, our aim is to characterize the experience, capacity, and process heterogeneity at the practice site level within and between Medicaid ACOs, drawing on the Massachusetts Medicaid and Children's Health Insurance Program (MassHealth), which launched an ACO reform effort in 2018. We used a 2019 survey of a representative sample of administrators from practice sites participating in Medicaid ACOs in Massachusetts (n = 225). We quantified the clustering of responses by practice site within all 17 Medicaid ACOs in Massachusetts for measures of process change, previous experience with alternative payment models, and changes in the practices' ability to deliver high-quality care. Using multilevel logistic models, we calculated median odds ratios (MORs) and intraclass correlation coefficients (ICCs) to quantify the variation within and between ACOs for each measure. We found greater heterogeneity within the ACOs than between them for all measures, regardless of practice site and ACO characteristics (all ICCs ≤ 0.26). Our research indicates diverse experience with, and capacity for, implementing ACO initiatives across practice sites in Medicaid ACOs. Future research and program design should account for characteristics of practice sites within ACOs. [ABSTRACT FROM AUTHOR]

This article studies the differences in the correlation between deaths and the Hispanic share for different Hispanic subgroups in New York City. Such differences are predicted by Segmented Assimilation Theory as different assimilation paths. The study is carried out at the level of PUMAs, and it is argued that such geographic locations are macro-level factors that determine health outcomes, as the theory of Racialized Place Inequality Framework claims. The study presents a spatially correlated model that allows to decompose the spatial effects into direct and indirect effects. Direct effects are linked to the macro structure where the individual lives, while indirect effects refer to effects in the adjacent macro structures where the individual lives. The results show that both types of effects are significant. The importance of the direct effects is predicted by RPIF, while the importance of the indirect effects is a new result that shows the complexity of the effects of macro structures. The article also shows results for subsamples that allow to test the importance of different factors that have been linked to the excess deaths observed among Hispanics. The effects of such factors are also found to be heterogenous among the different Hispanic subgroups, which also provides evidence in favor of the Segmented Assimilation Theory. Access to health insurance and doctor density are found to be the most important elements that serve as protective factors for all Hispanic subgroups in New York City, signaling its importance in achieving assimilation for Hispanic immigrants to New York City. [ABSTRACT FROM AUTHOR]