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Whether for organic life or intelligent machines (robots, Actuators), skin plays an important role as a barrier and sensor, and a lot of research is centered on making multifunctional skins. Here, the authors report an electronic skin with high stretchability, excellent mechanical sensing, and biochemical detection capabilities obtained by combining photonic crystals and sponge‐like filled liquid metal (LM)–polyurethane (PU)–spidroin (SP) composite materials. Inspired by geckos and mussels, a micropillar array is designed and coated with polydopamine to synergistically improve adhesion. P(MMA‐BA) elastic copolymer nanoparticles (are assembled into a photonic crystal pattern to endow electronic skin biochemical detection capabilities. The regionalization of the photonic crystal pattern allows the electronic skin to detect multiple target compounds simultaneously. The base material is an LM–PU–SP composite material with excellent stretchability and pressure sensitivity and is used for motion monitoring and tactile sensing. It is envisioned that this multifunctional electronic skin can be attached to animal skins for health monitoring to facilitate the diagnosis of metabolic diseases and wound inflammation. Alternatively, electronic skins can be attached to robots and soft robots for the collection of samples from heavily polluted areas, to obtain real‐time feedback information during the collection process. [ABSTRACT FROM AUTHOR]

Objective: To examine private insurance coverage and its impact on use of Veterans Health Administration (VA) care among VA enrollees without Medicare coverage.Data Sources: The 1999 National Health Survey of Veteran Enrollees merged with VA administrative data, with other information drawn from American Hospital Association data and the Area Resource File.Study Design: We modeled VA enrollees' decision of having private insurance coverage and its impact on use of VA care controlling for sociodemographic information, patients' health status, VA priority status and access to VA and non-VA alternatives. We estimated the true impact of insurance on the use of VA care by teasing out potential selection bias. Bias came from two sources: a security selection effect (sicker enrollees purchase private insurance for extra security and use more VA and non-VA care) and a preference selection effect (VA enrollees who prefer non-VA care may purchase private insurance and use less VA care).Principal Findings: VA enrollees with private insurance coverage were less likely to use VA care. Security selection dominated preference selection and naïve models that did not control for selection effects consistently underestimated the insurance effect.Conclusions: Our results indicate that prior research, which has not controlled for insurance selection effects, may have underestimated the potential impact of any private insurance policy change, which may in turn affect VA enrollees' private insurance coverage and consequently their use of VA care. From the decline in private insurance coverage from 1999 to 2002, we projected an increase of 29,400 patients and 158 million dollars for VA health care services. [ABSTRACT FROM AUTHOR]

Objective. To investigate whether a performance-based contracting (PBC) system provides incentives for nonprofit providers of substance abuse treatment to select less severe clients into treatment. Data Sources. The Maine Addiction Treatment System (MATS) standardized admission and discharge data provided by the Maine Office of Substance Abuse (OSA) for fiscal years 1991–1995, provides demographic, substance abuse, and social functional information on clients of programs receiving public funding. Study Design. We focused on OSA clients (i.e., those patients whose treatment cost was covered by the funding from OSA) and Medicaid clients in outpatient programs. Clients were identified as being “most severe” or not. We compared the likelihood for OSA clients to be “most severe” before PBC and after PBC using Medicaid clients as the control. Multivariate regression analysis was employed to predict the marginal effect of PBC on the probability of OSA clients' being most severe after controlling for other factors. Principal Findings. The percentage of OSA outpatient clients classified as most severe users dropped by 7 percent (p<=0.001) after the innovation of performance-based contracting, compared to the increase of 2 percent for Medicaid clients. The regression results also showed that PBC had a significantly negative marginal effect on the probability of OSA clients being most severe. Conclusions. Performance-based contracting gave providers of substance abuse treatment financial incentives to treat less severe OSA clients in order to improve their performance outcomes. Fewer OSA clients with the greatest severity were treated in outpatient programs with the implementation of PBC. These results suggest that regulators, or payers, should evaluate programs comprehensively taking this type of selection behavior into consideration. [ABSTRACT FROM AUTHOR]

To mitigate selection triggered by capitation payments, risk-adjustment models bring capitation payments closer on average to individuals' expected expenditure. We examine the maximum potential profit that plans could hypothetically gain by using their own private information to select low-cost enrollees when payments are made using four commonly used risk adjustment models. Simulations using a privately insured sample suggest that risk selection profits remain substantial. The magnitude of potential profit varies according to the risk adjustment model and the private information plans can employ to identify profitable enrollees. [ABSTRACT FROM AUTHOR]