Complementary Health Insurance Research Articles

The French ecology of medical care. A nationwide population-based cross sectional study.

Studies in the United States, Canada, Belgium, and Switzerland showed that the majority of health problems are managed within primary health care; however, the ecology of French medical care has not yet been described. Nationwide, population-based, cross sectional study. In 2018, we included data from 576,125 beneficiaries from the General Sample of Beneficiaries database. We analysed the reimbursement of consultations with (i) a general practitioner (GP), (ii) an outpatient doctor other than a GP, (iii) a doctor from a university or non-university hospital; and the reimbursement of (iv) hospitalization in a private establishment, (v) general hospital, and (vi) university hospital. For each criterion, we calculated the average monthly number of reimbursements reported on 1,000 beneficiaries. For categorical variables, we used the χ2 test, and to compare means we used the z test. All tests were 2-tailed with a P-value < 5% considered significant. Each month, on average, 454 (out of 1,000) beneficiaries received at least 1 reimbursement, 235 consulted a GP, 74 consulted other outpatient doctors in ambulatory care and 24 in a hospital, 13 were hospitalized in a public non-university hospital and 10 in the private sector, and 5 were admitted to a university hospital. Independently of age, people consulted GPs twice as much as other specialists. The 13-25-year-old group consulted the least. Women consulted more than men. Individuals covered by complementary universal health insurance had more care. Our study on reimbursement data confirmed that, like in other countries, in France the majority of health problems are managed within primary health care.

Management of gynecological cancers in the emergency department: Impact of precariousness and prognostic factors

ObjectiveThe primary objective was to determine the profile of patients consulting in an emergency department and diagnosed with a pelvic cancer. Our secondary objective was to assess the potential impact on this diagnostic trajectory on survival. MethodA single-center retrospective study including patients managed for a pelvic cancer between January 2018 and November 2020 in the center Hospitalier Intercommunal de Creteil was conducted. Patients’ characteristics were compared based on their diagnostic trajectory (emergency or referred to consultation). Precariousness was assessed using Pascal's tool based on 4 characteristics: being a beneficiary of the former Couverture Maladie Universelle (CMU) or Aide Medicale d'Etat (AME), not having complementary health insurance, being job seeking for more than 6 months and being beneficiary of allowances. A patient was defined as precarious if the Pascal tool was ‘TRUE’, i.e., at least one positive item. The main socio-demographic and cancer associated factors were analyzed as prognostic factors. ResultsOver the inclusion period, among the 283 eligible patients, 37.3 % (87/233) had a diagnosis of cancer following an emergency department visit. There was a significant association between precariousness, rupture of gynecological follow-up, lack of participation in national screening campaigns and the risk of being diagnosed through the emergency pathway for all cancers studied (p = 0.001). There was no difference in terms of stage at diagnostic, management (according to current guidelines), prognostic and overall survival between the two groups. ConclusionPatients in a situation of precariousness are more likely to be diagnosed with cancer in an emergency department. Our study underlines the importance of precariousness as a factor determining the type of diagnostic management of gynecological cancer. Efforts should be made toward improving frail patients to primary care.

Hospitalization for physical child abuse: Associated medical factors and medical history since birth

BackgroundPhysical abuse often begins at a very young age and sometimes results in serious or fatal injuries. It is crucial to diagnose physical abuse as early as possible to protect this vulnerable population. ObjectiveTo study the factors associated with the first hospitalization for physical abuse from birth to the infant's first birthday in France. Participants and settingWe included all singleton children born in a hospital setting in France between 2009 and 2013, who were identified from the French national information system database (SNDS). MethodsTo study factors associated with the first hospitalization for physical abuse during the first year after birth, we used the Fine and Gray regression model. Factors included in the multivariate model were the infant's sex, prematurity, neonatal conditions, the number of hospitalizations (at least two), medical consultations and complementary universal health insurance (proxy for family precariousness and socio-economic vulnerability). ResultsOver the 2009–2013 period, among 3,432,921 newborn singletons, 903 (0.026 %) were hospitalized for physical abuse in the year following birth. Among the factors associated with physical abuse, such as prematurity (aHR = 2.2[1.8–2.7]), male sex (aHR = 1.3[1.2–1.5]), or having had at least two hospitalizations (aHR = 1.7[1.4–2.1]), we found that complementary universal health insurance coverage was the factor most associated (aHR = 4.1[3.5–4.7]) with being hospitalized for physical abuse. ConclusionThese findings could help introduce preventative measures for infant protection in certain groups, such as parents of infants born prematurely, especially if they are in a precarious situation. This study also suggests that particular attention should be paid to infants who have been hospitalized at least two times in the first year of life, whatever the reason.

Trajectories of Benzodiazepine Use among Older Adults from a Concordance-with-Guidelines Perspective: A Nationwide Cohort Study.

Benzodiazepines (including zolpidem and zopiclone) are often associated with higher-than-recommended intake and durations of use, especially in older adults. The objective of this study was to characterize trajectories of benzodiazepine use according to recommended patterns in older adults, and to assess predictors of the risk of developing each of these trajectories. Using the French Health Insurance database, we constituted a cohort of adults aged ≥65years who initiated benzodiazepines in 2007 and were followed for up to 8years. Concordance with benzodiazepine use guidelines was assessed on a quarterly basis according to a "concordance-with-guideline score" with values 1-5. Group-based trajectory modeling was then applied as implemented in the Proc Traj procedure in SAS to define guideline-concordant trajectories based on seven baseline patient-centered characteristics: sex, complementary health insurance coverage, treated alcohol and tobacco use disorder, polypharmacy, hospital stay, and registered chronic diseases. Among 5080 new users (64.1% women, median age 74years), six trajectories of benzodiazepine use were identified. Three, representing 70% of users, were concordant with guidelines, whereas three implied non-concordant benzodiazepine use for part or all of the benzodiazepine use follow-up. Polymedicated patients were more prone to develop chronic non-guideline-concordant initially guideline-concordant use, whereas those with a history of long-term disease and hospitalization were more likely to develop chronic non-guideline-concordant use. The number of prescribers during the first quarter, number of daily defined doses, use of loperamide, and use of psychostimulants were associated with a higher risk of developing an initial and persistent non-guideline-concordant use. Treatment initiation by a psychiatrist, initial use of World Health Organization (WHO) step-2 opioids and non-benzodiazepine anxiolytics or sedatives were associated with a higher risk of late non-guideline-concordant use. Concordance with guidelines varied over time during benzodiazepine use in older adults. A third of these adults will hypothetically follow one of the identified non-guideline-concordant trajectories, consisting of initial and/or late non-guideline concordance. This was associated with modifiable and nonmodifiable factors that clinicians should be aware of for tailoring the monitoring of patients.

On the determinants and the role of the payers in the uptake of genetic testing and data sharing in personalized health.

New health technologies and data offer tailored prevention and spot-on treatments, which can considerably reduce healthcare costs. In healthy individuals, insurers can participate in the creation of health capital through data and preventing the occurrence of a disease. In the onset of a disease, sequencing an individual's genome can provide information leading to the use of more efficient treatments. Both improvements are at the core of the "personalized health" paradigm. As a positive side effect, a reduction in healthcare costs is expected. However, the integration of personalized health in insurance schemes starts with a closer understanding of the demand drivers. Using novel data from a survey carried out in Switzerland, we determine the factors influencing the uptake and sharing of data from genetic tests. In our regression analyses, we use five sets of socioeconomic, lifestyle, health insurance, sentiment, and political beliefs variables. Furthermore, two framings assess the willingness to undertake a test and the readiness to share results with an insurer when the costs of the test are borne by the insurer or the individual. We find that socioeconomic, lifestyle, or political belief variables have very little influence on the uptake of tests and the sharing of data. On the contrary, our results indicate that sentiment and insurance factors play a strong role. More precisely, if genetic tests are perceived as a mean to perform health prevention, this pushes individuals to take them. Furthermore, using the insurer's smartphone app leads to an increase of the likelihood to undergo a test and doubles the probability to share related data. Regarding insurance plans and deductible levels, there is no strong correlation neither with the willingness to take a test nor to share the data. Finally, individuals with complementary health insurance plans are less likely to share results. From the framings for the payment of genetic tests, our results indicate a positive effect of the insurer as a payer on the willingness to undertake tests as well as on data sharing. Our results lay the ground for a deeper understanding of the role of payers on health decisions and sharing of health-related data. In particular, we find that it is relevant for health insurers to engage with their clients.

The Pass, a medical and social device for vulnerable people

The permanence of access to health care is a system that aims to facilitate access to ambulatory medical care for poor and vulnerable people who do not have social security or health insurance coverage, or who have incomplete social security coverage (neither mutual insurance, nor complementary health insurance from the primary health insurance fund). A health care team from the Ile-de-France region shares its know-how and expertise with the most disadvantaged.

Perception of discrimination against immigrants compared to Chilean-born and its relationship with access to services and health outcomes.

Compare self-perceived discrimination between immigrants and locals in Chile and analyze the relationship between immigration and perceived discrimination and immigration, discrimination and health outcomes, adjusting for sociodemographic characteristics and social capital. Cross-sectional study, using population-based survey (CASEN2017). We selected 2,409 immigrants (representative of N = 291,270) and 67,857 locals (representative of N = 5,438,036) over 18 years of age surveyed. We estimated logistic regression models, considering the complex sample, with discrimination, self-rated health, medical treatment, healthcare system membership, complementary health insurance, medical consultation and problems when consulting as dependent variables, immigration and discrimination as main exposure variables, and social capital and sociodemographic variables as covariates of the models. Immigrants were more likely to perceive discrimination in general compared to locals (OR = 2.31; 95%CI: 1.9-2.9). However, this does not occur for all specific reasons for discrimination; skin color and physical appearance were the most frequent causes of discrimination in immigrants. The interaction between immigration and discrimination was significantly related to worse self-rated health outcomes and treatment for pathologies, disfavoring discrimination against immigrants. In both locals and immigrants, discrimination was not associated with health care access outcomes, except for problems during consultation in locals (OR = 1.61; 95%CI 1.4-1.8). In Chile, experiences of discrimination are intertwined with other forms of rejection and social exclusion, so it is urgent to raise awareness among the population to prevent these discriminatory practices, especially in health care and daily use places. It is essential to address discrimination in order to have an impact on intermediate variables and health outcomes. The extension of the results to the entire immigrant population could be very useful to deepen the problem and improve the estimates made.

Criteria for the selection of complementary private health insurance: the experience of a large organisation in Iran

BackgroundExpenses related to employee’s health benefit packages are rising. Hence, organisations are looking for complementary health financing arrangements to provide more financial protection for employees. This study aims to develop criteria to choose the most appropriate complementary health insurance company based on the experience of a large organisation in Iran.MethodsThis study was conducted in 2021 in Iran, in the Foundation of Martyrs and Veterans Affairs to find as many applicable criteria as possible. To develop a comprehensive list of criteria, we used triangulation in data sources, including review of relevant national and international documents, in-depth interviews of key informants, focus group discussion, and examining similar but unpublished checklists used by other organisations in Iran. The list of criteria was prioritised during focus group discussions. We used the best-worst method as a multi-criteria decision making method and a qualitative consensus among the key informants to value the importance of each of the finalised criteria.FindingsOut of 85 criteria, we selected 28 criteria to choose an insurer for implementing complementary private health insurance. The finalised criteria were fell into six domains: (i) Previous experience of the applicants; (ii) Communication with clients; (iii) Financial status; (iv) Health care providers’ network; (v) Technical infrastructure and workforce; (vi) and Process of reviewing claims and reimbursement.ConclusionWe propose a quantitative decision-making checklist to choose the best complimentary private health insurance provider. We invite colleagues to utilise, adapt, modify, or develop these criteria to suit their organisational needs. This checklist can be applied in any low- and middle-income country where the industry of complementary health insurance is blooming.

Impact of the COVID-19 pandemic on non-COVID-19 hospital mortality in patients with schizophrenia: a nationwide population-based cohort study

It remains unknown to what degree resource prioritization toward SARS-CoV-2 (2019-nCoV) coronavirus (COVID-19) cases had disrupted usual acute care for non-COVID-19 patients, especially in the most vulnerable populations such as patients with schizophrenia. The objective was to establish whether the impact of the COVID-19 pandemic on non-COVID-19 hospital mortality and access to hospital care differed between patients with schizophrenia versus without severe mental disorder. We conducted a nationwide population-based cohort study of all non-COVID-19 acute hospitalizations in the pre-COVID-19 (March 1, 2019 through December 31, 2019) and COVID-19 (March 1, 2020 through December 31, 2020) periods in France. We divided the population into patients with schizophrenia and age/sex-matched patients without severe mental disorder (1:10). Using a difference-in-differences approach, we performed multivariate patient-level logistic regression models (adjusted odds ratio, aOR) with adjustment for complementary health insurance, smoking, alcohol and substance addiction, Charlson comorbidity score, origin of the patient, category of care, intensive care unit (ICU) care, major diagnosis groups and hospital characteristics. A total of 198,186 patients with schizophrenia were matched with 1,981,860 controls. The 90-day hospital mortality in patients with schizophrenia increased significantly more versus controls (aOR = 1.18; p < 0.001). This increased mortality was found for poisoning and injury (aOR = 1.26; p = 0.033), respiratory diseases (aOR = 1.19; p = 0.008) and for both surgery (aOR = 1.26; p = 0.008) and medical care settings (aOR = 1.16; p = 0.001). Significant changes in the case mix were noted with reduced admission in the ICU and for several somatic diseases including cancer, circulatory and digestive diseases and stroke for patients with schizophrenia compared to controls. These results suggest a greater deterioration in access to, effectiveness and safety of non-COVID-19 acute care in patients with schizophrenia compared to patients without severe mental disorders. These findings question hospitals’ resilience pertaining to patient safety and underline the importance of developing specific strategies for vulnerable patients in anticipation of future public health emergencies.

Identifying, Prioritizing, and Assessing Factors Influencing Customer Loyalty Covered by Supplemental Insurance

Background. Given that the market environment is becoming specialized in different sectors, it is necessary to identify specialized indicators of customer loyalty and their priority to improve the provision of complementary health insurance services. This study aimed to identify, prioritize, and measure the loyalty indicators in people covered by supplemental insurance. Methods. An exploratory study was conducted using a mixed-method approach (qualitative-quantitative). In the qualitative section, a total of 20 interviews was conducted with faculty members, managers, and experts of insurance companies in Khuzestan province (Ahvaz city of Iran), and in the quantitative section, a total of 380 interviews was conducted with staff of supplementary health insurance. In the qualitative section, the data were first extracted using scoping review methodology, then coded and classified using the data-driven method. Next, each indicator was prioritized using the fuzzy Analytical Hierarchy Process (AHP). Data were analyzed using Structural Equation Modeling (SEM) and Smart PLS software. Results. Thirty eight articles was included in the scoping review. After the semi-structured interview, five indicators were identified, including customer satisfaction, customer trust, repurchase intention, recommendation to others, and brand preference. In our study, customer satisfaction (0.269), repurchase intention (0.233), brand preference (0.196), customer trust (0.155), recommendation to others (0.147), respectively, had the greatest impact on customer loyalty. Conclusion. According to the results, customer satisfaction was the most important factor influencing loyalty. Therefore, the managers of insurance companies should pay more attention to increase insured individual satisfaction and improved customer loyalty in companies.

Why People Forgo Healthcare in France: A National Survey of 164 092 Individuals to Inform Healthcare Policy-Makers.

Even in countries having nearly universal healthcare provision some individuals forgo or postpone healthcare to which they are entitled. Socioeconomic and geographic inequalities can make access to healthcare difficult for some people, such that they fail to seek it, particularly if they deem the type of care as non-essential. The need to pay at the point of care, the complexity and cost of top-up health insurance, and delays or only partial reimbursement can discourage take-up of care. This can affect the general health of the population. To estimate the rate of forgoing healthcare in the general French population, between 2015 and 2018 we conducted a nationwide cross-sectional survey of individuals visiting French primary healthcare insurance agencies (Caisse Primaire d'Assurance Maladie, CPAM). We asked whether the person had foregone or postponed healthcare in the last 12 months, if so the types of healthcare forgone or put-off, and reasons. Individuals were stratified by the type of complementary (top-up) health insurance they had. Out of 164 092 individuals who responded, 158 032 were included in the analysis. Respondents had either private complementary (top-up) insurance (60%), top-up insurance subsidized by the state (29%), or no top-up health insurance (11%). Forgoers (n=40 115; 25.4%) most often lived alone (with or without children), were unemployed, and/ or female. Dental care (54%) and consultations with ophthalmologists, gynaecologists and dermatologists (41%) were most commonly forgone. The reasons were: inability to advance payment and/or to pay the uninsured part (69%), time constraints and difficulty in obtaining appointments (26%). We present a snapshot of forgoing healthcare in a developed country, highlighting the need for continuing review by policy-makers of payment regimens, insurance cover, availability and accessibility. While initiatives have already emerged from the results, further reforms are needed to address the problem of people forgoing preventative or perceived non-urgent healthcare, particularly for disadvantaged subgroups.

Healthcare Utilization and Expenditures among Iranian Chemical Warfare Survivors Exposed to Sulfur Mustard.

This study aims to explore the healthcare utilization (HCU) and expenditures from complementary health insurance among Iranian people who survived sulfur mustard (SM) exposure during the Iran-Iraq war. This study was conducted between March 21, 2018 and March 21, 2019 using secondary data. Data on the HCU and expenditure of war survivors after their exposure to SM were obtained from the Iran Veterans and Martyr Affair Foundation (VMAF) database and the national complementary insurance organization that covers their medical expenses. Multiple linear and zero-inflated poison regression (ZIP) models were used to estimate the costs and HCU. Analyses were performed in R software version 3.6.3. Among 58880 survivors who were included in study, 36383 (61.7%) used at least one service during a year. The total frequency of HCU was 15.6 services per person per year. The annual mean medical cost of each survivor was US$807.6 (±2901.2). The highest number of utilizations was related to medicine and physician visits. The highest median cost was related to rehabilitation (US$151.7), medical equipment (US$84.5), medicine (US$83.3) and inpatient services (US$ 48.8). With increasing age, disability, weight, severity of injury in lung or eye injuries, the rate of health service utilization rose significantly. Over 30 years after the Iran-Iraq war, Iranian people who were exposed to SM and survived still suffer from injuries and pose a significant drain on healthcare resources.

Willingness to pay for complementary health insurance in Iran: Contingent valuation approach.

The Iranian health system is based on social health insurance, which is responsible for providing access to basic health care. In addition to basic treatment insurance, complementary health insurance (CHI) offers introductory packages that include surplus services. We recently observed an increase in Iran's health insurance loss coefficient, from 16.5% to 90.4% in 2017. To determine the willingness to pay (WTP) for (CHI). We attempted to determine the WTP for CHI in this study to understand better the potential market and the factors that influence CHI demand. The study surveyed 1023 households in the Kerman Province. A questionnaire developed by the researcher was used in this study, based on the principles of contingent valuation and the bidding game method principles. In each scenario, the factors affecting people's WTP, the demand function, and the effective factors on demand were determined using linear multivariate regression using the ordinary least squares method. The average WTP was $ 7.01, $ 12.57, $ 16.19, and $ 18.73 for the first to fourth scenarios, respectively. The demand elasticity for health insurance increased from the first to the fourth scenario, indicating that demand is expandable. On the other hand, it was observed that risk aversion dictates the demand for CHI. Contrary to the insurance claims theory, demand for CHI did not reverse. To this end, insurance fund policymakers can avoid risks and high financial costs by identifying risk-averse individuals.

Socio-Economic Determinants of Dental Service Expenditure: Findings from a French National Survey.

(1) Background: This study investigated how individual enabling resources influence (i) their probability of using dental services and (ii) consumers’ expenditure on dental treatment. (2) Methods: Data were derived from a self-administered national health survey questionnaire and from expenditure data from national health insurance. Multiple linear regression methods were used to analyze entry into the dental health system (yes/no) and, independently, the individual expenditure of dental care users. (3) Results: People with the highest incomes were more likely to use dental service (aOR = 1.59; 95% CI = 1.28, 1.97), as were those with complementary health insurance and the lowest deprivation scores. For people using dental services, good dental health status was associated with less expenditure (−70.81 EUR; 95% CI = −116.53, −25.08). For dental service users, the highest deprivation score was associated with EUR +43.61 dental expenditure (95% CI = −0.15; 87.39). (4) Conclusion: Socioeconomic determinants that were especially important for entry into the dental health service system were relatively insignificant for ongoing service utilization. These results are consistent with our hypothesis of a dental care utilization process in two steps. Public policies in countries with private fees for dentistry should improve the clarity of dental fees and insurance payments.

Identification of effective components and their determination to present complementary insurance for dental services in Iran

Background and aim: The inability of the government to finance the citizens' treatment in all therapy eras apparently shows the need for the presence and development of complementary insurance in the health field. This study aims to identify and determine the effective components to present complementary insurance of dental services in Iran. Materials and methodology: This research is applicable in terms of the goal and exploratory mixed in that of data, so 15 experts were used. The data analysis method is a theorethical coding taken from the meta-combination method. In this research, to identify the criteria after reviewing the literature of related studies and interviewing with studied elites and trustees, the meta-combination method was used. Finding: 39 papers associated with complementary health insurance were gathered by insurance organizations. The studied countries had complementary insurance coverage from private and public insurance organizations. Also, in most of the countries, the management and organization were mostly performed by the Ministry of Health at the national and supervision levels. After analyzing the data, variables were classified as nine different levels. Conclusion: Findings of the study showed that the presented complementary health model of dental services consists of 9 major dimensions, the most important of which are economic and service quality factors, and eventually using them, the customer satisfaction will increase.

Anti‐herpetic drugs: A potential way to prevent Alzheimer’s disease?

AbstractBackgroundConsidering the potential implication of Herpes viruses in the development of dementia, anti‐herpetic drugs (AHD) may represent a new means of prevention.MethodUsing a medico‐administrative database, we assessed the association between the intake of systemic AHD and the incidence of i) dementia, ii) Alzheimer’s disease (AD) and iii) vascular dementia (VaD) among 68 291 participants over 65 followed between 2009 and 2017. Cox models using systemic AHD as time‐dependent variable were adjusted for age, sex, being beneficiary of a complementary health insurance scheme for low‐income people, the presence of several co‐morbidities (hypertension, diabetes, hypercholesterolemia, stroke, heart diseases), the intake of anti‐inflammatory drugs, the number of consultations, and the number of different medications the year before inclusion.Result9.7% of the participants (n=6642) had at least one intake of systemic AHD and 8883 incident dementia were identified. The intake of at least one systemic AHD was significantly associated to a decreased risk of AD (aHR 0.85 95% confidence interval [0.75‐0.96], p=0.009) and, to a lesser extent regarding p‐values, to both dementia any cause (aHR 0.90 [0.82‐0.99], p=0.03) and VaD (aHR 0.80 [0.65‐0.995], p=0.045). As the percentage of participants with a regular intake was very low (among those with at least one intake of systemic AHD, the median number of deliveries per year of follow‐up was 0.12), the efficacy of regular intake of AHD could not be evaluated.ConclusionTaking at least one systemic AHD during follow‐up was significantly associated to a risk reduced by 15% of developing AD. Despite the low percentage of participants with a regular intake during the follow‐up, this association may reflect a protective impact of systemic AHD on the prevention of dementia in particular considering the possibility of more regular treatment in the period preceding the inclusion. It also highlights the limitations of medico‐administrative databases to assess the efficacy of a regular intake of systemic AHD given their current use in clinical practice. Thus, given the growing body of evidence supporting the infectious hypothesis, preventive clinical trials with prolonged treatment by systemic AHD are urgently needed.

Long-Term Mortality and State Financial Support in Invasive Meningococcal Disease-Real-World Data Analysis Using the French National Claims Database (SNIIRAM).

ObjectivesInvasive meningococcal disease (IMD) is an uncommon disease known for its acute phase mortality and long-term sequelae. The objective was to assess the impact of IMD on post-discharge mortality risk and dependence on the French state for financial aid.MethodsA 6-year retrospective analysis in the national insurance database (SNIIRAM) assessed mortality in IMD cases (both during acute phase and post-discharge) and matched controls as well as benefit claims (i.e., for salary loss compensation [SLC], long-term sickness [ALD] and complementary health insurance [CMUc]). Observed survival data were extrapolated to estimate lifetime life expectancy following IMD.ResultsBetween 2012 and 2017, 3532 incident IMD cases were hospitalised in France (peak in < 2 years and 15–24 year olds), of which 23.3% developed sequelae. With an average follow-up of 2.8 years, 12.9% of cases vs. 3.2% of controls died (p < 0.0001), with significantly more cases than controls dying both during the acute phase and post-discharge. Around a third of these deaths occurred post-discharge. Extrapolation to lifetime life expectancy estimated that having IMD at any age significantly reduces life expectancy in survivors of the acute disease phase, e.g., by around 16 years for cases aged 0–50 years. IMD cases in France were significantly more likely to receive state-funded SLC (relative risk [RR] 3.9, 95% confidence interval [95% CI] 2.3–6.4) and ALD benefits (RR 1.85, 95% CI 1.71–2.00).ConclusionsIMD has a significant impact on mortality post-discharge, expected to persist over a lifetime. In addition to long-term sequelae, the financial burden extends beyond the healthcare sector. These results highlight the importance of IMD prevention (e.g., vaccination).Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00546-z.

Integrative Health Policy for Migrants in Germany

It is not a new topic for Germany in receiving immigrants from various nations. However, it is thought-provoking how German integration policy is criticized to be exclusionist based on its immigration policies. 1 In Germany, efforts to integrate the current demand and needs of the migrant population into the healthcare system have proved uncoordinated and scattered as much as diversity in policy is slowly under the implementation process. Frequently, immigrants are not facing any complicated legal restrictions but it is reported that they experience extremely challenging access with barriers resulting in the worst results trying to utilize healthcare services. 2 Equal access to health care services is a crucial aspect of Germany's national health policy. Factors contributing to access barriers to healthcare are said to be: cultural differences; education; political issues; the absence of complementary voluntary health insurance. Therefore, this paper will explore the migrants’ health and barriers to healthcare access in Germany

PRAVILA EUROPSKE UNIJE O TRŽIŠNOM NATJECANJU I DRŽAVNIM POTPORAMA I DOPUNSKO ZDRAVSTVENO OSIGURANJE U REPUBLICI HRVATSKOJ: KRIVO SRASTANJE?

Competition and state aid rules are not applicable to compulsory health insurance in the Republic of Croatia, since the latter does not constitute an economic activity as defined by EU law. On the other hand, complementary health insurance, as established in Croatia, constitutes an economic activity, due to the existence of real competition between undertakings. The illustrated situation with competition in complementary health insurance market allows for the statement that special rules applicable to Croatian Health Insurance Fund (HZZO) provide the latter with a privileged position when compared to its private competitors to whom these rules do not apply. Moreover, this privileged position is strengthened by the fact that HZZO, as a legal monopolist within the sphere of compulsory health insurance, utilizes respective infrastructure in the field of complementary health insurance, which enables it to reduce expenses to the detriment of its private competitors lacking such a privilege. A solution for the described situation could be for the state to establish a separate entity to provide complementary health insurance. This entity would have to provide open enrolment and community rating, regardless of age, sex or health of the insured persons. In order to prevent private competitors from jeopardising the exercise of service of general economic interest by taking over only the insured persons with a more favourable risk profile, a risk equalisation scheme would have to be set up. This would result in a transfer of funds from insurers with a favourable risk profile to those with an unfavourable risk profile on basis of objective and clear criteria, thereby making it possible for the latter to provide service to the higher-risk insured persons like the elderly and the ones with chronic illnesses. In this way, a balance between the necessity to provide a service of general economic interest to all insured persons, including those with a higher risk, and competition on the EU internal market, would be struck.

Sustainability of Complementary Health Insurance: Evaluation of the Views of Lecturers

Bu çalışmanın amacı, Karadeniz Teknik Üniversitesi’ndeki öğretim elemanlarının tamamlayıcı sağlık sigortasının sürdürülebilirliği hakkındaki görüşlerini belirlemek ve sosyo demografik özellikleri ile tamamlayıcı sağlık sigortasının sürdürülebilirliği konusundaki görüşleri arasındaki ilişkiyi incelemektir. Bu kapsamda Karadeniz Teknik Üniversitesi’nde görev yapan ve araştırmaya gönüllü katılan toplam 420 öğretim elemanına yüz yüze anket uygulanmıştır. Araştırma verisi, kişisel bilgi formu ve tamamlayıcı sağlık sigortası sürdürülebilirlik ölçeği aracılığıyla toplanmış ve Anova ve t testlerinden yararlanılarak analiz edilmiştir. Tamamlayıcı sağlık sigortası sürdürülebilirlik ölçeği ortalama puan (2,83), öğretim elemanlarının tamamlayıcı sağlık sigortasının sürdürülebilirliği konusunda tam bir karara varamadıklarını göstermektedir. Tamamlayıcı sağlık sigortasının sürdürülebilirlik düzeyi ile cinsiyet, medeni durum, bilim dalı ve aylık gelir düzeyi değişkenleri arasında %5 düzeyinde anlamlı bir ilişki olduğu belirlenmiştir. Araştırma sonucunda erkeklerin kadınlara göre, bekar öğretim elemanlarının evli olanlara göre ve fen bilimleri alanında görev yapan öğretim elemanlarının sosyal bilimlerdekilere göre ve aylık gelir düzeyi düşük olanların yüksek olanlara göre tamamlayıcı sağlık sigortasının sürdürülebilirliği konusunda daha olumlu görüşe sahip oldukları tespit edilmiştir.