Cost Coverage Research Articles

Development and Outlook of Fast Charging for Electric Vehicles in China

With the escalating demand for sustainable transportation and the rapid growth of the electric vehicle (EV) market in China, the development of efficient fast charging solutions has gained paramount importance. This paper conducts a comprehensive analysis of the current status and historical evolution of fast charging for EVs in China, focussing on technological advancements such as the emergence of 800V high-voltage platforms and improvements in battery and charging facilities. Moreover, it examines the obstacles faced and proposes potential solutions. Fast charging not only alleviates range anxiety but also significantly boosts the practicality and popularity of EVs, facilitating their widespread adoption. However, despite the considerable progress made, challenges persist, including the high cost and limited coverage of charging infrastructure, as well as potential negative impacts on battery longevity. Achieving interoperability among super-fast charging protocols across different brands and expanding fast-charging station infrastructure will be critical to addressing the issues of slow charging and range anxiety, thereby achieving the full popularization of electric vehicles.

Impact of Reaching the Medicare Part D Drug Benefit Threshold on Surgical Care and Health Outcomes Among Patients Newly Diagnosed With Gastrointestinal Cancer.

Medicare Part D covers outpatient prescription drugs for elderly beneficiaries, but requires full cost coverage once the coverage gap threshold is reached. We assessed the impact of reachingMedicare Part D threshold on out-of-pocket costs (OOP), timely treatment, and outcomes for patients with gastrointestinal (GI) cancer. Individuals newly diagnosed with GI cancer between 2007 and 2019 were identified from the SEER-Medicare database. OOP costs were calculated for the year of diagnosis. Multivariable regression models compared timely surgical care and mortality risk among patients who did and did not reach the coverage gap threshold. Among 35 745 Medicare beneficiaries diagnosed with colorectal (50.7%), pancreatic (19%), and liver (30.4%) cancer, median age was 76 years (IQR: 71-82), and 56.6% were female. Notably, 48.9% (17 479) of patients reached the Medicare Part D threshold in the year of cancer diagnosis. Mean OOP cost for patients who reached the threshold was $1060 (SD: $1417) vs. $268 (SD: $270, p < 0.0001) for individuals who did not. On multivariable analysis, patients who reached the threshold were more likely to delay [OR: 1.13, 95% CI: 1.03-1.24] or not receive surgery [OR: 1.40, 95% CI: 1.27-1.54], and had a higher risk of 5-year mortality [HR 5-year: 1.12, 95% CI: 1.09-1.15, p < 0.0001] regardless of comorbidity status, cancer site, and disease stage. Reaching the coverage gap threshold was associated withdelayed or non receipt of surgical treatment, which resulted in increased long-term mortality. Lowering the Part D threshold through policy adjustments may reduce financial strain and improve health outcomes for cancer patients.

Investigating the Structural Health of High-Rise Buildings and Its Influencing Factors Using Sentinel-1 Synthetic Aperture Radar Imagery: A Case Study of the Guangzhou–Foshan Metropolitan Area

Urban growth is increasingly shifting from horizontal expansion to vertical development, resulting in skylines dominated by high-rise buildings. The post-construction operations and maintenance of these buildings are critical, requiring regular structural health monitoring (SHM) to proactively identify and address potential safety concerns. Interferometric synthetic aperture radar (InSAR) has proven effective for monitoring building safety, but most studies rely on high-resolution synthetic aperture radar (SAR) images. The high cost and limited coverage of these images restrict their use for large-scale monitoring. Sentinel-1 medium-resolution SAR images, which are freely available and offer broad coverage, make large-scale SHM more feasible. However, studies on the use of Sentinel-1 SAR images for structural health monitoring, especially at large spatial scales, remain limited. To address this gap, in this study, Sentinel-1 SAR images and PS-InSAR technology are proposed for performing a comprehensive structural safety assessment of super high-rise buildings in the Guangzhou–Foshan Metropolitan Area (GFMA) and for analyzing the influencing factors. Our assessment shows that while the overall structural safety of these buildings is satisfactory, certain areas, including Pearl River New Town, central Huadu district in Guangzhou, and southeastern Shunde district in Foshan, exhibit suboptimal safety conditions. We verified these findings using GNSS data and on-site investigations, confirming that Sentinel-1 SAR imagery offers reliable accuracy for monitoring building structural health. Furthermore, we identified factors such as settlement in soft soil layers, the construction of surrounding (underground) infrastructure, and building aging, which could potentially impact building structural safety. The results demonstrate that Sentinel-1 SAR images provide a reliable, rapid, and cost-effective method for the large-scale monitoring of building stability, enhancing our understanding of the underlying mechanisms and informing strategies to prevent potential safety crises, and also ensuring the sustainable development of society.

Public Preferences and Willingness to Pay for Social Health Insurance in Iran: A Discrete Choice Experiment

Background: Current health insurance programs in Iran suffer from low enrolment and are not sufficient to attain the country to universal health coverage (UHC). The study hypothesized that improving the enrollment rate and moving towards more sustainable UHC can be achieved by improving the benefit package and providing new incentives. The objective of this study is to assess public preferences and willingness to pay (WTP) for social health insurance (SHI) in Iran. Methods: A discrete choice experiment (DCE) was conducted in 2022, using a self-administered questionnaire on 500 participants to estimate WTP and determine individual’s preferences for the SHI plan. Respondents were presented with an eight choice set, and asked to select their preferred one. In each choice set, scenarios were described by eight attributes with varying levels. The conditional logit regression model was used to analyze the participants preferences. WTP for each attribute was also calculated by STATA13. Results: Most of the included attributes were significant predictors of health insurance package selection. The maximum coverage of hospitalization costs in the private sector, ancillary services such as glasses, canes etc., as well as coverage for hospitalization costs in the public sector and drug costs, were the most important determining factors for this choice. Coverage of preventive dental care did not significantly affect respondent choices. Estimating WTP showed that individuals are willing to pay more for higher financial protection, particularly against private sector costs; the WTP to increase the coverage of hospitalization costs in the private sector from 50% to 90% is estimated at 362,068 IR, Rials per month. Conclusion: This study identifies the key factors that the population value with regard to health insurance and the tradeoffs they are willing to make between them. Hospitalization, drugs and ancillary services were the most important determining factors for their choice. The data suggests that additional resources coming into the Iranian health system might best be prioritized to covering hospitalization and drug costs and those associated with ancillary services.

Integrating Broad Panel Somatic and Germline Testing in Prostate Cancer Care

Introduction: Genetic testing, including germline and tumor testing, using broad panel-based approaches has transformed treatment strategies for metastatic prostate cancer. Despite guideline consensus that all men with metastatic prostate cancer should undergo tumor testing to identify mutations, suboptimal testing rates diminish the impact genetic testing can have on diagnosis, prognosis, and treatment decisions. This article outlines the various barriers to clinical adoption and implementation of broad panel genetic testing in the prostate cancer care continuum and opportunities for addressing these challenges. Methods: A landscape assessment and literature review were conducted across medical databases as well as oncologic and urologic websites to assess the current guidelines and state of broad panel genetic testing in prostate cancer. Results: There are numerous barriers and clinical practice gaps that hinder implementation and integration of broad panel somatic and germline testing in prostate cancer clinical care. Identified areas of concern include patient identification, test ordering considerations, cost and payer coverage, sample collection, genetic education and interpretation of test results, and social inequities. These barriers have prevented guideline concordance and optimal care for patients with prostate cancer. Conclusions: Overall outcomes significantly improve for patients whose treatments are tailored to findings from genetic testing. The development of comprehensive care pathways that close clinical care gaps is necessary to ensure the continued optimization of broad panel genetic testing.

Monitoring oil and gas field CH4 leaks by Sentinel-5P and Sentinel-2

Methane (CH4) ranks as the second most abundant greenhouse gas globally, following carbon dioxide (CO2), constituting approximately one-sixth of total greenhouse gas emissions. While CH4 levels in the atmosphere are lower compared to CO2, the warming potential of CH4 greatly surpasses that of CO2. With a relatively short atmospheric lifespan of approximately 12 years, mitigating CH4 emissions presents a viable means to alleviate the impacts of climate change on human populations within a concise timeframe. The atmospheric sources of CH4 primarily stem from two categories: natural and anthropogenic. A small number of super-emitters frequently contribute significantly to the overall regional emissions. Monitoring and repairing leaks from super emitters of CH4 is a low-cost and effective way to slow down the greenhouse effect. Remote sensing satellites have gradually become an effective means of monitoring CH4 leakage due to their low cost and large coverage. There is a range of satellites that can be used to monitor CH4 concentrations and emissions, such as Sentinel-5P, GOSAT, GHGSat, Sentinel-2, GaoFen-5, Landsat, and so on. Because the pixel resolution is rough (about 7 km), Sentinel-5P (S5P) can only identify high-value CH4 anomalies in some areas, making it difficult to identify and monitor point source CH4 emission plumes. Sentinel-2(S2) can accurately detect CH4 leakage in band-11 and band-12 with high pixel resolution (about 20 m) but with every 5-day revisit time. In this paper, we monitored and quantified oil and gas field CH4 leakage using a combination of S5P and S2 data by taking advantage of the high temporal resolution (daily) of S5P and high spatial resolution (20 m) of S2. We used S5P data to find CH4 anomalies. Then we used S2 to zoom in on this location to find CH4 plumes. We used three different methods: Single-band–multi-pass (SBMP), Multi-band–single-pass (MBSP), and Multi-band-multi-pass (MBMP) to identify CH4 plumes. Using these methods, we successfully monitored three emission source cases (Algeria, Mexico, and Turkmenistan) and discussed them. Through the above three cases, we can conclude that the MBMP method has higher stability in identifying S2 CH4 plumes.

Does Policy Translate into Equity? The Association between Universal Advanced Placement Access, Student Enrollment, and Outcomes

Participating in advanced placement (AP) can improve high school students’ cognitive and noncognitive outcomes. Despite nationwide efforts, including Arkansas's mandate for statewide AP access since 2003 and exam cost coverage since 2005, disparities in enrollment persist. Using multilevel modeling, we investigate the relation between student/school factors influencing AP enrollment and success. Female versus male (odds ratio [OR] = 1.68), Asian American versus White (OR = 1.90), identified-as-gifted (GT) versus nonidentified as gifted (OR = 1.58) had the highest enrollment odds. Students in the Free and Reduced Lunch program, English Language Learners, and Special education students face pronounced underrepresentation (OR = 0.62; 0.76; 0.10 respectively) to ever enroll in an AP class. Despite universal access across schools, AP enrollment is explained by school factors (proportion of FRL, GT, and student diversity). Our findings have implications to understand the critical intersectionality of student identities—socioeconomic status, language proficiency, and special education needs—influencing AP enrollment despite universal access.

Changes in hotel activities in Ukraine and Poland due to the war: Migration aspect

Internal displacement to safer regions and migration abroad became a new phenomenon in Ukraine due to Russian military aggression. Accordingly, hotels began to provide services to a new category of consumers – internally displaced persons (in Ukraine) and migrants (abroad). In 2022, Poland received the most migrants from Ukraine due to its geographical position and significant economic ties. This study aims to identify changes in hotel activities in Ukraine and Poland caused by internal and external migration. The results are based on Computer Assisted Web Interviewing (CAWI) conducted in April-July 2023, to which 300 hotels in Ukraine and Poland were invited. Answers were received from 93 Ukrainian and 94 Polish hotels. The majority (66% in Ukraine and 62% in Poland) have a star rating of 2-3*, with an average capacity of 45 rooms in Poland and 49 in Ukraine. According to hotel managers, the level of occupancy of hotels increased on average – in Ukraine by 6% and in Poland by 13%. The specific weight of migrants in hotels in Poland was 23% of all customers; in Ukraine, it was 12%. Hotels in both countries began to introduce new services, attract different sources of cost coverage (however, Polish hotels used wider opportunities), and attract migrants to employment (34% in Poland and 7.5% in Ukraine), contributing to additional occupancy rates and financial stability. Changes in hotel operations caused by migration processes as a result of the war reflect their adaptability and economic sustainability. Acknowledgment The paper shows the results of the study performed in 2021−2023 at State University of Trade and Economics at the request of the Ministry of Education and Science of Ukraine “Forecasting the impact of the tourism system on the country’s economy” (state registration number 0122U001559).The authors would like to express their gratitude to the Kirkland Research Program, the Leaders of Change Foundation, the Polish American Freedom Foundation, Polish Chamber of Commerce for Hotel Industry, and to those who helped to disseminate information about the survey, as well as to the Polish hotels and all those who expressed interest in the results.

Surgical treatment of posttraumatic spinal cord tethering and syringomyelia: a retrospective cohort investigation of cost, reimbursement, and financial sustainability

BackgroundPosttraumatic spinal cord tethering and syringomyelia are considered disabling diseases in patients with spinal cord injury. In symptomatic patients, surgical management can achieve promising clinical outcomes. As the raising economic pressure might jeopardize optimal and thus personalized patient care, we aimed to exemplify expenses of surgical treatment in contrast to reimbursement by the Swiss diagnosis related group (DRG) system.MethodsThis retrospective investigation includes 60 patients who underwent surgery for spinal cord tethering and syringomyelia. The duration of surgeries was used to estimate the costs of care in the operating room (OR) considering established bench marks. Coverage of costs was calculated by comparing Swiss DRG reimbursements with the expenses from the investigated cases.ResultsThe mean duration of surgeries was 251.0 ± 93.5 min while 2.8 ± 1.4 vertebral segments were treated by spinal cord untethering. The mean OR costs (in USD) were $9,401.2±$3,500.2 (range $4,119.5 to $20,223.0). The mean reimbursement and the ratio of OR costs to reimbursement (in USD) were $24,122.5±$7,409.3 (range $17,249.8 to $31,977.1) and 0.41 ± 0.15 (range 0.14 to 0.74) for standard, and $39,106.0±$4,028.6 (range $35,369.1 to $43,376.8) and 0.24 ± 0.08 (range 0.10 to 0.47) for complex cases, respectively. The estimated costs of surgeries were different from reimbursements (p = 0.005).ConclusionsAlthough the cost of surgical management of patients with posttraumatic spinal cord tethering and syringomyelia are principally covered, it remains questionable if total hospital expenses are sufficiently outweighed by the current reimbursement system. This could potentially limit the availability of best medical care and might endanger personalized patient management.

The European Works Council and the Coverage of Expert Costs

In a recent case of the Austrian Supreme Court (OGH 29.8.2023, 8 ObA 28/23k), a European Works Council sought legal advice and wanted the costs to be covered by the central management of a group of undertakings. This request was denied on the ground that the European Works Council could also have obtained the same advice free of charge from a representative body. The Supreme Court ruled that the central management must also bear the expert costs in these cases and thus clarified that the European Works Council is not obliged to choose services that are free of charge. Case: Austrian Supreme Court ( Oberster Gerichtshof – OGH) of 29.8.2023, 8 ObA 28/23k, ECLI:AT:OGH0002:2023:008OBA00028.23 K.0829.000.

Six-degrees-of-freedom pelvic bone monitoring on 2D kV intrafraction images to enable multi-target tracking for locally advanced prostate cancer.

Patients with locally advanced prostate cancer require the prostate and pelvic lymph nodes to be irradiated simultaneously during radiation therapy treatment. However, relative motion between treatment targets decreases dosimetric conformity. Current treatment methods mitigate this error by having large treatment margins and often prioritize the prostate at patient setup at the cost of lymph node coverage. Treatment accuracy can be improved through real-time multi-target adaptation which requires simultaneous motion monitoring of both the prostate and lymph node targets. This study developed and evaluated an intrafraction pelvic bone motion monitoring method as a surrogate for pelvic lymph node displacement to be combined with prostate motion monitoring to enable multi-target six-degrees-of-freedom (6DoF) tracking using 2D kV projections acquired during treatment. A method to monitor pelvic bone translation and rotation was developed and retrospectively applied to images from 20 patients treated in the TROG 15.01 Stereotactic Prostate Ablative Radiotherapy with Kilovoltage Intrafraction Monitoring (KIM) trial. The pelvic motion monitoring method performed template matching to calculate the 6DoF position of the pelvis from 2D kV images. The method first generated a library of digitally reconstructed radiographs (DRRs) for a range of imaging angles and pelvic rotations. The normalized 2D cross-correlations were then calculated for each incoming kV image and a subset of DRRs and the DRR with the maximum correlation coefficient was used to estimate the pelvis translation and rotation. Translation of the pelvis in the unresolved direction was calculated using a 3D Gaussian probability estimation method. Prostate motion was measured using the KIM marker tracking method. The pelvic motion monitoring method was compared to the ground truth obtained from a 6DoF rigid registration of the CBCT and CT. The geometric errors of the pelvic motion monitoring method demonstrated sub-mm and sub-degree accuracy and precision in the translational directions ( , , ) and rotational directions ( , , ). The 3D relative displacement between the prostate and pelvic bones exceeded 2, 3, 5, and 7mm for approximately 66%, 44%, 12%, and 7% of the images. Accurate intrafraction pelvic bone motion monitoring in 6DoF was demonstrated on 2D kV images, providing a necessary tool for real-time multi-target motion-adapted treatment.

Treatment preferences in spinal muscular atrophy: A swing weighting study for caregivers of patients with SMA types 1 and 2.

Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder characterized by skeletal muscle weakness and atrophy. Patients with SMA types 1 and 2 develop severe disabilities conferring substantial patient and caregiver burden. Caregiver treatment characteristic preferences are useful for informing treatment choices and improving adherence. We aimed to identify drivers of SMA treatment preference from the perspective of caregivers of patients with SMA types 1 or 2 in the United States. We quantified the relative importance of different treatment characteristics and compared preferences for hypothetical treatment scenarios. Treatment attributes and attribute levels elicited were based on a literature search and interviews with caregivers and health care professionals. The most important treatment characteristics from the perspective of health care professionals and caregivers were identified and used in a survey to quantify relative importance for caregivers. Caregivers completed surveys regarding their preferences using swing weighting methodology. These results were used to estimate the relative value of four hypothetical SMA treatment scenarios exploring different modes of treatment administration. The swing weighting survey, completed by 20 caregivers, demonstrated that the attributes driving treatment preference were reduction in permanent ventilation needs and risk of severe adverse events, followed by treatment access (including cost coverage and availability), increased ability to sit without support, and less treatment administration burden. The hypothetical SMA treatment scenarios with the highest relative value offered an easier mode of administration, lowest risk of severe adverse events, less need of permanent ventilation, and highest ability of patients to feed and sit without support. Our findings suggest that caregivers prefer a treatment with reduced clinical burden and risk in which the cost is covered and treatment is available in the short term. These results can provide important contextual information for decision-makers and help promote patient-centered care for patients with SMA.

Connectedness between energy cryptocurrencies and US equity markets: A quantile-based analysis

Energy cryptocurrencies emerge as a new class of digital assets for morally conscientious investors to build long-term portfolios with high risk-adjusted returns. Focusing on this unique asset class, the current study investigates the static and dynamic spillovers between energy cryptocurrencies and US equity sector stocks at various quantiles. We apply the quantile VAR technique on the selected sample of four energy cryptocutrrencies and eleven major US equity markets for February 27, 2018 to November 25, 2022. This period includes two important subperiods: COVID-19 and the Russian-Ukraine War. Our findings support higher connectedness levels at the extreme lower and upper quantiles compared to the mean and median quantiles. While all energy cryptocurrencies are shock receivers at the extreme lower quantile, the majority of US equity sector stocks are shock transmitters at the lower quantile. The IT sector is a shock receiver at all quantiles, whereas the energy sector is a shock transmitter. Overall connectedness fluctuates over time and shows a significant rise at the start of the COVID period. Our results provide insights to investors, portfolio managers, and policymakers regarding portfolio allocation, forecasting, and risk management during downward and upward market conditions. Additionally, the ideal hedge ratios slightly increased during the COVID-19 pandemic, which increased the cost of asset coverage.

Use of Targeted Biologic Therapies in Asthma: Current Practice in India

Asthma remains a significant public health issue in India, with a growing number of patients experiencing severe and uncontrolled forms of the disease. Targeted biologic therapies, including omalizumab, mepolizumab, benralizumab, reslizumab, and dupilumab, have emerged as advanced treatment options for patients with severe asthma, especially those with allergic or eosinophilic phenotypes. These therapies work by targeting specific immunological pathways involved in asthma pathogenesis, offering better symptom control and reducing exacerbation rates. However, the high cost of biologics, limited access, and inconsistent insurance coverage pose significant barriers to their widespread use in India. Despite these challenges, real-world data from Indian studies demonstrate promising clinical outcomes with biologic therapies in patients with difficult-to-treat asthma. This review examines the current landscape of biologic use in India, challenges related to cost and accessibility, and future prospects for integrating these treatments into routine asthma care, particularly through cost- reduction strategies and expanded healthcare coverage.

Translating restrictive law into practice: An ethnographic exploration of the systemic processing of legally restricted health care access for asylum seekers in Germany

BackgroundAccess to health services for asylum seekers is legally restricted in Germany. The law is subject to interpretation, therefore the chance of receiving care is not equally distributed among asylum seekers. What services are provided to whom is ultimately decided by health professionals and government employees. The respective prioritization processes and criteria are not transparent. We sought to understand how legal restrictions are translated into daily practices and how this affects the health system. We aimed to outline the complex process of cost coverage for health services for asylum seekers and provide insights into common decision-making criteria.MethodsWe conducted an ethnographic exploration of routines in two outpatient clinics in two federal states over the course of three months, doing participant and non-participant observation. Additionally, we interviewed 21 professionals of health care and government organizations, and documented 110 applications for cost coverage of medical services and their outcome. In addition to qualitative data analysis and documentation, we apply a system-theoretical perspective to our findings.ResultsTo perform legal restrictions a cross-sectoral prioritization process of medical services has been implemented, involving health care and government institutions. This changes professional practices, responsibilities and (power) relations. Involved actors find themselves at the intersection of several, oftentimes conflicting priorities, since “doing it right” might be seen differently from a legal, medical, economic, or political perspective. The system-theoretical analysis reveals that while actors have to bring different rationales into workable arrangements this part of the medical system transforms, giving rise to a sub-system that incorporates migration political rationales.ConclusionsHealth care restrictions for asylum seekers are implemented through an organizational linking of care provision and government administration, resulting in a bureaucratization of practice. Power structures at this intersection of health and migration policy, that are uncommon in other parts of the health system are thereby normalized. Outpatient clinics provide low-threshold access to health services, but paradoxically they may unintentionally stabilize health inequities, if prioritization criteria and power dynamics are not made transparent. Health professionals should openly reflect on conflicting rationales. Training, research and professional associations need to empower them to stay true to professional ethical principles and international conventions.

Health Benefits In 2024: Higher Premiums Persist, Employer Strategies For GLP-1 Coverage And Family-Building Benefits.

In 2024, the average annual premium for employer-sponsored family health coverage was $25,572, an increase of $1,604 (7percent) from 2023. Over the course of the past five years, the average family premium has increased 24percent, which is similar to growth seen in inflation (23percent) and wages (28percent). On average, covered workers contributed 16percent ($1,368) of the cost of single coverage and 25percent ($6,296) of the cost of family coverage. The average general annual deductible for single coverage for workers with a deductible was $1,787, similar to that in recent years but 47percent higher than a decade ago. In 2024, 18percent of large firms offering health benefits, including 28percent of those with 5,000 or more employees, covered GLP-1 antagonists for weight loss. Large employers were more likely to perceive their overall provider networks as broader than their networks for mental health and substance use conditions.

Annual Family Premiums for Employer Coverage Rise 7% in 2024 After Also Rising 7% Last Year

Family premiums for employer-sponsored health insurance rose 7% this year to reach an average of $25,572 annually, KFF’s 2024 benchmark Employer Health Survey finds. On average, workers contribute $6,296 annually to the cost of family coverage. This marks the second year in a row that premiums are up 7%. Comparatively, there was an increase of 4.5% in workers’ wages and inflation of 3.2%

Complementary and integrative medicine in cancer-related fatigue

The majority of cancer patients experience fatigue during the course of their illness. Fatigue should not be seen as an inevitable consequence of cancer and its treatment. Cancer-related fatigue (CRF) is amultidimensional symptom complex that is influenced by avariety of factors. Complementary medicine approaches offer potentially promising strategies to address this fatigue and can therefore be avaluable addition to conventional therapies.In this narrative review, complementary medicine treatment approaches for tumor-associated fatigue are presented according to the historical development and current scientific evidence. The focus is on methods with the highest current evidence based on the recommendations of national and international guidelines. Therapeutic approaches from mind-body medicine, such as mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), yoga, tai chi, and qigong, as well as acupuncture, acupressure, moxibustion, and phytotherapeutic treatment approaches are presented.In Germany, the complementary therapies listed here are not generally covered by health insurances. However, afew clinics have developed comprehensive programs in mind-body medicine, for which cost coverage has already been obtained. As aresult, complementary medical treatments for cancer-related fatigue that adhere to national and international guidelines are typically available only as private services or within the framework of study participation.

Value for solidarity: a proxy for community understanding and acceptance of the basic principles of community-based health insurance in rural Ethiopia

BackgroundSolidarity is an aspect of human association that gives emphasis to the cohesive social bond that holds a group together and is valued and understood by all members of the group. A lack of understanding of the solidarity principle is one of the main reasons for low population coverage in microhealth insurance schemes. This study aimed to examine the extent to which people value solidarity and the factors that explain the differences.MethodsA community-based cross-sectional study was carried out in two districts of northeast Ethiopia among 1232 randomly selected households which have ever been registered in a community-based health insurance scheme. Face-to-face interviews were conducted with household heads using a standardized questionnaire deployed to an electronic data collection platform. Solidarity was measured using three dimensions: income solidarity, risk solidarity, and cost coverage. Principal component analysis was used to construct composite variables, and the reliability of the tools was checked using Cronbach’s alpha. A multivariable analysis was performed using the partial proportional odds model to determine the associations between variables. The degree of association was assessed using the odds ratio, and statistical significance was determined at 95% confidence interval.ResultsThree-quarters (75%) of the respondents rated risk solidarity as high, while 70% and 63% rated income solidarity and cost coverage as high, respectively. Place of residence (AOR = 2.23; 95% CI: 1.68, 2.94), wealth index (AOR = 1.51; 95% CI: 1.07, 2.12), self-rated health status (AOR = 1.64; 95% CI: 1.12, 2.40), trust in insurance schemes (AOR = 1.68; 95% CI: 1.22, 2.30), perceived quality of care (AOR = 1.75; 95% CI: 1.33, 2.31) and frequency of outpatient visits (AOR = 2.05; 95% CI: 1.30, 3.24) were significant predictors of value for solidarity.ConclusionsThe community placed greater value for solidarity, indicating community understanding and acceptance of the core principles of microhealth insurance. Administrators of the insurance scheme, health authorities, and other actors should strive to create a transparent management system and improve access to high-quality health care, which will facilitate community acceptance of the insurance scheme and its guiding principles.

Negotiating pricing and payment terms for insurance covered mHealth apps: a qualitative content analysis and taxonomy development based on a German experience

BackgroundGermany was the first country worldwide to offer mobile digital health applications (mHealth apps, “DiGA”) on prescription with full cost coverage by statutory health insurances. Especially statutory health insurances criticize the current pricing and payment regulations in Germany due to “free and non-transparent” pricing in the first year and lack of cost use evidence. The study consists of two parts: The first part evaluates interests of digital health application providers and statutory health insurances in Germany to identify overlaps and divergences of interests. The second part includes the development of a comprehensive pricing and payment taxonomy for reimbursable mHealth apps in general.MethodsBoth parts of the study used the input from 16 expert interviews with representatives of digital health application providers and statutory health insurances in Germany. In part one the authors conducted a qualitative content analysis and in part two they followed the taxonomy development process according to Nickerson et al. (2013).ResultsA value based care model is expected to bring the greatest benefit for patients while statutory health insurances welcome the idea of usage based pricing. The final pricing and payment taxonomy consists of four design and negotiation steps (price finding, payment prerequisites, payment modalities, composition of negotiation board).ConclusionsAs healthcare resources are scarce and thus need to be optimally allocated, it is important to implement pricing and payment terms for reimbursable mHealth apps that result in the greatest benefit for patients. To the best of the authors’ knowledge, there has been no structured study yet that examines alternative pricing strategies for reimbursable mHealth apps.The developed pricing and payment taxonomy for reimbursable mHealth apps serves as planning and decision basis for developers, health policy makers and payers internationally.