Explicit Coverage Research Articles

Medicaid coverage for gender-affirming surgery: A state-by-state review.

To systematically review Medicaid policies state-by-state for gender-affirming surgery coverage. Primary data were collected for each US state utilizing the LexisNexis legal database, state legislature publications, and Medicaid manuals. A cross-sectional study evaluating Medicaid coverage for numerous gender-affirming surgeries. We previously reported on state health policies that protect gender-affirming care under Medicaid coverage. Building upon our prior work, we systematically assessed the 27 states with protective policies to determine coverage for each type of gender-affirming surgery. We analyzed Medicaid coverage for gender-affirming surgeries in four domains: chest, genital, craniofacial and neck reconstruction, and miscellaneous procedures. Medicaid coverage for each type of surgery was categorized as explicitly covered, explicitly noncovered, or not described. Among the 27 states with protective Medicaid policies, 17 states (63.0%) provided explicit coverage for at least one gender-affirming chest procedure and at least one gender-affirming genital procedure, while only eight states (29.6%) provided explicit coverage for at least one craniofacial and neck procedure (p = 0.04). Coverage for specific surgical procedures within these three anatomical domains varied. The most common explicitly covered procedures were breast reduction/mastectomy and hysterectomy (n = 17, 63.0%). The most common explicitly noncovered surgery was reversal surgery (n = 12, 44.4%). Several states did not describe the specific surgical procedures covered; thus, final coverage rates are indeterminate. In 2022, 52.9% of states had health policies that protected gender-affirming care under Medicaid; however, coverage for various gender-affirming surgical procedures remains both variable and occasionally unspecified. When specified, craniofacial and neck reconstruction is the least covered anatomical area compared with chest and genital reconstruction.

Occupational Health and Safety Reporting in the Top 100 Australian Companies: Does Organisational Risk Profile Matter?

Increasingly, good quality and safe working conditions that promote employee health are expected by stakeholders. The aim of this study is to examine the extent and quality of occupational health and safety (OHS) reporting in the Top 100 companies listed on the Australian Stock Exchange (ASX). Method: Publicly available annual reports from the Top 100 ASX companies were reviewed using a policy scorecard against five dimensions drawn from the Australian Work Health and Safety Strategy 2012–2022. The dimensions were: OHS information, legislation, leadership, work health disorders, prevention and best practice. Results: Mean rank scores of high and low-risk industry sectors were compared. High-risk sectors provided more explicit coverage of OHS information across all five domains in comparison to low-risk sectors (p > 0.05). The Information Technology sector scored the lowest across all five dimensions. Conclusion: Higher quality reporting from those in high-risk sectors may be influenced by stakeholder expectations, as well as industry norms. The current analysis suggests that relying on stakeholders to drive improved reporting may be problematic, as those industries that are perceived to have a low OHS risk profile may not consider the need to provide transparent reporting on their strategies to ensure they are providing good quality working conditions.

Limited health insurance coverage of injectable neurotoxins and fillers for gender affirmation: a cross-sectional study of Affordable Care Act silver and Medicaid plans.

Injectable neurotoxins and fillers are potential options for facial gender affirmation for transgender/nonbinary patients. However, the largest barrier to access is cost/insurance coverage. The purpose of this article is to assess the extent to which Affordable Care Act (ACA) silver plans and Medicaid policies cover gender-affirming injectable neurotoxin and filler procedures. A cross-sectional study of all ACA silver plans and Medicaid policies was performed from June 22 to August 15, 2021. Plan-specific certificates of coverage, clinical policies of insurance providers, and Medicaid documents were evaluated. A total of 915 plans were reviewed (864 ACA silver plans and all 51 Medicaid policies). None potentially covered neurotoxins. Only 72 (71 ACA and 1 Medicaid) potentially covered fillers, specifically collagen injections and lipofilling. Coverage required demonstration of medical necessity or significant variation of physical appearance from the patient's experienced gender. However, of the 71 ACA plans, 69 outlined cosmetic exclusions, possibly nullifying this coverage. Data were sourced from publicly available online information in 2021. Additionally, we were unable to confirm explicit coverage of these procedures with insurance companies. The majority of ACA silver and Medicaid plans did not cover gender-affirming neurotoxin or filler procedures, limiting access to this gender-affirming care.

Time From Authorization by the US Food and Drug Administration to Medicare Coverage for Novel Technologies

A wide variety of novel medical diagnostics and devices are determined safe and effective by the US Food and Drug Administration (FDA) each year, but to our knowledge the literature lacks evidence documenting how long it takes to establish new Medicare coverage for these technologies. To measure time from FDA authorization to at least nominal Medicare coverage for technologies requiring a new reimbursement pathway. In this cross-sectional study, public databases were used to associate each technology to billing codes, determine the effective date of each code and Medicare coverage decisions, and stratify by the maturity of the Medicare coverage. At least nominal coverage was defined as achievement of explicit coverage milestones through a national coverage determination, local coverage determinations by Medicare administrative contractors, or by implicit coverage aligned to a new billing code. Characterization by product type (acute treatment, chronic or ongoing treatment, diagnostic assay, and diagnostic device), manufacturer size, and evidence level were assessed for association with coverage achievement. The study included new product applications authorized by the FDA through the premarket approval pathway, the de novo pathway, or with breakthrough designation in the 510(k) pathway from January 1, 2016, to December 31, 2019. Data analysis took place between May 1, 2022, and December 31, 2022. Time from FDA authorization to the first coverage milestone. Among 281 identified technologies in the total sample, 64 (23%) were deemed novel technologies based on the absence of coverage determinations and/or the use of temporary or miscellaneous billing codes. Twenty-eight of 64 technologies (44%) successfully achieved explicit or implicit coverage following FDA authorization. The median time to at least nominal coverage for the analysis cohort was 5.7 years (90% CI, 4.4-NA years). Analysis of time-to-coverage data highlighted company size (log-rank P<.001) and product type (log-rank P = .01) as significant covariates associated with coverage achievement. No association was observed for technologies with level 1 evidence at FDA authorization and subsequent coverage milestone achievement (log-rank P = .40). In this cross-sectional study of 64 novel technologies, only 28 (44%) achieved coverage milestones over the study timeline. The several-year period observed to establish at least nominal coverage suggests existing coverage processes may affect timely reimbursement of new technologies.

Comparison of COVID-19 Vaccination Rollout Approaches across Canada: Case Studies of Four Diverse Provinces

Across Canada, there were notable differences in the rollout of provincial/territorial COVID-19 vaccination programs, reflecting diverse sociodemographic profiles, geopolitical landscapes, health system designs, and pandemic experiences. We collected information regarding underlying principles and goals, governance and authority, transparency and diversity of communications, activities to strengthen infrastructure and workforce capacity, and entitlement and access in four diverse provinces (British Columbia, Saskatchewan, Ontario, Nova Scotia). Through cross-case analysis, we observed significant differences in provincial rollouts of the primary two-dose vaccination series in adults between December 2020 and December 2021. Nova Scotia was the only province to state explicit coverage goals and adhere to plans tying coverage to the relaxation of public health measures. Both Nova Scotia and British Columbia implemented fully centralized vaccination booking systems. In contrast, Saskatchewan's initial highly centralized approach enabled the rapid delivery of first doses; however, rollout of second doses was slower and more decentralized, occurring primarily through community pharmacies. In alignment with its decentralized health system, Ontario pursued a regionalized approach, primarily led by its existing public health unit network. Our research suggests explicit goals, centralized booking, and flexible delivery strategies improved uptake; however, ongoing learning will be crucial for informing the success of future vaccination efforts.

Optimizing for Equity: Sensor Coverage, Networks, and the Responsive City

Decisions about sensor placement in cities are inherently complex, balancing social-technical, digital, and structural inequalities with the differential needs of populations, local stakeholder priorities, and the technical specificities of the sensors themselves. Rapid developments in urban data collection and geographic data science have the potential to support these decision-making processes. Focusing on a case study of air-quality sensors in Newcastle-upon-Tyne, UK, we employ spatial optimization algorithms as a descriptive tool to illustrate the complex trade-offs that produce sensor networks that miss important groups—even when the explicit coverage goal is one of equity. We show that the problem is not technical; rather, it is demographic, structural, and financial. Despite the considerable constraints that emerge from our analysis, we argue the data collected via sensor networks are of continued importance when evidencing core urban injustices (e.g., air pollution or climate-related heat). We therefore make the case for a clearer distinction to be made between sensors for monitoring and sensors for surveillance, arguing that a wider presumption of bad intent for all sensors potentially limits the visibility of positive types of sensing. For the purpose of monitoring, we also propose that basic spatial optimization tools can help to elucidate and remediate spatial injustices in sensor networks.

A paradigm shift to ethical decision-making—incorporating systemic epistemology into complex socio-technical decision support systems research

ABSTRACT Current decision support systems (DSS) research is overwhelmingly positivist and limits the adequate representation of relevant stakeholders. This crisis of relevance precludes the systemic inclusion of social and ethical issues in complex socio-technical DSS designs. For their unstable boundary conditions, such systems also require explicit coverage of their dynamics. Lending a novel perspective to DSS research, this paper proposes a framework with the new decision-making paradigm and the systemic inquiry of boundary critique to explore stakeholder perspectives for more ethically-aware DSS development. Using qualitative research, the developed framework is applied to unleash ethical issues for a dynamic and complex socio-technical university timetabling scenario implemented as a web-based group decision support system. Multiple stakeholder perspectives are recognised and analysed for boundary judgements, while a dynamic stakeholder network considers boundary liquidity and emergence. This work aims to couple systemic epistemology with the socio-technical lens to encourage the inclusion of ethical dimensions in dynamic and complex DSS designs.

Reexamining Our Approach to Conjunctions and Adverbs in the Beginning French Classroom

While the importance of vocabulary for developing speaking, reading, writing, and listening skills is well known, our choice of which vocabulary to teach (and when) follows few pedagogically sound principles. This article compares the most frequent conjunctions and adverbs in French with those featured on vocabulary lists in six popular beginning-level college textbooks in the United States. It demonstrates that textbooks neglect to provide explicit coverage and practice of these crucial building blocks for organized speech and writing, and provides suggestions for ways to include them much earlier, paving the way for greater use as proficiency increases.

Pooling arrangements in health financing systems: a proposed classification

ObjectivesThe function of pooling and the ways that countries organize this is critical for countries’ progress towards universal health coverage, but its potential as a policy instrument has not received much attention. We provide a simple classification of country pooling arrangements and discuss the specific ways that fragmentation manifests in each and the typical challenges with respect to universal health coverage objectives associated. This can help countries assess their pooling setup and contribute to identifying policy options to address fragmentation or mitigate its consequences.MethodsThe paper is based on a review of published and grey literature in PubMed, Google and Google Scholar and our information gathered from our professional work in countries on health financing policies. We examined the nature and structure of pooling in more than 100 countries across all income groups to develop the classification.FindingsWe propose eight broad types of pooling arrangements: (1.) a single pool; (2.) territorially distinct pools; (3.) territorially overlapping pools in terms of service and population coverage; (4.) different pools for different socio-economic groups with population segmentation; (5.) different pools for different population groups, with explicit coverage for all; (6.) multiple competing pools with risk adjustment across the pools; and in combination with types (1.)-(6.), (7.) fragmented systems with voluntary health insurance, duplicating publicly financed coverage; and (8.) complementary or supplementary voluntary health insurance. However, we recognize that any classification is a simplification of reality and does not substitute for a country-specific analysis of pooling arrangements.ConclusionPooling arrangements set the potential for redistributive health spending. The extent to which the potential redistributive and efficiency gains established by a particular pooling arrangement are realized in practice depends on its interaction and alignment with the other health financing functions of revenue raising and purchasing, including the links between pools and the service benefits and populations they cover.

Analysis of the Factors of Climatic Productivity

Though researches about productivity from the aspects of economics and ecology have covered natural factors, the most basic climatic factors therein were ignored. The eco-footprint and climate capacity have an explicit coverage of the impact of climatic factors on productivity. It can be concluded that climate is also a kind of productivity and mitigating climate change is improving productivity, after an analysis of the primary, industrial, and ecological climatic productivities defined by the decisive factors of climatic productivity. In view of the above, the study of climatic productivity needs to be further deepened in both theory and methodology.

Mapping health and work provision in healthcare and business degrees in England

AbstractIll-health currently keeps a quarter of the UK’s working age population out of employment, at a significant social and economic cost to both those individuals and the country as a whole. It is, therefore, essential that healthcare and business professionals have sufficient skills to manage the physical and mental health of their teams and support individuals to re-enter employment. This study looked at the extent to which six core health and work topics were included in the curricula and assessment of healthcare and business degree courses. It included a quantitative review of 221 healthcare and business degree programmes in England. This was supplemented with secondary analysis of existing literature on health and work education and qualitative interviews with course leaders in 38 universities. The study found that across all healthcare and business courses, there was relatively little explicit coverage of health and work topics in course curricula or assessment. When health and work was covered,...

EFL Learners’ Knowledge and Use of Gender Stereotypes: Evidence from Arabic Native Speakers

&lt;p&gt;&lt;em&gt;The research explored EFL learners’ knowledge and use of gender stereotypes of common English nouns (e.g., doctor and nurse). In the study, we compared how EFL learners living in Saudi Arabia and native English speakers rated 24 nouns that can be used to refer to either males or females and how they interpreted sentences containing the gender-specific pronouns his and her preceded by one of the three types of these nouns (i.e., male stereotyped, female stereotyped, or gender neutral). The results showed that performance for EFL learners differed from native speakers’ in both tasks. EFL learners rated nouns as generally referring to males more often than did native English speakers. EFL learners were also significantly less likely to interpret her and his as referring to the preceding noun than were native English speakers. The results suggest that in EFL courses, learners are likely to benefit from explicit coverage of gender ambiguous English nouns and the topic of gender stereotyping as an important aspect of vocabulary knowledge.&lt;/em&gt;&lt;/p&gt;

Dispersion with connectivity in wireless mesh networks

We study a multi-objective access point dispersion problem, where the conflicting objectives of maximizing the distance and maximizing the connectivity between the agents are considered with explicit coverage (or Quality of Service) constraints. We model the problem first as a multi-objective model, and then, we consider the constrained single objective alternatives, which we propose to solve using three approaches: The first approach is an optimal tree search algorithm, where bounds are used to prune the search tree. The second approach is a beam search heuristic, which is also used to provide lower bound for the first approach. The third approach is a straightforward integer programming approach. We present an illustrative application of our solution approaches in a real wireless mesh network deployment problem.

Examining children’s health equity under the Chinese basic medical insurance system: A comparison between the United States and Mainland China

Public health insurance for China’s children is analyzed using an equity analysis framework and compared to US public health insurance for low-income children. Four dimensions of comparisons are addressed: fairness of financial support, equal treatment for equal need, equality of access to services, and equality of health outcomes. Secondary data from China and US government statistics were used for the comparisons. Recommendations to strengthen China’s health insurance for children include lower out-of-pocket expenses, standardized data collection and management, qualified nurse practitioners providing rural health care, and explicit coverage requirements.

Cultural sustainability as a strategy for the survival of museums and libraries

Cultural sustainability has become a growing priority within sustainable development agendas, and is now often depicted as a fourth pillar, equal to social, economic, and environmental concerns. Museums and libraries play a unique role within cultural sustainability by preserving their communities’ heritage. However, sustainability policy and research within these sectors still tends to focus on the social, economic, and environmental pillars. This article provides a critique of sustainability policy and research for museums and libraries. It argues that more explicit coverage of cultural sustainability is required to not only improve the contributions of museums and libraries to cultural sustainability, but also to provide an increased understanding and appreciation of the value of these institutions necessary for their continued survival.

Bringing the Elephant into the Room: Integrating Risk into Interdisciplinary Water Programs

Problems that require risk management are usually cross-disciplinary in nature, which makes it difficult to educate students and professionals on common language, skills, and strategies. Recognition of the interdisciplinary nature of many water challenges in terms of quality, allocation, future supply, infrastructure, damages, etc. has led to the establishment of interdisciplinary graduate water programs. Motivated by experience in an interdisciplinary water program at Tufts University, this paper argues that explicit coverage of the subject of risk is an important component of an interdisciplinary water training program, and that understanding risk should be a core competency of a water professional. The literature on water education is reviewed, particularly regarding the core competencies of an interdisciplinary water professional. Existing interdisciplinary water graduate programs are also surveyed to identify if, and how, risk features in their program descriptions or curriculums. Our analysis found that risk was not mentioned as a core competency or key issue in any of the literature on interdisciplinary water education or training, and featured in only a few program descriptions or curriculums. Based on this analysis, we conclude that there is a significant need to address risk more centrally and explicitly in interdisciplinary water programs.

A Specified Coverage Analysis Method Used For Comparison Logic

The commonly used hardware verification languages, such as SystemVerilog have explicit coverage constructs which entitle verification engineers the power to model the function of design into coverage requirement. Verification Engineers usually subtract the functional coverage from their knowledge of the design requirements and map them into coverage points which can be expressed by hardware verification languages. However due to the limitation of syntax of these hardware verification languages, it is very hard in a reasonable way to specify the coverage points for the kind of module whose output is decided by scale-size relationship of its inputs. This paper presents a workaround to analyze the total effective scenarios for this kind of module. The paper also provides a method on how to model these effective scenarios with current syntax of hardware verification language.

Deposit Insurance Coverage, Ownership, and Bank Risk-Taking Behavior: Evidence from Indonesian Commercial Banks

In the first part, this paper aims to examine how explicit deposit insurance coverage affects bank stability using the data from the Indonesian commercial banking industry, which offers a unique setting of natural experiment for this purpose. In the second and third parts, this paper studies how market power and ownership structure affect bank stability. My analysis shows that blanket and full guarantee have adverse impact to the Indonesian bank stability, as well as low explicit coverage, suggesting an inverted U-shaped relation. The analysis then shows that higher degree of market power is significantly associated with lower bank stability, supporting the competition-stability hypothesis. Moreover, the analysis reveals that higher cash flow right is associated with lower bank stability, while central government ownership is associated with higher bank stability, as well as foreign and family ownership. Publicly held banks tend to be lower in overall risk, but have relatively higher allowance for loan losses and lower equity-to-asset ratio compared to private banks. Meanwhile, findings on local government and managerial ownership are mixed. The analysis further shows that bank ownership structure interact with the explicit deposit insurance coverage to influence bank stability.

IFRS Knowledge, Skills, and Abilities: A Follow-Up Study of Employer Expectations for Undergraduate Accounting Majors

Although the most recent International Financial Reporting Standards (IFRS) work plan report from the U.S. Securities and Exchange Commission no longer includes a timetable for the U.S. adoption of global financial accounting standards, experts predict that the United States will transition to some form of convergence later this decade. In anticipation of the likely change, explicit coverage of IFRS was added to the Uniform Certified Public Accountant Examination in 2011. To identify what it will take for students to become IFRS-ready, this research continues a multiyear exploration into key IFRS student learning objectives, their relative importance, and strategies for incorporating them into the undergraduate accounting curriculum. Survey results suggest employer expectations have evolved.

Including quality attributes in efficiency measures consistent with net benefit: Creating incentives for evidence based medicine in practice

Evidence based medicine supports net benefit maximising therapies and strategies in processes of health technology assessment (HTA) for reimbursement and subsidy decisions internationally. However, translation of evidence based medicine to practice is impeded by efficiency measures such as cost per case-mix adjusted separation in hospitals, which ignore health effects of care.In this paper we identify a correspondence method that allows quality variables under control of providers to be incorporated in efficiency measures consistent with maximising net benefit. Including effects framed from a disutility bearing (utility reducing) perspective (e.g. mortality, morbidity or reduction in life years) as inputs and minimising quality inclusive costs on the cost-disutility plane is shown to enable efficiency measures consistent with maximising net benefit under a one to one correspondence. The method combines advantages of radial properties with an appropriate objective of maximising net benefit to overcome problems of inappropriate objectives implicit with alternative methods, whether specifying quality variables with utility bearing output (e.g. survival, reduction in morbidity or life years), hyperbolic or exogenous variables. This correspondence approach is illustrated in undertaking efficiency comparison at a clinical activity level for 45 Australian hospitals allowing for their costs and mortality rates per admission. Explicit coverage and comparability conditions of the underlying correspondence method are also shown to provide a robust framework for preventing cost-shifting and cream-skimming incentives, with appropriate qualification of analysis and support for data linkage and risk adjustment where these conditions are not satisfied.Comparison on the cost-disutility plane has previously been shown to have distinct advantages in comparing multiple strategies in HTA, which this paper naturally extends to a robust method and framework for comparing efficiency of health care providers in practice. Consequently, the proposed approach provides a missing link between HTA and practice, to allow active incentives for evidence based net benefit maximisation in practice.