Healthcare Insurance System Research Articles

Trend Analysis of Regulatory Approvals for Generics and Biosimilars in Japan: 15 Years of PMDA During Fiscal Years 2009-2023.

Generics and biosimilars play an important role in sustaining the universal healthcare insurance systems in Japan. The Pharmaceuticals and Medical Devices Agency (PMDA) reviews the quality, efficacy, and safety of generics and biosimilars for marketing authorization in Japan. Trend analyses of generics and biosimilars in terms of regulatory science have rarely been published. The PMDA and National Institute of Health Sciences websites were verified for generics and biosimilars, and information related to guidelines and notifications and the number of newly approved generics and biosimilars for fiscal year (FY) 2009-2023 were compiled. Approximately 1,900 and 200 generic drug products were approved in Japan in FY 2010 and 2023, respectively. The number of approved generic drug products has gradually decreased to one-tenth in the past 15years. Overall, 35 biosimilars were approved in FY 2009-2023. The number of approved biosimilars has increased since FY 2017. This article reported a trend analysis of generics and biosimilars in terms of guidelines, notifications, and the number of applied and approved drug products in FY 2009-2023. Our primary goal is to increase patient access to affordable generics and biosimilars with assurance in appropriate quality.

1.L. Scientific session: Public Health data in support of healthy ageing policies

Abstract As Europe grapples with an ageing population, the imperative of health policies that promote healthy ageing is increasingly critical. This workshop aims to explore the significant role of public health data in shaping and supporting such policies. By integrating insights from administrative records to sophisticated research infrastructures, we will highlight the multifaceted uses of data in public health, particularly in the realms of non-communicable diseases and health-related behaviours in older populations. The session will open by examining how administrative records have been utilised within Lombardy’s regional health system to understand the epidemiology and access to care for people living with dementia. The discussion will then cover the advantages and challenges associated with integrating health data from diverse sources, emphasising the importance of quality, privacy, and the potential for real-time surveillance and response systems in healthcare. Following this, the focus will shift to the determinants of good health among older adults, presenting findings from a comprehensive cross-sectional study that identifies key factors contributing to what can be termed as “superhero” health status: seniors who maintain excellent physical and mental health. This analysis will delve into socioeconomic, behavioural, and environmental factors that influence health outcomes in the elderly, providing evidence-based recommendations for public health interventions and highlighting the potentialities of ad hoc surveys in examining health outcomes during emergencies. Thirdly, the workshop will also address the impact of significant life transitions on health behaviours, specifically the transition to retirement and its effects on alcohol consumption. Leveraging longitudinal data from a pan-European multidisciplinary research infrastructure, it will be demonstrated how retirement affects daily habits and lifestyles, including changes in alcohol consumption patterns. This segment will explore the implications of these findings for public health planning and policy formulation. In conclusion, there will be a discussion about healthcare system policies that support healthy ageing and the global impact of ageing on economics and health economics. These discussions will draw from the presented data sources and studies to suggest ways in which public health policies can be designed to reduce disparities and improve overall health outcomes among the elderly. This workshop is designed to provide a comprehensive overview of how data-driven insights can inform effective public health strategies and interventions to support an ageing society. By exploring various aspects of health data application, from individual behaviour to systemic policy adjustments, the session aims to highlight the critical role of data in promoting sustainable health and well-being in older adults, especially in the context of increasing life expectancy and prolonged retirement periods. Key messages • Harnessing data from diverse sources is crucial for understanding and enhancing healthy ageing processes. • Utilising longitudinal studies and robust data to design informed public health policies is essential for effective ageing interventions.

KAZAKHSTAN'S HEALTHCARE SYSTEM IN THE CONTEXT OF THE INTRODUCTION OF COMPULSORY SOCIAL HEALTH INSURANCE

This article is devoted to the analysis of the Kazakhstani healthcare system in the context of the implementation of the compulsory social health insurance system. It will examine issues related to healthcare costs, the degree of satisfaction of the population with health insurance, the quality of medical services, etc. Since its introduction in 2020, the healthcare insurance system in Kazakhstan has encountered significant challenges. These include public dissatisfaction with the quality of medical services, inadequate coverage of the population with health insurance, vulnerabilities in the insurance information system, the existence of medical supplements, underdeveloped infrastructure in rural areas, and information asymmetry in the health insurance sector. President of Kazakhstan, Kassym-Jomart Tokayev, criticized the reform process of the health insurance system and addressed these issues during a meeting with the Government on February 7, 2024. This article delves into the evolution of the Kazakhstan health insurance system by analyzing financial indicators and monitoring data. Through this analysis, problematic areas were identified, and practical recommendations were developed to optimize the compulsory social health insurance system. Various scientific methods were employed in this study, including institutional analysis, synthesis, literature review, comparative and contrastive, and sociological methods. The goal of this study is to provide recommendations for enhancing the healthcare system in Kazakhstan during the implementation of compulsory social health insurance. The empirical foundation of this study consists of legislative documents in the healthcare sector, official publications, and analytical and statistical reports from the Ministry of Health of the Republic of Kazakhstan. The hypothesis of the study is that the introduction of compulsory social health insurance in Kazakhstan is intended to promote positive changes in the healthcare system, but due to existing organizational and financial barriers does not improve the availability and quality of medical services. Keywords: health, health insurance, health care system, public administration, health care costs.

Mental health in a post-pandemic perspective: economic and social costs

The COVID-19 pandemic has caused a significant increase in the number of mental health disorders, such as depression, anxiety, and PTSD, leading to higher treatment costs and placing a burden on social insurance systems. The aim of this literature review was to examine the economic costs of the pandemic related to mental health and assess its impact on social insurance systems. The review also analyzed the growing demand for mental health services during different phases of the pandemic. The methodology included an analysis of scientific literature from 2020-2023, with sources from databases like PubMed, Scopus, and JSTOR. The focus was on studies that provided a detailed examination of the economic aspects of the pandemic in the context of mental health, including both direct costs (consultations, medications) and indirect costs (reduced productivity, work absences). The findings indicate significant economic burdens for both healthcare and social insurance systems. The COVID-19 pandemic has increased the cost of treating mental health disorders globally. Both WHO and OECD highlight that global indirect costs related to lost productivity amount to approximately $1 trillion annually. Additionally, the pandemic exposed weaknesses in social insurance systems, which need to be reformed to address new health challenges. Key conclusions emphasize the need for further investment in mental health care, particularly in prevention and early intervention. Such investments could lead to significant economic savings by reducing treatment costs and improving productivity. Reforming social insurance systems is also recommended to better accommodate the needs of individuals suffering from mental health disorders.

Development of a practical framework and indicators for monitoring integrated long-term health and care needs and service use

This case study presents an evidence-building approach to support policy planning for integrated health and care delivery for older adults. We developed an integrated needs-assessment framework to monitor the complex long-term medical and care needs of older individuals, using routinely collected, standardized needs-assessment and utilization data from the public health and long-term care (LTC) insurance systems in South Korea. We also developed a set of misuse indicators and analyzed service utilization patterns, while accounting for their varying types of needs. Approximately 11 % of older Koreans were identified as having complex long-term medical and care needs, which were categorized into four distinct need groups. More than one-third of those in the higher-medical/lower-care needs group stayed in LTC hospitals for six months or more during the year, and about one-third of those in the higher-medical/higher-care needs group inappropriately resided in LTC facilities, where medical services are limited. The newly developed integrated needs-assessment framework and misuse indicator set provide practical tools for monitoring the extent and nature of complex needs, as well as patterns of over- or under-utilization of health and care services over time. The empirical evidence gathered here highlights the need for reforms in South Korea's health and LTC systems.

Appointment Blitz: Optimizing Patient-Therapist Rehab Scheduling.

Taiwan has a well-structured healthcare insurance system that offers accessible medical resources to the public through nominal health insurance fees. Consequently, individuals in need of care willingly pay nominal charges for medical services, including rehabilitation treatment. This study delves into the rehabilitation department of a medical center in southern Taiwan. Despite offering comprehensive traditional rehabilitation services covering neurological, musculoskeletal, pediatric, cardiopulmonary, communication, and swallow disorders, the demand for appointments significantly surpasses the number of available therapists. Therefore, this paper proposes an efficiently method to optimize patient-therapist appointment. With a Complex Conditional Logic that we have designed in this paper, we aim to simplify the scheduling processing for patient seeking appointment either online or via phone calls. More than 50,000 cases have been treated since the system's launch within a year, facilitates hospital resource allocation and enhancing patient medical experiences.

Health care expenditure, economic growth, and population ageing in Japan: empirical evidence using the nonlinear ARDL approach

ABSTRACT In Japan, health care expenditure (HCE) has increased with the rapid ageing of the population. It raises concerns on how the public health care insurance system should be sustained in the future, since the dependence on public burdens is growing under the government’s difficult financial conditions. This study investigates the cointegration relationship between HCE, GDP, and the population ageing rate (AGE) in Japan for the period 1960–2019 by using the nonlinear ARDL approach. The results revealed that per capita HCE may increase more significantly during an economic downturn than during an economic improvement in the long-run. Moreover, an increase in AGE has a positive effect on per capita HCE. These findings show the need to achieve stable economic growth and seriously address the issue of ageing for policymakers in Japan.

The efficacy of schema therapy on the inflammation severity in rheumatoid arthritis patients

The present study aimed to examine the efficacy of schema therapy on the severity of inflammation in RA patients. The research method was cohort entry and end of study. The research sample consisted of 30 RA patients meeting the study's inclusion criteria selected through purposeful sampling. The intervention method in this research was schema therapy based on Rizzo, Tweet, Stein, and Young's (2007) model. Descriptive statistics indicators were used to describe the research data, and inferential statistics indicators, including repeated measures analysis of variance, were used to analyze data. The results showed that 16 people (53.3%) were women and 14 (46.7%) were men, i.e., the ratio of males and females in the experimental and control groups was the same. The age range of the two research groups was between 27 and 61 years. The results showed that there is a significant difference (P ≤ 0.01) between the average scores of disease activity intensity and inflammation intensity in the stages before and after the intervention and follow-up, which means that the intensity of disease activity and inflammation intensity in the experimental group significantly You have decreased. On the other hand, the lack of post-test-follow-up difference in inflammation intensity scores (P > 0.05) showed that the effectiveness of schema therapy on the inflammation intensity of patients with RA was stable. It is suggested that in the country's health care system policy, plans should be made to use schema therapy to reduce the patient's pain.

A Hexagonal Aim as a Driver of Change for Health Care and Health Insurance Systems.

Improving health systems, such as the U.S. or French, requires simultaneous pursuit of a patient centered approach aligned with the health professional: improving the experience of care, improving the health of populations, reducing per capita costs of care - Triple Aim - and improving the work life of the care providers, including clinicians and staff - Quadruple Aim -. While these aims are already ambitious, they may be insufficient when considering the economic, social and environmental challenges to the health of our communities in the near and long term. A conceptual framework to provide additional ethical guardrails for health systems. Recently, authors have articulated a Fifth Aim and we propose to add a Sixth Aim to the Quadruple Aim model. These additional aims are meant to account for our growing knowledge around the determinants of health and the challenging processes and structures of governance across a wide range of sectors in society including healthcare. We are strengthening the Fifth Aim defined as equity through "health democracy" to represent the wants, needs and responsibility of the population in taking care of their health and their healthcare. The Sixth Aim is to account for the increase in risk to population health due to climate change as well as the impact our health systems have on the environment. As social tension and environmental changes seem to continue to impact the structure of our society this "Hexagonal Aim" taken together might provide additional ethical guiderails as we set our healthcare goals.

Medical insurance, livelihood capital and public health in China

BackgroundMedical insurance stands as a pivotal component within the overarching framework of public service systems. The intricate interplay between the extent of healthcare coverage and the overall well-being of the populace remains a pivotal research question within the academic sphere.MethodsDrawing from the comprehensive dataset of the Chinese Household Livelihood Survey, this article employs a rigorous data model to delve into the profound implications of medical coverage on population health.ResultsThe descriptive analysis revealed that areas with broader medical coverage tend to exhibit higher levels of overall population health. This initial observation provided a foundation for further quantitative exploration using multiple regression analysis. The regression analysis demonstrated a statistically significant positive relationship between medical coverage and population health. This finding is particularly noteworthy as it suggests that expanding access to healthcare services has tangible benefits for improving the overall health of a population.ConclusionFrom the lens of familial sustenance, this article delves into the intricate health implications of medical coverage, thereby introducing a novel theoretical lens to the evolving discourse surrounding medical insurance healthcare systems and their impact on public health. This approach aims to enrich the current understanding of this complex relationship and contribute to the scholarly dialogue.

Abstract PO2-11-09: European Lobular Breast Cancer Advocates: Bridging the Geographical Gaps in Lobular Breast Cancer Education and Awareness

Abstract Introduction In 2019, Invasive Lobular Cancer (ILC) Patient Advocates attended the 3rd meeting of the European Lobular Breast Cancer Consortium (ELBCC), a scientific community focused on lobular research and treatment. European Lobular Breast Cancer Advocates (ELBCA) now have a network of ILC patient advocates across Europe. ILC is classified by the World Health Organisation as the most common Special Type of Breast Cancer. In 2022 there were 576,300 diagnoses of breast cancer in Europe, 15% ~86,500 were ILC. ILC is a histologically distinct breast cancer with diverse presentations including a tendency to metastasize to unique locations. Current endocrine therapies may have different effectiveness for ILC making treatment challenging. Current imaging tools are often unreliable with up to 30% of ILC tumours not identified on mammograms and detection is often delayed. Challenges There are no standardised European diagnostic or treatment protocols for ILC. ELBCA addresses this with collaborative efforts between ILC medical professionals and researchers. It’s a major challenge because each European country has a different health care system and economic policy structure. It’s also a challenge to streamline the translation of clinically accurate information to European patients in their own language. Not all European countries are members of the EU, there are a minimum of 24 official European languages. Established European breast cancer patient organizations often don’t distinguish between different histological subtypes. Current European policy and administrative processes have hindered the formation of a not-for-profit Advocacy Organization. Without such an organization, fundraising and collaborative efforts with others is difficult. Conclusions ELBCA has made significant progress towards raising awareness and increasing knowledge of ILC across Europe. Our poster will expand on these accomplishments as well as the following goals: Work with European and International ILC research and patient communities to better understand this unique histological subtype. Elevate ILC research priorities and inform European policy to recognize ILC as a distinct disease. Enhance education of ILC among primary HCP’s and patients. Establish a recognized European ILC Advocacy Organization and collaborate with established BC organizations. Attend major BC research and clinical conferences. Lobby to achieve increased funding for ILC research and clinical trials. Citation Format: Siobhan Freeney, Helene Bonval, Esther Geven, Lori Petitti, Rian Terveer, Claire Turner, Cathrin Brisken, Patrick Derksen, Christine Desmedt, Thijs Koorman, ADRIAN LEE, Steffi Oesterreich, Anne Salomon, George Sflomos, Karen Van Baelen, Tone Lien, Damir Vareslija, Sabine Linn. European Lobular Breast Cancer Advocates: Bridging the Geographical Gaps in Lobular Breast Cancer Education and Awareness [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-11-09.

Enhancing pooling levels strengthens the risk resilience of healthcare insurance: a case study of basic medical insurance fund operations data in Gansu, China

BackgroundIn China, enhancing the pooling levels of basic health insurance has consistently been regarded as a pivotal measure to promote the refinement of the healthcare insurance system. From 2020 to 2022, the widespread outbreak of COVID-19 posed new challenges to China’s basic health insurance.MethodsThe research utilizes Data Envelopment Analysis (DEA), Malmquist index assessment, and fixed-effects panel Tobit models to analyze panel data from 2020 to 2022, assessing the efficiency of basic health insurance in Gansu Province.ResultsFrom 2020 to 2022, the average overall efficiency of the municipal pooling of Basic Medical Insurance for Urban and Rural Residents was 0.941, demonstrating a stable trend with a modest increase. The efficiency frontier regions have expanded from 5 (35.71%) to 7 (50%). Operational efficiency exhibited a negative correlation with per capita hospitalization expenses and per capita fund balance but a positive correlation with per capita accumulated fund balance and reimbursement rates for hospitalized patients. In 2021, compared to 2020, the county-pooling Basic Medical Insurance for Urban Employees saw a decline of 0.126 in overall efficiency, reducing the efficiency frontier regions from 8 to 3. However, from 2021 to 2022, the municipal-coordinated Basic Medical Insurance for Urban Employees experienced a 0.069 increase in overall efficiency, with the efficiency frontier regions expanding from 3 to 5. Throughout 2020 to 2022, the operational efficiency of the Urban Employee Basic Medical Insurance showed a consistent negative correlation with per capita fund balance.ConclusionFrom 2020 to 2022, the overall operational performance of basic health insurance in Gansu Province was satisfactory, and enhancing the pooling level is beneficial in addressing the impact of unforeseen events on the health insurance system.

Clinical and Diagnostic Utility of Genomic Profiling for Digestive Cancers: Real-World Evidence from Japan.

The usefulness of comprehensive genomic profiling (CGP) in the Japanese healthcare insurance system remains underexplored. Therefore, this large-scale study aimed to determine the usefulness of CGP in diagnosing digestive cancers. Patients with various cancer types recruited between March 2020 and October 2022 underwent the FoundationOne® CDx assay at the Keio PleSSision Group (19 hospitals in Japan). A scoring system was developed to identify potentially actionable genomic alterations of biological significance and actionable genomic alterations. The detection rates for potentially actionable genomic alterations, actionable genomic alterations, and alterations equivalent to companion diagnosis (CDx), as well as the signaling pathways associated with these alterations in each digestive cancer, were analyzed. Among the 1587 patients, 547 had digestive cancer. The detection rates of potentially actionable genomic alterations, actionable genomic alterations, and alterations equivalent to CDx were 99.5%, 62.5%, and 11.5%, respectively. APC, KRAS, and CDKN2A alterations were frequently observed in colorectal, pancreatic, and biliary cancers, respectively. Most digestive cancers, except esophageal cancer, were adenocarcinomas. Thus, the classification flowchart for digestive adenocarcinomas proposed in this study may facilitate precise diagnosis. CGP has clinical and diagnostic utility in digestive cancers.

Weight telemonitoring of heart failure versus standard of care in a real-world setting: Results on mortality and hospitalizations in a 6-month nationwide matched cohort study.

Evaluating the benefit of telemonitoring in heart failure (HF) management in real-world settings is crucial for optimizing the healthcare pathway. The aim of this study was to assess the association between a 6-month application of the telemonitoring solution Chronic Care Connect™ (CCC) and mortality, HF hospitalizations, and associated costs compared with standard of care (SOC) in patients with a diagnosis of HF. From February 2018 to March 2020, a retrospective cohort study was conducted using the largest healthcare insurance system claims database in France (Système National des Données de Santé) linked to the CCC telemonitoring database of adult patients with an ICD-10-coded diagnosis of HF. Patients from the telemonitoring group were matched with up to two patients from the SOC group based on their high-dimensional propensity score, without replacement, using the nearest-neighbour method. A total of 1358 telemonitored patients were matched to 2456 SOC patients. The cohorts consisted of high-risk patients with median times from last HF hospitalization to index date of 17.0 (interquartile range: 7.0-66.0) days for the telemonitoring group and 27.0 (15.0-70.0) days for the SOC group. After 6 months, telemonitoring was associated with mortality risk reduction (hazard ratio [HR] 0.71, 95% confidence interval [CI] 0.56-0.89), a higher risk of first HF hospitalization (HR 1.81, 95% CI 1.55-2.13), and higher HF healthcare costs (relative cost 1.38, 95% CI 1.26-1.51). Compared with the SOC group, the telemonitoring group experienced a shorter average length of overnight HF hospitalization and fewer emergency visits preceding HF hospitalizations. The results of this nationwide cohort study highlight a valuable role for telemonitoring solutions such as CCC in the management of high-risk HF patients. However, for telemonitoring solutions based on weight and symptoms, consideration should be given to implement additional methods of assessment to recognize imminent worsening of HF, such as impedance changes, as a way to reduce mortality risk and the need for HF hospitalizations. Further studies are warranted to refine selection of patients who could benefit from a telemonitoring system and to confirm long-term benefits in high-risk and stable HF patients.

Analysis of Policy and Social Issues in China's Healthcare Sector

The significance of government policies on healthcare has been amplified due to the swift progress observed in China's healthcare industry. The primary objective of this study was to conduct an in-depth examination of the societal implications of China's healthcare policies, with particular emphasis on the social dimensions of the healthcare insurance system, the essential medications system, and the regulation of drug pricing. Through a comprehensive analysis of these challenges, the objective is to establish a foundational framework for future enhancements in policy. The focus of this study centres around the policies of China's pharmaceutical business. Various research methodologies are employed, such as literature review, policy analysis, example analysis, and quantitative data assessment. The examination of policies in a thorough manner indicates that the execution of the government's pharmaceutical policies, particularly in relation to the health insurance system, critical drug system, and drug price control, has the potential to give rise to a range of societal issues. The issues encompassed in this context comprise, though are not restricted to, the problematic aspects of health insurance reimbursement, shortages of pharmaceutical drugs, and the inequitable allocation of medical resources. In order to tackle these issues, policymakers have proposed a set of recommendations aimed at enhancing the efficiency of the health insurance system, bolstering the management of the drug supply chain, optimising the allocation of medical resources, fostering drug innovation and research and development, and reinforcing the governance and utilisation of health insurance funds.

DuPont analysis among European dentistry companies to measure the impact of the COVID-19 pandemic

Although health economics belongs to the highly respected economic disciplines within the research literature, there is a considerable gap related to the investigation of dentistry in particular, even after the global pandemic of COVID-19 disease. Fundamentally, the DuPont framework is a well-known complex analysis to evaluate companies from the point of view of financial performance. The investigation of the return on equity as a relation between the return on assets and the equity multiplier, simply called the leverage effect, is presented in this paper. Therefore, this study aims to estimate the effect of leverage and its changes due to the COVID-19 pandemic among dentistry companies in selected European countries with different healthcare insurance systems. This comparative investigation focused on the generalised method of moments with dynamic panel data from Orbis, the Bureau van Dijk financial database for 1,128 dentistry companies in nine European countries. Methodologically, concerning those post-estimation techniques to evaluate over- and underestimation of the models. It has been differentiating between companies with a high or low ownership concentration structure. The results have shown differences in the leverage effect during the pandemic, assuming that companies with a major owner increased their equity, while the debt leverage increased among those companies with dispersed ownership and vice versa. If economic theory states that debt financing is more effective for a company than using internal sources, it is apparently different in the case of dentistry during the pandemic. However, dispersed ownership is more often related to dentistry, according to mergers in this particular business industry.

Flatten the curve. On a new covid-19 (hit) severity

ABSTRACT Background During the health crisis of the COVID-19 pandemic, the adagium was to ‘flatten the curve’. We investigate how well countries succeeded in this aim by constructing an appropriate severity measure. It is able to distinguish between countries that, e.g., experienced identical overall (excess) mortality rates or attained equal case load peaks over a certain period of time. Concretely, this implies that an identical total number of infections or deaths over a certain period is considered relatively worse if there is a higher and/or more peaks. More classical measures (like the total number or the maximum of cases/deaths) neglect this and are therefore inappropriate to assess the resilience of a health care system nor pandemic policy ex post performance. Methods & Results We applied our new (hit) severity to a set of 32 countries, and found that the flattening didn’t go equally well. The difference in severity is large, with Norway being consistently the least severely hit by the pandemic (using deaths as indicator) during the whole observation period, while Hungary comes out as eventually being hit the hardest in our sample. Conclusions Having constructed a (hit) severity measure that enables to differentiate between countries’ performances in a sound way, further research should now relate these observed differences to the pre-pandemic health care status and the sanitary measures or restrictions imposed during the pandemic; in order to reveal what measures help the most in what type of health care system and society.

Правовые аспекты использования эпигенетической информации: вопросы конфиденциальности, дискриминации и личной ответственности

Introduction: the article provides an overview of the legal, ethical, and social aspects of the epigenetic research development in the context of personalized medicine and the healthcare system as a whole. The authors address the issue of confidentiality of epigenetic information and assess the scale of its impact on the principle of patient autonomy. Purpose: to study the problematic aspects of using epigenetic information associated with the risks of discrimination, re-identification of donors of clinical samples, and the uncertainty of epigenetic predictors. Methods: traditional theoretical and empirical methods. Results: the study has revealed the specific nature of epigenetic information as a means of characterizing the relationship between lifestyle and environmental factors that influence human health and behavior. The paper also proves that there is differentiation in the understanding of epigenetic information among different population groups and uneven access to epigenetic data. Conclusions: Epigenetics is a promising area for the integration of public policy measures aimed at creating a more advanced health care and health insurance system. Epigenetic information, directly affecting the principle of patient autonomy, requires increased guarantees of legal protection.

Carrot Health: digitizing health care through consumer analytics

Theoretical basis The case is designed to be used with the digital business model framework developed by Peter Weill and Stephanie Woerner of Massachusetts Institute of Technology (MIT) (Weill and Woerner, 2015) and is referred to as the W & W framework. This approach provides a useful structure for thinking through the strategic options facing environments ripe for digital transformation. Research methodology Research for this case was conducted through face-to-face interviews with the protagonist, as well as through a review of their business planning documents and other data and documentation provided by the founder. Some of the market and industry data were obtained using secondary research and industry reports. Interviews were digitally recorded and transcribed to ensure accuracy. Case overview/synopsis The case follows the story of Kurt Waltenbaugh, a Minnesota entrepreneur who shared the dream of using data analytics to reduce costs within the US health-care system. In early 2014, Waltenbaugh and a physician colleague founded Carrot Health to bring together their personal experience and expertise in both consumer data analytics and health care. From the beginning, they focused on how to use data analytics to help identify high-risk/high-cost patients who had not yet sought medical treatment. They believed that they could use these insights to encourage early medical interventions and, as a result, lower the long-term cost of care. Carrot’s initial success found them in a consultative role, working on behalf of insurance companies. Through this work, they honed their capabilities by helping their clients combine existing claims data with external consumer behavioral data to identify new potential customers. These initial consulting contracts gave Carrot the opportunity to develop its analytic tools, business model and, importantly, to earn some much-needed cash flow during the start-up phase. However, they also learned that, while insurance companies were willing to purchase data insights for one-off market expansion projects, it was much more difficult to motivate them to use data proactively to eliminate costs on an ongoing basis. Waltenbaugh believed that Carrot’s greatest potential lay in their ability to develop predictive models of health outcomes, and this case explores Carrot’s journey through strategic decisions and company transformation. Complexity academic level This case is intended for either an undergraduate or graduate course on entrepreneurial strategy. It provides an effective introduction to the unique structure and constraints which apply to an innovative start-up within the health-care industry. The case also serves as a platform to explore the critical criteria to be considered when developing a digital transformation strategy and exposing students to the digital business model developed by Weill and Woerner (2015) at MIT (referred to in this instructor’s manual as the W&W framework). The case was written to be used in an advanced strategy Master of Business Administration (MBA) class, an undergraduate specialty health-care course or as part of a health-care concentration in a regular MBA, Master of Health Care Administration (MHA) or Master of Public Health (MPH). It may be taught toward the end of a course on business strategy when students are building on generic strategy frameworks and adapting their strategic thinking to the characteristics of specific industries or sectors. However, the case can also be taught as part of a course on health-care innovation in which case it also serves well as an introduction to the health-care payments and insurance system in the USA. Finally, the case can be used in a specialized course on digital transformation strategy in which case it serves as an introduction to the MIT W&W framework. The case is particularly well-suited to students who are familiar with traditional frameworks for business strategy and business models. The analysis builds on this knowledge and introduces students interested in learning about the opportunities and challenges of digital strategy. Equally, the case works well for students with clinical backgrounds, who are interested in how business strategy can influence changes within the health-care sphere. Finally, an important aspect of the case design was to develop students’ analytical confidence by encouraging them to “get their hands dirty” and to carry out some basic exploratory data analytics themselves. As such, the case requires students to combine and correlate data and to experience the potentially powerful combination of clinical and consumer data. Instructors should find that the insights from these activities give students unique insights into the potential for of data analytics to move health care from a reactive/treatment ethos to a proactive/intervention ethos. This experience can be particularly revealing for students with clinical backgrounds who may initially be resistant to the use of clinical data by commercial organizations.

Patient Readmission for Ischemic Stroke: Risk Factors and Impact on Mortality.

Patient readmission for ischemic stroke significantly strains the healthcare and medical insurance systems. Current understanding of the risk factors associated with these readmissions, as well as their subsequent impact on mortality within China, remains insufficient. This is particularly evident in the context of comprehensive, contemporary population studies. This 4-year retrospective cohort study included 125 397 hospital admissions for ischemic stroke from 838 hospitals located in 22 regions (13 urban and 9 rural) of a major city in western China, between January 1, 2015 and December 31, 2018. The Chi-square tests were used in univariate analysis. Accounting for intra-subject correlations of patients' readmissions, accelerated failure time (AFT) shared frailty models were used to examine readmission events and pure AFT models for mortality. Risk factors for patient readmission after ischemic stroke include frequent admission history, male gender, employee's insurance, advanced age, residence in urban areas, index hospitalization in low-level hospitals, extended length of stay (LOS) during index hospitalization, specific comorbidities and subtypes of ischemic stroke. Furthermore, our findings indicated that an additional admission for ischemic stroke increased patient mortality by 16.4% (P < .001). Stroke readmission contributed to an increased risk of hospital mortality. Policymakers can establish more effective and targeted policies to reduce readmissions for stroke by controlling these risk factors.