Health Insurance Members Research Articles

Perception of statutory skin cancer screening in the general population : Current findings on participation, knowledge and evaluation

Since 2008, German statutory health insurances offer routine skin cancer screening (rSCS) as astandard benefit. Insured persons aged 35years and older are eligible for screening every 2years. The aim of the study was to evaluate perception and utilization of rSCS in the general population. Arepresentative random sample of n= 1004 adult members of the German statutory health insurances were surveyed by the Forsa Institute via computer-assisted telephone interviews in across-sectional study in April 2015. On 39% of all persons interviewed, skin cancer screening had been executed at least once; the percentage of those entitled for rSCS was 45%. Of the participants, 50% were aware of the rSCS eligibility framework, with multiple sources of information. In 82% of cases, rSCS was performed by adermatologist. The majority (87%) of those who had already undergone rSCS stated that the advantages of the procedure outweighed inconveniences. While participation in rSCS constantly increased (2011-2013-2015), knowledge of eligibility did not. Seven years after implementation, rSCS has been utilized by almost half of those entitled and was rated positively by the majority. However, lack of knowledge about rSCS eligibility is also present in 50%. Further targeted informative measures are needed to increase awareness of rSCS.

Health facility and skilled birth deliveries among poor women with Jamkesmas health insurance in Indonesia: a mixed-methods study

BackgroundThe growing momentum for quality and affordable health care for all has given rise to the recent global universal health coverage (UHC) movement. As part of Indonesia’s strategy to achieve the goal of UHC, large investments have been made to increase health access for the poor, resulting in the implementation of various health insurance schemes targeted towards the poor and near-poor, including the Jamkesmas program. In the backdrop of Indonesia’s aspiration to reach UHC is the high rate of maternal mortality that disproportionally affects poor women. The objective of this study was to evaluate the association of health facility and skilled birth deliveries among poor women with and without Jamkesmas and explore perceived barriers to health insurance membership and maternal health service utilization.MethodsWe used a mixed-methods design. Utilizing data from the 2012 Indonesian Demographic and Health Survey (n = 45,607), secondary analysis using propensity score matching was performed on key outcomes of interest: health facility delivery (HFD) and skilled birth delivery (SBD). In-depth interviews (n = 51) were conducted in the provinces of Jakarta and Banten among poor women, midwives, and government representatives. Thematic framework analysis was performed on qualitative data to explore perceived barriers.ResultsIn 2012, 63.0% of women did not have health insurance; 19.1% had Jamkesmas. Poor women with Jamkesmas were 19% (OR = 1.19 [1.03–1.37]) more likely to have HFD and 17% (OR = 1.17 [1.01–1.35]) more likely to have SBD compared to poor women without insurance. Qualitative interviews highlighted key issues, including: lack of proper documentation for health insurance registration; the preference of pregnant women to deliver in their parents’ village; the use of traditional birth attendants; distance to health facilities; shortage of qualified health providers; overcrowded health facilities; and lack of health facility accreditation.ConclusionsPoor women with Jamkesmas membership had a modest increase in HFD and SBD. These findings are consistent with economic theory that health insurance coverage can reduce financial barriers to care and increase service uptake. However, factors such as socio-cultural beliefs, accessibility, and quality of care are important elements that need to be addressed as part of the national UHC agenda to improve maternal health services in Indonesia.

Using an intervention mapping approach for planning, implementing and assessing a community-led project towards malaria elimination in the Eastern Province of Rwanda.

BackgroundActive community participation in malaria control is key to achieving malaria pre-elimination in Rwanda. This paper describes development, implementation and evaluation of a community-based malaria elimination project in Ruhuha sector, Bugesera district, Eastern province of Rwanda.MethodsGuided by an intervention mapping approach, a needs assessment was conducted using household and entomological surveys and focus group interviews. Data related to behavioural, epidemiological, entomological and economical aspects were collected. Desired behavioural and environmental outcomes were identified concurrently with behavioural and environmental determinants. Theoretical methods and their practical applications were enumerated to guide programme development and implementation. An operational plan including the scope and sequence as well as programme materials was developed. Two project components were subsequently implemented following community trainings: (1) community malaria action teams (CMATs) were initiated in mid-2014 as platforms to deliver malaria preventive messages at village level, and (2) a mosquito larval source control programme using biological substances was deployed for a duration of 6 months, implemented from January to July 2015. Process and outcome evaluation has been conducted for both programme components to inform future scale up.ResultsThe project highlighted malaria patterns in the area and underpinned behavioural and environmental factors contributing to malaria transmission. Active involvement of the community in collaboration with CMATs contributed to health literacy, particularly increasing ability to make knowledgeable decisions in regards to malaria prevention and control. A follow up survey conducted six months following the establishment of CMATs reported a reduction of presumed malaria cases at the end of 2014. The changes were related to an increase in the acceptance and use of available preventive measures, such as indoor residual spraying and increase in community-based health insurance membership, also considered as a predictor of prompt and adequate care. The innovative larval source control intervention contributed to reduction in mosquito density and nuisance bites, increased knowledge and skills for malaria control as well as programme ownership.ConclusionThis community-based programme demonstrated the feasibility and effectiveness of active community participation in malaria control activities, which largely contributed to community empowerment and reduction of presumed malaria in the area. Further studies should explore how gains may be sustained to achieve the goal of malaria pre-elimination.

Determinants of Voluntary National Health Insurance Drop-Out in Eastern Sudan

Low enrolment and high drop-out rates are common problems in voluntary health insurance schemes. Yet, most studies in this research area focus on community-based health insurance and enrolment, rather than drop-out. This study examines what causes informal sector families not to renew their voluntary National Health Insurance Fund (NHIF) health insurance membership in Eastern Sudan. Primary data from about 600 informal sector households that dropped out or remained insured, collected through a household survey conducted in March 2014, were used. Logistic regressions were employed to examine what determines drop-out of the voluntary NHIF scheme. The logistic regression results are consistent with the existing literature and confirm the importance of household head, household and community characteristics. Notably, worse family health status and higher health care utilization decrease the probability of drop-out, which requires further analysis as it may indicate the problem of adverse selection and insufficient risk management. Most importantly, the results consistently show that household heads who are satisfied with health services and those who understand the main features of the voluntary NHIF scheme are less likely to drop out. Also, 30% of drop-out households hold a social support card and reported that the social support scheme is the main reason for not renewing their voluntary NHIF health insurance membership as they qualify for sponsored NHIF health insurance membership. This study shows that satisfaction with health services and knowledge of the health insurance scheme are important factors explaining drop-out of a national health insurance programme. The results suggest that education and information campaigns should be developed further to raise understanding of the NHIF voluntary scheme. In addition, information systems and coordination between the main agencies should be strengthened to reduce administrative costs and ensure policy coherence.

Japanese childhood cancer survivors' readiness for care as adults: a cross-sectional survey using the Transition Scales.

Childhood cancer survivors' (CCSs') readiness for adult care has not been evaluated in Japan. We conducted a survey to examine transition barriers and facilitators in CCSs and compared the results with those of CCSs in Canada. Participants were selected from the Heart Link mutual-aid health insurance membership directory and the Millefeuille Childhood Cancer Frontiers. We conducted a cross-sectional survey (self-report questionnaire) via mail, using the Transition Scales. In total, 268 questionnaires were collected by January 2016 (response rate, 42.5%). After confirming the reliability and validity of the Transition Scales, we analyzed 242 questionnaires. After excluding questionnaires for CCSs younger than 15 or older than 26years, we compared scales scores between Japanese and Canadian CCSs. Relative to that of Japanese CCSs, Canadian CCSs showed greater cancer-related worry for 4 items (P<.001) and preference for self-management in 3 items (P<.001). Japanese CCSs showed greater preference for self-management, relative to that of Canadian CCSs, in 5 items (P<.001). In the expectation scale, Japanese CCSs showed lower levels of expectation concerning adult care in 6 of 12 items (P<.001). Relative to that of Canadian CCSs, a significantly higher number of Japanese CCSs preferred to visit the same doctor for long-term care as adults (P<.001). The results confirmed the reliability and validity of the Transition Scales and showed that Japanese CCSs expressed fewer cancer concerns, but a higher number of Japanese CCSs preferred to visit the same doctor for long-term care as adults.

Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana

BackgroundUtilization of healthcare in Ghana’s novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme’s financial sustainability. This paper investigates the presence of adverse selection by assessing the effect of healthcare utilization and frequency of use on NHIS renewal.MethodRoutine enrolment and utilization data from 2008 to 2013 in two regions in Ghana was analyzed. Pearson Chi-square test was performed to test if the proportion of insured who utilize healthcare in a particular year and renew membership the following year is significantly different from those who utilize healthcare and drop-out. Logistic regressions were estimated to examine the relationship between healthcare utilization and frequency of use in previous year and NHIS renewal in current year.ResultsWe found evidence suggestive of the presence of adverse selection in the NHIS. Majority of insured who utilized healthcare renewed their membership whiles most of those who did not utilize healthcare dropped out. The likelihood of renewal was significantly higher for those who utilize healthcare than those who did not and also higher for those who make more health facility visits.ConclusionThe NHIS claims bill is high because high risk individuals who self-select into the scheme makes more health facility visits and creates financial sustainability problems. Policy makers should adopt pragmatic ways of enforcing mandatory enrolment so that low risk individuals remain enrolled; and sustainable ways of increasing revenue whiles ensuring that the societal objectives of the scheme are not compromised.

Women’s Membership in Health Insurance and Correlation with Contraception Use in Indonesia

&lt;p&gt;&lt;strong&gt;BACKGROUND &amp;amp; PURPOSE: &lt;/strong&gt;One important effort in reducing the Maternal Mortality Rate is integration of Family Planning services into Health Insurance policy. This is giving affordability in health service financing through providing contraceptive accordance with established policy. The purpose of this study is to examine women’s participation in health insurance and correlations to contraception use.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;MATERIAL &amp;amp; METHODS: &lt;/strong&gt;The study used the 2012 Indonesian Demographic and Health Survey data-set. Samples were women aged 15 to 49 years, of married status or living together (n=33,465). The dependent variable was contraception used for three categories: Using Long Term Contraceptive, using non-Long Term Contraceptive, and not using any kind of contraception. Data analysis used Chi-square and multinomial logistic regression with complex sample.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;RESULTS: &lt;/strong&gt;10.6% of women were found to have used a Long Term Contraception method. Health insurance membership has correlations to contraceptive use (OR=1.241 and 0.964, &lt;em&gt;p&lt;/em&gt;&amp;lt;0.05, CI 95%), with confounder variables of age (&lt;em&gt;p&lt;/em&gt;&amp;lt;0.05, OR=1.428 and 0.648), education (&lt;em&gt;p&lt;/em&gt;&amp;lt;0.05, OR=1.402 and 1.064), work status (&lt;em&gt;p&lt;/em&gt;&amp;lt;0.05, OR=1.151 and 0.966), parity (&lt;em&gt;p&lt;/em&gt;&amp;lt;0.05, OR=3.114 and 1.685), perception of ideal number of children (&lt;em&gt;p&lt;/em&gt;&amp;lt;0.05, OR=2.057 and 1.682), husband’s education (&lt;em&gt;p&lt;/em&gt;&amp;lt;0.05, OR=0.166 and 0.920), husband's work (&lt;em&gt;p&lt;/em&gt;&amp;lt;0.05, OR=1.247 and 2.469), and role of media (&lt;em&gt;p&lt;/em&gt;&amp;lt;0.05, OR=1.255 and 1.084).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;CONCLUSION &amp;amp; RECOMMENDATIONS: &lt;/strong&gt;This study was empirical evidence in Indonesia that health insurance factors have a significant correlation to Long Term Contraceptive use in women. It is recommended for government to maintain and improve policies that integrate Family Planning services into National Health Insurance. &lt;/p&gt;

Estimating the prevalence of Parkinson's disease (PD) and proportions of patients with associated dementia and depression among the older adults based on secondary claims data.

While the epidemiology of Parkinson's disease (PD) has been extensively studied, data on the prevalence of PD among the older adults in Germany are scarce, based on small samples, and limited to primary data designs. This study estimated the PD prevalence among the older adults in Germany in 2006 using secondary data. We included 815,573 health insurance members aged ≥65 years from all regions in Germany. PD was identified in case of at least one inpatient or outpatient diagnosis. An outpatient diagnosis had to be confirmed by either a subsequent diagnosis or an antiparkinsonian drug within 12 months. PD was also assumed if a first prescription was confirmed by a diagnosis within 12 months. Cases were checked for a diagnosis of dementia or depression. The standardized prevalence of PD was 1680 (95% confidence interval (CI): 1644-1716) cases per 100,000 persons. The prevalence increased with age and peaked in the age group of ≥90 years (4633 cases; 95% CI: 4227-5068) with higher rates in men (1729; 95% CI: 1684-1776) than in women (1644; 95% CI: 1593-1697). Dementia and depression occurred in 26.6% (95% CI: 25.8-27.5) and 32.6 (95% CI: 31.7-33.5) of PD cases, respectively. The age-related increase of PD prevalence and the age-specific prevalence estimates are in line with other European studies, stressing the public health relevance related to PD. In addition to the minimization of biases that might occur in primary data studies, further strengths of our findings are the large underlying sample size and the coverage of Germany.

Building Emotional Resilience at the Workplace

Building Emotional Resilience at the Workplace

Health insurance and maternal, newborn services utilisation and under-five mortality.

BackgroundGhana’s National Health Insurance Scheme (NHIS) was introduced in 2005 as a demand side intervention to remove financial barriers to accessing health services. After almost a decade of implementation, this study aims to investigate the association of NHIS membership with antenatal visits (ANC), postnatal visits (PNC) and under-five mortality, using data from the most recent Multiple Indicator Cluster Survey (MICS).MethodsThe survey was nationally representative and used a two-stage sample design to produce separate estimates for key indicators for each of the ten regions in Ghana. A generalised linear model (GLM) with binomial-family logit-link was used to estimate the effect of NHIS membership on each of the MNCH service utilisation indicators, adjusting for relevant confounding factors. Using birth history data, the Cox proportional hazard regression model was used to estimate the effect of NHIS membership on the incidence of under-five deaths, adjusted for wealth quintiles and other potential confounders.ResultsThe results support the role of health insurance membership in improving access to maternal and child health services, including antenatal care (ANC4+ adjusted OR = 1.94; 95 % CI = [1.28, 2.95]; P < 0.01), and content of antenatal care (adjusted OR = 2.05; 95 % CI = (1.46, 2.90); P < 0.0001). However, the study failed to show evidence of association of NHIS membership and under-five mortality (adjusted hazard rate = 0.86; 95 % CI = [0.64, 1.14]; P = 0.30).ConclusionsNational health insurance membership is associated with increased access to and utilisation of health care but not with under-five mortality.

Association of Health Insurance and Socio-economic Factors with Health Care for Malignant Melanoma

Objective: To analyze the relationship between socio-demographic and regional factors, health insurance status and clinical features of malignant melanoma (MM). Methods: Primary data from a nationwide dermato-histopathologic laboratory on all consecutive excisions with proven diagnosis of MM over the 5-year period 2009-2013 were analyzed regarding tumor-specific and socioeconomic characteristics. The tumor depth (Breslow index) being a predictor of invasive MM progression and mortality was defined as a major indicator for early detection and intervention, thus reflecting quality of health care. Results: N=4 840 histologically verified MM samples from 4 583 patients were analyzed; of these, 2 537 (52.4%) were invasive MM. The tumor depth, which was 1.09 mm on average, increased with age from 1.00 mm in the lowest to 1.56 mm in the highest age group, p<0.001). Controlled for age and sex, the members of agricultural health insurances (LKK) and of German local public health insurances (AOK) showed significantly increased tumor depths (1.67 resp. 1.20 mm). The lowest average levels were found in members of the substitute health funds (e. g. Barmer GEK 0.93 mm) and in privately insured persons (0.99 mm). Based on a regional 4-step classification, there was a gradient in MM depth from more populated to more rural areas, ranging from 1.05 mm in nucleated cities to 1.22 in small rural communities. Distribution of MM locations varied significantly by health insurance: The highest proportion of MM in the head/neck area was seen in members of the agricultural (52.3%) and of the local public health insurances (30.2%) vs. 18.5% in patients from the substitute health funds. In contrast, MM located on the trunk and lower extremities was more prevalent in private, substitute and company health insurance funds. Conclusion: Age, gender and health insurance status are relevant determinants of MM health care and progression risk in Germany. Prevention and early detection programs by health insurances should take this into account.

PHS130 - Predicting medical reimbursement amount - what factors drive the medical cost trend

Healthcare costs in the U.S. are the highest worldwide and are rapidly increasing. As a result of this upward trend, employers and health insurance companies are trying to contain the cost of healthcare. This study aimed to understand and identify several factors associated with medical reimbursement amount for Commercial and Medicare health insurance members in Southeastern Pennsylvania and surrounding counties. Using privately insured Commercial and Medicare health plan enrollment and claims data from 2011 and 2012 for 2 million participants, this study empirically examined the impact of socio-demographic, enrollment, census data, rate relativity, utilization, risk scores and chronic diseases on medical reimbursement amount using risk adjustment and risk predictive models. The dependent variables - medical reimbursement amount, was measured separately as concurrent, prospective, and change variable (taking first difference) at each plan participant level. Regression analysis was used to examine individually and cumulatively how much variation was explained by different independent variables for Commercial and Medicare separately using adjusted R-squared. Socio-demographic variables included age, gender, and derived 2010 census variables at the ZIP code level. Separate risk scores were derived for Commercial and Medicare using DxCG’s all medical predicting concurrent medical risk. Among both Commercial and Medicare members, utilization (including services by inpatient, outpatient and professional) was the predominant predictor of medical reimbursement amount. Risk scores and number of chronic diseases are predictive but not as significant as utilization in terms of explanatory power. Socio-demographic variables are important predictors but only explain a small portion of the variation. This study examined several factors associated with medical reimbursement amount. Further research is needed to help understand what other factors are important which may help shed light on potential options for ‘bending the cost curve’.

Willingness to pay for health insurance among the elderly population in Germany.

All elderly Germans are legally obliged to have health insurance. About 90 % of this population are members of social health insurances (SHI) whose premiums are generally income-related and independent of health status. For most of these members, holding social health insurance is mandatory. As a consequence, genuine information about preferences for health insurance is not available. The aim of this study was therefore to determine and analyze the willingness to pay (WTP) for health insurance among elderly Germans. Data from a population-based 8-year follow-up of a large cohort study conducted in the Saarland, Germany was used. Participants aged 57-84 years passed a geriatric assessment and responded to a health economic questionnaire. Individuals' WTP was elicited based on a contingent valuation method with a payment card. Mean monthly WTP per capita for health insurance amounted to €260. This corresponded to about 20% of individual disposable income. Regression analyses showed that WTP increased significantly with higher income, male gender, higher educational level, and privately insured status. In contrast, neither increasing morbidity level nor higher individual health care costs influenced WTP significantly. The relatively large extent of average WTP for health insurance indicates that the elderly would probably accept higher contributions to SHI rather than policy efforts to reduce contributions. The identified determinants of WTP might indicate that elderly generally approve the principle of solidarity of the SHI with contributions depending on income rather than morbidity.

Determinant of factors associated with child health outcomes and service utilization in Ghana: multiple indicator cluster survey conducted in 2011.

BackgroundThe effects of National Health Insurance Scheme in Ghana and its impact on child health outcome and service utilization cannot be underestimated. Despite the tremendous improvement in child health care in Ghana, there are still some challenges in relation to how National health insurance membership, socioeconomic status and other demographic factors impacts on child health outcomes. The study seeks to determine the association between NHIS membership, socio-economic status, geographic location and other relevant background factors, on child health service utilization and outcomes.MethodsSecondary data from the Multiple Indicator Cluster Survey conducted in 2011 was used. Multivariate analysis based on Binary Logistic Regression Models and Multiple linear regression techniques was applied to determine factors associated with child health outcomes and service utilization. Collection of best models was based on Hosmer-Lemeshow Goodness-Of-Fit as one criterion of fit and the Akaike Information Criterion.ResultsControlling for confounding effect of socioeconomic status, age of the child, mothers education level and geographic location, the odds of a child developing anemia for children with National Health Insurance Scheme Membership is 65.2% [95% CI: 52.9-80.2] times less than children without National Health Insurance Scheme Membership. The odds of being fully immunized against common childhood illnesses for children with NHIS membership is 2.3[95% CI: 1.4-3.7] times higher than children without National Health Insurance Scheme Membership. There was no association between National Health Insurance Scheme Membership and stunted growth in children.ConclusionsNational Health Insurance Scheme Membership was found to be related to child health service utilization (full immunization) of children under five a child’s anemia status. Children with NHIS are more likely to be fully immunized against common childhood diseases and are less likely to develop anemia. Stunted growth of children was not associated with National Health Insurance Scheme Membership. Health Education on the registration and the use of the National Health Insurance should be made a national priority to enable the Ministry of Health achieve routine Immunization targets and to reduce to the bearers minimum prevalence of anemia.

Association of cardiovascular health screening with mortality, clinical outcomes, and health care cost: A nationwide cohort study

ObjectiveTo determine whether a cardiovascular disease (CVD) health screening program is associated with CVD-related health conditions, incidence of cardiovascular events, mortality, healthcare utilization, and costs. MethodsCohort study of a 3% random sample of all Korea National Health Insurance members 40years of age or older and free of CVD or CVD-related health conditions was conducted. A total 443,337 study participants were followed-up from January 1, 2005 through December 31, 2010. ResultsIn primary analysis, the hazard ratios for CVD mortality, all-cause mortality, incident composite CVD events, myocardial infarction, cerebral infarction, and cerebral hemorrhage comparing participants who attended a screening exam during 2003–2004 compared to those who did not were 0.58 (95% CI: 0.53–0.63), 0.62 (95% CI: 0.60–0.64), 0.82 (95% CI: 0.78–0.85), 0.84 (95% CI: 0.75–0.93), 0.84 (95% CI: 0.79–0.89), and 0.73 (95% CI: 0.67–0.80), respectively. Screening attenders had higher rates of newly diagnosed hypertension, diabetes mellitus, and dyslipidemia, lower inpatient days of stay and cost, and lower outpatient cost compared to non-attenders. ConclusionsParticipation in CVD health screening was associated with lower rates of CVD, all-cause mortality, and CVD events, higher detection of CVD-related health conditions, and lower healthcare utilization and costs.

Incidence of herpes zoster and its complications in Germany, 2005–2009

After introduction of a herpes zoster (HZ) vaccine in Germany in 2013, a potential recommendation by the German Standing Vaccination Committee is still pending. This study estimated data on the disease burden of HZ in Germany to extend the data basis for the decision process. A retrospective cohort study on data from 7 million statutory health insurance members from 2005 to 2009 was conducted. HZ cases were identified using ICD-10-codes. IRs of HZ and complications were estimated overall, by age, sex and immune status. The proportion of postherpetic neuralgia (PHN), hospitalizations, the diagnosing physician specialty and systemic antiviral therapy were assessed. Annual standardized IRs ranged between 5.3 and 5.5 per 1000 person-years (PY) between 2006 and 2009 with higher IRs in females. In 2009, 72.4% of HZ patients were without complications, while 15.5% suffered from nervous system involvement. The age-related increase was higher for HZ complications than for uncomplicated HZ. Immunocompromised patients suffered slightly more complications than immunocompetent patients. The PHN proportion increased to 15% in 2009 with a steady age-related increase. About 3% of HZ cases were hospitalized. Age-related increases of HZ complications and PHN suggest that particularly older patients might benefit from HZ vaccination.

The Role of Health Insurance Membership in Health Service Utilisation in Indonesia

In 2014, Indonesia implemented a new, nationwide, subsidised universal-coverage health insurance program, under which poor Indonesians do not pay to become members and others pay a relatively low fee. This program has created a national debate about the effectiveness of the ownership of health insurance in increasing the use of health services—particularly among the poor—given the limitations in their quantity and quality. Using membership data on different health insurance programs from the 2007 rounds of Susenas and Riskesdas, this article researches the impact of having health insurance on health service utilisation, by controlling the levels of quality and quantity of health services in the area. We argue that having health insurance increases health service utilisation by approximately eight percentage points when people feel sick (or by approximately five percentage points if we include those who do not feel sick).

Health care characteristics of basal cell carcinoma in Germany: the role of insurance status and socio-demographic factors.

In Germany population-based data on health care of basal cell carcinoma (BCC) are rare. To analyze the relationship between socio-demographic and regional factors, health insurance status and clinical features of BCC. Data base was from a nationwide dermatopathology laboratory. All consecutive excisions from 2010 were analyzed regarding tumor-specific and socioeconomic characteristics of BCC. 9,467 histologically verified BCC derived from 7,116 patients (54.1 % male, mean age 70 years) were analyzed. 33 % of patients had multiple tumors. The average vertical depth of invasion of BCC was 1.27 mm. It was increased significantly (p ≤ 0.001) in men (1.33 mm vs. 1.19 mm in women) and in persons over 70 years of age (1.36 mm vs. 1.14 mm). Controlled for age and sex, members of agricultural health-insurances (LKK) and of German local public health insurances (AOK) showed the highest tumor depths (1.45 mm resp.1.42 mm). The lowest depths (1.17 mm) were found in insurees of the substitute health funds (Ersatzkassen) (p ≤ 0.001). Vertical depth of invasion was significantly increased for patients living in rural counties (1.34 mm) compared to patients from urban areas (1.21 mm). Furthermore, the distribution of BCC locations varied by type of health insurance. Area of residence, health insurance status, age and gender are relevant determinants of BCC health care in Germany. Prevention programs and activities to improve early detection by health insurances should take this into account.

Cost-of-illness studies of atrial fibrillation: methodological considerations

Atrial fibrillation (AF) is the most common heart rhythm arrhythmia, which has considerable economic consequences. This study aims to identify the current cost-of-illness estimates of AF; a focus was put on describing the studies’ methodology. A literature review was conducted. Twenty-eight cost-of-illness studies were identified. Cost-of-illness estimates exist for health insurance members, hospital and primary care populations. In addition, the cost of stroke in AF patients and the costs of post-operative AF were calculated. The methods used were heterogeneous, mostly studies calculated excess costs. The identified annual excess costs varied, even among studies from the USA (∼US$1900 to ∼US$19,000). While pointing toward considerable costs, the cost-of-illness studies’ relevance could be improved by focusing on subpopulations and treatment mixes. As possible starting points for subsequent economic studies, the methodology of cost-of-illness studies should be taken into account using methods, allowing stakeholders to find suitable studies and validate estimates.

Risk factors for discontinuation of insulin pump therapy in pediatric and young adult patients

BackgroundPrevious studies have shown that only a small number of pediatric and young adult patients discontinue pump therapy, but risk factors for discontinuation are unclear. ObjectiveTo identify characteristics of pediatric and young adult patients with pump therapy which are associated with discontinuation of treatment. Subjects and methodsRetrospective cohort study using a representative nationwide database (LRx; IMS Health) in Germany covering >80% of all prescriptions to members of statutory health insurances in 2008–2011. All patients (age group <25 years) with new prescriptions of insulin pumps were identified (2009–2010) and were followed for 12 months. ResultsOverall, 2452 new pump users were identified, of whom 177 (7.2%) switched to other forms of insulin therapy within 12 months. In multivariate logistic regression, younger age (<6 years; reference 18 to <25 years: Odds ratio, OR, 95% CI: 0.36; 0.17–0.74) and use of teflon needles (reference steel needles: OR, 95% CI: 0.59; 0.41–0.83) were related to a lower odds of pump discontinuation. A non-significant trend was found for male sex (OR, 95% CI: 0.75; 0.52–1.08). Prescriptions of thyroid therapeutics (ATC H03A: OR, 95% CI: 1.79; 1.23–2.61) and antiepileptics (N03: OR, 95% CI: 3.14; 1.49–6.59) were significantly associated with discontinuation of pump therapy. ConclusionsAbout 93% of pediatric and young adult patients maintained insulin pump therapy within 12 months. Age <6 years, male sex and teflon needle use were associated with a lower risk of discontinuation. Thyroid therapy (indicating autoimmunity) and antiepileptic drug prescriptions were associated with a higher likelihood for discontinuation of insulin pump treatment.