Health Insurance Plan Research Articles

Disease Pattern and Clinical Profile of Admitted Patients in Pediatric Intensive Care Unit of a Tertiary Care Hospital in Chattogram

Background: The care of critically ill children remains one of the most demanding and challenging aspects in the field of pediatrics. Pediatric Intensive Care Unit (PICU) aims at promoting early intervention and quality care for achieving good results and better prognosis. With the advancement in intensive care facilities, there is a dramatic increase in survival of critically ill children. It is usually offered to patients whose condition is potentially reversible and who have a good chance of surviving with intensive care support. Since these patients are critically ill, the outcome of intervention is sometimes difficult to predict. This study is aimed to assess the clinical profile of critically ill children presenting to the pediatric emergency room and then their admission pattern to the pediatric intensive care unit. This may help to assist intensivist and planners to pay due attention for better utilization of healthcare facilities. Better understanding leads to better management. Materials and methods: This is a cross-sectional study, conducted at the Pediatric Intensive Care Unit of Chattagram Maa Shishu-O-General Hospital from January to June of 2019. A total of 100 admitted cases were recruited and their symptoms and signs, clinical findings and diagnosis were recorded accordingly. All the patients were aged within 28 days to below 14 years. Results: Among the 100 study subjects, 66 were male and 34 were female. The mean age was 1.73 ± 2.6 years. Most children were admitted with respiratory distress though there were other accompanying signs and symptoms. The symptoms subjects commonly presented with were respiratory distress(76%), tachycardia(70%), lung crepitations (69%), tachypnea (68%), fever (67%), lethargy (59%), feeding difficulty (59%), convulsions (48%), low blood pressure (24%), hepatomegaly (19%), cyanosis (14%), edema (6%), congenital anomalies (4%). The clinical findings that led them to PICU admissions were bronchiolitis (4%), bronchopneumonia (42%), respiratory failure of any cause (4%), heart failure (7%), cyanotic congenital heart disease (8%), acyanoticcongenital heart disease (7%), meningitis (13%), encephalitis (12%), cerebral palsy with seizure disorder (21%), status epilepticus (2%), Gullein Barre Syndrome (3%), hyponatremic dehydration (6%), acute kidney injury (2%), acute leukemia (2%).In this study, neurological disorders such as cerebral palsy with seizure disorder and encephalitis and meningitis were among the top five in the diagnosis list. Septicemia with shock was also a very common finding promoting admission to PICU. GCS was found to be significantly lower in the above-mentioned disease conditions making admission to the ICU quite plausible. Conclusion: Children admitted to PICU may have multiple clinical findings and disease patterns. However, some diseases predominate the patient population admitted to PICU.The knowledge of clinical spectrum and epidemiological profile of critically ill children plays a significant role in the planning of health policies that would mitigate various factors related to the evolution of diseases prevalent in these sectors. Descriptive epidemiology focuses on identifying and reporting the pattern and frequency of events related to the health of a population. IAHS Medical Journal Vol 7(1), June 2024; 44-49

Effectiveness of Ayush Rasayana A and B on the Quality of Life of Older Adults: Protocol for a Cluster Randomized Controlled Trial.

With advancing age among older adults, the associated debilities increase, indicating a deteriorating health status as there is a gradual loss of muscle mass, strength, and functionality. Ayush Rasayana A and B are coded Ayurvedic medicines developed from herbal extracts. This study has been planned to prevent debilitating conditions and improve the quality of life (QOL) in older adults. This study aimed to assess the effectiveness of Ayush Rasayana A and B on the QOL, quality of sleep, and functionality of older adults, along with the tolerability of the intervention. This was a multicenter, open-label, cluster randomized controlled trial conducted with 720 participants aged 60 to 75 years. The participants were divided into 2 groups (intervention and control), with both receiving Ayurvedic ancillary treatment for 3 months. The intervention group additionally received 10 g of Ayush Rasayana A orally once daily at bedtime for 6 days, followed by 1.5 g of Ayush Rasayana B orally twice daily before food for the remaining 84 days. The assessment criteria included the Older People's Quality of Life Questionnaire Brief, Katz Index of Independence in Activities of Daily Living, Pittsburgh Sleep Quality Index, Five Times Sit-to-Stand Test, and shoulder and scapular movements. Any change in hematological and biochemical parameters and occurrence of treatment-emergent adverse events were also assessed during the study period. The recruitment of the participants started in December 2023, and the final follow-up was completed in April 2024. Out of the total 720 enrolled participants, 686 (95.3%) completed the study up to the last follow-up. This study may provide evidence-based data to establish preventive treatment protocols for enhancing the QOL and functionality among older adults. The study results may also be helpful for the planning of interdisciplinary health policies for improving the health conditions of different populations. DERR1-10.2196/58186.

Health Insurance Awareness and its Socio Demographic Correlates among Fishermen of Dakshina Kannada District, Southern India

Background: Fishing is a substantial contributor to the Indian economy and Fishermen are subjected to a variety of occupational risks and are at high risk of injury. Health insurance (HI) is a strategy for reducing out-of-pocket expenses during times of illness. Fishermen are subjected to a variety of occupational risks and are at high risk of injury. People with limited resources often lack access to quality health care. Most people obtain healthcare from private providers. This results in catastrophic healthcare costs and the impoverishment of low- and middle-income people. Lack of information about health insurance schemes, budgetary restrictions, and the unavailability of suitable insurance plans customized to their individual needs, the fisherman community frequently struggles to secure health insurance coverage.Methodology: Community-based interventional research among fisherman in the field practice area of medical college in Dakshina Kannada District in Coastal Karnataka. The data was gathered from consented individuals.Results: The majority of the study participants 248 (75.2%) were men between the ages of 40- 50 years 101 (30.6%). A large part of study population belonged to nuclear households 260 (78.8%), with a monthly income of less than or equal to INR 10,000/- among 209 (63.3%) participants. Intervention on health insurance led to increase in awareness and entitlement among the participants.Conclusions: Enrolment in any health insurance plan would be a tool for reducing the family's financial burden and accessing appropriate treatment when needed. This may be accomplished by educating communities about the need for health insurance.

Antihypertensive Medication Adherence and Medical Costs, Health Care Use, and Labor Productivity Among People With Hypertension.

Hypertension affects nearly half of US adults yet remains inadequately controlled in over three-quarters of these cases. This study aimed to assess the association between adherence to antihypertensive medications and total medical costs, health care use, and productivity-related outcomes. We conducted cross-sectional analyses using MarketScan databases, which included individuals aged 18 to 64 years with noncapitated health insurance plans in 2019. Adherence was defined as ≥80% medication possession ratio for prescribed antihypertensive medications. We used a generalized linear model to estimate total medical costs, a negative binomial model to estimate health care use (emergency department visits and inpatient admissions), an exponential hurdle model to estimate productivity-related outcomes (number of sick absences, short-term disability, long-term disability), and a 2-part model to estimate productivity-related costs in 2019 US dollars. All models were adjusted for age, sex, urbanicity, census region, and comorbidities. We reported average marginal effects for outcomes related to antihypertensive medication adherence. Among 379 503 individuals with hypertension in 2019, 54.4% adhered to antihypertensives. Per person, antihypertensive medication adherence was associated with $1441 lower total medical costs, $11 lower sick absence costs, $291 lower short-term disability costs, and $69 lower long-term disability costs. Per 1000 individuals, medication adherence was associated with lower health care use, including 200 fewer emergency department visits and 90 fewer inpatient admissions, and productivity-related outcomes, including 20 fewer sick absence days and 442 fewer short-term disability days. Adherence to antihypertensives was consistently associated with lower total medical costs, reduced health care use, and improved productivity-related outcomes.

Children and Youth with Special Health Care Needs: Progress Towards More Family-Centered Systems of Care.

Children and youth with special health care needs have increasingly been included in community and society over the past 50 years. Changing definitions and programs in the education, health, and public health/Title V sectors document this greater inclusion. The most profound change was in the education system, with the passage of legislative mandates for inclusion and parental rights. Although the health system has no similar universal mandate, the sequential passage of Medicaid, Children's Health Insurance Plan, and the Patient Protection and Affordable Care Act led to expanded health care coverage with no pre-existing conditions and lifetime caps. Title V of the Social Security Act, originally passed in 1935, evolved from a focus on individual medical services to a public health systems approach focusing on building family-centered, coordinated, comprehensive care in community settings. Most of the changes in all the sectors are the result of the advocacy and engagement of parents and families; the Maternal and Child Health Bureau was a supportive and innovative leader for family-professional partnerships. Much work on understanding disparities across the sectors has led to more recent focus on equity.

The Norwegian Counties Public Health Survey (NCPHS)

Abstract Effective public health initiatives should be based upon a thorough understanding of important health-related factors. The purpose of The Norwegian Counties Public Health Survey (NCPHS) is to gain insights from the adult population on topics relevant for planning of public health policy, interventions, and action at the county and municipality levels. The survey includes a core questionnaire on public health-related topics such as health behaviour, subjective quality of life, distress, subjective health, social support, social capital, community contexts, and demographics, including indicators of socio-economy, with additional optional questions and scales varying across data collections. Samples are drawn from the Norwegian National Population Register. NCPHS was piloted in three counties in 2015 and in one county in 2018. After some revision of instruments and sampling procedures, surveys have been carried out in most Norwegian counties since 2019. The total number of participants has now passed 400 000. Expedient data analysis and reporting has enabled the Norwegian Institute of Public Health to present comprehensive reports within six weeks after completed data collections. In these, outcome variables are analysed against district (within counties), gender, age, educational attainment, and assessment of household economy. Tables are also made available at the municipality level. The NCPHS represent a valuable addition to existing health registries and regional health surveys, providing critical information for planning purposes for local and regional public health authorities, for assessing trends over time, comparisons across counties and regions, and for evaluation of policies and interventions. The value of such a system during times of crises was demonstrated during the COVID-19 pandemic. At the Lisbon 2024 European Public Health conference, a few selected examples of use of data from the NCPHS system will be presented. Key messages • Large-scale community surveys provide important insights for planning of public health policies and action. • Strong involvement and collaboration with regional and local public health personnell as well as with media and local people is a prerequisite for succeeding.

Prevalence and outcomes of American Heart Association stages of heart failure in an adult brazilian population of the ELSA-Brasil study

Abstract Aims Heart failure (HF) has a major impact on public health, affecting up to 2% of adult population. HF staging is helpful in capturing pre-clinical disease and its progression to advanced stages. We aimed to determine the prevalence and mortality of HF stages in the participants of a Brazilian adult cohort. Methods The ELSA-Brasil cohort comprises 15,105 adult public servants from 6 Brazilian capitals. In the initial evaluation of the study (2008-2010), ELSA carried out interviews and clinical, laboratory, and cardiovascular ancillary tests. In this analysis, we included participants who had electrocardiogram and echocardiogram performed at baseline visit, and additional information regarding risk factors and functional capacity. The HF stages were defined based on AHA guidelines criteria as follow: Stage 0 was defined as a healthy individual with no risk factors for heart failure. Stage A (at risk for HF) included those without cardiac structural or functional abnormality but with any of the following conditions: systemic hypertension; diabetes mellitus, obesity, history of myocardial revascularization, history of rheumatic fever, and seropositivity for Chagas’ disease. Stage B (pre-HF) was defined as asymptomatic participants with history of myocardial infarction or any major abnormalities on ECG or echocardiogram. Stage C (symptomatic HF) included participants with a clinical history of HF, or HF symptoms in the presence of structural heart disease (defined as in Pre-HF stage). Considering the community-dwelling profile of the sample, we did not expect to have advanced heart failure patients in our sample. Results We included the 3,267 participants (61±9 years; 53% women) with baseline data. Prevalences of HF stages were stage 0: 938 (29%) A: 1,385 (42%), B: 651 (28%) and C: 293 (9%), with different distribution between sexes (p<0.001). Older participants had higher prevalences of stages B and C (p<0.001), with the prevalence of stage C increasing from 1.8% at 35-44 years to 12.2% at 65-74 years. After 12 years of follow-up, total mortality rates of HF stages were Stage 0: 4%; A:10%. B: 16%, and C: 26%, and respective Cox proportional hazard ratios [95% CI] adjusted for age and sex were A: 1.94 [1.3-2.8], B:2.78 [1.9-4.1], and C: 5.39 [3.6-8.1] compared to stage 0. Conclusions The prevalence of HF in Brazilians reflects what is described in international literature, with a large proportion of individuals in pre-symptomatic stages. A notable shift in the sample toward pre-symptomatic and symptomatic HF occurred gradually and persistently across the age span studied. Mortality rates increase incrementally across the HF stages. This information is important for understanding and planning health policies for this syndrome.

Environmental Justice and Sustainable Development: Cumulative Environmental Exposures and All-Cause Mortality in Colorado Counties

(1) Background: Colorado’s (CO) Environmental Justice mapping tool, CO EnviroScreen, quantifies environmental injustices through “EnviroScreen Scores”, highlighting areas likely affected by environmental health disparities. Identifying the specific scores most strongly associated with mortality could help prioritize interventions and allocate resources to address these issues. This study contributes to sustainable development goals by examining the relationship between environmental justice indicators and population health outcomes. By utilizing the CO EnviroScreen tool, we assess how cumulative environmental exposures and vulnerabilities impact mortality rates, providing insights for sustainable planning and public health policies. (2) Methods: We assessed the cross-sectional association between county-level all-cause mortality rates in CO, using 2019 data from the Colorado Department of Public Health and Environment, and three county-level component scores obtained from CO EnviroScreen: sensitive populations (i.e., health-related outcomes), environmental exposures (e.g., from air, water, noise), and climate vulnerability (i.e., risk of drought, flood, extreme heat, wildfire). A quasi-Poisson generalized linear model was utilized, incorporating covariates (county-level metrics for insufficient sleep, alcohol overconsumption, physical inactivity, and smoking) to explore associations adjusted for behavioral risk factors (n = 64 counties). (3) Results: The analysis revealed that a 10% increase in the “Environmental Exposures” component score was associated with a 3% higher all-cause mortality rate (95% CI: 1.00, 1.05), highlighting the importance of addressing environmental determinants for sustainable community health. No significant associations were observed for the “Sensitive Populations” or “Climate Vulnerability” component scores. (4) Conclusions: This study provides novel evidence of an association between the CO EnviroScreen score, particularly the environmental exposure component, and all-cause mortality rates at the county level in Colorado in 2019. The findings suggest that cumulative environmental exposures may contribute to geographic disparities in mortality risk, even after adjusting for key behavioral risk factors. These results underscore the importance of integrating environmental justice considerations into sustainable development strategies to promote equitable health outcomes and resilient communities. While our study demonstrates the utility of CO EnviroScreen in identifying areas at risk due to environmental factors, it does not establish a direct link to broader environmental justice outcomes. Further research is needed to explore specific environmental exposures and their direct impacts on health disparities to provide a more complete picture of environmental justice in Colorado.

The impacts of New York's balance billing regulation on ground ambulance pricing.

To examine the effects of New York's surprise billing regulations on price changes by emergency ground ambulance service providers. We exploited a natural experiment using a difference-in-differences design with randomization inference (RI) to examine the effects of New York state regulations on the prices of emergency ground ambulances, analyzing 2012-2019 commercial claims data. In March 2015, New York implemented a law protecting patients from surprise out-of-network (OON) balance bills, including ground ambulance services. New York's policy tied OON ground ambulance reimbursements to usual, customary, and reasonable rates that typically reflect charges. The control group consisted of similar states that never enacted surprise billing laws. Although self-funded plans are exempted from state laws, we also examined for spillover effects on self-funded plans. Multi-payer national commercial plan claims data were used. The study sample was selected by isolating claims involving an emergency ground ambulance activation code. The event study findings indicated that New York's law led to a continuous increase in prices, relative to controls. The law's implementation was associated with an overall emergency ground ambulance price increase of 13 percentage points (RI p-value: 0.07). We observed a 21-percentage-point increase in in-network prices (RI p-value: 0.07) and a 19-percentage-point increase in OON prices (RI p-value: 0.07), relative to controls, for fully insured health plans. Similar changes in overall prices and in in-network prices were observed in self-insured plans. Last, our study did not find statistically significant evidence of changes in out-of-pocket cost-sharing amounts under New York's regulation. Balance billing laws based on charges can lead to price increases for emergency ground ambulance services. Legislation intended to inoculate patients from these surprise billings for ground ambulance transportation may have unintended consequences for costs of care. Emergency ground ambulances are a major source of surprise billing. The federal No Surprises Act of 2020 excluded emergency ground ambulance services. Some states have regulations that prohibit out-of-network balance bills for ground ambulance services. The study provides the first empirical evidence on the potential impacts of regulations on price changes among emergency ground ambulance providers. The study offers evidence of state policies' effects on fully insured plans and potential spillover effects on self-funded plans. Experiences from New York's state ambulance out-of-network billing regulation indicate that tying reimbursement policies to charges may have the unintended consequences of increasing health care costs.

Improved survival and decreased cancer deaths in young adults with cancer after passage of the Affordable Care Act Dependent Coverage Expansion.

The Patient Protection and Affordable Care Act (ACA) allowed Americans aged 19-25 years to remain on their parents' health insurance plans until age 26 years (the Dependent Care Expansion [DCE]). Have those with cancer diagnoses benefited? The ACE DCE 7-year age range of 19-25 years was compared for changes in cancer survival and mortality before and after enactment of the ACA with groups that were younger and older (in 7-year age spans: ages 12-18 and 26-32 years, respectively). Cancer death data for the entire United States were obtained from the Centers for Disease Control and Prevention, and relative survival data of patients who were diagnosed with cancer were obtained from the National Cancer Institute Surveillance, Epidemiology, and End Results regions representing 42%-44% of the country. Joinpoint analysis identified the DCE-eligible cohort as the only age group of the three groups evaluated that have had improvements in both cancer survival and death rate trends after ACA implementation and that 2010, the year the ACA was passed, was the inflection year for both survival and deaths. By 6 years, the relative survival after cancer diagnosis was 2.6 and 3.9 times greater in the DCE-eligible age group than in the younger and older control groups, respectively (both p<.001), and the cancer death rate in the DCE-eligible age group improved 2.1 and 1.5 times greater than in the younger and older control age groups, respectively (both p<.01). During the first decade of the ACA, eligible young adults with cancer have had significantly improved survival and mortality. Additional policies expanding insurance coverage and enabling earlier cancer diagnosis among young adults are needed. The Patient Protection and Affordable Care Act (ACA) Dependent Care Expansion (DCE) that began in the United States in 2011 allowed young adults aged 19-25 years to remain on their parents' health insurance plans until age 26 years. The survival rate at 6 years in young adult patients diagnosed with cancer was 2.6 to 3.9 times greater in the DCE-eligible age group compared with the younger and older age groups, and the rate of deaths from cancer improved 1.5 to 2.1 times more. During the first decade of the ACA, young adults with cancer who were in the eligible group had significantly longer survival and reduced deaths from cancer. Additional policies that expand insurance coverage and allow the diagnosis of cancer sooner are needed in young adults.

Acceptability of innovative department community-based health insurance in central Mali: A mixed methods study.

As the Universal Health Insurance Plan (RAMU) is gradually being implemented in Mali, community-based health insurance (CBHI) -considered one of the pillars of this programme- must innovate to meet the challenge of universal health coverage. An experimental CBHI was tested in central Mali between 2017 and 2021. This innovative CBHI professionalizes and organizes risk sharing on a larger scale than before, moving from municipalities to circles (departments). A mixed-method study was carried out in the Mopti region to assess the acceptability of this innovation among CBHI elected representatives. In April 2021, 118 questionnaires were administered to CBHI elected representatives, followed by 43 qualitative interviews from the same sample in October 2021. Sekhon etal. (2017) developed an approach outlining seven dimensions of acceptability (attitude, burden, values, coherence, opportunity costs, perceived efficiency, and personal effectiveness), which was used as a conceptual model for data analysis. The results obtained by factor analysis indicate that more than half of individuals (58%) reported above-average acceptability. Elected representatives feel well supported in their activities by the Technical Union of Malian Mutuality (TUM), the umbrella organisation of CBHI. They show some confidence in their ability to perform their duties effectively despite varying levels of commitment that often fall short of expectations and needs, which they justify by their volunteer status. Elected representatives note that the system is very effective despite the nonoptimal conditions linked to the prevailing insecurity. The new CBHI is highly advantageous for the population in terms of content, financial, and geographical access. Professionalisation is an unavoidable condition for the performance of the innovation, as well as the new community assembly. However, elected representatives are concerned about the sustainability of this CBHI and rely on the State and its partners to assume responsibility. The TUM will play an essential role in continuing its support and fulfiling its functions as a delegated management organisation within the framework of the RAMU.

Health insurance plans from NCI-designated public and private cancer centers versus federal health insurance plans.

24 Background: Understanding health insurance plans is crucial for making informed financial decisions and ensuring equitable access to healthcare. While physicians are directly involved in healthcare, the plans available to them are poorly understood. This study compared plans offered at NCI-designated cancer centers with federal plans to better understand and further investigate the differences in beneficiary costs. Methods: We collected data on health plans from 65 cancer centers and federal plans from 5 major insurers by reviewing their websites from 11/2023 - 03/2024. We included up to 3 plans (regardless of insurer) per cancer center and up to 6 federal plans per insurer. We abstracted cost data on premium, deductible, co-pay for physician visits, out-of-pocket (OOP) maximum, and coinsurance for hospitalizations. We compared HMO and PPO plans between public and private cancer centers, as well as with federal plans. Results: We obtained data of 153 plans from 39 public and 26 private cancer centers to compare with 18 federal plans. In the comparison of plans offered at public and private cancer centers, private cancer centers had significantly higher deductible ($597.6 vs $225.9, p=0.03), specialist visit co-pays ($36.1 vs $27.1, p=0.01), and inpatient stay co-insurance ($1281.0 vs $582.9, p=0.02) in HMO plans compared to public cancer centers. For PPO plans, private cancer centers had higher inpatient stay co-insurance ($2,100.5 vs $1,526.3, p=0.03). The premiums of private cancer centers are lower than those in public centers for both HMO plans ($113.5 vs $139.5, p=0.43) and PPO plans ($140.8 vs $190.2, p=0.33), although these differences were not statistically significant. Compared to federal plans, cancer centers plans had significantly higher HMO deductibles ($387.8 vs $100, p=0.02), lower PPO specialist visit co-pays ($30.4 vs $40.5, p=0.05), and lower OOP maximum ($3,823.8 vs $6,554.6, p&lt;0.001) (Table). Conclusions: Our research reveals differences in beneficiary costs between health plans offered by cancer centers and federal plans, as well as among different types of cancer centers. Notably, private cancer centers had higher average costs for deductible, specialist visit, and inpatient stays compared to public cancer centers, likely as a tradeoff to offer a lower premium. These findings underscore the complexities within health plans offered to physicians, emphasizing the necessity for a more comprehensive understanding. Comparison of health plans. Average costs ($) Cancer centers HMO Federal HMO p Cancer Centers PPO Federal PPO p Premium 133.6 425.1 0.1 176.8 259.3 0.1 Deductible 387.8 100 0.02* 906.2 768.2 0.52 Co-pay of PCP visit 20 21.7 0.52 19.7 18.8 0.78 Co-pay of specialist visit 29.4 36.7 0.14 30.4 40.5 0.05* Co-insurance for inpatient stay 955.2 1231.6 0.53 1712 1957.9 0.48 OOP Maximum 3300.2 4416.7 0.24 3823.8 6554.6 &lt;0.001* *p-value &lt; 0.05.

Recognition of Traumatic Brain Injury as a Chronic Condition: A Commentary.

Many clinicians believe that residual impairments due to traumatic brain injury (TBI) are static once initial recovery has plateaued. That is, the effects of the injury are not expected to change significantly over the remainder of a person's life. This assumption has been called into question by several independent longitudinal studies showing that the long-term course of TBI may be better characterized as dynamic rather than static. Health care services that recognize brain injury as a chronic condition would encourage education on self-management to improve or protect health, as well as proactive health care that anticipates common co-morbidities. Those who have had a TBI would be encouraged to engage in lifestyles that optimize wellness. Almost all developed countries commit additional public health resources to addressing chronic conditions. In the United States, specific benefits are available from health insurance plans, particularly Medicare and Medicaid, for persons experiencing chronic health conditions. Potentially the most important benefit would derive from health care practitioners becoming aware of the dynamic nature of chronic brain injury and thus being more attentive to how their patients could be better served to optimize improvement and minimize decline. Recognition of TBI as a chronic condition would not only focus more resources on problems associated with living with brain injury but would also enhance both the public's and professionals' awareness of how to optimize the health and well-being of persons living with the effects of TBI.

How Does a Health Insurance Program Covering 500 Million Poor Impact Credit Market Outcomes?

I study the impact of the world’s largest publicly funded health insurance plan for the poor on credit markets. India launched a health insurance plan that covered 500 million beneficiaries. The fact that opposition-ruled states did not implement the program for political reasons allows me to compare border districts of implemented and nonimplemented states within a difference-in-differences framework. I find that loan delinquency reduced significantly in implemented districts. Increased liquidity for loan repayment seems to be the mechanism at work. I rule out the federal-level ruling party’s influence as an explanation. This paper was accepted by Kay Giesecke, finance. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2023.01039 .

Systemic Treatments for Advanced Prostate Cancer: Relationship Between Health Insurance Plan and Treatment Costs

Systemic Treatments for Advanced Prostate Cancer: Relationship Between Health Insurance Plan and Treatment Costs

Chronically ill patients’ perspectives on support services and activities of patient organizations

BackgroundPatient Organizations (POs) are an important support factor in helping chronically ill patients cope with their illness. Patient involvement in the management of their disease helps to achieve the best possible care for the patient, streamline the work of healthcare providers, shape healthcare policy, and even influence the structures of healthcare systems. The perspective of chronically ill patients on the activities and services provided by patient organizations has not been evaluated yet. This study aimed to identify and map the services and activities of all types of non-profit patient organizations from the perspective of chronically ill patients so that they can be integrated as an integral part of the healthcare system.MethodsNineteen services and activities of patient organizations were sampled from Israeli patient organizations and scientific literature. These services and activities were evaluated by chronically ill patients in Israel. Patient-Oriented Questionnaires (POQ) were distributed among patients with chronic diseases (N = 1395) using snowball sampling.ResultsExploratory factor analysis (EFA) was performed, followed by confirmatory factor analysis (CFA) for convergent and discriminant validity. Findings showed that twelve services and activities suggested by patient organizations were found to represent chronically ill patients’ needs and categorized into three groups: Interpersonal support (five items), patients’ rights (four items), and medical information (three items). CFA showed a good fit for the observed data. CFI = 0.98, NFI = 0.97, TLI = 0.96, RMSEA = 0.058.ConclusionsWell-organized patient organizations are an important pillar in reformed healthcare systems. They can serve as the social arm of the healthcare system and as an intermediary between patients and healthcare institutions. We narrowed down twelve services and activities given by patient organizations that were important to chronically ill patients in Israel. patient organizations can utilize patient needs or preferences into clinical practice and influence health policy planning, patient-caregiver relationships, research and even healthcare costs. patient organizations recognition by the healthcare system, and establishment of a national patient council will help to realize these processes.

Examining factors associated with poor metered-dose inhaler technique in a cohort of bronx patients with uncontrolled asthma

Objective Most studies investigating at-risk groups for poor inhaler technique (PT) have been in adolescents. However, evidence suggests older age correlates with PT. This study aimed to correlate patient characteristics with PT in an adult asthma cohort in the Bronx. Methods We categorized 237 patients with uncontrolled asthma by demonstration of good inhaler technique (GT) (n = 112) or PT (n = 58) at their initial visit. Independent variables included age, sex, ethnicity, language, insurance status, BMI, depression severity, and socioeconomic data. Two logistic regression models were created to assess odds of PT among independent variables at initial visit and odds of improvement in technique at follow-up. Results At the initial visit, patients with PT had a mean age of 53.74 (±13.54) versus 45.12 (±13.26) among those with GT (p= <0.001). The PT group also had a lower percentage of patients with private insurance (52.53% versus 71.15%, p = 0.037). When controlling for language, ethnicity, insurance status, and educational attainment, the odds of PT increased with age (OR, 1.051; CI, 1.017-1.087, p = 0.003) and BMI (OR, 1.065; CI, 1.010-1.123, p = 0.020). Males had lower odds of PT (OR, 0.379; CI, 0.144-0.997; p = 0.049). While insurance status did not affect odds of PT, Medicaid users had lower odds of improving technique (OR, 0.184; CI, 0.040-0.854; p = 0.031). Conclusions At baseline, individuals with PT were younger and more likely to be on a public health insurance plan. Increasing age, increasing BMI, and female sex were associated with higher odds of PT at the baseline visit, but were not associated with improvements in technique.

Valuation of the EQ-5D-3L in Jordan.

In Jordan, no national value set is available for any preference-accompanied health utility measure. This study aims to develop a value set for EQ-5D-3L based on the preferences of the Jordanian general population. A representative sample of the Jordanian general population was obtained through quota sampling involving age, gender, and region. Participants aged above 18 years were interviewed via videoconferencing using the EuroQol Valuation Technology 2.1 protocol. Participants completed ten composite time trade-offs (cTTO) and ten discrete choice experiments (DCE) tasks. cTTO and DCE data were analyzed using linear and logistic regression models, respectively, and hybrid models were applied to the combined DCE and cTTO data. A total of 301 participants with complete data were included in the analysis. The sample was representative of the general population regarding region, age, and gender. All model types applied, that is, random intercept model, random intercept Tobit, linear model with correction for heteroskedasticity, Tobit with correction for heteroskedasticity, and all hybrid models, were statistically significant. They showed logical consistency in terms of higher utility decrements with more severe levels. The hybrid model corrected for heteroskedasticity was selected to construct the Jordanian EQ-5D-3L value set as it showed the best fit and lowest mean absolute error. The predicted value for the most severe health state (33333) was -0.563. Utility decrements due to mobility had the largest weight, followed by anxiety/depression, while usual activities had the smallest weight. This study provides the first EQ-5D-3L value set in the Middle East. The Jordanian EQ-5D-3L value set can now be used in health technology assessments for health policy planning by the Jordanian health sector's decision-makers.

Factors affecting individual sports consumption motivation towards sports consumption behavior: A bibliometric analysis

The purpose of this research is to present a bibliometric analysis of the literature on the ways in which the motivations of individual sports consumers impact the creation of sports infrastructure and the creation of sports-related policy. Design/methodology/approach: Based on the PRISMA approach and information gleaned from the Scopus database, 2605 publications were found to be pertinent to the subject. We conducted a literature analysis of trends and patterns using VOSviewer-based knowledge mapping. Findings: Recent years have seen a proliferation of scholarly publications on the topic of individual sports consumption motivation and its influence on policy formulation and infrastructure development. This suggests that interest in this field is expanding. The list of eminent journals, decision-makers, and organizations involved in this issue demonstrates its global influence. The interdisciplinary nature of the subject is reflected in the study’s emphasis on the most widely published authors and key research terminology. Originality/value: This study closes significant knowledge gaps regarding the complex interactions between societal, environmental, and individual factors that affect the motivation to consume sports and how these motivations influence decisions about sports infrastructure and policies. It does this by using bibliometric techniques and the most recent data. The project aims to create a more thorough picture of how public health policy, sports governance, and urban planning are impacted by the motivations behind sports consumption. Policy implications: Policymakers, planners, and sports organizations can use the results to generate more targeted and effective strategies for the development of sports infrastructure and policy formulation. The study highlights how important it is to make well-informed policy decisions and participate in customized involvement in order to improve public welfare and the overall sports consumer experience.

How Child Health Financing and Payment Mitigate and Perpetuate Structural Racism

Health financing for children and youth comes mainly from commercial sources (especially, a parent’s employer-sponsored insurance) and public sources (especially, Medicaid and Children’s Health Insurance Plan [CHIP]). These 2 sources serve populations that differ in race and ethnicity. This inherent segregation perpetuates a system of disparities in health and health care. Medicaid (and CHIP) have become the largest single provider of health insurance to US children and youth, currently insuring over 50% of all children and youth, with even higher rates for children of racial and ethnic minorities. Medicaid provides substantial benefit to the populations it insures, with good evidence of both short- and long-term improved health and developmental outcomes, and better health and well-being as adults. Nonetheless, some characteristics of Medicaid, especially the major state-by-state variation in eligibility, enrollment practices, and covered services, along with persistent low payment rates, have helped to maintain a separate and unequal health program for racial and ethnic minority children and youth. Several changes in Medicaid—including linking CHIP more closely with Medicaid, strengthening national standards of payment and care, assuring coverage of all children, and incorporating social and family risk adjustment—could make the program even more beneficial and diminish racial differences in child health financing.