Health Insurance Research Articles

Predicting hospitalization with LLMs from health insurance data.

Predictions of hospitalizations can help in the development of applications for health insurance, hospitals, and medicine. The data collected by health insurance has potential that is not always explored, and extracting features from it for use in machine learning applications requires demanding processes and specialized knowledge. With the emergence of large language models (LLM) there are possibilities to use this data for a wide range of applications requiring little specialized knowledge. To do this, it is necessary to organize and prepare this data to be used by these models. Therefore, in this work, an approach is presented for using data from health insurance in LLMs with the objective of predict hospitalizations. As a result, pre-trained models were generated in Portuguese and English with health insurance data that can be used in several applications. To prove the effectiveness of the models, tests were carried out to predict hospitalizations in general and due to stroke. For hospitalizations in general, F1-Score = 87.8 and AUC = 0.955 were achieved, and for hospitalizations due to stroke, the best model achieved F1-Score = 88.7 and AUC of 0.964. Considering the potential for use, the models were made available to the scientific community.

Effect of health shocks on the absenteeism magnitude at work in Togo: is health insurance a mitigating factor?

The occurrence of health shocks affects households economically in various ways. It most often leads to missed work, thus inducing a decrease in productivity and a loss of income. These effects are even more significant if the extent of absenteeism is high or if its duration is long. This study aims to analyse the effects of health shocks on the magnitude of absenteeism and to highlight the potential mitigating effect of health insurance on the magnitude of absenteeism among households affected by the shocks. Absenteeism at work was measured here by the number of days lost due to health problems. Data from the Harmonised Survey on Household Living Conditions (EHCVM) 2019 were used for this purpose. To account for the endogeneity problem in this context, we use Two-Stage Least Square (2SLS) model to achieve our objectives. Our results suggest that health shocks significantly increase the magnitude of absenteeism from work by increasing the probability of a longer duration of absenteeism. Health insurance mitigates the magnitude of absenteeism by significantly reducing the probability of moving from short to long absenteeism by 3.27. Health shocks have a significant effect on the magnitude of absenteeism. Given the role of health insurance in mitigating the effect of health shocks, this study highlights the need for an extension of health insurance to a greater number of people for a more significant effect.

Work-Related Injury and Healthcare Access Among Day Laborers. Struggling at the Esquina.

California has a significant day laborer population, with about one-third of the total U.S. day laborer population working in the state. Day laborers, characterized by a lack of labor protections, low socioeconomic status, English illiteracy, and irregular immigration status, face numerous challenges regarding work-related injuries and limited access to healthcare. Eighty percent of day laborers are undocumented, and most do not have access to healthcare. Despite recent research growth, little is known about their experiences with work-related injuries and healthcare treatment. Our findings reveal that only 8.4% of day laborers have health insurance, and around 26% have experienced work-related injuries. This paper highlights the challenges faced by this population and emphasizes the importance of understanding their experiences to improve occupational health and safety policy. Additionally, we acknowledge the critical role of worker centers and national efforts in addressing health and safety issues among day laborers.

Impact of glycemic treatment and blood glucose monitoring on outcomes in patients with acute ischemic stroke without prior diabetes: a longitudinal cohort study

ObjectivesTo explore the short- and long-term effects of glycemic management—through glycemic treatment and blood glucose monitoring (BGM)—on stroke recurrence and mortality specifically in patients experiencing a first-ever ischemic stroke (FIS) with hyperglycemia (FISHG) who have not previously been diagnosed with diabetes mellitus (DM).MethodsWe gathered data on patients who were registered on Taiwan’s National Health Insurance Research Database from 2000 to 2015. We one-fold propensity-score-matched (by sex, age, and index date) 207,054 patients into 3 cohorts: those with FIS (1) without hyperglycemia, (2) hyperglycemia without glycemic treatment, and (3) hyperglycemia with glycemic treatment. We used Cox proportional hazard regression to evaluate the short- (within 1 year after FIS) and long-term (9.3 ± 8.6 years after FIS) prognostic effects of glycemic management on stroke recurrence and mortality of FISHG.ResultsStroke recurrence and mortality were significantly more likely in the patients with FISHG than their counterparts without hyperglycemia (p < 0.05). Under glycemic treatment, patients with FISHG demonstrated lower risk of mortality at every follow-up than those without (p < 0.001) but were not less likely to have stroke recurrence (p > 0.05). Integrating BGM with glycemic treatment in the FISHG cohort significantly reduced the risk of stroke recurrence compared to patients receiving only glycemic treatment at 1-month, 3-month, 6-month, and 1-year post-stroke follow-ups (adjusted hazard ratios = 0.84, 0.90, 0.88, and 0.92, respectively); additionally, this approach significantly decreased mortality risk at each post-stroke follow-up period (p < 0.05).ConclusionsBGM combined with glycemic treatment significantly improves prognosis in patients with FISHG who have not been previously diagnosed with DM, reducing the risks of stroke recurrence and mortality.

Patient-Reported Distress in Individuals With Head and Neck Cancer.

Distress is common among patients with cancer, and evidence of disparities associated with distress has been mixed. Head and neck cancer (HNC) is one of the most emotionally distressing cancers and is also a highly disparate disease. However, it is unknown whether there are disparities associated with patient-reported distress in HNC. To examine racial and sociodemographic factors associated with clinically meaningful distress in a cohort of patients with HNC. This retrospective cohort study analyzed data from a single tertiary institution at a National Cancer Institute-designated comprehensive cancer center in the Southeastern US. Participants included adult patients from January 2017 to December 2022 with confirmed diagnoses of head and neck squamous cell carcinoma who received radiation therapy up to 5 weeks from initial diagnosis. The outcome of interest was clinically meaningful distress (score of at least 4 on the distress thermometer). The distress thermometer is a single-item, self-reported tool used to measure a person's level of psychological distress over the past week, represented on a scale from 0 (no distress) to 10 (extreme distress). Patients were included in the study if they had visits with clinicians in the radiation oncology department within 5 weeks of diagnosis. Sociodemographic factors were race and ethnicity, age, sex, marital status, and health insurance status. Clinical variables (stage of presentation, anatomical subsites, smoking, and alcohol history) and problem list domain items were included in the adjusted model. Using multivariable logistic regression analysis, odds of meaningful distress by sociodemographic factors were estimated, adjusting for clinical factors and problem list domains. A total of 507 patients met the inclusion criteria. The study population included 389 male patients (76.7%). The median (IQR) age of participants was 63 (56-71) years, with a racial distribution of 89 Black patients (17.6%), 385 White patients (75.9%), and 33 patients of other categories (6.9%), including Asian, Native American, multiracial, declined to respond, and unknown. Overall, 232 patients (45.8%) had meaningful distress. The median (IQR) DT score for the entire cohort was 3 (0-6). Black patients had the highest rate of physical concerns (n = 31 [34.8%]) compared to the other racial groups (78 White patients [20.3%] and 7 persons of other race [21.2%]). However, in the final multivariable model, race was not significantly associated with clinically meaningful distress (Black compared with White: adjusted odds ratio [aOR], 0.76 [95% CI, 0.45-1.28]; other compared with White: aOR, 0.85 [95% CI, 0.37-1.94]). Compared to those married, unmarried patients were significantly more likely to report distress (aOR, 1.61 [95% CI, 1.05-2.50]). Also, patients with emotional problems had double the odds of reporting clinically meaningful distress (aOR, 2.03 [95% CI, 1.02-4.08]). Other factors associated with significant clinical distress included tobacco use (aOR, 2.14 [95% CI, 1.02-4.50]) and reported practical problems (aOR, 2.08 [95% CI, 1.17-3.69]). Independent of race or sociodemographic factors, the results of this retrospective cohort study underscore the need for social and emotional support in mitigating distress and optimizing mental health care in this patient population. Further studies should explore distress trajectories across the HNC continuum and their impact on HNC outcomes.

How do citizens with low health insurance literacy choose a health insurance policy in the Netherlands? An interview study

Various countries have implemented a choice-based health insurance system. For such systems to function as intended, it is crucial that all citizens have the opportunity to make well-informed decisions with regard to their health insurance policy. There is, however, ample research evidence to suggest that many citizens may lack the required skills to do so, thus increasing the likelihood of suboptimal insurance choices and incurring unexpected costs. The current study explored what barriers citizens in the Netherlands, with low health insurance literacy (HIL), face when selecting a health insurance policy, and what their specific needs and preferences are regarding information and support. Semi-structured interviews (online or telephone) were performed between January 2023 and April 2023 among sixteen with a low level of HIL. The data were analyzed using thematic analysis methods. Our results show that not all citizens with low HIL are sufficiently motivated to actively look for alternative health insurance options every year. This is partly due to the feeling that it is a task imposed upon them by the government, and because choosing a health insurance policy is perceived as too complicated and not sufficiently worthwhile. There is a need among citizens with low HIL for clear and practical information about health insurance policies, especially from the government and health insurers. In addition to this need, we recommend enhancing awareness regarding the consequences of neglecting to explore such health insurance options. Moreover, more personal attention for the process of selecting a health insurance policy should be offered to vulnerable groups such as those who possess insufficient digital skills.

Declining Blowout Fracture Cases and Rising Costs in South Korea (2010-2023).

Blowout fractures are a significant component of maxillofacial trauma care, but their incidence appears to be declining in South Korea. This study aims to investigate the trends in blowout fracture cases from 2010 to 2023 and assess the implications for plastic and reconstructive surgery, as well as the financial burden on patients. A retrospective observational study was conducted using data from the Health Insurance Review and Assessment Service in South Korea. Patients diagnosed with orbital fractures (International Classification of Diseases, 10th Revision code S02.3) between 2010 and 2023 were included. Variables such as patient demographics, National Health Insurance (NHI) payments, and patient out-of-pocket expenses in United States dollars were analyzed. Time-series forecasting was performed using the Auto-Regressive Integrated Moving Average (1,1,1) model to predict future trends. A total of 163,146 patients were diagnosed with blowout fractures from 2010 to 2023. The number of cases decreased by 48.0%, from 18,340 in 2010 to 9534 in 2023 (P < 0.001). Despite the decline in cases, the average NHI payment per patient increased by 135.5%, and patient out-of-pocket expenses rose by 127.5% (P < 0.01). Strong negative correlations were found between patient numbers and per-patient costs for both NHI payments (r = -0.933) and patient expenses (r = -0.929). The Auto-Regressive Integrated Moving Average model forecasts suggest that case numbers may stabilize, but health care costs will continue to rise through 2028. The declining trend in blowout fracture cases poses challenges to the sustainability of this subspecialty in plastic and reconstructive surgery. Concurrently, the increasing financial burden on patients highlights limitations in the current health care coverage. Plastic and reconstructive surgeons must adapt by diversifying skills and fostering interdisciplinary collaboration. Policy reforms are necessary to reduce the financial burden on patients and ensure equitable access to care.

Disparities exist among US adolescents in the receipt of transition to adult healthcare services: the differential impact of social determinants of health, healthcare needs, and COVID-19

IntroductionWe examined the influence of special healthcare needs, onset of the COVID-19 pandemic, and their interaction on receiving transition services to prepare for future adult care among US adolescents, and whether social determinants of health moderated the relationship of these factors with receiving transition services.MethodsWe analyzed the National Survey of Children's Health (2019, 2020–2021) using adjusted multivariable logistic regression models. We assessed a repeated cross-sectional, nationally representative sample of adolescents aged 12–17 years old. Sampling weights were used to generalize samples to the populations of interest. The main outcome was receipt of transition services to prepare for future adult healthcare. Measures included pre vs. post COVID-19 onset, special healthcare needs, and social determinants of health (health insurance, food sufficiency, neighborhood safety, household language, race/ethnicity, and household poverty level). Sex and two-parent households were included as covariates.ResultsA total of 45,935 adolescents were included, with N=12,230 in the pre COVID-19 group and N=33,705 in the post COVID-19 group. We found statistically significant higher odds of receiving transition services among adolescents with special healthcare needs (95 CI = 1.23, 1.58), females (95 CI = 1.09, 1.39), and during pre COVID-19 (95 CI = 1.14, 1.45). Private insurance (95 CI = 1.03, 1.37), English as primary household language (95 CI = 1.19, 2.27), and race/ethnicity were significant predictors of receipt of transition services. Neighborhood safety significantly moderated (95 CI = 1.70, 6.60) the relationship between special healthcare needs and receipt of transition services.DiscussionThis population-based study identified significant disparities in receipt of transition services provided to US adolescents via the differential impact of social determinants of health, special healthcare needs, and COVID-19 onset on receipt of services.

Difficulty in financing fracture care in south-western Nigeria: a prospective cohort study of predictors and recommendations for improvement

BackgroundBone fractures remain a significant global public health issue despite preventive measures, leading to substantial health and economic consequences. Effective treatment options are difficult to access in most sub-Saharan African countries, leading to reliance on unqualified practitioners and resulting in serious complications that worsen poverty. In Nigeria, the main challenge is the need for out-of-pocket payment for healthcare, which is the primary method of health financing. However, anecdotal evidence suggests that some patients find it easier to finance their fracture care than others. This study aimed to identify the factors that predict difficult fracture-care financing among patients treated operatively for long-bone fractures (LBFs) in southwestern Nigeria.MethodsThe study collected socio-demographic and clinical data on 690 consecutive adult patients with LBFs treated with SIGN nails between July 2014 and June 2024 at a mission teaching hospital in southwestern Nigeria. A literature review and preliminary interviews were conducted with patients, caregivers, and hospital staff to understand potential risk factors for difficult fracture-care financing. The patients were divided into two cohorts – easy fracture-care financing (EF) and difficult fracture-care financing (DF) – based on their promptness in paying the in-patient care bills. Potential risk factors for DF identified in the initial univariate analysis were entered as covariates into a binary logistic regression to determine the significant predictors of DF.ResultsThe mean age of the patients was 45.1 years (SD = 17.52). The DF cohort comprised 321 (46.5%) patients. Significant predictors of DF included younger age (p = 0.018), male gender (p = 0.002), lack of formal education or low level of education (p < 0.001), residence in the hospital city (p < 0.001), absence of health insurance (p = 0.013), lack of extended family support (p < 0.001), previous traditional bone setting treatment (p = 0.005), concomitant injury (p = 0.017), and a post-operative hospital stay longer than one week (p = 0.036).ConclusionsThe findings suggest that improving people’s socioeconomic status through job creation, women’s empowerment, reduction of gender inequality, higher education, comprehensive health insurance coverage, and stronger family bonds, as well as preventive strategies to reduce the occurrence and severity of injuries, can improve fracture-care financing in low-resource settings.

Views on the well-being of groups of informal caregivers. A cluster analysis using the example of Saxony

BackgroundAs a result of demographic change, a further increase in the number of people in need of care in Germany can be expected in the future. Nursing activities performed by family members are a central component of care provision. Providing care for people in need of care is increasingly associated with additional physical and psychological stress for informal caregivers. The aim of this study is to identify and characterize groups of informal caregivers with regard to their well-being.MethodologyThe empirical study was based on a cross-sectional survey on home care in Saxony from 2019, which was intended as exploratory work to provide insights into the care situation in Saxony. The central component is a two-step cluster analysis with exclusively informal caregivers.ResultsThe net sample size for the cluster analysis comprised 178 subjects who were involved in caring for relatives. The cluster analysis revealed two groups of caregiving relatives in Saxony, which were differentiated by a different experience of stress and various sociodemographic factors.DiscussionInformal caregivers in Saxony are not a homogeneous group. Depending on various sociodemographic factors or the care effort and situation, they are confronted with different challenges in caring for relatives, which are directly reflected in their well-being. In order to achieve a targeted reduction in the burden on family caregivers, cooperation and constructive collaboration between political decision-makers, care and health insurers, and the various players in health and care provision is required.

Health benefits package selection in oncology: a clinical audit of palliative chemotherapy for breast cancer in an Indian health insurance scheme

BackgroundThe effective operation of health insurance requires functioning administrative processes, including appropriate filing for reimbursements. The unlisted palliative care package is one of the most utilized oncology packages within Indian state health insurance schemes. We conducted a clinical audit to evaluate the appropriateness of claims for this package for patients with breast cancer.MethodsWe obtained documentation submitted to support a random sample of insurance claims for the unlisted palliative care package for 50 patients (total) from one public and one private hospital, cataloged the available records, and assessed the appropriateness of package selection using clinical guidelines from India’s National Cancer Grid. Where sufficient documentation was available, we also assessed the clinical appropriateness of care. We also examined whether these patients received relevant care at other hospitals that participate in the scheme and, for five purposefully selected patients, whether additional documentation had been submitted alongside other claims.ResultsClaims for 45 of the 50 patients had sufficient documentation to assess whether the selected package was appropriate. Among these 45 claims only 33% were selected in accordance with guidelines; the public hospital had a relatively higher share of appropriate selections. In many cases (21 claims), the palliative care package was selected for adjuvant therapy and targeted therapy. While more than half of the sampled patients had multiple related encounters and sometimes received care from multiple hospitals, reviewing additional claims did not affect our conclusions.ConclusionClaims for the palliative chemotherapy unlisted package often had deficient documentation and were inappropriately selected.

The Economic Burden of Myasthenia Gravis (MG): A Survey of Affected People and Their Families.

Claims-based analyses have demonstrated high medical costs associated with myasthenia gravis (MG). We examined the economic burden of MG from the perspective of affected people and their families. The Muscular Dystrophy Association developed and conducted an online survey of people with MG and their caregivers between October 26 and December 6, 2021. Major themes were: MG-associated financial decisions, quality of life, employment and direct/indirect costs of diagnosis, healthcare insurance, medical visits, medications/treatments, medical equipment/devices, and caregiving. Eight hundred people with MG and 238 caregivers responding on behalf of a person with MG completed the survey. Most respondents were white (85%) and about half (55%) had received a 4 year college degree or higher education. Respondents indicated that MG impacted their health, recreation, and finances. 70% reported making financial adjustments or seeking financial assistance. Annual out-of-pocket costs (mean, $15,798; median, $7750) were primarily driven by medications, cost to receive a diagnosis, and healthcare insurance premiums. People receiving infusions paid significantly more across all care domains. Demographic disparities were observed, with people of color, women, and those on disability paying significantly more to receive a diagnosis than their counterparts. The economic burden on people with MG and their families is substantial, primarily driven by direct costs. There is a need to engage more broadly with the MG community for generalizable information. Respondents were self-selected, which may impact results. The results will be used to educate the public and inform advocacy work, with the goal of improving the lives of people with MG.

Examining patient choice and provider competition under the National Health Insurance Fund outpatient cover in Kenya: does it enhance access and quality of care?

BackgroundWhile patient choice and provider competition are predicted to influence provider behaviour for enhancing access and quality of care, evidence on provider perceptions and response to patient choice and provider competition is largely missing in low-resource settings such as Kenya. We examined provider and purchaser perceptions about whether patient choice and provider competition influenced provider behaviour and enhanced access and quality of outpatient care in Kenya.MethodsWe conducted a qualitative study to explore this across two purposefully selected counties. We conducted 15 in-depth interviews (IDIs) with health facility managers and National Health Insurance Fund (NHIF) staff across the two counties. We examined these across five areas summarised as either local market conditions or patient feedback following the Vengberg framework.ResultsNHIF members’ choice of outpatient facilities compelled private and faith-based providers to compete for members while public providers did not view choice as a way of spurring competition. Besides, all providers did not receive any information regarding the exit of NHIF members from their facilities. Providers felt that that information would be crucial for their planning, especially in enhancing service accessibility and quality of care. Most providers ensured the availability of drugs, provided a wider range of services and leveraged on marketing to attract and retain NHIF members. Finally, providers highlighted their redesign of service delivery to meet NHIF members’ needs whilst enhancing the quality-of-care aspects such as waiting time and having qualified health workers.ConclusionThere is a need for NHIF to share NHIF members’ exit information with providers to support their service delivery arrangements in response to NHIF members’ needs. Besides, this study contributes evidence on patient choice and provider competition and their influence on access and quality of care from a low-resource setting country which is crucial as NHIF transitioned to the Social Health Authority.

The Role of Cardiac Rehabilitation in Promoting Lifestyle Modification Among Cardiovascular Patients: A Nationwide Cohort Study

Background: Cardiac rehabilitation (CR) is crucial for the secondary prevention of cardiovascular disease, primarily by promoting lifestyle modifications. However, its impact on lifestyle changes in the Korean population has not been well studied. This study analyzed data from the National Health Insurance Database to evaluate the effect of CR on lifestyle improvement in patients with cardiovascular disease. Methods: Patients who underwent coronary revascularization in 2017 were included. This study investigated whether the lifestyle habits of patients with cardiovascular disease who were physically inactive, obese, and smoked improved after coronary revascularization. To analyze whether CR affected each lifestyle factor, multiple regression analysis was performed, adjusting for socioeconomic and medical conditions as covariates. Results: CR had a significant effect on the acquisition of regular physical activity among physically inactive patients before revascularization (odds ratio [OR]: 1.205, 95% confidence interval [CI]: 1.046–1.389). However, CR did not have a significant impact on smoking cessation in smokers (OR: 1.172, 95% CI: 0.890–1.545) and weight reduction in patients with obesity (OR: 1.104, 95% CI: 0.977–1.248). Conclusion: This nationwide study showed that CR after coronary revascularization significantly improved physical activity in patients with cardiovascular disease. However, CR had no significant effect on smoking cessation or weight reduction, indicating a need for more comprehensive approaches to address these lifestyle factors.

Associations of care continuity and care coordination with the overuse of healthcare services: a nationwide population-based study

BackgroundCare continuity and care coordination have received increased attention as important ways of decreasing overuse/low-value care. Prior research has verified an association between care continuity and overuse or an association between care coordination and overuse. However, little is known about the relative influences of care continuity and care coordination on overuse. We used nationwide population-based data from Taiwan to examine the relative associations of care continuity and care coordination with overuse.MethodsWe analyzed 1,462,960 beneficiaries in 2015 randomly sampled from all people enrolled in the Taiwan National Health Insurance. Having adjusted for patient characteristics, the multivariable logistic regression model was used to examine the associations of the Continuity of Care (COC) Index and care density on overuse, using a previously validated set of 18 potentially low-value care services.ResultsHigher COC index was associated with lower overuse (low vs. medium: odds ratio [OR], 1.11; 95% confidence interval [CI], 1.09–1.12; high vs. medium: OR, 0.80; 95% CI, 0.795–0.813). Higher care density was associated with lower overuse (low vs. medium: OR, 1.01; 95% CI, 1.001–1.024; high vs. medium: OR, 0.88; 95% CI, 0.87–0.89).ConclusionsIncreased care continuity and care coordination are associated with decreased overuse. Facilitating care continuity and care coordination may be an important strategy for reducing overuse/low-value care.

Prophylaxis of topical levofloxacin against endophthalmitis after cataract surgery in Taiwan, 2001-2019: an interrupted time series analysis.

Since May 2007, topical levofloxacin 0.5% ophthalmic solution for prophylaxis of postoperative endophthalmitis (POE) in cataract surgery has been reimbursable in Taiwan. We used the National Health Insurance Research Database to estimate the practice of levofloxacin in cataract surgery from 2001 to 2019 and compared the POE rates before and after the introduction of levofloxacin using interrupted time series (ITS) analysis. We did propensity score-based stabilized weights (PSSW) for each quarterly cohort and used the Joinpoint Regression Program to determine the significant change time point. 1,456,380 patients and 2,208,126 eyes were eligible. The Joinpoint Regression Program revealed a significant change in the second quarter of 2010. Levofloxacin use started from 0% in the second quarter of 2007, and increased to 6.3% and 30.2% in the second quarter of 2010 and the last quarter of 2019. The POE rate (per 1000 eyes) was 3.7 in the first quarter of 2001, reduced to 1.9, 1.7, and 1.4 in the first, second quarters of 2010, and the last quarter of 2019, respectively. ITS reveals a significant but smaller time trend of - 0.0088‰ during 2010Q2-2019 (post-interruption). The r-square between the levofloxacin use and the POE rate was 0.305. The results of ITS and r-square after PSSW are similar to those without PSSW. Although the POE reduction rate in cataract surgery aligns with the increased use of levofloxacin, the small r-square and low usage implied topical levofloxacin use is not the sole determinant of POE reduction.

Survivability prognosis of lung cancer patients with comorbidities-a Gaussian Bayesian network model.

Comorbidities are influencing factors that cause lung cancer. An accurate survivability prediction model is required considering these confounding factors (a variety of comorbidities and treatments). The study developed a conditional Gaussian Bayesian network (CGBN) model to predict the related survival time with likelihood under various conditions. The lung cancer patients were collected from the National Health Insurance Research Database in Taiwan. Six major chronic diseases (i.e., pulmonary tuberculosis, COPD, kidney failure, diabetes mellitus, stroke, and liver disease) are investigated. A total of 2875 lung cancer cases with key comorbidities were selected. This study examined three types of lung cancer treatment: surgery, chemotherapy, and targeted therapy. The study outcomes provided the likelihood of survival time occurrences. Survival analysis indicates that diabetes mellitus and liver disease are significantly riskier than the other comorbidities for lung cancer patients. The proposed CGBN model achieved high accuracy as compared to the existing literature. The proposed CGBN model is advantageous for modeling the relationship between numerical and categorical influencing factors and response variables for lung cancer with comorbidities. The proposed model facilitates the flexible and accurate estimation of various lung cancer-related queries.

ANALISIS IMPLEMENTASI BPJS KESEHATAN KOTA LAHAT

BPJS Kesehatan is part of the social health insurance system aimed at providing better access to health services to all Indonesian people. Although this program has shown success in achieving wide coverage of participants, its implementation in several areas, including Lahat City, still faces various challenges. This study aims to analyze the implementation of BPJS Kesehatan in Lahat City with a focus on service effectiveness, public understanding, and obstacles faced in its implementation. This study uses a qualitative approach with an in-depth interview method with BPJS participants, medical personnel, and BPJS administration in Lahat City. The results of the study show that although the BPJS Kesehatan program has provided great benefits to the community, there are problems related to public understanding of the program, limited health facilities that collaborate with BPJS, and difficulties in the claim administration process. The community, especially those in rural areas, still do not understand the BPJS registration mechanism and benefits. In addition, many health facilities in Lahat City are not fully adequate in terms of capacity and quality of service. In addition, the complicated administrative process is also an obstacle for many participants. To improve the implementation of BPJS Kesehatan in Lahat City, it is necessary to increase socialization to the community, improve the quality of health facilities, and simplify BPJS administrative procedures.

Neurobehavioral disorders among children born to mothers exposed to illicit substances during pregnancy

BackgroundExposure to illicit substances during pregnancy may have long-term impacts on children’s neurodevelopment. This study explores subsequent risks for intellectual disability, autistic disorders, and attention deficit and hyperactivity disorders in children born to mothers exposed to illicit substances before or during pregnancy.MethodsWe identified women with illicit drug use by linking the police records from the “Substance Abuse Control Databases” and Taiwan Birth Registration and Birth Notification records from 2004 to 2014. Children whose mothers that had exposed to illicit substances during pregnancy identified from the police records were the “substance-exposed cohort.” A 1:1 ratio exact-matched comparison cohort based on child’s gender, child’s birth year, mother’s birth year, and child’s first use of the health insurance card, as well as a “propensity score (PS)-matched” comparison cohort of children born by substance-unexposed mothers, was established. Multivariate Cox regression analyses with competing risk models were performed.ResultsHigher incidences of intellectual disability (adjusted hazard ratio (aHR) = 2.41, 95% confidence interval (CI): 1.15–5.03) and attention deficit and hyperactivity disorder (ADHD) (aHR = 2.35, 95% CI: 1.63–3.28) were found in children prenatally exposed to illicit substances during pregnancy compared to exact-matched non-exposed cohorts. Adjusted risks of ADHD were significantly higher in mothers exposed to substances during pregnancy (aHR = 1.77 (1.42–2.21)) and before pregnancy (aHR = 1.43 (1.14–1.80)) compared to PS-matched unexposed cohorts after adjusting for covariates.ConclusionsThis is one of the first studies using large population-based data linked to criminal records to reveal increased risks of intellectual disability and ADHD in children with prenatal exposure to illicit substances compared to matched unexposed controls. Our results also highlight the importance of preventive measures and interventions for the well-being of both the mother and the child.

Evolving trends of hand injuries in Korea (2010-2023): a comprehensive analysis and implications for hand surgeons

Purpose: Recent changes in industrial safety, technology, and demographics have raised questions about the evolving landscape of hand injuries in Korea. This study analyzed trends in hand injuries from 2010 to 2023 and assessed their implications for hand surgery.Methods: Data from the Health Insurance Review and Assessment Service Big Data Open Portal were analyzed. Trends in crush injuries (S67), amputations (S68), fractures (S62), and lacerations (S61) were examined using descriptive statistics, time series decomposition, linear regression, and the chi-square test.Results: Crush injuries and amputations exhibited significant decreases (54.95% and 24.18% respectively, p&lt;0.0001). Fractures increased by 16.19% (p=0.0228), while lacerations decreased by 6.73% (p&lt;0.0001). The coronavirus disease 2019 (COVID-19) pandemic temporarily altered these trends, particularly for fractures.Conclusion: While severe industrial hand injuries have declined, likely due to improved safety measures and automation, the rise in fractures suggests a shift towards age-related and lifestyle injuries. This evolving pattern indicates a continuing need for hand surgery expertise, albeit with a changing focus. Future research should investigate the long-term impacts of societal changes, including the COVID-19 pandemic, on hand injury patterns.