Insurance Bill Research Articles

The American Cancer Society National Lung Cancer Roundtable strategic plan: Methods for improving turnaround time of comprehensive biomarker testing in non-small cell lung cancer.

Comprehensive biomarker testing for patients with non-small cell lung cancer is critical for selecting appropriate targeted therapy or immunotherapy. Ensuring timely ordering, processing, and reporting is key to optimizing patient outcomes. However, various factors can prevent or delay patients from being offered the option of treatment selection based on comprehensive biomarker testing. These factors include problems with access to testing, tissue adequacy, turnaround time, and health insurance coverage and billing practices. Turnaround time depends on several logistical and tissue handling factors, which involve institutional policies, processes, resources, testing methodology, and testing algorithms that vary across different practices. In this article, the authors identify key factors that prolong biomarker testing turnaround time, propose strategies to reduce it, and present a process map to aid physicians and key organizational stakeholders in improving testing efficiency.

Clinical Outcomes and Cost Implications of a Community Psychosocial Rehabilitation Service for Severe and Persistent Mental Illness in Nova Scotia, Canada.

Introduction: Individuals with severe and persistent mental illness (SPMI) present distinct challenges in mental healthcare due to the chronic and complex nature of their conditions. This study was conducted to assess the clinical efficacy and potential cost-effectiveness of a multidisciplinary community-based psychosocial rehabilitation team serving individuals with SPMI in Nova Scotia, Canada. Method: This study was conducted to evaluate the effects of a community-based psychosocial rehabilitation program on individuals with severe and persistent mental illness (SPMI) in Nova Scotia, Canada. This research focused on clinical outcomes and potential cost savings following a one-year intervention, offering critical insights into the benefits of community-based care for this population. A cohort of 137 clients accepted into the community rehabilitation service (Connections Dartmouth) between September 2016 and September 2020 was analyzed. Each participant received one year of community rehabilitation intervention. Using data from the Canadian Medical Service Insurance (MSI) billing system, this research compared the use of inpatient services and Emergency Department visits in the year prior to and the year following the intervention. The findings provide valuable evidence on the role of community rehabilitation in reducing healthcare utilization for individuals with SPMI. Results: The results demonstrated a statistically significant reduction in mean admission rates and length of inpatient admissions in the year following rehabilitation compared to the pre-rehabilitation year. A substantial percentage of patients experienced no inpatient admissions (88% vs. 60%) or Emergency Department visits (82% vs. 67%) in the post-rehabilitation year, compared to the pre-rehabilitation year. There was a significant reduction in inpatient days by 90%, translating into substantial cost savings. The findings highlight the potential economic benefits of community rehabilitation for people with SPMI. Conclusions: This uncontrolled study suggests that community rehabilitation is associated with positive clinical outcomes for individuals with SPMI in terms of reduced inpatient service use and associated costs. Further research, including controlled studies and cost-effectiveness studies, into the community psychosocial rehabilitation services in the Canadian setting is needed.

Feminism, reproductive labour and the gendered welfare state in Britain’s National Insurance Act of 1911

Abstract In 1911, numerous women’s organizations, of varying political interests, mounted a campaign against the National Insurance Bill. Such opposition emerged despite feminist support for increased welfare provision in general and especially for the maternity benefit that the Bill proposed to introduce. Feminists criticized National Insurance for discriminating against women, especially its failure to recognize the economic contribution of women’s unwaged reproductive labour. They lobbied and campaigned for a series of amendments, some of which were successful. Feminist opposition to National Insurance sheds new light on an ongoing historiographical debate over the degree to which women were able to influence early welfare states prior to enfranchisement. Their activities cannot be easily contained within a framework of ‘maternalist feminism’, and call into question distinctions between ‘maternalist’/‘social’ feminism and ‘equality’ feminism, and middle-class and working-class women’s agendas. Instead, feminist campaigns around National Insurance reveal an early analysis of ‘social reproduction’ (the origins of which are usually traced back only to ‘second wave’ feminism) whereby British feminists participated in international conversations contesting the gendered definitions of work that went on to inform insurance-based welfare states across Europe.

Upfront versus deferred cytoreductive nephrectomy following targeted or immunotherapy: a population-based propensity score-matched analysis of perioperative complications.

To evaluate the incidence of postoperative complications after cytoreductive nephrectomy (CN) following first-line treatment for metastatic renal cell carcinoma (mRCC), and to compare it with postoperative complications of upfront CN. For this population-based retrospective study, the PearlDiver Mariner database (PearlDiver Technologies, Colorado Springs, CO), a database of insurance billing records was analyzed. Using relevant ICD-9/10 and CPT codes, patients diagnosed with mRCC between 2011 and 2021, who received first-line systemic molecular therapy (SMT), either tyrosine kinase inhibitors (TKI) or immune-checkpoint inhibitors (ICI), were identified. The selected population was stratified into two cohorts according to the timing of CN (deferred: after SMT vs. upfront: before SMT). Propensity-score matching (PSM) was performed as per baseline patients' characteristics to control for potential confounders between the two cohorts. The primary outcome was to compare 30-day postoperative complications rate between patients undergoing upfront vs. deferred CN. After PSM, 162 patients who received upfront CN were compared with 162 patients who underwent deferred CN. The overall rate of 30-day postoperative complications was statistically significantly higher in patients undergoing deferred CN (33.9%), compared to patients treated with upfront CN (21%, p < 0.01). In addition, the rate of both medical (26.5% vs. 14.2%, p < 0.01) and surgical (14.8 vs. 7.4%, p = 0.03) complication rate was statistically significantly higher in deferred vs. upfront CN. Multivariable logistic regression analysis revealed that none of the treatment regimens significantly predicted the occurrence of postoperative complications. Patients undergoing deferred CN experience a higher rates of overall, medical, and surgical 30-day postoperative complications compared to those receiving upfront surgery. Findings from this study should be interpreted within the limitations of this type of analysis.

Trends and Costs of Minimally Invasive Surgery for Kidney Cancer in the US: A Population-based Study

ObjectiveTo analyze temporal trends and costs associated with the use of minimally invasive surgery (MIS) for kidney cancer in the US over the past decade. To examine the impact of social determinants of health (SDOH) on perioperative outcomes. MethodsThe PearlDiver Mariner, a national database of insurance billing records, was queried for this retrospective observational cohort analysis. The MIS population was identified and stratified according to treatment modality, using International Classification of Diseases (ICD) and current procedural terminology (CPT) codes. SDOH were assessed using ICD codes. Negative binomial regression was used to evaluate the overall number of renal MIS and Cochran-Armitage tests to compare the utilization of different treatment modalities, over the study period. Multivariable logistic regression analysis identified predictors of perioperative complications. ResultsA total of 80,821 MIS for kidney cancer were included. Minimally invasive partial nephrectomy (MIPN) adoption as a fraction of total MIS increased significantly (slope of regression line, reg. = 0.026, p<.001). Minimally invasive radical nephrectomy (MIRN) ($26,9k±40,9k) and renal ablation (RA) ($18,9k±31,6k) were the most expensive and the cheapest procedure, respectively. No statistically significant difference was observed in terms of number of complications (p=.06) and presence of SDOH (p=.07) among the treatment groups. At multivariable analysis, patients with SDOH undergoing MIRN had higher odds of perioperative complications, while RA had a significantly lower probability of perioperative complications. ConclusionsThis study describes the current management of kidney cancer in the US, offering a socioeconomic perspective on the impact of this disease in everyday clinical practice. Data AvailabilityRaw data generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

South African healthcare reforms towards universal healthcare – where to next?

The National Assembly approval of the National Health Insurance (NHI) Bill represents an important milestone, but there are many uncertainties concerning its implementation and timeline. The challenges faced by the South African healthcare system are huge, and we cannot afford to wait for NHI to address them all. It is critical that the process of strengthening the health system to advance universal healthcare (UHC) begins now, and there are several viable initiatives that can be implemented without delay. This article examines potential scenarios after the Bill is passed and ways in which UHC could be advanced. It begins with an overview of the trajectory of health system reform since 1994, then examines the scenarios that may emerge once the Bill is passed by Parliament and makes a case for finding ways in which UHC could be advanced within the country, regardless of any legal or financial barriers that may delay or limit NHI implementation.

Identification of Pending Claim Factors at X Hospital City of Medan in 2021

&lt;div&gt;&lt;table cellspacing="0" cellpadding="0" align="left"&gt;&lt;tbody&gt;&lt;tr&gt;&lt;td align="left" valign="top"&gt;&lt;p&gt;&lt;em&gt;An overview of Covid 19 claims in the city of Medan submitted for the period March 2020 to November 2021 amounted to IDR 5.046 trillion, of which IDR 4.767 trillion has been verified (94.71%) and IDR 1994 trillion is pending (33,868 cases). This research aims to identify pending claim factors at one of the Covid-19 referral hospitals in Medan City in 2021. The location that will be used in this research is the Murni Teguh Memorial National Health Insurance Billing Unit. Researchers conducted interviews with informants regarding Covid-19 claims and the sample used in this research was purposive sampling, namely a sample that was considered representative of the research data by meeting the criteria, namely inclusion and exclusion. Data analysis was carried out through several stages, namely data reduction, data display and verification. The results of the research are that the factors that cause delays in hospitals are the INACBG application update, communication between patients and the doctor in charge is less open regarding clinical complaints and travel history out of town or abroad, the number of human resources is insufficient compared to patients numbering up to thousands with an HR ratio of 1: 1685 patients and DPJP 1:96 patients, this was also experienced by several other hospitals as stated in the journal entitled Review of Inpatient Claim Dispute Settlement for Corona Virus Disease 2019 (Covid-19) Patients at Ajibarang Regional Hospital in 2020 and officers had problems in implementing Covid-19 claims, namely changes in regulations up to 6 times in 3 years, so that it caused a lot of miscommunication with officers on duty within the scope of Covid-19 services, but this change in regulations was due to adapting to Covid-19 conditions&lt;/em&gt;&lt;em&gt;.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt; &lt;/em&gt;&lt;/p&gt;&lt;/td&gt;&lt;/tr&gt;&lt;/tbody&gt;&lt;/table&gt;&lt;/div&gt;&lt;strong&gt;&lt;em&gt;Keywords: &lt;/em&gt;&lt;/strong&gt;&lt;strong&gt;&lt;em&gt; Covid-19, Identification, Pending, Social Security Administrator&lt;/em&gt;&lt;/strong&gt;

Minimally Invasive Adrenalectomy: A Population-Based Analysis of Contemporary Trends, Outcomes, Costs, and Impact of Social Determinants of Health.

We sought to analyze temporal trends in the utilization of minimally invasive vs open adrenalectomy in the United States; to assess costs, perioperative outcomes, and the determining factors influencing these variables. A retrospective analysis of claims data obtained from PearlDiver Mariner, a Health Insurance Portability and Accountability Act-compliant deidentified nationwide database of insurance billing records, was performed. Per-population utilization rates and trends were analyzed using negative binomial regression and trends tests respectively. Continuous and categorical variables were compared using 2-sided t tests and χ2 tests. Multivariable logistic regression analysis was conducted to identify predictors of perioperative complication. A total of 10,753 patients were identified (mean age 53.3 ± 16.1 years). Using the 2011 to 2014 time frame as reference, utilization of adrenalectomy decreased over time (incidence rate ratio for 2015-2018: 0.65 [95% CI 0.62-0.68, P < .001]; incidence rate ratio for 2019-2021: 0.39 [95% CI 0.37-0.41, P < .001]). Minimally invasive adrenalectomies increased significantly over time (P < .001). A greater number of adrenalectomies were performed by general surgeons compared with urologists (70.4% vs 29.5%). Complications were not significantly predicted by any surgical specialty. Significant predictors for complication rates were Charlson comorbidity index > 1 (odds ratio [OR] 1.11, 95% CI 1.09-1.13), presence of social determinants of health (OR 1.5, 95% CI 1.18-1.88) and open approach (OR 1.54, 95% CI 1.34-1.77). The number of adrenalectomies in the United States decreased over the past decade, with a shift towards minimally invasive approach. No difference in outcomes for general surgeons vs urologists can be observed. Social determinants of health are independent predictors of increased rate of complications.

Multiple risk factors are associated with an incremental increase in acute venous thromboembolism risk after total joint arthroplasty: A pearldiver cohort study.

Several risk factors are associated with acute venous thromboembolism (VTE) after total joint arthroplasty (TJA). However, there is a lack of literature regarding the cumulative impact of multiple risk factors. To address this gap, we utilized the PearlDiver database, an insurance billing claims database containing de-identified data from 91 million orthopedic patients. The PearlDiver database was queried for records of patients who underwent total hip and knee arthroplasty from 2010 to 2019 using ICD-10 and CPT codes. Twelve persistent and two transient risk factors were analyzed for their association with the occurrence of acute VTE within three months after surgery. Univariate and logistic regression analyses with odds ratios (ORs) and confidence intervals (CIs) were conducted to determine the odds associated with each risk factor and the impact of multiple concurrent risk factors. A total of 988,675 patients who underwent hip and knee arthroplasty met the inclusion criteria, of whom 1.5% developed acute VTE after three months. The prevalence of VTE risk factors ranged from 0.2 to 38.6%. Individual, persistent risk factors demonstrated 14-84% increased odds of VTE compared to a 1.2% increase for a transient risk factor (acute myocardial infarction). Three or more persistent risk factors were associated with a higher risk of VTE. Persistent risk factors were associated with a higher incidence of postoperative VTE than transient risk factors. An incremental increase in risk was noted if three or more persistent risk factors were present.

Adipositas Care and Health Therapy (ACHT) after Bariatric-Metabolic Surgery: A Prospective, Non-Randomized Intervention Study

Introduction: Almost 25% of German adults have obesity and numbers are rising, making it an important health issue. Bariatric-metabolic surgery reduces body weight and complications for persons with obesity, but therapeutic success requires long-term postoperative care. Since no German standards for follow-up by family physicians exist, follow-up is provided by surgical obesity centers, but they are reaching their limits. The ACHT study, funded by the German Innovation Fund, is designed to establish and evaluate the follow-up program, with local physicians following patients supported remotely by obesity centers. Methods: ACHT is a multicenter, prospective, non-randomized control group study. The 18-month ACHT follow-up program is a digitally supported, structured, cross-sectoral, and close-to-home program to improve success after bariatric-metabolic surgery. Four groups are compared: intervention group 1 starts the program immediately (3 weeks) after Roux-en-Y gastric bypass or sleeve gastrectomy (months 1–18 postoperatively), intervention group 2 begins the program 18 months after surgery (months 19–36 postoperatively). Intervention groups are compared to respective control groups that had surgery 18 and 36 months previously. In total, 250 patients, enrolled in the intervention groups, are compared with 360 patients in the control groups, who only receive standard care. Results: The primary endpoint to compare intervention and control groups is the adapted King’s score, a composite tool evaluating physical, psychological, socioeconomic, and functional health status. Secondary endpoints include changes in care structures and care processes for the intervention groups. Multivariate regression analyses adjusting for confounders (including the type of surgery) are used to compare intervention and control groups and evaluate determinants in longitudinal analyses. The effect of the intervention on healthcare costs will be evaluated based on health insurance billing data of patients who had bariatric-metabolic surgery in the 3 years prior to the start of the study and of patients who undergo bariatric-metabolic surgery during the study period. Conclusions: ACHT will be the one of the first evaluated structured, close-to-home follow-up programs for bariatric surgery in Germany. It will evaluate the effectiveness of the implemented program regarding improvements in health status, mental health, quality of life, and the feasibility of such a program outside of specialized obesity centers.

The Paradox of the Ugandan Health Insurance System: Challenges and Opportunities for Health Reform.

For nearly four decades, Ugandans have experienced a period marked by hope, conflict, and resilience across various aspects of healthcare reform. The health insurance system in Uganda lacks a legal framework and does not extend benefits to the entire population. In Uganda, community-based health insurance is common among those in the informal sector, while private medical insurance is typically provided to employees by their workplaces and agencies. The National Health Insurance Scheme Bill, introduced in 2019, was passed in 2021. If the President of Uganda gives his assent to the National Health Insurance Bill, it will become a significant policy driving health and universal health coverage. However, this bill is not without its shortcomings. In this perspective, we aim to explore the complex interplay of challenges and opportunities facing Uganda's health sector.

Improving Access to Healthcare in South Africa through the National Health Insurance Scheme: A Hit or a Miss?

The South African healthcare system is plagued by inequalities at various levels. The National Health Insurance (NHI) Bill was recently passed by the National Assembly and has revived debate on whether the NHI can effectively bridge the gap between the rich and the poor in accessing healthcare services. This paper explores the effectiveness of the NHI as a healthcare system reform aimed at bridging the gap between the public and private sectors of South Africa’s two-tiered healthcare system. To assist policymakers in its effective implementation, the paper explores the constitutional obligations regarding the provision of healthcare services and offers an analysis of whether the NHI Bill meets constitutional muster. In its conclusion, the paper also suggests solutions to address the Bill’s shortcomings by including practical steps that can be taken to ensure that the vision of universal health coverage is achieved.

Acts of negotiation: toward a grounded theory of nursing practice in chronic wound care in Austria

BackgroundDemographic change and the rise of diabetes mellitus are leading to a projected increase in the prevalence of chronic wounds. People suffering from chronic wounds experience significant losses in their health-related quality of life. Health systems struggle to meet the needs of these persons, even in high-income countries. This paper explores wound nurses’ perspectives on their professional practice in Austria. They play a key role as they do much of the treatment work, contribute to advancing the field, and enable interprofessional coordination. Their perspectives enable insights into how a health system provides care for elderly and chronically ill people.MethodsWe used the Constructivist Grounded Theory framework to analyse transcripts of 14 semi-structured qualitative interviews with nurses who work in different treatment settings.ResultsWe identified three themes. Firstly, the interviewees characterise working with patients as a balancing act between offering enough support to build a trustful relationship while protecting themselves against the overwhelming situation of caring for a chronically ill person. Secondly, the interviewees compensate for nonexistent care pathways by building informal networks with doctors, which requires delicate relationship work. Thirdly, the study participants must prove their competence in every new professional encounter. Their need for professional autonomy clashes with the traditional doctor-nurse hierarchy. Based on these insights, we propose a grounded theory that conceives of nursing practice in terms of ‘acts of negotiations’.ConclusionOur results demonstrate that wound nurses in Austria operate in an institutional environment whose outdated imagination of the nursing role is at odds with the care demands that arise from a growing number of elderly and chronically ill people. We detailed the ‘acts of negotiation’ nurses deploy to compensate for this situation. We identify areas for policy intervention to strengthen the autonomy of wound nurses, including access to statutory health insurance billing.

Evaluating the potential impact of National Health Insurance on medical scheme members' rights to have access to health-care services in South Africa

The National Health Insurance Bill proposes to establish a national health insurance scheme that aims to provide universal access to health-care services for everyone. Section 33 of the Bill also proposes to limit the provision of parallel services by medical schemes if such services are provided or covered by the tabled NHI scheme. The establishment of the NHI scheme is likely to have a negative effect on the existing access rights of general private health-care users, particularly members of medical schemes. The NHI scheme may enhance access to and the quality of health-care services for millions; however, enabling large portions of the population to access services currently provided by costly private practitioners - services at present almost exclusive to a minority - is not without its perils. It risks negatively impacting on existing access rights and reducing the quality currently enjoyed by users of private health-care services. The propriety of these potential infringements is not necessarily suspect, and may in fact be justifiable. However, this contribution argues that the limitation proposed under section 33 of the NHI Bill is cause for concern. The contribution explores the state's constitutional duty to observe and respect the right of members of medical schemes to access health-care services. It uncovers the constitutional shortcomings of the limitation, and argues that it does not appear to serve any particular legitimate economic or legal purpose.

Using standard-of-care screening to identify inequities in cancer-related financial hardship.

196 Background: Financial hardship is known as an “adverse event” for individuals with cancer. This study used data collected as part of routine care to understand the magnitude of and potential inequities in cancer-related financial hardship for patients with cancer receiving care in the Deep South. Methods: Universal financial hardship screening was piloted among oncology patients initiating treatment at University of Alabama at Birmingham from October 2020-May 2023. Financial hardship screening questions were added to a standard-of-care treatment planning survey administered by lay navigators. Questions included measures of (1) financial distress (Comprehensive Score for financial Toxicity [COST], scored 0-44; scores &lt;26 indicate financial distress), and (2) financial difficulties affording one or more of 10 items. Proportions of screens completed and variations in financial hardship were calculated overall and by patient race and rurality. Results: Patients who completed treatment planning surveys (N=2,741) were an average 62 years old (SD 13), 18% Black, Indigenous, or persons of color (BIPOC), and 16% rural dwelling. Financial hardship screening was completed by the majority (90%) of patients with treatment planning surveys. Patients with a breast (23%), gynecologic (16%), or gastrointestinal (14%) cancer most commonly completed screening. Completion was similar by race and rurality. Screening identified 34% of patients were experiencing financial distress (mean COST 28, SD 11). However, 49% of BIPOC patients screened positive for financial distress compared to 30% of White patients. The most commonly reported financial difficulties were insurance or medical bills (reported by 32% of patients), upfront medical payments (29%), and medications (22%). Large differences in reported financial difficulties were seen comparing patients who were BIPOC and White (Table). Rural- and non-rural-dwelling patients reported similar proportions of financial difficulties. Conclusions: Most patients completed lay navigator-led financial hardship screening, which identified racial inequities in financial hardship even before treatment initiation. Efforts to collect patient economic data should support the design, implementation, and evaluation of patient-centered interventions to improve equity and reduce adverse cancer-related economic outcomes.[Table: see text]

Analyzing a New Model of Medical Tourism Policy: Target Country-Specific Models and Marketing Strategies.

The three-year the pandemic has increased the preference for "safer and healthier" medical tourism destinations at a global level. Busan in South Korea aims to increase its competitiveness as a "medical city" destination. This study aimed to explore the best marketing strategies designed based on country-specific attraction model. We collected data from surveys with 10 participants of a focus group from the medical tourism field in Busan and 352 participants of doctors, stakeholders, and moderators working in the medical tourism field in Nov and Dec 2022 to investigate key success factors for the medical tourism in Busan. The interview identified key target countries and effective strategies such as ease of visa acquisition, non-face-to-face care, insurance billing systems, foreign language expertise, win-win systems for agencies and healthcare organizations, and international accessibility. When participants were asked about their country-specific attraction for patients, they ranked healthcare quality and tourism resources as both important and satisfactory. Although cultural environment, economic support, and administrative support were ranked important, they were less satisfactory. For Japanese patients, the infrastructure showed high levels of importance and satisfaction. This study identified specific items for a new model of patient attraction customized to target countries. This model was based on cultural background and preferences of each target country. Strategies are needed to strengthen the cultural environment and administrative support. Results of this study can be used to promote medical cities through target specific policies.

Health chain-block chain based electronic healthcare record system with access and permission management

An electronic health record (EHR) is a technology that allows you to keep track of your health information. It keeps computerized records of several healthcare organizations. Records are exchanged via enterprise-wide data systems as well as other networking technologies and exchanges. Patients nowadays expect immediate access to their health information. However, the health sector comes with immediate access to data, and there are worries about the privacy and security of medical records of patients. As a result, a blockchain-based solution can assist in resolving this issue. The blockchain has the potential to beat the conventional centralized system, which suffers from a severe lack of accessibility. The current healthcare system is often seen as being both costly and convoluted. However, with improved health data management and insurance providers, this may be reduced via the use of Blockchain Technology (BT). It is the goal of the developers of BT to make it possible to keep track of financial transactions without having to rely on a central authority or a bank. Innovations in BT have allowed for better health records, insurance billing, and smart contract transactions, and it also enable a decentralized data structure of activities, as well as eternal availability and security over health information. Access to medical records, instrument tracking, prescription databases, hospital facilities, and property lifetime all inside a blockchain architecture is made possible by BT that also greatly improves the seamless integration of health information. The use of BT in the medical field has this advantage as one of its primary advantages. Access to a patient's medical history is crucial for prescribing the right treatment, and BT has the potential to greatly enhance the current state of public healthcare delivery. This paper offers a block chain-based scheme called “Health Chain” as a solution for maintaining medical records. Health Chain is made to be better than the existing systems since it gives patients, health professionals, and other external stakeholders safe, efficient, and ubiquitous medical information available while maintaining the patients' confidentiality. To regulate operations and restrict access to digital health records, Health Chain uses timed-based smart contracts. In addition, it uses cutting-edge encryption methods to boost security. This study suggests a new reward system that uses healthcare professionals to track patients' medical information and construct additional units. Numerous tests are run to assess the proposed Health Chain model's performance, and the findings demonstrate that the proposed suggestion effectively manages a huge dataset called (nCOV19) from the Covid-19 study with little delay. Maximum efficiency will be expected to be attained by 98%, transaction latency by 95%, overall system execution time by 96%, data security by 92%, and data scalability by 95%, according to the suggested research.

Driving oral-health transformation in South Africa: The need for a roadmap to implementing the WHO Resolution

The World Health Assembly’s adoption of the Resolution on oral health in 2021 was a turning point in the worldwide effort to advance oral health outcomes. The resolution underlines the significance of promoting oral health, integrating oral health care within the primary health-care system, and ensuring universal coverage, shifting the paradigm from a curative to a preventive approach. In this editorial, a prospective action plan is explored that would include a national oral health survey, short-, medium-, and long-term goals, as well as appropriate regulations and procedures to fulfill the WHO’s 2030 target. With the roll-out of the National Health Insurance (NHI) bill, complying with these resolutions are becoming more important and urgent.

Blacklisting Health Insurance Premium Defaulters: Is Denial of Medical Care Ethically Justifiable?

Rising health insurance costs and the cost of living crisis are likely leading to an increase in unpaid health insurance bills in many countries. In Switzerland, a particularly drastic measure to sanction defaulting insurance payers is employed. Since 2012, Swiss cantons – who have to cover most of the bills of defaulting payers - are allowed by federal law to blacklist them and to restrict their access to medical care to emergencies.In our paper, we briefly describe blacklisting in the context of the Swiss healthcare system before we examine the ethical issues involved in light of what is known about its social and health impacts. We found no evidence that blacklisting serves as an effective way of recovering unpaid health insurance contributions or of strengthening solidarity within the health insurance system. Furthermore, the ambiguous definitions of what constitutes an emergency treatment and the incompatibility of the denial of medical care with the obligation to provide professional assistance complicate the implementation of blacklists and expose care providers to enormous pressure.Therefore, we conclude that blacklists and the (partial) denial of medical care not only pose profound ethical problems but are also unsuitable for fulfilling the purpose for which they were introduced.

Entwicklung von Qualitätsindikatoren für die Versorgung von Patient:innen mit chronischer Nierenerkrankung

ZusammenfassungHintergrundDie chronische Nierenkrankheit (CKD) ist eine häufige Erkrankung, insbesondere im höheren Alter. Um der Progression der Erkrankung und deren Komplikationen vorzubeugen, ist eine leitliniengerechte ambulante Versorgung von Patient:innen mit CKD anzustreben. Zur Messung und Bewertung der Versorgungsqualität können Qualitätsindikatoren (QI) genutzt werden. In Deutschland existieren bisher keine QI für CKD. Ziel der Arbeit war die Entwicklung von QI für die Qualitätsüberprüfung der ambulanten Versorgung von Patient:innen über 70 Jahren mit nichtdialysepflichtiger CKD.Material und MethodenAuf Grundlage der nationalen S3-Leitlinie CKD und eines Reviews internationaler QI wurde eine Liste von QI erstellt. Die ausgewählten QI wurden in 2 Sets eingeteilt: basierend auf Routinedaten (z. B. Abrechnungsdaten der Krankenkassen) und auf Datenerhebung in der Praxis (Chart-Review). Expert:innen verschiedener Fachrichtungen sowie ein Patient:innenvertreter bewerteten diese in einem Delphi-Verfahren mit 2‑stufiger Onlinebefragung im Oktober 2021 und Januar 2022 und abschließender Konsensuskonferenz im März 2022. Zusätzlich wurden Ranglisten der wichtigsten QI von jedem Set erstellt.ErgebnisseEin Inzidenz- und ein Prävalenzindikator wurden a priori festgelegt und standen nicht zur Abstimmung. Weitere 21 QI standen zur Abstimmung durch die Expert:innen. Für jedes QI-Set wurden die 7 wichtigsten Indikatoren ausgewählt. Nur 1 QI wurde von dem Expert:innenpanel für den zusätzlichen Einsatz bei Erwachsenen unter 70 Jahren als nicht geeignet eingestuft.DiskussionDie QI sollen es ermöglichen, die Qualität der ambulanten Versorgung von Patient:innen mit CKD zu untersuchen, mit dem Ziel, die leitlinienkonforme ambulante Versorgung zu optimieren.