Insurance Coverage Research Articles

Factors Influencing Vehicle Owners’ Intentions to Extend Special Perils Coverage in Motor Insurance

The rising frequency and severity of natural disasters have intensified the need for comprehensive motor insurance, particularly focusing on special perils coverage. This coverage plays a vital role in safeguarding vehicle owners against financial losses resulting from environmental hazards such as floods, landslides, and other catastrophic events. This study investigates the factors that influence vehicle owners' intentions to extend special perils coverage within their motor insurance policies in Klang Valley, Malaysia. A quantitative and descriptive research approach was adopted, employing convenience sampling techniques, with data analyzed using descriptive statistics through the Statistical Package for Social Sciences (SPSS) to extract valuable insights. A structured survey involving 100 vehicle owners examines the impact of knowledge, promotional efforts, and perceived benefits on their decisions to opt for extended special perils coverage. The findings highlight that these three factors - knowledge, promotion, and benefits - significantly influence the decision-making process. The study's insights are valuable for insurance companies, policymakers, and educational institutions in crafting strategies to encourage the wider adoption of special perils coverage. By increasing awareness, enhancing promotional efforts, and communicating the benefits of such coverage, stakeholders can better meet the needs of vehicle owners and boost the uptake of comprehensive motor insurance. This study underscores the importance of a multifaceted approach in promoting insurance products that offer essential protection against escalating environmental risks.

Eliciting medication preferences of patients with type 2 diabetes under different insurance coverages in China.

To understand the medication preference of type 2 diabetes mellitus (T2DM) patients with different insurance coverages, and to provide reference for improving the patient-centered clinical treatment decision. This study used Discrete Choice Experiment (DCE) to elicit preferences of T2DM patients with different insurance coverages in China. A multistage stratified cluster-sampling procedure for data collection and a total of 1,409 valid respondent were conducted. Seven attributes have significant influence on the preference of T2DM patients with Urban Employee Basic Medical Insurance (UEBMI) and Urban and Rural Residents Basic Medical Insurance (URRBMI) (p < 0.05). T2DM patients with UEBMI pay the most attention to Gastrointestinal adverse events, while T2DM patients with URRBMI pay the most attention to the Treatment efficacy/reduction in HbA1c. Patients with different medical insurance have different willingness to pay for Cardiovascular benefits, Mode of administration and Weight change. When Gastrointestinal adverse events is changed from higher (40%) to none (0%), patients with UEBMI are willing to pay ¥523.49 more per month, while patients with URRBMI are only willing to pay ¥266.62; When the Treatment efficacy/reduction in HbA1c changes from poor (0.5%) to Highest (2.5%), patients with UEBMI are willing to pay ¥518.44 more per month, while patients with URRBMI are willing to pay ¥328.33 more per month. The Gastrointestinal adverse events and the Treatment efficacy/reduction in HbA1c are the primary factors for T2DM patients with UEBMI and URRBMI, followed by the Hypoglycemic risk. Physicians should consider patients' medication preferences in clinical medication treatment of T2DM patients with different insurance coverages, make targeted treatment decisions, and improve patients' medication compliance to achieve better treatment results.

Mechanical Thrombectomy Access Score: A Systematic Review and Modified Delphi of Global Barriers to Endovascular Therapy.

The availability of mechanical thrombectomy (MT) for acute ischemic stroke is limited, and vast disparities exist between countries. We aim to create a MT access score to measure the drivers of access to help quantify and accelerate treatment worldwide. We used a systematic review complemented by a modified Delphi method. In the first of 3 rounds, 4 independent investigators performed a systematic literature review using key search terms that drive MT access, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In the second round, a panel of 6 anonymous international experts selected key attributes needed for scoring. In the final round, a total of 12 attributes were selected on consensus, each given a score on a 0 to 3 scale. An ultimate MT access score (range, 0-36) was proposed as a new tool to use in identifying barriers to MT access and assist in providing an initial framework for public health interventions. Of 2864 abstracts screened, 121 studies were included in the final systematic review. A total of 34 attributes that potentially drive MT access were initially identified. In the final round, 12 attributes were selected by the expert panel: public awareness, emergency medical services transportation, prehospital large vessel occlusion screening, interhospital transfer policy, emergency department protocols, stroke imaging protocols, emergency department stroke expertise or telestroke availability, interventionalists, MT-capable centers, device availability, and insurance coverage. These attributes were weighted as part of the final score of 0 to 36. The MT access score represents the first tool to quantify barriers to global MT access. Its implementation stands not just as an academic achievement but as a beacon of hope for improving stroke care and outcomes worldwide, bringing us a step closer to bridging the gap in stroke treatment disparities.

Colorectal cancer research priorities in Uganda: perspectives from local key experts and stakeholders.

The incidence of colorectal cancer (CRC) is increasing in Uganda but there is limited local research to guide policy and programming for CRC prevention and control. A stakeholder engagement workshop took place in Kampala on 19March 2024 to identify challenges and opportunities for CRC prevention and control in Uganda. A total of 30 stakeholders with expertise in CRC primary and secondary prevention, diagnosis, treatment, palliative care as well as cancer survivors participated in the workshop. Key challenges for primary prevention included low knowledge/awareness of CRC among the general population and health workers, and rising prevalence of CRC related risk factors. Limited CRC screening, diagnostic facilities and specialists were identified as barriers to diagnosis. Treatment related challenges included limited accessibility to surgical services and drugs, late-stage presentation leading to poor treatment response, treatment abandonment and drug related toxicity. Lack of universal health coverage policies, limited community-based cancer awareness programs, and lack of national cancer registries were cited as policy and economics challenges. Opportunities to address these challenges were discussed. Our findings highlight areas for further research and prioritization to address Uganda's growing CRC burden and may be applicable to other low-resource settings.

An assessment of adequate quality antenatal care and its determinants in India

BackgroundAntenatal care (ANC) is an important component in the continuum of care. Providing adequate quality ANC is necessary to prevent maternal and newborn mortality. The coverage of ANC has increased significantly in the last decade in India, but a mere increase in coverage is insufficient if the issue of quality is not simultaneously addressed. This study examines the change in each component of quality ANC between 2015-16 and 2019-21, highlights the factors associated with adequate quality ANC, and observes the state- and district-level distribution of adequate quality ANC during 2019-21.MethodsThis study is based on data from the two most recent rounds of the National Family Health Survey (NFHS), the Indian equivalent of the Demographic and Health Surveys (DHS). These rounds were conducted in 2015-16 and 2019-21 in selected households of India with a total of 190,797 and 176,843 sampled births, respectively. The dependent variable was quality antenatal care, a composite variable consisting of skilled healthcare providers, timeliness, sufficiency, and appropriateness of content. The independent variables were mother’s age, education, wealth quintile, birth order, mass media exposure, health insurance coverage, relationship with the head of household, facility exposure, intended pregnancy, history of adverse pregnancy outcomes, and other socio-demographic variables. Change in each component and dimension of quality antenatal care was assessed using data from both rounds of the survey. A multivariate multinomial logistic regression analysis was employed to identify the determinants of adequate quality ANC using the NFHS-5 data.ResultsThe findings revealed that 32 per cent of mothers received adequate quality antenatal care in 2019–2021, an increase of only 9% points compared to the 2015-16 period. Two significant barriers to achieving adequate quality antenatal care, in terms of appropriateness of content, were the provision of Iron and Folic Acid (IFA) tablets and counselling. The highest utilisation of adequate quality antenatal care was observed in the southern states. The utilisation of quality ANC increased with an increase in women’s education and wealth status; and was more prevalent among those with health insurance coverage and exposure to mass media.ConclusionDespite some improvements in the coverage of antenatal care, the quality of antenatal care continues to be very low and needs urgent attention. Achieving quality antenatal care in both content and experience requires addressing service gaps and developing better measures to capture and improve women’s care experiences.

Resumption Of Medicaid Eligibility Redeterminations: Little Change In Overall Insurance Coverage.

In anticipation of the end of the COVID-19 public health emergency, Congress ended the Medicaid continuous coverage requirement on March31, 2023, allowing states to terminate coverage for ineligible people and resume eligibility determinations through a process known as unwinding. Although administrative data have documented substantial declines in Medicaid enrollment since April2023, the impact on uninsurance is unknown. Using data from the Census Bureau's Household Pulse Survey, we estimated the early effect of Medicaid unwinding on insurance coverage among people ages19-64. We found that within the first three months of unwinding, the number of people self-reporting Medicaid coverage declined by approximately two million, and there was a much smaller, statistically insignificant decline in overall coverage of approximately 467,000 people. It appears that for many people, the availability of employer-sponsored insurance and other private coverage offset Medicaid coverage loss. These results suggest that the resumption of redeterminations has had less impact on uninsurance than was initially feared. Our findings highlight the importance of tracking coverage transitions during unwinding. By identifying populations at risk for uninsurance after Medicaid loss, these data could enhance the effectiveness of state outreach and enrollment assistance for people eligible for Marketplace coverage and subsidies.

Artificial intelligence in healthcare: a scoping review of perceived threats to patient rights and safety

BackgroundThe global health system remains determined to leverage on every workable opportunity, including artificial intelligence (AI) to provide care that is consistent with patients’ needs. Unfortunately, while AI models generally return high accuracy within the trials in which they are trained, their ability to predict and recommend the best course of care for prospective patients is left to chance.PurposeThis review maps evidence between January 1, 2010 to December 31, 2023, on the perceived threats posed by the usage of AI tools in healthcare on patients’ rights and safety.MethodsWe deployed the guidelines of Tricco et al. to conduct a comprehensive search of current literature from Nature, PubMed, Scopus, ScienceDirect, Dimensions AI, Web of Science, Ebsco Host, ProQuest, JStore, Semantic Scholar, Taylor & Francis, Emeralds, World Health Organisation, and Google Scholar. In all, 80 peer reviewed articles qualified and were included in this study.ResultsWe report that there is a real chance of unpredictable errors, inadequate policy and regulatory regime in the use of AI technologies in healthcare. Moreover, medical paternalism, increased healthcare cost and disparities in insurance coverage, data security and privacy concerns, and bias and discriminatory services are imminent in the use of AI tools in healthcare.ConclusionsOur findings have some critical implications for achieving the Sustainable Development Goals (SDGs) 3.8, 11.7, and 16. We recommend that national governments should lead in the roll-out of AI tools in their healthcare systems. Also, other key actors in the healthcare industry should contribute to developing policies on the use of AI in healthcare systems.

Influential factors shaping cocoa farmers' crop insurance participation and coverage amount in Ghana

Influential factors shaping cocoa farmers' crop insurance participation and coverage amount in Ghana

A qualitative study of the barriers and facilitators for women with a disability seeking sexual and reproductive health services in Addis Ababa, Ethiopia

BackgroundThe need to advance the sexual and reproductive health (SRH) and rights of women with a disability is becoming more widely recognized. Regrettably, in low- and middle-income settings like Ethiopia, several barriers impede women with a disability (WWDs) from receiving SRH services and care.ObjectivesThis study aims to explore barriers and enablers for women with a disability to access sexual and reproductive health services in Addis Ababa, Ethiopia.MethodsA qualitative phenomenological study was conducted among the purposively selected reproductive age (18–49) group of WWDs living in Addis Ababa who were members of the Ethiopian National Association of Persons with physical disabilities and the Ethiopian National Association for Blind. Ten in-depth interviews, and 2 focus group discussions, were conducted using an interview guide. The analysis involved the use of both a priori codes (from the theory) and emergent inductive codes (from the question guide).ResultsIn this study, several barriers were identified as keeping participants from accessing SRH services, such as unfavorable community views, organizational barriers in health facilities [HFs], financial limitations, transportation problems, and a lack of knowledge about the SRH programs that are available. The enabling factors that made WWDs access SRH services include social support and networking, access to education, positive providers' attitudes, and women's self-confidence/Assertiveness.ConclusionThe study reveals that financial problems brought on by inadequate health insurance coverage, economic hardship, the expense of transportation to the health facility, and the lack of preferential treatment at the health facility are some of the hurdles that WWDs face while accessing SRH services and care. To address these problems and promote SRH access, measures should be taken to decrease financial barriers, improve physical access, and build strong relationships with the community, the church, and healthcare providers.

Barriers and facilitators of healthcare access for long COVID-19 patients in a universal healthcare system: qualitative evidence from Austria

BackgroundLong COVID-19 challenges health and social systems globally. International research finds major inequalities in prevalence and healthcare utilization as patients describe difficulties with accessing health care. In order to improve long-term outcomes it is vital to understand any underlying access barriers, for which relevant evidence on long COVID-19 is thus far lacking in a universal healthcare system like Austria. This study aims to comprehensively identify access barriers and facilitators faced by long COVID-19 patients in Austria and explore potential socioeconomic and demographic drivers in health and social care access.MethodsApplying an exploratory qualitative approach, we conducted semi-structured interviews with 15 experts including medical professionals and senior health officials as well as focus groups with 18 patients with confirmed long COVID-19 diagnosis reflecting varying participant characteristics (age, gender, urbanicity, occupation, education, insurance status) (July-Nov 2023). Data were analysed following a thematic framework approach, drawing on a comprehensive ‘access to health care’ model.ResultsBased on expert and patient experiences, several access barriers and facilitators emerged along all dimensions of the model. Main themes included scepticism and stigma by medical professionals, difficulties in finding knowledgeable doctors, limited specialist capacities in the ambulatory care sector, long waiting times for specialist care, and limited statutory health insurance coverage of treatments resulting in high out-of-pocket payments. Patients experienced constant self-organization of their patient pathway as stressful, emphasizing the need for multidisciplinary care and centralized coordination. Facilitators included supportive social environments, telemedicine, and informal information provided by a nationwide patient-led support group. Differences in patient experiences emerged, among others, as women and younger patients faced gender- and age-based stigmatization. Complementary health insurance reduced the financial strain, however, did not ease capacity constraints, which were particularly challenging for those living in rural areas.ConclusionsThe findings of this study indicate a call for action to improve the long COVID-19 situation in Austria by empowering both providers and patients via increased information offerings, strengthened interdisciplinary treatment structures and telemedicine offerings as well as research funding. Our insights on potentially relevant socioeconomic and demographic drivers in access barriers lay the necessary foundation for future quantitative inequality research.

Comparison of the Burdens and Attitudes Between Standard and Web-Based Remote Programming for Deep Brain Stimulation in Parkinson Disease: Survey Study.

Remote programming enables physicians to adjust implantable pulse generators over the internet for patients with Parkinson disease who have undergone deep brain stimulation (DBS) surgery. Despite these technological advances, the demand for and attitudes toward remote programming compared with standard programming among patients with Parkinson disease are still not well understood. This study aims to investigate the preferences and perceptions associated with these 2 programming methods among patients with Parkinson disease through a web-based survey. A web-based survey was administered to 463 patients with Parkinson disease who have undergone DBS surgery. The survey aimed to assess the burdens associated with postoperative programming and to compare patients' attitudes toward the 2 different programming methods. A total of 225 patients completed the survey, all of whom had undergone standard programming, while 132 patients had also experienced remote programming. Among those who received standard programming, 191 (85%) patients required the support of more than 1 caregiver, 129 (58%) patients experienced over 2 days of lost work time, 98 (42%) patients incurred expenses ranging from US $42 to US $146, and 14 (6%) patients spent over US $421. Of the 132 patients who had used remote programming, 81 (62%) patients indicated a preference for remote programming in the future. However, challenges with remote programming persisted, including difficulties in obtaining official prescriptions, a lack of medical insurance coverage, and limited medical resources. Postoperative programming of DBS imposes significant burdens on patients and their caregivers during standard programming sessions-burdens that could be mitigated through remote programming. While patient satisfaction with remote programming is high, it is imperative for clinicians to develop personalized programming strategies tailored to the needs of different patients.

Commentary: Accessibility and Insurance Coverage for Gender-Affirming Surgery in Canada: A Cross-Sectional Analysis.

Commentary: Accessibility and Insurance Coverage for Gender-Affirming Surgery in Canada: A Cross-Sectional Analysis.

Economic burden of knee joint replacement in Iran

BackgroundThe knee is the most commonly afflicted weight-bearing joint. Osteoarthritis of the knee is regarded as one of the most commonly diagnosed causes of disability in the elderly. Knee joint replacement can be regarded as a final solution for Osteoarthritis of the knee in which the joint is worn out, accompanied by clinical symptoms such as pain, deformity, and limited movement.Aimthis study sought to estimate the economic burden of knee joint replacement procedures carried out in Iran.MethodThis cross-sectional descriptive study utilized the Incidence-based approach to assess the economic burden of knee joint replacement surgeries conducted in Iran during 2022, estimating the costs of the disease from a societal perspective. The sampling method employed was random sampling, and the sample size consisted of 300 patients. Direct costs were calculated employing the top-down approach, while indirect costs were estimated using the human capital approach. Microsoft Excel was employed for data analysis.ResultThe average direct medical costs of the knee replacement procedure per patient were $10,076.87 and $13,099.93 in the public and private sectors, respectively. The average direct non-medical costs of knee joint replacement surgery are $1123.64, with companion costs constituting most of the direct non-medical costs. Finally, the economic burden of the knee joint replacement surgery was estimated at $67340417.28.ConclusionDespite insurance coverage, knee joint replacement surgery in Iran incurs substantial costs. With the anticipated rise in the elderly population, the frequency of these procedures is expected to increase, amplifying the economic burden on the Iranian public.

The impact of rural health insurance on vulnerability to chronic poverty among rural residents in China: analysis using Probit and IVprobit models.

Poverty is a global problem, and combating it is a major governance issue worldwide. In China, poverty management efforts have shifted from eliminating absolute poverty to managing relative poverty. One of the most important tasks in managing relative poverty in the post-poverty reduction era is to prevent recurring poverty due to illness. Rural health insurance is an important method of preventing and mitigating disease risk and a key part of China's poverty reduction policy, including among rural residents. However, the mechanism by which basic health insurance alleviates vulnerability to poverty, the causal effect of rural health insurance on vulnerability to poverty, and differences based on having a second health insurance policy and by age and income have not been sufficiently explored. Therefore, this study examined the impact of rural health insurance on vulnerability to long-term poverty among rural residents in China. In addition, this study evaluated the impact of having a second health insurance policy and differences in the effects of rural health insurance by age and income. This study used data from the 2014, 2016, 2018, and 2020 China Family Panel Studies. Household-related characteristics, such as finance, education, and healthcare, were retrieved from the household database; while data on healthcare expenditures, healthcare insurance, and personal-related characteristics were retrieved from the adult database. Robustness tests were conducted with Probit models, and endogeneity tests were conducted with IVprobit models. Vulnerability to poverty was significantly lower among residents with rural health insurance than those without any health insurance coverage, and this difference was observed across age and income groups. These findings were consistently robust and significant after controlling for endogeneity, considering sample selectivity, and eliminating measurement bias in the core variables. The findings indicate that rural health insurance is an important tool for poverty alleviation. The current results could effectively reduce the economic vulnerability of rural households facing health risks, ensuring broader economic security. Moreover, these findings provide policy references for managing relative poverty in China.

Predictive machine learning models for anticipating loss to follow-up in tuberculosis patients throughout anti-TB treatment journey

Loss to follow-up (LTFU) in tuberculosis (TB) management increases morbidity and mortality, challenging effective control strategies. This study aims to develop and evaluate machine learning models to predict loss to follow-up in TB patients, improving treatment adherence and outcomes. Retrospective data encompassing tuberculosis patients who underwent treatment or registration at the National Center for Clinical Medical Research on Infectious Diseases from January 2017 to December 2021 were compiled. Employing machine learning techniques, namely SVM, RF, XGBoost, and logistic regression, the study aimed to prognosticate LTFU. A comprehensive cohort of 24,265 tuberculosis patients underwent scrutiny, revealing a LTFU prevalence of 12.51% (n = 3036). Education level, history of hospitalization, alcohol consumption, outpatient admission, and prior tuberculosis history emerged as precursors for pre-treatment LTFU. Employment status, outpatient admission, presence of chronic hepatitis/cirrhosis, drug adverse reactions, alternative contact availability, and health insurance coverage exerted substantial influence on treatment-phase LTFU. XGBoost consistently surpassed alternative models, boasting superior discriminative ability with an average AUC of 0.921 for pre-treatment LTFU and 0.825 for in-treatment LTFU. Our study demonstrates that the XGBoost model provides superior predictive performance in identifying LTFU risk among tuberculosis patients. The identification of key risk factors highlights the importance of targeted interventions, which could lead to significant improvements in treatment adherence and patient outcomes.

Narrative Review: Telemedicine Quality after the COVID-19 Public Health Emergency: Time to Reevaluate?

OBJECTIVE: This narrative review explores concerns and potential solutions for improving the quality of synchronous telemedicine visits for high utilizers like primary care, particularly after the COVID-19 pandemic. METHODS: A literature review identified studies published within the past 10 years focusing on telemedicine quality, primary care, and related aspects like liability, virtual exams, and patient safety. RESULTS: Despite the surge in popularity of telemedicine visits, concerns regarding their quality linger. These concerns encompass various aspects of the patient experience, administrative processes, and potential safety risks. Limitations in physical exam capabilities and the lack of readily available vital signs during telemedicine visits raise concerns about the accuracy of diagnoses. This is particularly true for situations requiring a more comprehensive physical assessment. Incomplete documentation due to abbreviated patient histories, missing physical exam findings, and the reliance on generic templates pose liability risks. This lack of thorough information makes it challenging to accurately capture the patient's condition and raises concerns about the quality of care provided. Patients themselves have expressed concerns about accuracy of a virtual visit, thus raising questions about the effectiveness of telemedicine in building rapport and ensuring clear communication. From an administrative standpoint, fears of misdiagnosis due to the limitations of virtual exams, inconsistencies in insurance coverage for telemedicine services, and unclear reimbursement standards for thorough visits continue to pose challenges. These uncertainties create ambiguity and make it difficult for healthcare providers to fully embrace telemedicine as a viable option. Finally, although mirroring in-person visit protocols for patient safety is considered crucial, many organizations currently lack standardized measures to ensure safety throughout the entire telemedicine journey. This includes potential risks during scheduling, appointment execution, and post-visit follow-up, highlighting the need for more robust safety protocols specifically designed for the telemedicine setting. Addressing these concerns is essential for ensuring the quality and sustainability of telemedicine integration. CONCLUSION: While telemedicine offers significant benefits, improving quality is essential for its sustainable integration into primary care. Standardizing protocols, educating clinicians and patients, implementing comprehensive physical exam procedures, and ensuring patient safety throughout the visit are key areas for improvement. Continuous monitoring and data analysis are crucial for identifying and addressing weaknesses and ensuring quality telemedicine care.

Intraoperative navigation in craniofacial surgery.

Craniofacial surgery requires comprehensive anatomical knowledge of the head and neck to ensure patient safety and surgical precision. Over recent decades, there have been significant advancements in imaging techniques and the development of real-time surgical navigation systems. Intraoperative navigation technology aligns surgical instruments with imaging-derived information on patient anatomy, enabling surgeons to closely follow preoperative plans. This system functions as a radiologic map, improving the accuracy of instrument placement and minimizing surgical complications. The introduction of first-generation navigation systems in the early 1990s revolutionized surgical procedures by enabling real-time tracking of instruments using preoperative imaging. Initially utilized in neurosurgery, intraoperative navigation has since become standard practice in otolaryngology, cranio-maxillofacial surgery, and orthopedics. Since the 2000s, second-generation navigation systems have been developed to meet the growing demand for precision across various surgical specialties. The adoption of these systems in craniofacial surgery has been slower, but their use is increasing, particularly in procedures such as foreign body removal, facial bone fracture reconstruction, tumor resection, and craniofacial reconstruction and implantation. In Korea, insurance coverage for navigation in craniofacial surgery began in 2021, and new medical technologies for orbital wall fracture treatment were approved in August 2022. These technologies have only recently become clinically available, but are expected to play an increasingly important role in craniofacial surgery. Intraoperative navigation enhances operative insight, improves target localization, and increases surgical safety. Although these systems have a steep learning curve and initially prolong surgery, efficiency improves with experience. Calibration issues, registration errors, and soft tissue deformation can introduce inaccuracies. Nonetheless, navigation technology is evolving, and the integration of intraoperative computed tomography data holds promise for further enhancements of surgical accuracy. This paper discusses the various types and applications of navigation employed in craniofacial surgery, highlighting their benefits and limitations.

Statistical Analysis of Telehealth Use and Pre- and Postpandemic Insurance Coverage in Selected Health Care Specialties in a Large Health Care System in Arkansas: Comparative Cross-Sectional Study.

The COVID-19 pandemic triggered policy changes in 2020 that allowed insurance companies to reimburse telehealth services, leading to increased telehealth use, especially in rural and underserved areas. However, with many emergency rules ending in 2022, patients and health care providers face potential challenges in accessing these services. This study analyzed telehealth use across specialties in Arkansas before and after the pandemic (2017-2022) using data from electronic medical records from the University of Arkansas for Medical Sciences Medical Center. We explored trends in insurance coverage for telehealth visits and developed metrics to compare the performance of telehealth versus in-person visits across various specialties. The results inform insurance coverage decisions for telehealth services. We used pre- and postpandemic data to determine the impacts of the COVID-19 pandemic and changes in reimbursement policies on telehealth visits. We proposed a framework to calculate 3 appointment metrics: indirect waiting time, direct waiting time, and appointment length. Statistical analysis tools were used to compare the performance of telehealth and in-person visits across the following specialties: obstetrics and gynecology, psychiatry, family medicine, gerontology, internal medicine, neurology, and neurosurgery. We used data from approximately 4 million in-person visits and 300,000 telehealth visits collected from 2017 to 2022. Our analysis revealed a statistically significant increase in telehealth visits across all specialties (P<.001), showing an 89% increase from 51,589 visits in 2019 to 97,461 visits in 2020, followed by a 21% increase to 117,730 visits in 2021. Around 92.57% (134,221/145,001) of telehealth patients from 2020 to 2022 were covered by Medicare, Blue Cross and Blue Shield, commercial and managed care, Medicaid, and Medicare Managed Care. In-person visits covered by Medicare and Medicaid decreased by 15%, from 313,196 in 2019 to 264,696 in 2022. During 2020 to 2022, about 22.84% (33,123/145,001) of total telehealth visits during this period were covered by Medicare and 53.58% (86,317/161,092) were in psychiatry, obstetrics and gynecology, and family medicine. We noticed a statistically significant decrease (P<.001) in the average indirect waiting time for telehealth visits, from 48.4 to 27.7 days, and a statistically significant reduction in appointment length, from 93.2 minutes in 2020 to 39.59 minutes in 2022. The indirect waiting time for psychiatry telehealth visits was almost 50% shorter than that for in-person visits. These findings highlight the potential benefits of telehealth in providing access to health care, particularly for patients needing psychiatric care. Reverting to prepandemic regulations could negatively affect Arkansas, where many live in underserved areas. Our analysis shows that telehealth use remained stable beyond 2020, with psychiatry visits continuing to grow. These findings may guide insurance and policy decisions in Arkansas and other regions facing similar access challenges.

Health-seeking dynamics and uptake of ethnomedical therapies for chronic pain among people who use drugs in Nigeria

This study explored health-seeking practices and utilization of ethnomedical therapies for chronic pain management among people who use drugs (PWUD) in Nigeria. Data were generated through in-depth interviews with PWUD who lived with chronic pain (n = 26). Participants were recruited through snowball sampling in Uyo, Nigeria. Interviews were recorded, transcribed verbatim, coded and analysed thematically. Participants reported challenges with biomedical pain management, including a lack of cure for pain and low adherence to medications due to financial constraints and restrictions on dispensing of pharmaceutical opioids. These challenges contributed to inadequate biomedical management of chronic pain and encouraged utilization of herbal remedies, including those originating from other ethno-linguistic settings. While some preferred herbal remedies to biomedical care, others used these remedies due to inability to access biomedical pain management. Further, while some found herbal remedies to be helpful in relieving pain, others experienced adverse reactions and sought emergency medical services for this reason. As a result, they disavowed ethnomedical therapies and reaffirmed trust in biomedicine. Participants choose between biomedicine and ethnomedical therapies in managing chronic pain, and these choices were often shaped by structural inequality and the wider context of medical pluralism. Findings indicate a need to promote diversity and choice in healthcare and ensure access to safe, equitable and culturally-appropriate care through health insurance coverage and formal regulation of ethnomedical providers.

Lifetime insurance cover for horses in Ireland

Lifetime insurance cover for horses in Ireland