Insurance Gaps Research Articles

Research on Extreme Weather Risk Management Based on Gray Prediction and Multi-Criteria Evaluation Models

This study investigates the growing challenges faced by the insurance industry due to extreme weather events and climate change, with a focus on the widening global insurance gap. We propose a novel dual-model approach to address these complex issues. First, we develop a Gray Prediction-Based Risk Assessment Framework (GPRAF) that integrates multidimensional data on natural disasters, economic development, population dynamics, and agricultural trends. This framework enables insurance companies to make more informed underwriting decisions in the context of increasing climate-related risks. Through case studies in Japan and Mexico, we demonstrate the practical applications and implications of our approach. Our research contributes to the growing body of literature on climate risk management in the insurance sector and provides valuable insights for policymakers and industry practitioners. By bridging the gap between risk assessment and community preservation needs, this study offers a holistic perspective on adapting insurance strategies to the challenges of climate change while preserving community values.

Prediction model of insurance profit and loss under extreme weather based on PCA and ARIMA Models

Because global catastrophe insurance gap widening, insurance profit forecast is important for ensuring the operation of insurance companies under extreme weather. In this paper, on the basis of analyzing the profit structure of insurance, the dimensionality reduction capability of PCA and the flexibility of ARIMA are combined to establish a prediction model of insurance profit and loss under the extreme weather. On the basis of using PCA (Principal Component Analysis) to extract the important features of extreme weather data and to conduct correlation analysis, the influences of each factor on the expression of different principal components are clarified, and the calculation formula of the principal component is obtained. ARIMA (Autoregressive Integrated Moving Average Model) is used to fit historical catastrophe insurance data and capture trends, to predict the likely future compensation ratio in this region. This method can not only reduce the dimension of complex weather data to simplify the analysis, but also flexibly predict the risk degree of future losses of insurance companies. The results show that with the increase of the frequency of extreme weather and the maximum rainfall, the operating risk of insurance companies will rise. Finally, in order to better develop regional catastrophe insurance, it’s a good choice to carry out long-term and short-term planning according to the prediction model.

Healthcare costs and resource utilization of patients with chronic post-traumatic stress disorder: a retrospective US claims analysis of commercially insured patients.

Aim: Exploring the healthcare costs and resource use among privately insured US patients with post-traumatic stress disorder (PTSD). Methods: This study used Merative MarketScan data. The index date was defined as the first PTSD claim. Study period included a 1-year pre-index and 2-year post-index follow-up. Cases with only acute PTSD, cancer, or insurance gap during the study period were excluded. The PTSD with (PwC) and PTSD without comorbidities (PwoC) cohorts were defined by the presence/absence of comorbid mental health conditions (schizophrenia, bipolar and major depressive disorder). Baseline PTSD (BP) cohort included PwoC cases with only index PTSD event and without FDA-approved PTSD medications or psychotherapy. Sub-analysis is conducted among patients with PTSD and substance/alcohol use disorder. Study cohorts were matched in a 1:1:1 ratio. Results: The matched sample included 5076 patients (1681 PwC, 1681 PwoC, 1714 BP). PwC patients had higher 2-year PTSD-related costs than PwoC and BP patients ($3762 vs $1750 and $841; all p<0.001). The same trend was noted among all-cause and anxiety-related costs. PwC patients had higher 2-year PTSD-related inpatient and emergency department (ED) rates than PwoC (10.2% vs 1.7% and 6.8% vs 2.6%, all p<0.001) and inpatient and outpatient rates than BP (10.2% vs 2.1% and 98.0% vs 93.1%; all p≤0.004). The sub-analysis had 3776 patients (3154 PwC, 537 PwoC, 85 BP). PwC had higher 2-year PTSD-related costs than PwoC and BP ($7668 vs $2919 and $1,483; all p<0.001). The same trend was noted in all-cause and anxiety-related costs. PwC also had higher 2-year PTSD-related inpatient and ED rates than PwoC (25.6% vs 10.4% and 12.7% vs 5.2%; all p<0.001) and inpatient and outpatient rates than BP (25.6% vs 8.2% and 95.5% vs 84.7%; all p<0.001). Conclusion: PTSD is associated with high healthcare costs and resource use. The highest economic burden was observed in patients with PTSD and mental health comorbidities.

Treatment patterns and characteristics of patients with Post-Traumatic Stress Disorder (PTSD): A retrospective claims analysis among commercially insured population.

This retrospective claims analysis explored the treatment utilization and characteristics among patients with post-traumatic stress disorder (PTSD) of different severity. The index date was the first PTSD claim. The analysis observed 12 months pre- and 24 months post-index. Adults with insurance gaps, cancer, or acute PTSD during the observation were excluded. Patients were categorized into three severity cohorts based on treatment and healthcare services utilization for PTSD: 1. Baseline PTSD (BP) (no PTSD visits post-index, no FDA-approved medications/ psychotherapy, and no severe mental health comorbidities); 2. PTSD without Comorbidities (PwoC) (≥1 PTSD visits post-index and no severe mental health conditions); 3. PTSD with Comorbidities (PwC) (≥1 PTSD visits post-index and severe mental health comorbidities present). For the primary analysis, cohorts were propensity-score matched. A sub-analysis examined patients with PTSD and Substance or Alcohol Use Disorder (SUD/AUD). The primary analysis observed 1714 BP, 1681 PwoC, and 1681 PwC patients. Treatment utilization rates were highest among PwC vs. other cohorts (84.5% psychotherapy, 76.1% off-label medications, and 26.1% FDA-approved medications [p<0.001]). PwC cohort also had the highest number of psychotherapy sessions and medication prescriptions per patient (20.1 sessions, 12.6 off-label prescriptions, and 2.0 FDA-approved prescriptions [p<0.001]). The proportion of days covered (PDC) indicated low medication adherence (0.25-0.40) with adherent patient rates (PDC ≥0.80) between 8.0-17.5%. The SUD/AUD sub-analysis identified 85 BP, 537 PwoC, and 3154 PwC patients. Conclusions were similar, with PwC cohort having highest treatment utilization rates (87.1% psychotherapy, 85.0% off-label medications, 28.2% FDA-approved medications [p≤0.013] with 24.4 sessions, 16.1 off-label prescriptions, and 2.0 FDA-approved prescriptions per patient [p≤0.002]). Only 4.7-11.4% of patients were adherent. PwC patients received psychotherapy and pharmacotherapy more frequently than PwoC and BP patients. Medication adherence among treated patients was low. Patients with SUD/AUD had numerically higher treatment utilization and lower medication adherence.

Insurance coverage for AYAs at cancer diagnosis: A claims-based analysis.

105 Background: Adolescents and Young Adults (AYAs), aged 15-39, experience unique challenges in cancer care. Frequent health insurance gaps for this population due to age, employment, and living changes hinder effective care and outcome assessments. Uninsured AYAs have lower survival rates, and insurance disparities are notable among Black, Hispanic, and rural patients; however, patterns of enrollment among AYAs have not been well described. Our study examined these patterns using insurance claims data to better inform AYA cancer care and outcomes. Methods: We conducted a retrospective cohort study with the Cancer Information and Population Health Resource (CIPHR), a linkage of cancer registry data and private and public payer data in North Carolina, including Medicaid and over 70% of the private insurance market. We included patients aged 15-39 diagnosed with common AYA cancers (leukemia, lymphoma, breast cancer, melanoma, sarcoma, germ cell tumors) from 2003-2019, linked to claims from 2003-2020. We analyzed insurance coverage patterns, comparing continuous enrollment 1) from two months pre-diagnosis to 12 months post-diagnosis and 2) from the month of diagnosis through 12 months. We compared demographics, clinical characteristics, and insurance types across scenarios. Results: The full cancer registry cohort included 21,060 AYAs; 11,024 (52.3%) had no link to Medicaid or private insurance in the year of cancer diagnosis. Continuous enrollment was 4,707 (22.4%) from two months prior through 12 months after, increasing to 5,912 (28.1%) for month of diagnosis through 12 months, particularly among Medicaid beneficiaries (from 10.8% to 15.6% of total cohort). Less restrictive criteria increased representation among Black (from 29.1% to 38.5%) and rural patients (from 25.2% to 33.1%) and those with leukemia (25.2% to 33.8%) and lymphoma (24.0% to 31.0%). Conclusions: AYAs face substantial hurdles with discontinuous insurance coverage around their cancer diagnosis. Claims-based research can characterize cancer care delivery, and use of less restrictive eligibility criteria expands the generalizability of findings to a more diverse cohort of AYAs. Increasing health insurance coverage over time may be due to the Affordable Care Act. Medicaid expansion within our state is likely to further improve access for AYAs. Continued efforts are essential to help AYAs with cancer secure necessary insurance coverage. Characteristics of AYAs by insurance enrollment criteria. Registry Cohort (n = 21,060) Continuous Enrollment –2 mos to 12 mos (n= 4,707) Continuous Enrollment 0 to 12 mos (n = 5,912) Cancer Type Breast 5817 1345 (23.1%) 1754 (30.2%) Sarcoma 1833 429 (23.4%) 532 (29.0%) Lymphoma 4436 1064 (24.0%) 1374 (31.0%) Leukemia 2393 604 (25.2%) 809 (33.8%) Race/Ethnicity Black 3951 1150 (29.1%) 1521 (38.5%) White 14620 3153 (21.6%) 3886 (26.6%) Hispanic 1296 164 (12.7%) 210 (16.2%) Location Urban 16277 Rural 4728 1190 (25.2%) 1565 (33.1%)

A - 36 Cognitive Impairments Linked to ADHD Severity and Insurance Gaps among U.S. Children

Abstract Objective To evaluate the presence and severity of attention-deficit/hyperactivity disorder (ADHD) in children in the United States, and to explore the relationship between ADHD, functional cognitive impairments, access to evidence-based treatments, and adequate health insurance. Method This study included children aged six to 17 (n = 34,109) from the 2022 National Survey of Children’s Health (NSCH) representing diverse races, ethnicities, and socioeconomic statuses. Data was collected on ADHD diagnosis, severity, insurance coverage, medication/behavioral treatment, and cognitive impacts. Results Of the participants, 10.5% reported ADHD, with 4.4% reporting mild symptoms and 6% reporting moderate to severe symptoms. The more severe ADHD symptoms were, the greater impact on cognitive performance was noted χ2(2,N = 4772) = 705 p &amp;lt; 0.001; with mild ADHD rarely impacting cognition resid.(1,2) = −421. Only 13.9% of children with ADHD is currently covered by health insurance, and only 6.6% of children with ADHD have health insurance to cover their mental and/or behavioral health services. Of those insured, children with severe ADHD were more likely to have insufficient coverage χ2(8,N = 4642) = 362 p &amp;lt; 0.001; resid.(3.3) = −23.5. Conclusions The study revealed a considerable 10.5% of U.S. children currently have ADHD, with greater cognitive impacts revealed for children with greater severity of symptoms. Results also revealed critical disparities in ADHD management, and in turn their cognitive functioning. While 59.7% reported insurance always covered mental health needs, and 13.9% indicated inconsistent coverage, contributing to treatment gaps. This lack of coverage particularly affects children with moderate to severe ADHD, exacerbating cognitive impacts. These findings underscore the need for comprehensive ADHD care and improved, consistent mental health coverage.

The Role of Supplementary Insurance in Achieving Universal Health Coverage: A Comprehensive Review.

The gradual movement towards universal health coverage (UHC) is an important issue in many countries. The aim of this study is to identify the role of supplementary health insurance in achieving universal coverage. This comprehensive review study was conducted to identify the role of supplementary health insurance in achieving universal health coverage. 4894 articles were found in the search in databases (Scopus, PubMed, and Web Science), and finally42 articles were selected. Considering the criteria of titles and abstracts, the reviewed articles were assessed, and a thematic analysis approach was used to analyze the collected data. The review showed 52 Sub dimensions in 7 dimensions. Policymakers can draw on international experiences to ensure that private health insurance contributes to achieving universal health coverage by Providing clarity within the national health financing policy framework regarding the role of private health insurance. Enhancing understanding of how supplementary health insurance impacts the performance of the healthcare system. They are improving oversight of private health insurance, regulating financial protection and consumer support, and implementing thorough market surveillance and proper allocation of health subsidies between the private and public sectors. Supplementary insurance holds promise as a complementary tool in achieving universal health coverage. Addressing gaps in primary insurance and providing additional financial protection can contribute to enhanced access, improved quality of care, and reduced financial barriers to healthcare services. However, careful attention must be given to affordability, equity, regulation, and coordination with primary insurance schemes to ensure its effective implementation and prevent unintended consequences.

Consistency and Adequacy of Public and Commercial Health Insurance for US Children, 2016 to 2021

Before and during the COVID-19 public health emergency (PHE), commercially and publicly insured children may have faced different challenges in obtaining consistent and adequate health insurance. To compare overall rates, COVID-19 PHE-related changes, and child and family characteristics associated with inconsistent and inadequate coverage for publicly and commercially insured children. This was a cross-sectional study using nationally representative data from the 2016 to 2021 National Survey of Children's Health of children from age 0 to 17 years living in noninstitutional settings. Parent- or caregiver-reported current child health insurance type defined as public or commercial. Inconsistent insurance, defined as having an insurance gap in the past year; and inadequate insurance, defined by failure to meet 3 criteria: (1) benefits usually/always sufficient to meet child's needs; (2) coverage usually/always allows child to access needed health care practitioners; and (3) no or usually/always reasonable annual out-of-pocket payments for child's health care. Survey-weighted logistic regression was used to compare outcomes by insurance type, by year (2020-2021 vs 2016-2019), and by child characteristics within insurance type. Of this nationally representative sample of 203 691 insured children, 34.5% were publicly insured (mean [SD] age, 8.4 [4.1] years; 47.4% female) and 65.5% were commercially insured (mean [SD] age, 8.7 [5.6]; 49.1% female). Most publicly insured children were either non-Hispanic Black (20.9%) or Hispanic (36.4%); living with 2 married parents (38.4%) or a single parent (33.1%); and had a household income less than 200% of the federal poverty level (79%). Most commercially insured children were non-Hispanic White (62.8%), living with 2 married parents (79.0%); and had a household income of 400% of the federal poverty level or higher (49.1%). Compared with commercially insured children, publicly insured children had higher rates of inconsistent coverage (4.2% vs 1.4%; difference, 2.7 percentage points [pp]; 95% CI, 2.3 to 3.2) and lower rates of inadequate coverage (12.2% vs 33.0%; difference, -20.8 pp; 95% CI, -21.6 to -20.0). Compared with the period from 2016 to 2019, inconsistent insurance decreased by 42% for publicly insured children and inadequate insurance decreased by 6% for commercially insured children during the COVID-19 PHE (2020-2021). The child and family characteristics associated with inadequate and inconsistent insurance varied by insurance type. The findings of this cross-sectional study indicate that insurance gaps are a particular problem for publicly insured children, whereas insurance inadequacy and particularly, out-of-pocket costs are a challenge for commercially insured children. Both challenges improved during the COVID-19 PHE. Improving children's health coverage after the PHE will require policy solutions that target the unique needs of commercially and publicly insured children.

Access to Care for Adolescents and Young Adults With Cancer in the United States: State of the Literature.

Access to care remains a persistent challenge for adolescents and young adults (AYAs) with cancer. We review key findings in the science to date. (1) Location of care matters. There is survival benefit for AYAs treated either at a pediatric center or site with special status (eg, Children's Oncology Group, National Cancer Institute [NCI]-designated Comprehensive Cancer Center). (2) Socioeconomic status and insurance require further investigation. Medicaid expansion has had a moderate effect on AYA outcomes. The dependent care expansion benefit has come largely from improvements in coverage for younger populations whose parents have insurance, while some subgroups likely still face insurance gaps. (3) Clinical trial enrollment remains poor, but access may be improving. Numerous barriers and facilitators of clinical trial enrollment include those that are system level and patient level. NCI has established several initiatives over the past decade to improve enrollment, and newer collaboratives have recently brought together multidisciplinary US teams to increase clinical trial enrollment. (4) Effective AYA programs require provider and system flexibility and program reflection. With flexibility comes a need for metrics to assess program effectiveness in the context of the program model. Centers treating AYAs with cancer could submit a subset of metrics (appropriate to their program and/or services) to maintain their status; persistence would require an entity with staying power committed to overseeing the metrics and the system. Substantial clinical and biological advances are anticipated over the next 20 years that will benefit all patients with cancer. In parallel, it is crucial to prioritize research regarding access to health care and cancer care delivery; only with equitable access to care for AYAs can they, too, benefit from these advances.

The Impact of Drug Pricing and Insurance Coverage on Medication Adherence in Saudi

This study explores the complex interactions in Saudi Arabia between medicine costs, insurance coverage, and medication adherence. 250 individuals’ data were analysed, and significant relationships were found. With a significant coefficient of -0.773 (p = 0.006), high medicine prices were shown to be a significant barrier to medication adherence. On the other hand, complete insurance protection showed a favorable connection with adherence, highlighting its crucial function. The fact that 69% of the participants had health coverage and 31% did not highlights a sizable insurance gap. Males comprised 80% of the sample, 62% of respondents were in the 29–39 age range, and 56% had bachelor’s degrees. The income range showed that 43% made more than 20,000 SAR monthly. The significant effects of medicine cost and insurance coverage on medication adherence were highlighted by regression analysis (Beta = -0.749, p = 0.001, and 0.759, p = 0.006, respectively). These results highlight the criticality of addressing the affordability of prescription costs and advocating for open insurance programmes to improve healthcare outcomes in Saudi Arabia. Prioritising actions can help reduce costs and provide comprehensive coverage, say policymakers. This study emphasises the need for more research to dive further into the intricacies of healthcare accessibility, particularly in a healthcare environment that is continually expanding.

Mind the Gap – Assessing the Size and Determinants of the Life Insurance Gap

Preparing for the monetary loss associated with premature death of the breadwinner has become more relevant during the COVID-19 pandemic. However, very little is known about how much of the financial vulnerabilities are covered by the life insurance holdings in different population groups. We employ unique individual-level life insurance data of the Finnish population to study the voluntary life insurances, the components of financial loss following from a death of a breadwinner, and the gap in death cover (life insurance gap) calculated as the difference of the two. We find that only about 10% of Finns have a voluntary life insurance, and that they are concentrated on married people, people of working age and with higher income. The largest insurance gaps are among young individuals, men, high income and highly educated people. We also find that the insurance behavior is poorly explained by the net losses following from a death.

Racial and Ethnic Disparities in Glycemic Control Among Insured US Adults

Poor access to care and lack of health insurance are important contributors to disparities in glycemic control. However expanding health insurance coverage may not be enough to fully address the high burden of poor glycemic control for some groups. To characterize racial and ethnic disparities in glycemic control among adults with private and public insurance in the US over a 15-year timeframe and to evaluate whether social, health care, and behavioral or health status factors attenuate estimates of disparities. This cross-sectional study used data from the National Health and Nutrition Examination Survey from 2003 to 2018. Participants included Hispanic or Latino, non-Hispanic Black, and non-Hispanic White adults aged 25 to 80 years with self-reported diabetes and health insurance. Data were analyzed from January 15 to August 23, 2023. Participants self-identified as Hispanic or Latino, non-Hispanic Black, or non-Hispanic White. The main outcome, poor glycemic control, was defined as glycated hemoglobin A1c (HbA1c) of 7.0% or greater. Information about social (education, food security, and nativity), health care (insurance type, routine place for health care, insurance gap in past year, and use of diabetes medications), and behavioral or health status (years with diabetes, waist circumference, and smoking) factors were collected via questionnaires. A total of 4070 individuals (weighted mean [SE] age, 61.4 [0.27] years; 1970 [weighted proportion, 49.3%] were women) were included, representing 16 337 362 US adults, including 1146 Hispanic or Latino individuals (weighted proportion, 13.2%), 1196 non-Hispanic Black individuals (weighted proportion, 15.7%), and 1728 non-Hispanic White individuals (weighted proportion, 71.1%). In models adjusted for age, sex, and survey year, Hispanic or Latino and non-Hispanic Black individuals had significantly higher odds of poor glycemic control than non-Hispanic White individuals (Hispanic or Latino: odds ratio [OR], 1.46; 95% CI, 1.16-1.83; Black: OR, 1.28; 95% CI, 1.04-1.57). There was some attenuation after adjustment for social factors, especially food security (Hispanic or Latino: OR, 1.39; 95% CI, 1.08-1.81); Black: OR, 1.39; 95% CI, 1.08-1.81). However, accounting for health care and behavioral or health status factors increased disparities, especially for Hispanic or Latino individuals (OR, 1.63; 95% CI, 1.24-2.16), with racial and ethnic disparities persisting even among those with private insurance (OR, 1.66; 95% CI, 1.10-2.52). In this cross-sectional study of insured adults with diabetes in the US, disparities in poor glycemic control persisted despite adjustment for social, health care, and behavioral factors. Research is needed to identify the barriers contributing to poor control even in populations with access to care.

Black Women’s Maternal Health: Insights From Community Based Participatory Research in Newark, New Jersey

This study on Black women’s maternal health engaged a group of six community members in a community based participatory research project in a state with one of the largest racial disparities in maternal mortality and severe maternal morbidity in the United States. The community members conducted 31 semi-structured interviews with other Black women who had given birth within the past 3 years to examine their experiences throughout the perinatal and post-partum period. Four main themes emerged: (1) challenges related to the structure of healthcare, including insurance gaps, long wait times, lack of co-location of services, and financial challenges for both insured and uninsured people; (2) negative experiences with healthcare providers, including dismissal of concerns, lack of listening, and missed opportunities for relationship building; (3) preference for racial concordance with providers and experiences with discrimination across multiple dimensions; and (4) mental health concerns and lack of social support. CBPR is a research methodology that could be more widely deployed to illuminate the experiences of community members in order to develop solutions to complex problems. The results indicate that Black women’s maternal health will benefit from multi-level interventions with changes driven by insights from Black women.

Abstract #1395486: Uncontrolled Acromegaly Resulting in the Need for LVAD as Bridge to Heart Transplant

Acromegaly is an uncommon pituitary disorder with an incidence of six per million persons. While hypertension is often encountered in these patients, heart failure rarely is seen with an incidence rate under 10%. We describe a case of an individual who was diagnosed with acromegaly after an acute exacerbation of heart failure with subsequent management requiring an LVAD to perform Transsphenoidal Surgery (TSS). 37-year-old male otherwise healthy initially presented to an emergency room and was found to be in acute heart failure exacerbation. Concerning acromegaly features included macrognathia, enlarged hands and feet, swollen phalanges, widened spacing of teeth, and frontal bossing. IGF-1 level was found 455 ng/mL. MRI showed a 10mm macroadenoma. A right heart catheterization showed elevated filling pressures. Cardiac MRI showed no defects or enhancement. Endomyocardial biopsy showed no inflammatory infiltrates or evidence of infiltrative diseases. Patient had an ejection fraction of 15% corroborated by cardiac MRI along with the presence of aortic root dilatation and mitral regurgitation. The patient started on 0.5mg of Cabergoline twice weekly and 120mg weekly Lanreotide injections. Patient stabilized with plans for further close monitoring and outpatient neurosurgical evaluation. The COVID-19 pandemic and insurance gaps led the patient to spend two years off his medicines and he was unable to be seen by his medical team. Patient was seen by our system after recurrent hospitalizations for heart failure at our sister hospital, AICD was unable to be placed due to the patient’s anatomy, he was placed on wearable cardiac defibrillator and required milrinone infusion for progression to end-stage heart failure with cardiac cachexia. At our institution, the patient was evaluated for Orthotopic Heart Transplant (OHT) but due to active GH secreting macroadenoma there was concern for OHT failure without TSS. Decision was made to utilize LVAD as Bridge-to-Transplant for OHT so the patient could be stabilized and safely undergo TSS. The patient tolerated surgeries well and is currently on the active transplant list. Heart failure is an uncommon presentation of severe acromegaly requiring multidisciplinary management. We describe a case of a patient who initially presented with heart failure too unstable for surgery. Due to the COVID-19 pandemic the patient’s disease progressed resulting in end-stage heart failure requiring LVAD placement for further treatment. We would like to draw attention to the use of LVAD placement in acromegalic patients who develop severe cardiovascular disease who are not candidates for OHT.

Delaying the Fellowship Start Date in Obstetrics and Gynecology.

To evaluate residents planning fellowship, their preferences for fellowship start date, and the acceptability of resultant gaps in pay and insurance coverage. A survey was conducted during the 2022 in-service training examination querying obstetrics and gynecology residents about their desire to pursue fellowship, their preferred fellowship start date (understanding the salary gap), and the acceptability of a medical insurance gap. Survey analysis of respondents planning to pursue fellowship demonstrated that, acknowledging the pay gap that would occur, 93.9% preferred a fellowship start date after July 1, with the majority (65.1%, 593/911) preferring an August 1 fellowship start date. Most respondents (87.7%, 798/910) found the potential resultant gap in medical insurance coverage acceptable. Survey data showed that racial and ethnic identity was not a determining factor in either of these issues. The majority of current residents planning to pursue fellowship prefer a delayed fellowship start date, even if it means a gap in salary and insurance coverage. The results of this study, requested by a specialty-wide, consensus-building workgroup, informed a statement signed by the majority (88.9%) of workgroup constituents supporting an August 1 clinical fellowship start date.

The Effect of Health Insurance Status on School Attendance.

Introduction Educational achievement is impacted by a student's ability to be present and motivated in the classroom. Since health and education influence one another, disparities in health insurance status amongchildren may exert educationally relevant consequences. However, the association between health insurance coverage and school absenteeism remains poorly understood. Our study aims to assess the association between not having/having gaps in health insurance coverage and an increased number of missed school days. Methods A historical cohort study was performed via secondary analysis of data collected as part of the 2018 National Survey of Children's Health (NSCH). We included children enrolled in school between the ages of 6-17 yearsand who provided answers to survey questions involving our two variables of interest: health insurance status and missed school days. Our data analysis included 1) a descriptive analysis of the baseline sample characteristics, 2) a bivariate analysis to determine the association between baseline characteristics/confounding variables and the outcome, and 3) a multivariable regression analysis using logistic regression to determine the association of interest while controlling for potential confounding variables. Results A total of 21,498 respondents were included. The unadjusted odds of chronic absenteeism were found to be 16% (OR=1.16) higher in children without insurance or with gaps in insurance compared to children with consistent insurance throughout the year, but the association was not statistically significant (95% CI 0.74 - 1.82, p=0.051). After adjustment by age, sex, race, Hispanic ethnicity,and confounding variables, the odds of chronic absenteeism in children without insurance or with gaps in insurance remained statistically insignificant (aOR=1.05; 95% CI 0.64 - 1.73, p=0.848) compared to those with consistent insurance coverage. Conclusions According to our analysis, the data do not support our hypothesis of a significant difference in missed school days (greater than or equal to 11 missed days of school) among those children who had health insurance compared to those without health insurance/had gaps in insurance coverage.

'We don't have the right to get sick': A qualitative study of gaps in public health insurance among Im/migrant women in British Columbia, Canada.

Globally, the exclusion of im/migrants from public health care systems remains a significant health and human rights issue, calling into question claims of 'universality' of public health systems where eligibility for coverage is determined by immigration status. We aimed to describe lived experiences of health insurance coverage and the health and social impacts of gaps in health insurance amongst im/migrant women in British Columbia (BC), Canada. This analysis draws on qualitative in-depth interviews (n = 78) with im/migrant women and im/migrant-focused service providers (n = 10) conducted between July 2018-March 2021 in Metro Vancouver, BC, as part of a larger community-based, mixed-methods study of im/migrants' health access (IRIS). In contrast to common perceptions of Canada's health system as 'universal', participants faced multifaceted barriers to health insurance and necessary healthcare for themselves and their families following arrival in BC. Narratives highlighted the ways in which ineligibility for public health insurance coverage resulted in unmet needs for essential sexual and reproductive health and preventive care among im/migrant women, children, and families. Participants also described ineligibility for public health insurance as resulting in a high economic burden, and that exclusion from public health insurance perpetuated experiences of discrimination, invisibility, and exclusion from systems of care amongst im/migrant participants. Despite these structural challenges, participant narratives highlighted the crucial role of community-based supports for minimizing harm and navigating oppressive immigration and health systems. Changes to immigration and health policies are required to remove barriers to public health care for im/migrant women and ensure that Canada's health system is accessible to all. Expanding health insurance options to cover all residents and decoupling health insurance eligibility from immigration status are recommended, alongside implementation of 'Sanctuary' policies at the local level.

Affordable Health Insurance Options for Small Business and Low-Wage Workers Remains Elusive: Experience With New Health Reimbursement Arrangements in New Jersey.

Low-wage workers and those employed by small businesses are least likely to be offered health insurance coverage and they are over-represented among the uninsured. Two new forms of health reimbursement arrangements (HRAs) that allow employers to help fund individual market coverage for workers have been touted as breakthrough strategies to help fill this gap. Despite several years of experience and low adoption, little is known about employer understanding of or views about these HRA options. Consistent with other evidence, only 11.8% of New Jersey employers we surveyed offer or plan to offer either of the HRA options. Few respondents (18.5%) report familiarity with either option. Even among businesses that offer or plan to offer this form of HRA, under half (47.6%) say that they are familiar with them. Other reasons cited for not offering these options include broker advice and complexity. While more investigation is needed, these findings suggest that new strategies should be explored to fill the gap in health insurance for low-wage and small business employees.

Study of Uncertainty and Inaccuracies of the Income for Inequality Paradox through Fuzzy Logic for Sustainable Development

The sustainable goal can also be the global goal of preserving nature and green resources and taking precautionary measures to safeguard the planet and its prosperity. Green technology depicts, as the name signifies, eco-friendly, energy-efficient, and reusable safety concerns. Fundamentally, renewable resources are to be reiterative and available to retain nature's natural core of existence. The proposed study is destined to discuss one of the sustainable goals defined in 2015 by the United Nations: reduced inequality (SDG: Goal 10). The study is inclined to find uncertainty and a degree of inaccuracy in the inequality paradox with respect to differences in earnings between male and female workers based on their educational attainment in EU countries. The indicators of statistics are observed and monitor variations of below-upper secondary education, upper secondary and post-non-territory education, and, very importantly, the overall income with respect to all levels of education, which can alert policymakers to impending problems. On the other hand, quantify the impact of the difference in earnings between male and female workers and encourage an education system to improve by comparing it, or parts of it, with other countries or systems.Inequality defines the occurrence of an unequal administration of resources and opportunities among the members of the given clusters. There are different dimensions of the inequality paradox, such as wage inequality, homelessness, racial gaps in education, child poverty, residential separation, and health insurance. There is a need to quantify the degree of each entity, and every real-world data set has a degree of randomness that cascades to uncertainty and is technically called "statistical uncertainty". In other words, estimating the uncertainty is another dimension of measuring the entity itself. While measuring, there is also risk embedded; hence, we do not have an appropriate probability model, and fuzzy logic took its existence to serve the purpose. Fuzzy logic is a modus operandi in accordance with convolutional and imprecise systems. By applying the principles of fuzzy logic, arithmetic, and substandard data can be studied in an instinctive and viable manner. With the support of fuzzy logic, the uncertainty of the data can be measured meticulously by measuring the possibilities. This article facilitates quantifying the degree of inaccuracy and uncertainty of the income paradox from the primary data, which has been derived from the Organization for Economic Cooperation and Development Statistics, and the main data repository, "Differences in earnings between female and male workers, by educational attainment" for respective countries for the reference year 2020.

The influence factors of consumers comprehensive car insurance demand: evidence from Turkey

Purpose- Car insurance stands out as the most important line in the individual insurance industry. Even though it is a legal obligation for drivers to have car liability insurance in many countries, there is a coverage gap in comprehensive insurance, especially in emerging countries such as Turkey. Although the comprehensive car insurance penetration rate has slightly increased in the last five years in Turkey, it still has limited coverage. The study investigates the effects of perceived insurance benefit and insurance literacy variables, in addition to socio-economic indicators, as the determinants of comprehensive car insurance demand in Turkey Methodology- The survey method was used for data collection. The survey was prepared digitally and distributed to car owners in Turkey via a social media platform using a simple random method. The total number of usable responses obtained was 261. The binary logistic regression was applied to determine the effect of the socio-economic factors, perceived insurance benefit, and insurance literacy on the comprehensive car insurance demand. Findings- The results showed a significant and strong relationship between comprehensive car insurance demand and having a traffic ticket, driving experience, driver’s age, and vehicle age indicators. The other important determinants of comprehensive car insurance demand with a relatively low weight are perceived insurance benefit and insurance literacy. There was no relationship between insurance demand and driving frequency or experiencing a traffic accident. Conclusion- This study has several practical implications for the insurance industry in terms of marketing, product development and the underwriting process. Insurance companies should consider the factors affecting consumers’ insurance demand while designing products and services. Furthermore, they should act together with regulatory authorities to organize awareness campaigns and financial literacy courses to better explain the individual and social benefits of insurance products and services.