Insurance Scheme Research Articles

Exploring The Implementation Challenges Faced By Healthcare Providers In Delivering Services Under Ayushman Bharat -Arogya Karnataka Health Scheme In Bengaluru, Karnataka-A Qualitative Study

Background: Ayushman Bharat-Arogya Karnataka (AB-ArK) is a flagship health insurance scheme of Karnataka started in Oct-2018. The integrated health assurance scheme of Ayushman Bharat-Arogya Karnataka is implemented by the State of Karnataka on an assurance/trust mode through the State Health Agency-Suvarna Arogya Suraksha Trust (SAST). AB-Ark is a Universal Health coverage scheme that provides a comprehensive healthcare to both Below Poverty Line (BPL) and Above Poverty Line (APL) families, covering a wide range of secondary and tertiary healthcare services. This scheme, part of the broader Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), seeks to offer financial protection against catastrophic health expenditures and improve access to quality healthcare services. Learning the experiences and insights from the scheme's implementers can enhance our understanding of how contextual factors impact a program's success. Therefore, it is crucial to examine the different contextual elements that can either support or obstruct the effective execution of a scheme. Objective: To understand the specific obstacles and barriers in effectively implementing the Ayushman Bharat Arogya Karnataka health scheme from a healthcare provider perspective. Methods: The study employed a qualitative approach involving 8 in-depth interviews. Interviews were audio recorded and were transcribed as per the reported verbatim. The transcripts were then analysed in Microsoft excel using thematic analysis for emerging patterns and insights leading to conclusions drawn from the analysis results. Results: Findings were depicted in broad themes and subthemes under individual, community, health system and policy levels. In brief, factors like infrastructure, patient load, awareness, affordability, quality of care and operational challenges were discussed. Conclusion: Study finding revealed various challenges faced by the health care provider, which needs to be addressed for the scheme’s long-term success and sustainability. Continuous monitoring, policy adjustments, and stakeholder engagement are essential to overcoming these hurdles and achieving the scheme's objectives.

Acceptability of the National Health Insurance scheme and preferred benefit package among civil servants in Rivers State, Nigeria

Health-care insurance is one of the financial risk protection tools available to clients in the health-care industry. In most developing countries, citizens are in favor of paying for their health-care expenses out of pocket, a payment mode that potentially tips these people into poverty. This study aims to determine the level of acceptance of and the preferred benefit package available in the National Health Insurance Scheme (NHIS) among civil servants in Rivers State, Nigeria. In this descriptive cross-sectional study, respondents were selected through simple random sampling. The collected data were cleaned and analyzed with Statistical Product and Service Solution version 23. Out of the 351 respondents, male subjects accounted for the big majority of the sample (n = 208; 59.3%); only 30 (8.5%) had any form of health insurance; and about two-thirds of the respondents, at around 223 (63.5%), expressed acceptance of using NHIS as a strategy for payment. The most preferred benefits package was the one that covers all services 178 (50.7%). The poor and the poorest showed a preference for the health-care benefits package that covers all expenses, whereas the rich showed a preference for services covering basic diseases. The overall acceptability of the NHIS was statistically associated with socio-economic status (p ≤ 0.05). Thus, the opinions of the consumers and their health needs must be taken into consideration when planning a health insurance benefits package.

Blended insurance scheme: A synergistic conventional-index insurance mixture

Conventional indemnity-based insurance (“conventional insurance”) and index-based insurance (“index insurance”) represent two primary insurance types, each harboring distinct advantages depending on specific circumstances. This paper proposes a novel blended insurance whose payout is a mixture of the two, to achieve enhanced risk mitigation and cost efficiency. We present the product design framework that employs a multi-output neural network (NN) model to determine both the triggering type and the index-based payout level. The proposed framework is then applied to an empirical case involving soybean production coverage in Iowa. Our results demonstrate this blended insurance could generally outperform both conventional and index insurance in enhancing policyholders' utility.

Integrating Feminism, Transforming the National Disability Insurance Scheme (NDIS): An Analysis of the Scheme Through the NDIS Plans of People with Intellectual Disability

ABSTRACT The implications of gender inequality have been overlooked in the lives of women with intellectual disability who suffer intersectional discrimination because they are women but also because they have a disability. The individualised funding models used by the National Disability Insurance Scheme (NDIS) aims to advance human rights concerns, such as gender equality, by giving people the ability to decide how they are supported. Underpinning the strategy is that individuals have ‘choice and control’ over care under a market-based economy model as businesses create services to meet their needs. However, it is unclear to what extent the system recognises the needs of women with intellectual disability and the intersectional discrimination that they experience. The article presents research aimed at locating how the notions of choice, control and autonomy intersect with gender by examining 20 NDIS plans for men and women with intellectual disability. We use a feminist perspective to analyse how the complexities of power dynamics in the planning process, the subjugation of women in society, and epistemic knowledge creation are part of women with intellectual disabilities' experience of the NDIS. This article contributes to the feminist discourse and makes suggestions for improving the approach and policy of the NDIS.

Non-communicable comorbidities in pulmonary tuberculosis and healthcare utilization: a cross-sectional study of 2021 Indonesian national health insurance data

BackgroundLimited research exists on the comorbidity of pulmonary tuberculosis with non-communicable diseases (NCDs) and its implications for healthcare utilization in Indonesia. The lack of investigation into NCD comorbidity among pulmonary tuberculosis patients could adversely affect both the healthcare system and the national health insurance scheme. Understanding the NCD comorbidity among pulmonary tuberculosis patients, associated factors, and healthcare utilization is crucial for ensuring the effective and efficient delivery of health services.MethodThis study utilized an observational cross-sectional design based on anonymized sample data from tuberculosis cases covered by Indonesia's National Health Insurance in 2021. Chi-square tests were employed to analyze dependent and independent variables, while unadjusted and adjusted logistic regressions were used to explore further associations.ResultsThe prevalence of NCD comorbidity in tuberculosis patients was 11.81%. Aged over 60 (aOR 5.16; [CI] 4.23—6.3), married (aOR 1.19; [CI] 1.05—1.34), and unemployed (aOR 1.27; [CI] 1.08—1.49) were associated with the NCD comorbidity in pulmonary tuberculosis patients. Factors associated with increased inpatient service utilization among pulmonary tuberculosis patients included aged over 60 (aOR 5.69; [CI] 4.81—6.74), male (aOR 1.32; [CI] 1.23—1.40), self-employment (aOR 1.42; [CI] 1.29—1.56), having insurance subsidized by central government (aOR 1.89; [CI] 1.73—2.08) or local government funds (aOR 1.75; [CI] 1.58—1.93), and having comorbidity non-communicable diseases (aOR 1.80; [CI] 1.66—1.96).ConclusionPulmonary tuberculosis patients exhibit a significant prevalence of NCD comorbidity, which substantially impacts healthcare utilization. Early detection and management of these conditions are critical to mitigate burdens on both the healthcare system and the financial sustainability of the national health insurance scheme. Integrating health services for tuberculosis and NCDs through bidirectional screening is essential for comprehensive patient care.

Promoting the social in psychosocial recovery: Interviews with Australian National Disability Insurance Scheme participants

AbstractSocial connection is a central element in mental health recovery and has been found to have a significant impact on the health and well‐being of individuals. This study examines the experiences of social connectedness for people accessing NDIS support for psychosocial disability. Interviews were conducted with eight NDIS participants. The study's findings suggest that people with psychosocial disabilities experience limited social connections and small social worlds. While NDIS support relationships were seen as important facilitators in increasing social engagement, these relationships may also limit opportunities for participants to extend their social connections beyond these professional support contacts. The impacts of participants' illnesses were identified as major barriers to establishing social connections and further research is needed to identify effective interventions that reduce social isolation in this population. This study highlights the role the NDIS can play in supporting social connection and inclusion for participants. Further consideration regarding the role of NDIS support relationships and NDIS‐funded interventions in supporting the social connectedness of participants is needed.

Community-based health insurance beneficiaries' satisfaction on laboratory services and associated factors in selected public hospitals in Jimma Zone, Oromia Region, Southwest, Ethiopia.

The community-based health insurance (CBHI) scheme is a growing initiative aimed at enhancing healthcare access for the most impoverished members of the community. The Ethiopian CBHI scheme aims to enhance access to essential healthcare services, including medical laboratory services, for the poorest members of the community, but there is limited evidence on satisfaction levels. The aim of this study was to assess the satisfaction level of CBHI beneficiaries with laboratory services and their associated factors among selected public hospitals in Jimma Zone, Oromia Region, Ethiopia. A facility-based cross-sectional study was conducted on selected public hospitals in the Jimma Zone from September to October 2023. A total of 421 CBHI beneficiaries were enrolled in the study using a convenient sampling technique, and interviewers administered structured questionnaires to collect data. Data were entered into Epi-data and analyzed using the Statistical Package of Social Sciences version 25. Descriptive analysis was used to summarize independent variables; bivariate and multivariable logistic regression analyses were done to test the association between independent and dependent variables; and statistical significance was declared at P<0.05. More than half (55.8%) of the 419 study participants were female. Above half, 57.5% of the respondents were satisfied by the clinical laboratory services at public hospitals in Jimma Zone. Components with a higher satisfaction rate were providers' professional appearances (98.3%), procedures for specimen collection (87.6%), and availability of entertainment facilities at the waiting area (67.8%). On the contrary, longer waiting times to receive the test results (76.6%), inefficiency of the reception area (74.7%), and the inability of professionals to explain diagnostic procedures (58.0%) were associated with higher rates of dissatisfaction. Educational status and the number of hospital visits were found to have a statistically significant association with level of satisfaction with laboratory services. CBHI beneficiaries' satisfaction with laboratory service was at a moderate level in Jimma Zone public hospitals. Therefore, attention should be given to continuous monitoring of patients' satisfaction with services, improving reception areas, and practicing routine explanations about the purposes and procedures during specimen collection to improve the beneficiaries' satisfaction level with clinical laboratory services.

The Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) after four years of implementation – is it making an impact on quality of inpatient care and financial protection in India?

BackgroundIndia launched a national health insurance scheme named Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) in 2018 as a key policy for universal health coverage. The ambitious scheme covers 100 million poor households. None of the studies have examined its impact on the quality of care. The existing studies on the impact of AB-PMJAY on financial protection have been limited to early experiences of its implementation. Since then, the government has improved the scheme’s design. The current study was aimed at evaluating the impact of AB-PMJAY on improving utilisation, quality, and financial protection for inpatient care after four years of its implementation.MethodsTwo annual waves of household surveys were conducted for years 2021 and 2022 in Chhattisgarh state. The surveys had a sample representative of the state’s population, covering around 15,000 individuals. Quality was measured in terms of patient satisfaction and length of stay. Financial protection was measured through indicators of catastrophic health expenditure at different thresholds. Multivariate adjusted models and propensity score matching were applied to examine the impacts of AB-PMJAY. In addition, the instrumental variable method was used to address the selection problem.ResultsEnrollment under AB-PMJAY was not associated with increased utilisation of inpatient care. Among individuals enrolled under AB-PMJAY who utilised private hospitals, the proportion incurring catastrophic health expenditure at the threshold of 10% of annual consumption expenditure was 78.1% and 70.9% in 2021 and 2022, respectively. The utilisation of private hospitals was associated with greater catastrophic expenditure irrespective of AB-PMJAY coverage. Enrollment under AB-PMJAY was not associated with reduced out-of-pocket expenditure or catastrophic health expenditure.ConclusionsAB-PMJAY has achieved a large coverage of the population but after four years of implementation and an evidence-based increase in reimbursement prices for hospitals, it has not made an impact on improving utilisation, quality, or financial protection. The private hospitals contracted under the scheme continued to overcharge patients, and purchasing was ineffective in regulating provider behaviour. Further research is recommended to assess the impact of publicly funded health insurance schemes on financial protection in other low- and middle-income countries.

Climate shocks, adaptive mechanisms and household energy transition in Uganda

Nearly 41% of the global populace depends on unclean fuels for cooking. As a result, about 4 million premature deaths connected to household air pollution are registered annually. Worryingly, over 2.1 billion people are estimated to continue using unclean fuels by 2030 if no strong policy actions are taken to alter the status quo. Climate parameters including; temperature, solar radiation, wind, and moisture have been widely touted as having an impact on multidimensional energy poverty, their effect on household energy consumption and subsequent transition to cleaner fuels is seldom investigated in Uganda. The purpose of this study is to investigate the effect of climate shocks, and adaptation mechanisms on household energy transition in Uganda. The study adopted a panel data methodology employing an ordered logit model with random effects to estimate the effect of climate shocks and adaptation mechanisms on household fuel transition from high to low-pollutant cooking fuels in Uganda. The findings revealed that climate shocks, adaptation mechanisms significantly affect household energy transition in Uganda. The study recommended that policies aimed at enhancing detection and report of early warning signs should be emphasized. Furthermore, investing in an insurance scheme especially for people living in climate shock prone areas can help households to cope up with shocks are eventually transition to clean cooking fuels.

Evaluation of Bayelsa Health Insurance Scheme (BHIS) and Healthcare Delivery in Bayelsa State, Nigeria (2017-2022)

Evaluation of Bayelsa Health Insurance Scheme (BHIS) and Healthcare Delivery in Bayelsa State, Nigeria (2017-2022)

“The system allows for it to happen”: the experiences of human service workers in engaging with Aboriginal participants of the National Disability Insurance Scheme

Purpose The purpose of this study was to explore the experiences of human service workers (HSWs) in engaging with Aboriginal participants of the National Disability Insurance Scheme (NDIS). Methods Semi-structured interviews were undertaken with HSWs engaging with Aboriginal participants of the NDIS on Kaurna Country (Adelaide, South Australia). Data were analyzed using thematic analysis. Results In total, n = 10 HSWs participated in the study. Three themes impacting upon HSWs ability to effectively engage with Aboriginal participants were identified: (1) lack of access to training, support and supervision, (2) difficulties in navigating assessment and intervention, and (3) limited availability of culturally specific services. Conclusions This study contributes to Australian disability policy and practice with insights gained from the experiences of human service workers engaging with aboriginal participants of the NDIS. Systemic changes are required within policy and funding arrangements to create a system flexible enough to respond to the needs of Aboriginal Peoples with disability.

A typology framework for unethical medical practices under public health insurance schemes in India: Analysis of evidence over the past 12 years.

Unethical provider practices in public healthcare schemes adversely impact beneficiaries' health, result in the loss of public funds, and also bring disrepute to the schemes. There is extensive literature on the typologies of unethical practices in healthcare in developed countries. This study aims to develop a typology framework which is applicable in the Indian context. In this study, 25 media reports and research studies were analysed on unethical provider practices under public health insurance schemes in India over the past 12 years from 2010 to 2022. The reports were collated from de-empanelment orders issued by state health authorities against various erring entities, and research studies conducted on the abuse of these schemes. Based on the analysis and classification of the cases reported, an "Unethical Provider Practices" typology for healthcare fraud has been defined. Additional fraud typologies are found to be prevalent in India in addition to those captured by existing frameworks. These include patient harm, ID theft of beneficiary data to create cards for non-beneficiaries, and collusion between providers and different entities. Fraud control mechanisms leveraging technology such as AI-enabled digital apps for medical audits, biometric technology at the point of care and rigourous checks of ID documents before beneficiary cards are issued as well as having more specific legal provisions in place for healthcare fraud will enable enhanced prevention, detection and deterrence of healthcare fraud.

Satisfaction of chronic patients with community-based health insurance schemes and related factors: Explanatory sequential mixed methods study.

Chronic disease poses a serious threat to accessible, high-quality healthcare. Community-based health insurance (CBHI) schemes provide the poor with financial security. However, there is no evidence in Ethiopia on how satisfied chronic patients are with the schemes. The objective of the current study was to evaluate the satisfaction of chronic patients with the schemes and identify contributing factors. A hospital-based explanatory sequential mixed methods study on 632 chronic patients and 12 key informants was carried out between February 28 and May 31, 2022, in the hospitals of East Gojjam, Northwest Ethiopia. Hospitals and study participants were selected using multistage sampling methods. Quantitative data was entered using Epi Data 3.1 and exported to SPSS version 25 for analysis. P value <0.05 was used to consider significant association in multivariable binary logistic regression. Thematic analysis was a method to manually review qualitative data. A narrative approach was used for integrating the two data. The mean age of study participants was 46.1 (46.1± 5.2, range: 25-82). Patients aged 45 to 64 made up the majority of the population (60.6%). Rheumatoid arthritis affected the preponderance of individuals (36.4%). The overall level of satisfaction of chronic patients with the CBHI scheme was 31% (95% CI; 27-35%). Respect and friendliness (AOR = 7.05; CI: 3.71-13.36), knowledge of benefits packages (AOR = 2.02; CI: 1.24-3.27), partial or non-availability of drugs (AOR = 0.24, AOR = 0.21, respectively), waiting times (AOR = 1.84; CI: 1.12-3.0), and availability of laboratory tests (AOR = 1.59; CI: 1.01-2.48) were significantly associated with participants' satisfaction with the schemes. Our study revealed that the overall satisfaction of chronic patients was quite low and affected by the availability of drugs and laboratory tests, caregivers' respect and friendliness, waiting times, and participant knowledge. Therefore, stakeholders must concentrate on reducing waiting times, improving the availability of drugs and laboratory tests at each hospital, opening back up community pharmacies, and promoting awareness about benefits packages primarily through health education. The main focus of researchers needs to be on nationally representative studies that include more important factors.

Catastrophic out-of-pocket payments related to non-communicable disease multimorbidity and associated factors, evidence from a public referral hospital in Addis Ababa Ethiopia

BackgroundIn low and middle-income countries (LMICs), non-communicable diseases (NCDs) are on the rise and have become a significant cause of mortality. Unfortunately, accessing affordable healthcare services can prove to be challenging for individuals who are unable to bear the expenses out of their pockets. For NCDs, the treatment costs are already high, and being multimorbid further amplifies the economic burden on patients and their families. The present study seeks to bridge the gap in knowledge regarding the financial risks that come with NCD multimorbidity. It accomplishes this by examining the catastrophic out-of-pocket (OOP) expenditure levels and the factors that contribute to it at Tikur Anbesa Specialized Hospital, Addis Ababa, Ethiopia.MethodsA facility-based cross-sectional study was conducted at Tikur Anbesa Specialized Hospital between May 18 and July 22, 2020 and 392 multimorbid patients participated. The study participants were selected from the hospital’s four NCD clinics using systematic random sampling. Patients’ direct medical and non-medical out-of-pocket (OOP) expenditures were recorded, and the catastrophic OOP health expenditure for NCD care was estimated using various thresholds as cutoff points (5%, 10%, 15%, 20%, 25%, and 40% of both total household consumption expenditure and non-food expenditure). The collected data was entered into Epi Data version 3.1 and analyzed using STATA V 14. Descriptive statistics were utilized to present the study’s findings, while logistic regression was used to examine the associations between variables.ResultsA study was conducted on a sample of 392 patients who exhibited a range of socio-demographic and economic backgrounds. The annual out-of-pocket spending for the treatment of non-communicable disease multimorbidity was found to be $499.7 (95% CI: $440.9, $558.6) per patient. The majority of these expenses were allocated towards medical costs such as medication, diagnosis, and hospital beds. It was found that as the threshold for spending increased from 5 to 40% of total household consumption expenditure, the percentage of households facing catastrophic health expenditures (CHE) decreased from 77.55 to 10.46%. Similarly, the proportion of CHE as a percentage of non-food household expenditure decreased from 91.84 to 28.32% as the threshold increased from 5 to 40%. The study also revealed that patients who traveled to Addis Ababa for healthcare services (AOR = 7.45, 95% CI: 3.41–16.27), who were not enrolled in an insurance scheme (AOR = 4.97, 95% CI: 2.37, 10.4), who had more non-communicable diseases (AOR = 2.05, 95% CI: 1.40, 3.01), or who had more outpatient visits (AOR = 1.46, 95%CI: 1.31, 1.63) had a higher likelihood of incurring catastrophic out-of-pocket health expenditures at the 40% threshold.Conclusion and recommendationThis study has revealed that patients with multiple non-communicable diseases (NCDs) frequently face substantial out-of-pocket health expenditures (CHE) due to both medical and non-medical costs. Various factors, including absence from an insurance scheme, medical follow-ups necessitating travel to Addis Ababa, multiple NCDs and outpatient visits, and utilization of both public and private facilities, increase the likelihood of incurring CHE. To mitigate the incidence of CHE for individuals with NCD multimorbidity, an integrated NCD care service delivery approach, access to affordable medications and diagnostic services in public facilities, expanded insurance coverage, and fee waiver or service exemption systems should be explored.

Informal Employment and High Burden of Out-of-Pocket Healthcare Payments among Older Workers: Evidence from Longitudinal Ageing Study in India.

India's economy is among the fastest growing in the world. However, a large share of informal workforce is a common characteristic of country's economy, comprises a significant portion of most of its labour markets. This workforce often receives low wages and lacks benefits such as strong social security and health coverage for all. The majority of healthcare spending in India is private. As India's population ages and the informal sector expands, it is expected that many of these workers will continue to work beyond the retirement age to bear their own healthcare costs due to lack of savings, pensions and the precarious nature of their employment. In this context, this study estimates the burden of Out-of-Pocket (OOP) payments on India's informal older workers compared to their formal counterparts, using data from the first wave of the nationally representative Longitudinal Ageing Study in India. According to estimates from the Two-part regression model, informal older workers pay, on an average, INR 1113 (p<0.01) and INR 55 (p<0.05) less than their formal counterparts for inpatient and outpatient care, respectively. However, probit regression models revealed that the burden of combined (both inpatient and outpatient) OOP payments exceeding (by 40%, 20%, and 10%) of their income is significantly higher among informal older workers compared to formal older workers. The study underscores the need for strengthening of universal health insurance schemes to ensure everyone has access to medical services without experiencing financial hardship. It also advocates for policies specifically tailored towards informal workers, considering their unique challenges with regard to livelihoods and healthcare security. In particular, this encompasses bolstering the existing social security and healthcare system, and related policies for ensuring financial security against OOP payments, especially for informal workers and all the population in general.

A Critical Analysis of Challenges and Prospects of the National Health Insurance Scheme in Zambia-A Case Study of Lusaka District

Zambia’s National Health Insurance (NHI) was established by the enactment of the NHI Act No. 2 of 2018 and supported by statutory instrument No. 63 of 2019 which led to the establishment of the National Health Insurance Scheme (NHIS) under the management of the National Health Insurance Management Authority (NHIMA). The goal of the NHIS was to guarantee the provision of universal health insurance coverage for all residents, regardless of their socioeconomic status. As one of the prospective financing solutions for protecting populations from high health care service prices, NHIS is receiving increased attention from the international community. This study set out to investigate the difficulties and opportunities that the plan faces from the standpoint of the service providers and subscribers in Lusaka, Zambia. The study used the descriptive research design since it seeks to analyze the prospects and challenges of the national health insurance scheme in Lusaka, Zambia. The study came to a conclusion that in Lusaka, Zambia, consumers who wish to utilize the NHIS plan face challenges related to health literacy and awareness, fraud, and corruption, as well as, subpar service quality. The survey also discovered that consumers in Lusaka have difficulties with enrolment and registration while attempting to use the NHIS program due to intermittent availability and constant breakdown of the NHIMA system. The study further came to conclude that some of the prospects for the NHIS plan in Lusaka is public knowledge and involvement, enhancing monitoring and evaluation of the private and public health facilities accredited with NHIMA and improving the internet connectivity of the NHIMA system to enhance service delivery.

Impact of medical insurance integration on reducing urban-rural health disparity: Evidence from China

The urban-rural health disparity poses a significant challenge for countries worldwide. China encounters substantial disparities in healthcare services and health outcomes between urban and rural regions. In 2015, the Chinese government integrated the medical insurance schemes for urban and rural residents into a unified program, with the goal of mitigating the disparities and enhancing the sustainability and efficiency of the medical insurance system. Using data from the China Health and Retirement Longitudinal Study (CHARLS), we explored the impact of this integration on health outcomes and the health disparity between urban and rural residents, employing a triple difference approach with propensity score matching. We found that both urban and rural residents benefited from the medical insurance reform, experiencing improvements in their health outcomes to some extent. Urban residents reported better self-reported health, while rural residents exhibited improved health in terms of both self-reported health and number of diagnosed diseases. Notably, the disparity in activities of daily living (ADL) difficulties decreased. However, we also observed a worsening trend in ADL difficulties, especially among the elderly and the working population. This underscores the urgent need for further attention to health behaviors and healthcare resource allocation to these socio-demographic groups.

Inappropriate antibiotic access practices at the community level in Eastern Ethiopia

Access to antibiotic medications is critical to achieving the Sustainable Development Goal for good health and well-being. However, non-prescribed and informal sources are implicated as the most common causes of inappropriate antibiotic access practices, resulting in untargeted therapy, which leads to antibiotic resistance. Hence, knowing antibiotic access practices at the community level is essential to target misuse sources. In this study, 2256 household representatives were surveyed between July and September 2023 to examine their antibiotic access practices. Of 1245 household members who received antibiotics, 45.6% did so inappropriately. Non-prescribed antibiotic access was more common among urban residents and individuals not enrolled in health insurance schemes. This means of antibiotic access was also more common among individuals concerned about distance, drug availability, and healthcare convenience at public facilities. In addition, women and rural individuals were more likely to get antibiotics from unauthorized sources. Unrestricted antibiotic dispensing practices in urban areas enabled their non-prescribed access, while unlicensed providers prevailed with this access practice in rural areas. In this regard, personal behaviors and healthcare-related gaps such as the lack of health insurance, inconvenience, and drug unavailability have led community members to seek antibiotics from unofficial and non-prescribed sources. Targeting the identified behavioral and institutional factors can enhance antibiotic access through prescriptions, hence reducing antibiotic resistance.

Pricing weekly motor insurance drivers’ with behavioral and contextual telematics data

Telematics boxes integrated into vehicles are instrumental in capturing driving data encompassing behavioral and contextual information, including speed, distance travelled by road type, and time of day. These data can be amalgamated with drivers' individual attributes and reported accident occurrences to their respective insurance providers. Our study analyzes a substantial sample size of 19,214 individual drivers over a span of 55 weeks, covering a cumulative distance of 181.4 million kilometers driven. Utilizing this dataset, we develop predictive models for weekly accident frequency. As anticipated based on prior research with yearly data, our findings affirm that behavioral traits, such as instances of excessive speed, and contextual data pertaining to road type and time of day significantly aid in ratemaking design. The predictive models enable the creation of driving scores and personalized warnings, presenting a potential to enhance traffic safety by alerting drivers to perilous conditions. Our discussion delves into the construction of multiplicative scores derived from Poisson regression, contrasting them with additive scores resulting from a linear probability model approach, which offer greater communicability. Furthermore, we demonstrate that the inclusion of lagged behavioral and contextual factors not only enhances prediction accuracy but also lays the foundation for a diverse range of usage-based insurance schemes for weekly payments.

Transition from rehabilitation hospital to the National Disability Insurance Scheme (NDIS) for people with brain injury and spinal cord injury: a data linkage protocol

IntroductionTraumatic brain injury (TBI) and spinal cord injury (SCI) are both major contributors to permanent disability globally, with an estimated 27 million new cases of TBI and 0.93 million new...