Insurance System Research Articles

The roads to managed competition for mixed public-private health systems: a conceptual framework.

Health systems' insurance/funding can be organised in several ways. Some countries have adopted systems with a mixture of public-private involvement (e.g. Australia, Chile, Ireland, South Africa, New Zealand) which creates two-tier health systems, allowing consumers (groups) to have preferential access to the basic standard of care (e.g. skipping waiting times). The degree to which efficiency and equity are achieved in these types of systems is questioned. In this paper, we consider integration of the two tiers by means of a managed competition model, which underpins Social Health Insurance (SHI) systems. We elaborate a two-part conceptual framework, where, first, we review and update the existing pre-requisites for the model of managed competition to fit a broader definition of health systems, and second, we typologise possible roadmaps to achieve that model in terms of the insurance function, and focus on the consequences on providers and governance/stewardship.

UHC in Morocco: a bottom-up estimation of public hospitals' financing size based on a costing database

BackgroundMorocco is engaged in a health system reform aimed at generalizing health insurance across the whole population by 2025. This study aims to build a national database of costs at all levels of public hospitals in Morocco and craft this database as a resource for further use in a strategic purchasing system. It also aims at estimating the funding gap and the budget that should be secured for public hospitals in Morocco to fully play their roles in the current ambitious reform.MethodA costing study was implemented in 39 hospitals in 12 regions of Morocco (10 provincial hospitals, 11 regional hospitals, and 18 teaching hospitals). Using the hospital costing approach, we adapted and validated nationally our methodology to generate a database of unit costs based on data from 2019. All perspectives on cost were considered. Data collection was performed by cadres from MoH and facilitated by the WHO country office in Morocco. The production of the cost database allowed the development of a bottom-up estimation of the financing size for public health hospitals.ResultsThe study showed the feasibility of large-scale costing in the context of Morocco. The ownership of MoH and adherence to the process ensured the high quality of the collected data. There are many differences in unit costs for the same services moving from one hospital to another, which indicates existing inefficiencies. The database will contribute to shaping the strategic purchasing mechanism within the generalized health insurance schemes. The studied hospitals could be used as references to systematically update the billing system for health insurance.

Impacts of the Zero-Markup Drug Policy on Hospitalization Expenses of Patients with Stroke in Western China: An Interrupted Time Series Analysis.

In 2016, an innovative medical pricing reform called zero-markup drug policy (ZMDP) was implemented in selected pilot cities in China, which focuses on curbing the unreasonable growth of medical expenses. This study aimed to evaluate the impacts of ZMDP on medical expenditure of stroke in western China. The quantitative data of inpatients diagnosed with stroke was extracted from the medical insurance system in 7 tertiary public hospitals. An interrupted time series (ITS) was used to analyze the instantaneous level and long-term trend changes of hospitalization expenses per visit from January 2015 to November 2018. A total of 22,407 stroke inpatients were extracted. The total hospitalization expense per visit had the highest proportion of 20,000 CNY and above (33.66%). After the ZMDP, the median total hospitalization expense and western medicine expense per visit decreased by 631.74 CNY and 966.35 CNY, respectively (P <0.001). Before the policy, the total hospitalization expense, traditional Chinese medicine (TCM) expense, examination expense, treatment expense, laboratory expense and surgical expense per visit showed upward trends (P<0.05), while the anesthesia expense per visit showed a downward trend (P<0.001). When the policy was implemented, the anesthesia expense per visit instantaneously increased by 91.70% (P<0.001). After the policy, the total hospitalization expense, western medicine expense, TCM expense, treatment expense and surgical expense per visit changed from upward trends to downward trends (P<0.05). The anesthesia expense per visit changed from a downward trend to an upward trend (P<0.001), and the examination expense per visit maintained an upward trend (P=0.005). The economic burden of stroke inpatients decreased significantly with the implementation of the ZMDP, especially for the drug expenses. The medical service expenses increased significantly, reflecting the improvement in the value of medical staff's technical labor. However, the unexpected increase in the examination expenses was likely to be associated with the unreasonable medical compensation mechanism.

Work experience in the quality control system of medical care during the rise of digital technologies: the case of the NIIAP clinic of the Rostov State Medical University

In order to implement the legislation on compulsory health insurance in terms of monitoring the volume, timing, quality and conditions of providing medical care, it is necessary to refine the mechanisms of interaction between participants in the compulsory health insurance system. The active implementation of digital technologies in the healthcare industry will allow medical organizations to provide primary medical documentation in a timely manner for conducting medical and economic examinations and examinations of the quality of medical care.

Strategic planning as an element of management of the development of the pension system of the Russian Federation

The object of the study is the pension system of the Russian Federation, the subject is the long–term strategic planning for the development of the national pension system. The purpose of the research is to develop proposals for improving the strategic planning of the development of the pension system of the Russian Federation. Special attention is paid to the structure and key provisions of the Strategy for the Long-term Development of the Pension System of the Russian Federation until 2030 (the "Strategy"), the possibility of assessing its implementation, the comparability of the parameters of the functioning of the Russian pension system and data from the long-term budget forecast and forecasts of socio-economic development of the Russian Federation, the interconnection of the goals and objectives of the Strategy and national development goals of the Russian Federation, which makes it possible to develop and implement a comprehensive and coordinated state policy in the field of pension provision for the population. The author considers the expediency of maintaining the current high-level goals of the Strategy in the context of modern socio-economic parameters and trends in the functioning of the Russian economy. The author proceeds to systematization and comparison of the provisions of normative legal acts that are strategic planning documents, modeling of the volume of pension rights, coefficient, graphical, comparative, vertical and horizontal analysis of pension provision indicators. In the course of the study, it was found that the strategy is being implemented in conditions of imperfection of strategic planning documents in terms of pension provision, characterized by low reliability of forecasts, outdated terminology and weak alignment of medium- and long-term planning documents in terms of goal setting, forecasting and programming, weak alignment with the national development goals of the Russian Federation until 2030 and for the future until 2036 the year, the lack of program-oriented cost management in the compulsory pension insurance system. The strategy does not contain unambiguously interpreted indicators of its implementation, does not take into account a significant change in the macroeconomic situation, the transition to a point pension formula, does not contain an assessment of the risks of its implementation, and indicators of the implementation of many of its tasks are not disclosed in other types of strategic documents. We have proposed a number of principles for developing a long-term plan for the development of the pension system, including risk assessment, internal stabilizers and a phased breakdown of the values of indicators of its implementation, as well as defined guidelines for its long-term development, including limiting the growth of the share of the budget mechanism in the national pension system.

Exploring the challenges of taiwanese nurses in the COVID-19 post-pandemic era

In the wake of the COVID-19 pandemic, the fluctuating nurse resignation rates highlighted an understudied area in healthcare: post-pandemic challenges in clinical settings. This study, conducted from May to November 2023, employed a qualitative inquiry using focus groups to delve into these challenges. Six focus group sessions, involving 33 nurse participants recruited through snowball sampling from various hospital settings were conducted to explore their clinical experiences during and after the pandemic. Thematic analysis revealed two primary themes: the 'Invisibility of Nurses' within the healthcare system and the 'Moral Duty of Nursing Practice'. These findings illuminate a tension between the overlooked role of nurses and their ethical obligations, underscoring a critical need for policy reassessment. The study advocates for systemic changes, particularly in the undervaluation of the nursing profession and the National Health Insurance system, to address the poor working environment and mitigate long-term nursing shortages. This research deepens understanding of post-pandemic nursing workforce challenges in Taiwan, highlighting the need for policy evolution to enhance recognition and support for the nursing industry. It is suggested to provide tangible compensation to acknowledge nurses' daily care and health education for patients. A healthier working environment can be enhanced by collaborative efforts between healthcare institutions and nurses.

Изменения в направлениях и предельных размерах использования средств обязательного медицинского страхования с 2024 года.

The economic independence of medical organizations as legal entities presupposes their right to determine the direction of their expenses. However, the targeted nature of compulsory health insurance funds imposes restrictions on the freedom to use the income received from the provision of medical care in the compulsory health insurance system. And although the legislation defines the structure of expenses (tariffs), limiting them to the framework of compulsory health insurance programs, in practice, attributing expenses to certain groups often presents great difficulties, accompanied by sanctions and lawsuits. In this regard, recent changes in the legislation on compulsory health insurance, which expand the possibilities of using funds, seem to be very significant. This is also facilitated by an increase in the marginal cost of purchased equipment from 100 to 400 thousand rubles. However, such opportunities are due to a large number of restrictions and reservations, which requires a more detailed analysis of new legislative norms and an assessment of their impact on the conditions of medical organizations, which determined the relevance of this publication.

Clinical Results and Prognostic Factors in Boron Neutron Capture Therapy for Recurrent Squamous Cell Carcinoma of the Head and Neck Under the Japan National Health Insurance System: A Retrospective Study of the Initial 47 Patients

PurposeRecurrent head and neck cancer presents a therapeutic challenge due to cumulative toxicity from initial radiation therapy, limiting re-irradiation options. Boron neutron capture therapy (BNCT) offers a promising alternative, selectively delivering a radical dose to tumors while sparing adjacent normal tissue. This study investigates the initial clinical outcomes and prognostic factors associated with BNCT for recurrent squamous cell carcinoma of the head and neck. Materials and MethodsThis retrospective analysis investigated the initial 47 patients treated with BNCT between May 2020 and February 2021 in Japan. All patients had received radiotherapy with a median dose of 70 Gy (range, 44–176) prior to BNCT. Median tumor size was 11 cm3 (range, 1–117 cm3), with 23% of tumors larger than 30 cm3, and 87% of patients had prior systemic therapy. The most common prescribed dose to the pharyngeal mucosa was 15 Gy-Eq (36%), followed by 18 Gy-Eq (34%). The minimum dose given to tumor was 27.4 Gy-Eq (range, 13.3–45.2). In 23 patients, 18F-FBPA-PET was performed within 1 week before BNCT, tumor to blood 10B ratio was 3.5 (range, 2.0–8.7). ResultsEfficacy analysis revealed a 51% complete response rate and a 74% overall response rate. Disease-free survival rates at 1 and 2 years were 34.6% and 26.6%, respectively. Overall survival rates at 1 and 2 years were 86.1% and 66.5%, respectively. Multivariate analysis revealed that, among the patient characteristics, whether the lesion was mucosal had a significant impact on achieving complete response. ConclusionsThis study provided valuable insights into the early integration of BNCT into routine clinical practice, highlighting its efficacy and safety. Technical improvements are needed to ensure precise dose administration. Ongoing prospective studies, such as the phase II REBIVAL study, will further elucidate the role of BNCT in recurrent head and neck cancer.

High Quality Development of Regional Inclusive Insurance in China: Based on Logistic Multiple Linear Regression Model

As one of the key projects of poverty alleviation, inclusive insurance has received much attention in recent years. In May 2022, the Banking and Insurance Regulatory Bureau issued a document entitled “Circular on further enriching the supply of Life Insurance products”, which is intended to encourage more commercial insurance companies to participate in the construction of an inclusive insurance system closely related to the protection of people's livelihood. First of all, from the background of the development of inclusive insurance, this paper finds that there is still a gap in basic medical security, and inclusive insurance will play an important role in the development of the “main artery”. The second part focuses on the profound connotation of inclusive insurance from the perspectives of the product characteristics, operation mode, development status of each region, protection scope and so on. The third part makes an in-depth analysis of the factors affecting the inclusive insurance participation rate based on the multiple linear regression model and finds that the opening of basic medical insurance to individual accounts is important factors affecting the inclusive insurance participation rate. Starting from the reality of inclusive insurance, the last part of this paper puts forward three suggestions for the future development of inclusive insurance based on the coverage, “product &amp;service”, multi-channel of science and technology.

Micro Level Analysis on Health Insurance Enrolment among Selected Women in Ghana: Barriers and Predictors

Background: The enrolment onto a health insurance scheme is a viable means of improving access and utilisation of healthcare services which play critical roles in efforts to attain universal health coverage in most countries for which Ghana is inclusive. However, at the micro level, there appears to be inequitable patterns of health insurance enrolment based on gender, and contextual factors. To account for these disparities, the Micro Indicator Cluster Survey (MICS) 2017/2018 was conducted to investigate, inter alia, women enrolment on national health insurance services, and the reasons behind non-enrolment of women in the reproductive ages on health insurance schemes. Thus, this paper explores the barriers and predictors of health insurance enrolment in Ghana using data obtained from a nationality representative micro indicator cluster survey. Methods: Based on health insurance enrolment trajectories, this paper comprehensively investigates the predictors of health insurance enrolment at the micro level among 9,533 women between the ages of 15 years to 49 years in Ghana using data from MICS 2017/2018 which was made available for public access in 2020. Specific items relating to health insurance enrolment which is the independent variable, and contextual and compositions factors were selected in line with relevant literature as predictors to conduct an ordinal logistic regression analysis. Findings: The findings revealed that lack of money or funds, perceived irrelevance of the scheme, relative far proximity to registration centres, and lack of confidence in the operation of health insurance services accounted for the major barriers to non-enrolment. In all, the parameters under wealth index quintile were the most significant predictors of health insurance enrolment in this study. The poorest wealth quintile exhibited the highest odd ratio of 4.655 with lower bound value of 3.873 and an upper bound of 5.595 at p value of &lt;0.001. In sum, the higher odd ratios and statistically significant values in wealth quintile index, education, pregnancy status, and regional location demonstrate the spatial-demographic disparities in enrolment among respondents which lead to exclusion of the most vulnerable in health insurance coverage, and thus, limit the realization of its objective to provide pre-payment arrangement to cater for healthcare cost and reduce financial burden among individuals and households. Conclusion: It is concluded that at the micro level, access to health insurance services is likely to be impeded by system level factors and compositional attributes. There is the need for extensive subscriber segmentation and targeting to help address the challenges of people who are in most need of health insurance services. The national health insurance system should strengthen its pro-poor enrolment incentives and build synergies to derive support from relevant government and non-state actors to improve education and livelihood opportunities for women across the country.

THE ACTIVITIES OF INSURANCE COMPANIES UNDER MARTIAL LAW AND THEIR ROLE IN THE POST-WAR RECOVERY OF UKRAINE

The article analyzes the current state of activity of insurance companies, which is formed under the influence of crisis trends of recent years: the Covid-19 pandemic and quarantine restrictions, a full-scale invasion of the russian federation and mass damage. The extent of the damage to the Ukraine’s economy and the needs for recovery have been analyzed, which will include special support and mobilization of the private sector, as well as necessary costs for the recovery of housing, social infrastructure, energy and transport. It is noted that the downward changes in the number of companies do not have a negative impact on the quality of services provided and the penetration of the insurance market, as these trends may indicate changes in the insurance market and its adaptation to new conditions, reflecting the impact of changes in the economy as a whole, the regulatory environment and demand for specific types of insurance products. It has been determined that in the future, the number of lawsuits under military policies from the ships damaged by sea mines, missile attacks and bombings in the conflict zone in the Black and Azov seas, as well as under private contracts, will increase in the activity of insurance companies. The structural changes in the insurance market and the factors that caused them are analyzed, as well as the trends of changes are given. It has been proven that in the conditions of martial law, the issue of war risk insurance possibilities is quite natural. The possibilities of introducing a fully functional military risk insurance system in Ukraine, which is provided for by the Memorandum on Economic and Financial Policy between Ukraine and the IMF, have been studied. This concept was developed with the participation of specialists from the World Bank, the National Bank of Ukraine of Ministry of Finance and the Ministry of Economy of Ukraine, which is positive for the progressive development of the insurance market of our country in the direction of adaptation to EU standards. A comprehensive analysis of the insurance products of the leading Ukrainian insurers, which provide protection against war risks, was carried out. Prospects for the introduction of new insurance products that will meet the needs of society have been determined. The most promising is the implementation of the effective measures for the proper insurance of investments against war risks, which can contribute to the attraction of funds for the reconstruction of the country, the relocation of enterprises, the organization of high-tech production and services, the creation of new jobs, the adoption and application of innovative experience, an increase in the level of income and an increase in income to state.

보상제도의 선호도 분석을 통한 현행 보험제도의 한계점과 개선방안

This study aims to investigate the relationship and preference regarding satisfaction with the compensation process under the current liability insurance system among 500 car drivers who have experienced automobile accidents in the last five years. It also seeks to identify the limitations of South Korea's current insurance system based on a survey of perceptions towards the system and to propose improvements. Firstly, the attribute of safe driving had a significant negative (-) impact on cost satisfaction within insurance processing satisfaction. Insurance attributes had a significant positive (+) impact on satisfaction with adjudication fairness, cost satisfaction, and procedural satisfaction. However, accident attributes had no significant impact on satisfaction with adjudication fairness, cost satisfaction, or procedural satisfaction. Secondly, the biggest complaint in determining compensation was 'fault determination' (36%), with 'filing complaints against insurance companies' (15.8%) being the most cited method for handling dissatisfaction with traffic accidents, and 'mutual fault processing' (37%) as the main issue with fault determination. Among respondents, 13.6% had experience with litigation due to traffic accidents, 70.8% pointed out equity issues between offenders and victims in handling traffic accidents, and 78.8% indicated problems with fault determination. Therefore, it is expected that the implementation of a no-fault insurance system, which would alleviate the burden of proof of fault from all citizens and allow for rapid compensation without the need for litigation, would increase compensation satisfaction among insurance consumers in the event of traffic accidents. This would also reduce disputes between victims and offenders, thereby enhancing the stability of the insurance system through swift compensation. Additionally, it is anticipated that unnecessary complaints due to fault disputes and the unnecessary costs incurred by victims in hiring loss adjusters or lawyers would decrease.

APPLICATION OF BANK DEPOSIT INSURANCE LEGISLATION: MAIN ASPECTS

The article highlights the special relevance of the legal study of the bank deposit insurance system. The authors have identified the main trends in the historical development of the bank deposit insurance system, which are generally of positive importance. The article also analyzes the main problems of legislation and law enforcement practice in the field of bank deposit insurance. The conclusion is formulated that the legitimate interest of depositors should be protected primarily, while the established judicial practice in some cases indicates the opposite. In addition, the legislation on insurance of bank deposits violates the principle of equality of subjects of civil law. This situation leads to a drop in the level of depositors' trust and is an obstacle to the effective implementation of the bank deposit insurance system.

Abstract 3465: Association with total reproductive year and the risk of biliary tract cancer in women

Abstract Background: Many studies have reported that female reproductive factors, such as parity, age at menarche or menopause, breastfeeding, or age at first birth, were associated with or not associated with the development of biliary tract cancer (BTC). Our study was planned to determine whether a long-term rather than transient exposure was associated with the risk of BTC, including total reproductive year, which was defined as the time from menarche to menopause throughout the life cycle. Methods: This nationwide cohort study included 1,059,533 women with natural menopausal women aged 40-69 years who underwent the periodic health check-up provided by the Korean National Health Insurance System in 2009. The median follow-up period was 9.3 years. Cox proportional hazard regression analysis was performed to estimate the risk of BTC based on the female reproductive factors. Results: During the 9,867,152 person-years of follow-up, 4,198 patients (0.4%) were newly diagnosed with BTC. The incidence of BTC was significantly increased in subjects younger than 40 years at menopause compared with those aged 40 years or older (HR 1.341, 95% CI, 1.095-1.642). This trend was consistent even when menopause age was subdivided into 5-year intervals (&amp;lt;40 vs. 40−44, 45−49, 50-54, and ≥ 55 years) for those aged 40 years or older. When compared by categorization into four quartiles, the incidence of BTC tended to be numerically lower than that of the bottom 25% with the lowest age of menopause (designated as Q1 reference group). Compared to those with total reproductive year of 30 years or more, the incidence of BTC increased significantly in the group with less than 30 years of total reproductive year (HR 1.106, 95% CI, 1.014-1.206). This tendency was significantly reproduced in comparison by categorizing the entire group into quartiles. Compared to the lower 25% group (designated as Q1 reference group), the risk of BTC showed a significant linear inverse correlation with the longer total reproductive year. Q1 group has significantly higher incidence of BTC compared to the other groups (p &amp;lt; 0.001). This trend was repeated in various subgroup analysis. Conclusions: In conclusion, this study demonstrated that women under the age of 40 at menopause had an increased risk of BTC compared to those over 40 years of age. Similarly, a longer period of total reproductive year was associated with a lower risk of BTC, suggesting a protective female hormonal effect on BTC. Total reproductive year may be more reliable indicator in that it reflects the actual lifetime exposure to female hormones. Citation Format: Chi Hoon Maeng, Kyungdo Han, Joo-Hyun Park, Jung Yong Hong. Association with total reproductive year and the risk of biliary tract cancer in women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3465.

STRATEGY AND IMPORTANCE OF DEPOSIT INSURANCE SYSTEM IN GEORGIA

Georgia is a country that has chosen the path of development of European integration and, taking into account European practice and experience, introduced a deposit insurance system in the country at the cost of certain risks. From the point of view of socio-economic development in Georgia, the introduction of the deposit insurance system and its complete formation was related to the strengthening of the financial security system, the protection of depositors and the prevention of systemic crisis in the banking sector.&#x0D; The main goal of the paper is to study and analyze the strategy and importance of the deposit insurance system in Georgia and its economic and financial effects, both for the country and for the wide circle of users interested in this system. However, the problem lies in the fact that, despite the sharing of theoretical and practical experiences of various countries of the world, the mentioned issues still require refinement and formation as a final result.

Public-Private engagement and health systems resilience in times of health worker strikes: a Ghanaian case study.

In low and middle-income countries like Ghana, private providers, particularly the grouping of faith-based non-profit health providers networked by the Christian Health Association of Ghana (CHAG), play a crucial role in maintaining service continuity during health worker strikes. Poor engagement with the private sector during such strikes could compromise care quality and impose financial hardships on populations, especially the impoverished. This study delves into the engagement between CHAG and the Government of Ghana (GoG) during health worker strikes from 2010 to 2016, employing a qualitative descriptive and exploratory case study approach. By analysing evidence from peer-reviewed literature, media archives, grey literature and interview transcripts from a related study using a qualitative thematic analysis approach, this study identifies health worker strikes as a persistent chronic stressor in Ghana. Findings highlight some system-level interactions between CHAG and GoG, fostering adaptive and absorptive resilience strategies, influenced by CHAG's non-striking ethos, unique secondment policy between the two actors and the presence of a National Health Insurance System. However, limited support from the government to CHAG member facilities during strikes and systemic challenges with the National Health Insurance System pose threats to CHAG's ability to provide quality, affordable care. This study underscores private providers' pivotal role in enhancing health system resilience during strikes in Ghana, advocating for proactive governmental partnerships with private providers and joint efforts to address human-resource-related challenges ahead of strikes. It also recommends further research to devise and evaluate effective strategies for nations to respond to strikes, ensuring preparedness and sustained quality healthcare delivery during such crises.

The impact of pension on the health behavior of elderly rural residents: evidence from China

BackgroundUnhealthy behavior is an important factor threatening the health of older rural residents in China. We examine the effects of receiving pension on elderly rural residents’ health behavior (namely conscious control of sugar, salt, and edible oil intake, as well as learning health or wellness knowledge), also including effect heterogeneity by income level and gender.MethodsUsing China Rural Revitalization Survey (CRRS) in 2020, we used the policy rule of the China’s New Rural Pension Scheme that only those people who are over 60 years old can have access to pension as the natural experiment, and explore the causal effect of receiving pensions on the health behaviors by using regression discontinuity design method.ResultsHaving access to pension can improve the health behavior of rural elderly residents, including increasing the probability of rural residents’ conscious control of sugar (p < 0.1) and conscious control of salt intake (p < 0.1), which is still valid after a series of robustness tests. Heterogeneity analysis finds that access to pensions is more likely to improve the health behavior of low-income families and male rural elderly residents.ConclusionsThe research has expanded the discussion on the correlation between the pension and the health of rural elderly residents, and the conclusion provides important policy implications for optimizing the rural elderly insurance system and leveraging pension to improve the health behavior of rural elderly residents.

Analyzing Job Satisfaction Among Healthcare Professionals: A Case Study from Greece's Medical Sector

Job satisfaction plays a crucial role in enhancing productivity and performance across all economic sectors, and this is particularly true in the healthcare industry where medical personnel deliver essential services to the population. The contentment of healthcare providers is vital for elevating the standard of care they offer. Despite its importance, there is a scarcity of literature focusing on the job satisfaction of medical care providers, with most studies concentrating on patient satisfaction with healthcare services. The healthcare sector globally is navigating through a period of uncertainty, with social insurance systems under pressure to adapt to various challenges. Greece's healthcare system is facing similar issues, exacerbated by a prolonged economic downturn that has led to significant cuts in healthcare spending and adversely affected working conditions in public hospitals. This paper aims to explore, through empirical research, the job satisfaction levels among Greek doctors working in public hospitals and identify the factors influencing their workplace happiness.

Outcomes and costs with the introduction of robotic-assisted thoracic surgery in public hospitals.

Robotic-assisted thoracic surgery (RATS) is an effective treatment of non-small cell lung cancer (NSCLC) but the effects of its implementation in university hospital networks has not been described. We analyzed the early clinical outcomes, estimated costs, and revenues associated with three robotic systems implemented in the Paris Public Hospital network. A retrospective study included patients who underwent RATS for NSCLC in 2019 and 2020. Ninety-day morbidity, mortality, hospital costs, and hospital revenues were described. Economic analyses were conducted either from the hospital center or from the French health insurance system perspectives. Cost drivers were tested using univariate and multivariable analyses. Sensitivity analyses were performed to assess uncertainty over in-hospital length of stay (LOS), number of robotic surgeries per year, investment cost, operating room occupancy time, maintenance cost, and commercial discount. The study included 188 patients (65.8 ± 9.3years; Charlson 4.1 ± 1.4; stage I 76.6%). Median in-hospital LOS was 6days [5-9.5], 90-day mortality was 1.6%. Mean hospital expenses and revenues were €12,732 ± 4914 and €11,983 ± 5708per patient, respectively. In multivariable analysis, factors associated with hospital costs were body mass index, DLCO, major complications, and transfer to intensive care unit. Sensitivity analyses showed that in-hospital LOS (€11,802-€15,010) and commercial discounts on the list price (€11,458-€12,732) had an important impact on costs. During the first 2years following the installation of three robotic systems in Paris Public Hospitals, the clinical outcomes of RATS for NSCLC have been satisfactory. Without commercial discount, hospital expenses would have exceeded hospital revenues.Clinical registration number CNIL, N°2221601, CERC-SFCTCV-2021-07-20-Num17_MOPI_robolution.

Practicing weight-inclusive healthcare in a weight-centric field: An examination of the barriers faced by weight-inclusive healthcare practitioners in the U.S.

ABSTRACT The provision of stigmatizing, weight-centric healthcare negatively affects health in many ways, including the stress generated during discriminatory and microaggressive provider-patient interactions, the barriers to healthcare access it creates, and the way it encourages healthcare avoidance, facilitating the reproduction of widespread health disparities. As the harms of weight-centric healthcare have been increasingly exposed across both scholarly publications and lay media in recent years, a greater number of healthcare practitioners have begun adopting a weight-inclusive practice paradigm in their work with patients and clients. Yet, given the constraining nature of social structures, healthcare practitioners committed to providing weight-inclusive care likely face barriers they must contend with as they transition toward and carry out weight-inclusive care in their work. Currently, little is known about the experiences of weight-inclusive healthcare practitioners, the barriers they face in adopting or enacting a weight-inclusive care, and the ways they navigate those barriers. The present study explores these questions via a thematic analysis of 53 semi-structured, in-depth interviews with self-identified weight-inclusive healthcare practitioners (36 dietitians/nutritionists, 13 mental health therapists, 2 physical therapists, 1 fitness coach, and 1 physician’s assistant) recruited through the Association for Size Diversity and Health’s Health at Every Size professional listing and snowball sampling. The results of this study indicate several barriers to adopting and enacting weight-inclusive healthcare in the U.S., including weight-centric healthcare training, weight-centric workplaces, and weight-centric insurance systems, which require time, money, and energy to navigate. Suggestions for how these barriers can be mitigated are discussed.