Local Insurance Research Articles

Significant increase in newly diagnosed hepatitis B and C cases in Germany due to screening

In 2016, the World Health Organization (WHO) decided on an initiative to identify 90% of the world's existing hepatitis B and C virus infections by 2030, treat 80% and reduce the mortality by 65%. In 2016, the federal government endorsed these goals. From Oct 1, 2021, the G-BA included a one-time screening for hepatitis B and C in the health examination (GU) for people aged 35 and over who have statutory health insurance. The previous participation rates in the GU were evaluated and the effectiveness of the program is documented using the reporting data on hepatitis B and C of Robert Koch Institute (RKI).Notifications from Central Institute of Statutory Health Insurance (ZI) and Scientific Institute of the local health insurance companies (WIdO) were compiled with regard to the GU, the reporting data from the RKI were collected and analyzed using SURVSTAT@RKI 2.0 as well as billing data from the Association of Statutory Health Insurance Physicians (KBV).Between 2007 and 2021, around 83% of all insured persons took part in a GU at least once. From the fourth quarter of 2021, the number of newly diagnosed cases of hepatitis B and C increased. In 2022, the increase for hepatitis B was 91.9% and for hepatitis C 68%. This trend continued in 2023, with new diagnoses of hepatitis B increasing by 160% (to 22,795 cases) and hepatitis C increasing by 121% (to 10,508 cases) compared to 2021. The analysis of the KBV billing data showed that the increase in new diagnoses shows a strong correlation between the number of new diagnoses within the GU and the total number of diagnoses.The decision of the Federal Joint Committee (G-BA) to include hepatitis B and C screening in the GU seems to be a success in detecting previously undetected cases of the disease. Based on the billing data from the KBV, a high level of agreement could be demonstrated between the number of new diagnoses within the GU and the increase in the total number of diagnoses. The goals of the WHO may be achievable.

මාතර හෙළ වෙදකම පිළිබඳ විමර්ශනාත්මක අධ්‍යයනයක්

Hela wedakama is Sri Lanka’s local helth insurance system. That has existed since time immemorial.This was not introduced from any other country, but was produced by the ancient inhabitants of ourcountry. Traditional Hela medicine treats the three categories of human, animal and non-humanTraditional medicine helps in the prevention of physical, mental, infectious and non-infectious diseases.The specialties of Hela medicine are unique to each region and they differ from each other. Matararegion has been known as the birth place of Hela medicine since time immemorial. Matara Helavedakama is at the forefront in providing treatment for human and non-human categories as well asphysical, mental, infectious and non-infectious diseases. Matara Hela medicine is special, because it isbased on the practices of the area for disease prevention. Accordingly, the content and practices ofMatara Hela medicine were studied in this research. Data was collected through library reference, fieldstudy and interviews. According to the facts revealed in the study, it was possible to identify thepeculiarities of Hela medicine, that is unique to the Matara area.

Prognostic impact of SGLT2-inhibitor therapy on survival in patients with transthyretin amyloid cardiomyopathy

Abstract Background Sodium-glucose co-transporter 2 inhibitors (SGLT2i) significantly improve cardiovascular outcomes in patients with heart failure across the whole spectrum of ejection fraction. Recently published data indicates the safety and tolerability of SGLT2i therapy in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). However, there is a lack of evidence regarding the impact of SGLT2i therapy on clinical outcomes in those patients. Purpose This study aims to investigate the association between SGLT2i therapy and clinical outcomes in patients with ATTR-CM. Methods This is an analysis of a prospective registry conducted at an expert center for hypertrophic cardiomyopathies. We included all participants with a confirmed diagnosis of ATTR-CM, who were enrolled until December 2022. Prior and concomitant SGLT2i treatment was systemically assessed according to the patient interview and medical records. Patients’ outcomes were retrieved from local medical and health insurance records. Results We enrolled 116 patients, of whom 7 patients (6%) were treated with SGLT2i at inclusion and 44 patients (38%) were started on SGLT2i therapy during the observational period while 65 patients (56%) were SGLT2i-naïve. There were no significant differences in baseline characteristics between groups, as shown in the table. Median (interquartile range) age was 80 (76-82) years with 15% females. Median N-terminal pro-brain natriuretic peptide (NT-proBNP) was 2844 (1519-5033) pg/ml, median estimated glomerular filtration rate (eGFR) 58 (46-69) ml/min/1,73m2, and median troponin T 56 (34-83) pg/ml. During a median follow-up of 2.6 (1.8-3.7) years, 28 patients (24%) died, of whom 6 patients (5%) were in the treatment group and 22 patients (19%) in the control group. In univariate Cox-regression analysis, SGLT2i treatment was significantly associated with a lower mortality (HR 0.325, 95%CI 0.132-0.802, p=0.015). This association persisted after adjusting for age and sex (HR 0.347, 95%CI 0.139-0.867, p=0.023). However, when treatment initiation time was considered, the benefit did not remain statistically significant. No significant associations between SGLT2i treatment and worsening heart failure hospitalizations or cardiovascular death were observed. Conclusion In a prospective registry-based cohort of patients with ATTR-CM, SGLT2i therapy was associated with significantly better survival, with a potential treatment initiation time bias. These results suggest that SGLT2i may exert beneficial effects in patients with ATTR-CM and warrant a randomized controlled trial.

Exploration of Property Insurance Benefits in Extreme Weather

In recent years, the increasing frequency of extreme weather events has highlighted the insurance industry's dilemma - the profitability of insurance companies and the capacity of policyholders to bear the burden are in crisis. Therefore, seeking the development of property insurance in this environment is crucial. This paper establishes a Risk Assessment Model with a four-level index system, including four main indicators: natural, economic, social, and engineering defense, to assess the disaster risk and losses of a specific area. Subsequently, a Rate-Adjusted Break-Even Analysis Model is established and coupled with the Risk Assessment Model to facilitate practical insurance decision-making. By establishing this highly flexible and practical assessment system, precise indicators can be selected for evaluation based on the varying impacts of natural disasters in different regions. This will enable more accurate decision-making for local catastrophic insurance coverage. Consequently, it allows local residents to obtain better post-disaster relief protection against natural calamities, while businesses can also benefit from substantial reconstruction returns.

Impact of cumulative exposure to anticholinergic and sedative drugs on cognition in older adults: a memory clinic cohort study

BackgroundLong-term exposure to anticholinergic and sedative drugs could be a modifiable risk factor for cognitive decline. The objective of this study was to measure the association between previous cumulative anticholinergic and sedative drug exposure (Drug Burden Index) and cognitive decline.MethodsA cohort study (MEMORA cohort) was conducted in a French memory clinic for patients attending a consultation between November 2014 and December 2020, with at least 2 Mini-Mental State Examination (MMSE) measurements (≥ 6 months apart) and available medication data from the local Primary Health Insurance Fund database (n = 1,970). Drug Burden Index was linearly cumulated until each MMSE measurement and was used to categorise patients according to their level of exposure (no exposure, moderate, or high). The longitudinal association between Drug Burden Index and MMSE was assessed using a multivariate linear mixed model, adjusted for age, education level, anxiety disorders, depressive disorders, functional autonomy, and behavioural disorders.ResultsOverall, 1,970 patients were included with a mean follow-up duration of 2.78 years (± 1.54) and 2.99 visits per patients (5,900 MMSE + Drug Burden Index measurements collected). At baseline, 68.0% of patients had moderate cumulative anticholinergic and sedative drug exposure and a mean MMSE of 21.1. MMSE decrease was steeper in patients with moderate and high Drug Burden Index ( -1.74 and -1.70/year, respectively) than in patients with no exposure (-1.26/year) after adjusting for age, education, anxiety and depressive disorders, functional autonomy, and behavioural disorders (p < 0.01).ConclusionsLong-term exposure to anticholinergic and sedative drugs is associated with steeper cognitive decline. Medication review focusing on de-prescribing these drugs could be implemented early to reduce cognitive impairment.

Health performance assessment modeling and its application to compact medical communities in China.

Some regions in China have already implemented capitation payment or capitation budget management for medical insurance funds. However, there remains a shortage of adequate tools and methodologies to accurately quantify differences in population health risks. Therefore, this paper constructs a health performance assessment model that comprises four steps. The first step is to categorize all participants into health risk groups based on whether they have contracted with a family doctor, their age, sex, and the type of consultation. The second step is to categorize health risk groups based on differences in healthcare resource utilization. The third step is to analyze health performance by examining healthcare resource utilization year over year. The fourth step is to apply the assessment results to assist local finance bureaus and medical insurance bureaus in developing incentive schemes. According to cost weights, the health risk groups are split into six classes: insured residents without health care visits, healthy insured person, slightly ill insured patients, ill insured patients, more seriously disease patients, and severely ill insured patients. We evaluate one compact medical community's health performance by examining changes in the proportion of resource usage group size and expense. From 2019 to 2021, both the proportion of patients with severe and ultra-severe diseases and the proportion of costs in the sample increased, according to changes in resource utilization levels. This result indicates that the population's overall health has not improved and that the compact medical community is still primarily focused on treating diseases, with poor implementation of health maintenance measures and minimal improvement in health performance.

The cross-regional settlement methods in hospitals and the treatment-seeking behavior of patients with malignant tumors in China: an evolutionary game model.

Cross-regional settlement management is a key indicator of national health insurance system maturity. Given the significant demand for cross-regional medical treatment among Chinese patients with malignant tumors and the territorially managed health insurance system, further research is necessary to explore the relationship between hospital settlement methods and treatment-seeking behaviors among these patients. This study introduces and validates an evolutionary game model that provides a theoretical foundation for direct settlement policies in cross-regional treatment. An evolutionary game model was constructed with patients and hospitals serving as strategic players within a dynamic system. This model integrates the patients' treatment utility, medical and nonmedical costs, and hospitals' financial and technological advancement benefits. The evolutionary stability analysis revealed seven-game outcomes between hospitals and patients with malignant tumors. The numerical simulations suggest an evolutionary convergence toward strategy (1, 0), indicating a trend where patients with malignant tumors opt for cross-regional treatment, yet hospitals choose not to implement a direct settlement policy. Parameter sensitivity analysis showed that the parameters set in this study affected player behavioral choices and game equilibria. A strong demand for cross-regional medical treatment among Chinese patients with malignant tumors, and some hospitals require more incentives to implement cross-regional settlements. The key factors influencing the willingness of some patients with malignant tumors to resettle include the costs of in-area medical care, costs of cross-regional treatment without direct settlement, and the utility of cross-regional treatment. Technological advancement benefits and input costs influence some hospitals' motivation to adopt cross-regional settlements. Policy adjustments that effectively implement direct settlement policies can facilitate equilibrium, enhance the initiatives of some local health insurance management departments, improve the accessibility and efficiency of medical services, and reduce nonmedical expenses for patients.

The Effect of Flood Exposure on Insurance Adoption Among US Households

AbstractDespite increasing exposure to flooding and associated financial damages, estimates suggest more than two‐thirds of flood‐exposed properties are currently uninsured. This low adoption rate could undermine the climate resilience of communities and weaken the financial solvency of the United States National Flood Insurance Program. We study whether repeated exposure to flood events, especially the disaster‐scale floods that are expected to become more frequent in a warming climate, could spur insurance adoption. Using improved estimates of residential insurance take‐up in locations where such insurance is voluntary, and exploiting variation in the frequency and severity of flood events over time, we quantify how flood events impact local insurance demand. We find that a flood disaster declaration in a given year increases the take‐up rate of insurance by 7% in the following year, but that the effect diminishes in subsequent years and is gone after 5 years. This effect is more short‐lived in counties in inland states that do not border the Gulf and Atlantic coasts. We also find that the effect of a flood on take‐up is substantially larger if there was also a flood in the previous year, and that recent disasters are more salient for homeowners whose primary residences are exposed to a disaster declaration compared to non‐primary residences. Overall, these findings suggest that relying on households to self‐adapt to increasing flood risks in a changing climate is insufficient for closing the insurance protection gap.

Green hydrogen exports in New Zealand and Chile can improve electricity supply security if configured as local energy insurance

Extreme weather events, for example, prolonged droughts, are increasingly stressing electricity systems and threatening the achievement of energy transition goals. At the same time, countries such as Chile and New Zealand are developing strategies to export renewable energy through green hydrogen. This paper economically evaluates the use of future green hydrogen exports as strategic storage under the logic of energy insurance, based on the assumption that Chile and New Zealand will adopt a hydrogen economy. Our first contribution is to compare the marginal costs of re-electrified green hydrogen, for different scenarios, to the value of lost load in New Zealand and Chile. We then determine the marginal cost of energy produced from green hydrogen based on projected production, transportation, and re-electrification costs for the year 2030. Finally, we estimate the eventual penalties that exporters would incur in the case of breaking their contracts and the overall resulting system costs of using hydrogen for system security. We found that re-electrifying hydrogen can be competitive with conventional technologies at 3 USD/kg. At 1.5 USD/kg, hydrogen is more competitive than fossil fuel-based technologies, for both New Zealand and Chile. Thus, in 2030, it could make economic sense for New Zealand and Chile to use hydrogen as a strategic reserve. The system cost of the proposed insurance scheme in 2030 ranges from 0.53 to 1.76 USD/MWh, which is small compared to total electricity costs. These values can be used for power system expansion and operation planning.

A retrospective multidimensional comparison of microprocessor and mechanical knee users: Analysis of quality of life and satisfaction with the prosthesis.

Despite the demonstrated greater efficacy of microprocessor knees (MPK) over mechanical knees (MK), the latter is still widely used by persons with transfemoral amputation. Besides motivations related to local insurance policies, quality of life (QoL) and satisfaction with the prosthesis play a key role in user preference. The aim of this study is to compare QoL and satisfaction in a large sample of MPK and MK users and to assess how these outcomes are explained by clinical and demographic characteristics. Retrospective study. The study was conducted on 75 MPK and 60 MK users. Quality of life was assessed using the EuroQoL Five Dimensions and the EuroQoL Visual Analog Scale questionnaires. Satisfaction was assessed with the Satisfaction with Prosthesis questionnaire. All 3 instruments were self-administered. Univariate and multivariate regression analyses were conducted thereafter. The difference in satisfaction between MPK and MK users was not statistically significant. Significant differences were observed instead for QoL. From the univariate regression analysis, 6 factors were significant predictors of QoL and satisfaction. On multivariate analysis, the number of significant factors was reduced to 3, namely knee type, age at the first prosthesis, and experience with prosthesis. Type of knee and age at the first prosthesis significantly predicted QoL scores, explaining 12% of EuroQoL Five Dimensions and 25% of EuroQoL Visual Analog Scale variances. Age at the first prosthesis and experience with prosthesis predicted Satisfaction with Prosthesis scores in the multivariate model, explaining 25% of the variance. MPK affects QoL but not satisfaction, which is positively driven by patients' experience with prosthesis and negatively affected by the age at the time of the first prosthesis.

Pollution risk and life insurance decisions: Microgeographic evidence from the United Kingdom.

Recent research documents that exposure to air pollution can trigger various behavioral reactions. This article presents novel empirical evidence on the causal effect of pollution risk on life insurance decisions. We create a unique dataset by linking microgeographic air quality information to the confidential UK Wealth and Assets Survey. We identify an inverse N-shape relationship between pollution risk and life insurance adoption by exploiting the orthogonal variations in meteorological conditions. Over a given range above a threshold of exposure, rising pollution is associated with rising demand for life insurance, whereas at lower than the threshold levels of pollution, higher exposure risk reduces demand for insurance. Our findings indicate-for the first time-a nonlinear relationship between local pollution risk and life insurance demand.

The impact of basic health insurance participation characteristics on the health of mobile populations: the mediating role of health service utilization behavior.

It is a pivotal element of China's health system reform to improve the health security of health insurance for the mobile population. Achieving this objective is integral to the success of the reform. The aim of this study was to analyze the impact of different enrollment characteristics of basic health insurance on the health of the mobile population and to investigate the mediating role of health service utilization behavior. This cross-sectional study included 135,372 migrants who participated in the 2018 China Migrants Dynamic Survey (CMDS). Two indicators were employed in this study to assess the characteristics of the mobile population's involvement in basic health insurance-namely, whether or not they participated in local health insurance and the type of health insurance in which they participated. The health status of the mobile population was measured using self-assessed health. Health service utilization behavior was divided into public health service utilization and medical service utilization. Multivariate ordered logistic regression was employed to examine the effect of health insurance on the health of the mobile population. Subsequently, the Bootstrap method was applied to analyze the mediating effect of health service utilization behavior in the relationship between health insurance and the health of the mobile population. Health insurance had a positive impact on health, public health services, and health service utilization among the mobile population. However, enrollment in local health insurance (OR = 1.088, 95% CI = 1.043-1.134) and enrollment in Basic Medical Insurance for Urban Employees (OR = 1.178, 95% CI = 1.090-1.273) were more likely to be associated with higher levels of health and a greater likelihood of receiving health service utilization. The results of the mediating mechanism analysis indicated that health education, health records, family doctor contracting, receiving inpatient services, and being hospitalized locally all played a partially mediating role in the impact of the place of enrollment on health. Regarding the effect of the type of enrollment on health, three types of services-namely, health education, health records, and contracting with a family doctor-played a partially mediating role, while receiving inpatient services and being hospitalized locally did not exhibit a mediating effect. The effect of the type of participation on health is partially mediated. Based on the impact of the different enrolment characteristics of basic health insurance on the health of the mobile population and the mediating role of health service utilization in this impact, furthermore, improvement of health insurance coverage for the mobile population should focus on improving the accessibility of health services, increasing the level of health insurance coverage, mitigating differences in treatment between the different insurance systems, and simplifying the process of transferring the health insurance relationships.

A cost-effectiveness analysis of lung cancer screening with low-dose computed tomography and a polygenic risk score

IntroductionSeveral studies have proved that Polygenic Risk Score (PRS) is a potential candidate for realizing precision screening. The effectiveness of low-dose computed tomography (LDCT) screening for lung cancer has been proved to reduce lung cancer specific and overall mortality, but the cost-effectiveness of diverse screening strategies remained unclear.MethodsThe comparative cost-effectiveness analysis used a Markov state-transition model to assess the potential effect and costs of the screening strategies incorporating PRS or not. A hypothetical cohort of 300,000 heavy smokers entered the study at age 50–74 years and were followed up until death or age 79 years. The model was run with a cycle length of 1 year. All the transition probabilities were validated and the performance value of PRS was extracted from published literature. A societal perspective was adopted and cost parameters were derived from databases of local medical insurance bureau. Sensitivity analyses and scenario analyses were conducted.ResultsThe strategy incorporating PRS was estimated to obtain an ICER of CNY 156,691.93 to CNY 221,741.84 per QALY gained compared with non-screening with the initial start age range across 50–74 years. The strategy that screened using LDCT alone from 70–74 years annually could obtain an ICER of CNY 80,880.85 per QALY gained, which was the most cost-effective strategy. The introduction of PRS as an extra eligible criteria was associated with making strategies cost-saving but also lose the capability of gaining more LYs compared with LDCT screening alone.ConclusionThe PRS-based conjunctive screening strategy for lung cancer screening in China was not cost-effective using the willingness-to-pay threshold of 1 time Gross Domestic Product (GDP) per capita, and the optimal screening strategy for lung cancer still remains to be LDCT screening for now. Further optimization of the screening modality can be useful to consider adoption of PRS and prospective evaluation remains a research priority.

Nonparametric intercept regularization for insurance claim frequency regression models

Abstract In a subgroup analysis for an actuarial problem, the goal is for the investigator to classify the policyholders into unique groups, where the claims experience within each group are made as homogenous as possible. In this paper, we illustrate how the alternating direction method of multipliers (ADMM) approach for subgroup analysis can be modified so that it can be more easily incorporated into an insurance claims analysis. We present an approach to penalize adjacent coefficients only and show how the algorithm can be implemented for fast estimation of the parameters. We present three different cases of the model, depending on the level of dependence among the different coverage groups within the data. In addition, we provide an interpretation of the credibility problem using both random effects and fixed effects, where the fixed effects approach corresponds to the ADMM approach to subgroup analysis, while the random effects approach represents the classic Bayesian approach. In an empirical study, we demonstrate how these approaches can be applied to real data using the Wisconsin Local Government Property Insurance Fund data. Our results show that the presented approach to subgroup analysis could provide a classification of the policyholders that improves the prediction accuracy of the claim frequencies in case other classifying variables are unavailable in the data.

Technical Efficiency of Prevention Services for Functional Dependency in Japan's Public Long-term Care Insurance System: An Ecological Study.

Public long-term care insurance (LTCI) systems can promote equal and wider access to quality long-term care. However, ensuring the financial sustainability is challenging owing to growing care demand related to population aging. To control growing demand, Japan's public LTCI system uniquely provided home- and community-based prevention services for functional dependency for older people (ie, adult day care, nursing care, home care, functional screening, functional training, health education, and support for social activities), following nationwide protocols with decentralized delivery from 2006 until 2015. However, evaluations of the effects of these services have been inconclusive. We estimated the marginal gain and technical efficiency of local prevention services using 2009-2014 panel data for 474 local public insurers in Japan, based on stochastic frontier analysis. The outcome was the transformed sex-and age-adjusted ratio of the observed to expected number of individuals aged ≥65 years certified for moderate care. Higher outcome values indicate lower population risk of moderate functional dependency in each region in each year. The marginal gains of the provided quantities of prevention services as explanatory variables were estimated, adjusting for regional medical and welfare access, care demand and supply, and other regional factors as covariates. Prevention services (except functional screening) significantly reduced the population risk of moderate functional dependency. Specifically, the mean changes in outcome per 1% increase in adult day care, other nursing care, and home care were 0.13%, 0.07%, and 0.04%, respectively. The median technical efficiency of local public insurers was 0.94 (interquartile range: 0.89-0.99). These findings suggest that population-based services with decentralized local operation following standardized protocols could achieve efficient prevention across regions. This study could inform current discussions about the range of benefit coverage in public LTCI systems by presenting a useful option for the provision of preventive benefits.

TRANSFORMATION OF THE GLOBAL INSURANCE MARKET IN THE CONTEXT OF THE INTRODUCTION OF NEW BUSINESS MODELS AND MODERN INSURANCE TECHNOLOGIES

Introduction. The insurance industry has undergone significant changes in the last decade. Global transformations in society, rapid development of financial technologies, systemic financial shocks and the coronavirus pandemic, escalation of military conflicts into war, necessitate a rethinking of the conceptual foundations of insurance activities, modification of relationships between participants in the insurance market, and the testing of new business models for insurance companies. In this context, the study of current trends and the development of directions for further transformation of the global and local insurance markets in the context of optimizing the business processes of insurance companies in the global InsurTech environment become particularly important. The purpose of the article is to analyze the realities of the functioning of the global insurance market in the conditions of changing the paradigm of its development; to identify key challenges, identify new threats, and outline the main vectors of transformation of the insurance business environment in the modern InsurTech space. Results. The decisive role of the insurance market in providing insurance protection to economic entities, individuals, and international institutions has been clarified; macroeconomic uncertainty and geopolitical transformations that significantly affect the development of local and global insurance markets have been identified. It has been proven that the insurance business has demonstrated its adaptability to new realities of functioning by improving operational systems, applying innovative strategies and digital marketing technologies, implementing new financial solutions, and establishing strategic partnerships. New vectors of development of the insurance market in the global insurance space have been identified, aimed at introducing InsurTech and automating business processes in the activities of insurers; a customer-oriented approach in working with policyholders; and the development of new insurance products taking into account their hyper-personalization and accessibility. Conclusions. The following conclusions have been drawn based on the results of the study: new trends in the transformation and modernization of the insurance market are observed in the context of the implementation of innovative technological achievements, the formation of strategic alliances between insurance companies and other financial structures; intensive shifts in the insurance business are taking place in a regional context, particularly in Asian and other developing countries; insurance companies are being reprofiled towards a customer-oriented business model, digital marketing, remote customer service, and the promotion of new insurance products.

Investigating and Analyzing the Current Situation of College Students Participating in Local Social Basic Medical Insurance

The health of college students is directly related to the quality and quantity of national talents. Therefore, it is particularly important to guarantee the medical rights and interests of college students, ensuring that they can receive timely and effective treatment when they encounter diseases. However, the current situation of college students participating in local social basic medical insurance is not optimistic. Based on this, this article takes Dongguan Campus of Guangdong Medical University as an example and explores the participation status and influencing factors of college students in social basic medical insurance through questionnaire survey. It also aims to propose targeted suggestions to increase the participation rate of college students in insurance, strengthen their understanding of the importance of medical insurance, and enable them to better enjoy the protection brought by medical insurance, paving the way for their health and future. At the same time, it aims to contribute to the construction of a social medical security environment.

Krasnoyarsk Mutual Fire Insurance Society (1904-1917)

The subject of the study is the organization and activity of the Krasnoyarsk Mutual Fire Insurance Society. On the basis of the historical and genetic method, the reasons for the origin of the insurance business in the Yenisei province, the leading trends in its development during the second half of the XIX - early XX centuries, changes that occurred under the influence of the First World War are analyzed. The application of the historical-systematic method allowed the authors to determine the role and place of the city mutual insurance society in the emerging fire insurance system in one of the provincial centers of Eastern Siberia. The historical-comparative method made it possible to identify the differences between mutual insurance companies and joint-stock companies. The statistics of fires and the scale of losses from them grew in the Russian Empire in the second half of the 19th - early 20th centuries. At the same time, a fire insurance system was being formed. A specific non–commercial form of insurance was mutual insurance (the main types are zemstvo and city), which arose due to the fact that the services of private insurance companies were inaccessible to a wide range of the population. In the Yenisei province , the only society of this type appeared only at the beginning of the XX century. Krasnoyarsk City Mutual Insurance Society for a short period of its existence could not significantly change the situation in the local insurance market, where the dominant position was occupied by branches of joint-stock insurance companies. Nevertheless, his activity has had a beneficial effect on the development of the insurance business in the city by reducing tariffs, supporting fire-fighting measures of the city authorities. The First World War carried the threat of loss of organizational and financial independence of mutual insurance companies, since the government became interested in the idea of introducing a state monopoly of fire insurance in order to compensate for the budget deficit.

Data driven population health management: first steps to an integrated approach in Leuven Cares (Zorgzaam Leuven)

In 2018 we started the Leuven Cares project in the city of Leuven. The aim of this project is to develop, implement and evaluate the necessary changes to enable integrated care.&#x0D; We installed a proactive approach to manage the health and wellbeing of the population of Leuven, to move away from the provision of reactive, demand-led care.&#x0D; All inhabitants of Leuven are targeted, 102000 people. All relevant healthcare organizations participate in the project, which is financially supported by the federal government and by 60 local organizations.&#x0D; We use a data driven population health management approach based on 4 building blocks:&#x0D; 1.Know your population health’s needs: obtaining data from the population for constant re-evaluation of the interventions at as many levels as possible. Define clearly for every action the type and subgroup of patients.&#x0D; 2.Engage with your population: collaboration in integrated neighborhood teams at a local level of 5000 to 10000 inhabitants. Map clearly local level interventions (5000 to 10000 inhabitants) versus meso level (100000 inhabitants) using natural existing networks, functional collaborations and structures.&#x0D; 3.Manage your population: different interventions or different types of patients starting with the correct stratification. Every intervention and intermediate evaluation is based as much as possible on data, existing or collected data.&#x0D; 4.Provide support from an integration management team: a so called integrator structure as a backoffice to permanently catalyze the transition towards population based integrated care. &#x0D; Our results (September 2022):&#x0D; -50%-60 % of primary caregivers participated in at least one Leuven Cares action.&#x0D; -for the various Leuven Cares actions, a total of 6500 patients were included on an individual basis and stratified within the ‘Leuven cares stratification map’.&#x0D; -the stakeholder consortium consists of more than 73 partners and is still augmenting. This consortium consists of partners representing health care organizations, social welfare organizations, academic partners, local health insurance partners and other broadly oriented local partners.&#x0D; -the “integrator” function was constructed as a complex conceptual entity inside the global governance arrangement. It consists in total of more than 40 individuals and a small coordination team of 3 FTE functions.&#x0D; Lessons learned and next steps: At a micro level, a key facilitator for a population health management approach is to install integrated neighborhood teams of primary care professionals, to manage the population. At the meso level, create a strong integrator function with a diversity of liaison arms in the different partner organizations. The integrator needs support of a central backoffice team with visionary leadership and management skills to facilitate a population-oriented approach.&#x0D; The effects on the entire population of this project and the various subactions of this project will be studied in the coming years. The ongoing process shows good participation of professional caregivers and their organizations, a need for leadership, a collaborative attitude, a data- and evidence-based approach and a strong local integrator supporting the transition towards integrated care. In a next step, we want to measure the long-term impact of this project on relevant quintuple aim parameters.&#x0D;

Risks for Readmission Among Older Patients With Chronic Obstructive Pulmonary Disease: An Analysis Using Korean National Health Insurance Service - Senior Cohort Data.

The high readmission rate of patients with chronic obstructive pulmonary disease (COPD) has led to the worldwide establishment of proactive measures for identifying and mitigating readmissions. This study aimed to identify factors associated with readmission, as well as groups particularly vulnerable to readmission that require transitional care services. To apply transitional care services that are compatible with Korea's circumstances, targeted groups that are particularly vulnerable to readmission should be identified. Therefore, using the National Health Insurance Service's Senior Cohort database, we analyzed data from 4874 patients who were first hospitalized with COPD from 2009 to 2019 to define and analyze readmissions within 30 days after discharge. Logistic regression analysis was performed to determine factors correlated with readmission within 30 days. The likelihood of readmission was associated with older age (for individuals in their 80s vs. those in their 50s: odds ratio [OR], 1.59; 95% confidence interval [CI], 1.19 to 2.12), medical insurance type (for workplace subscribers vs. local subscribers: OR, 0.84; 95% CI, 0.72 to 0.99), type of hospital (those with 300 beds or more vs. fewer beds: OR, 0.77; 95% CI, 0.66 to 0.90), and healthcare organization location (provincial areas vs. the capital area: OR, 1.66; 95% CI, 1.14 to 2.41). Older patients, patients holding a local subscriber insurance qualification, individuals admitted to hospitals with fewer than 300 beds, and those admitted to provincial hospitals are suggested to be higher-priority for transitional care services.