Major Health Insurance Research Articles

Ambient Air Pollution and Hospitalizations for Schizophrenia in China

Schizophrenia episodes may be triggered by short-term environmental stimuli. Short-term increases in ambient air pollution levels may elevate the risk of schizophrenia episodes, yet few epidemiologic studies have examined this association. To investigate whether short-term increases in air pollution levels are associated with an additional risk of schizophrenia episodes, independent of absolute air pollution concentrations, and whether sustained increases in air pollution levels for several days are associated with more pronounced risks of schizophrenia episodes. This nationwide, population-based, time-stratified case-crossover study was performed based on hospitalization records for schizophrenia across 295 administrative divisions of prefecture-level or above cities in China. Records were extracted from 2 major health insurance systems from January 1, 2013, to December 31, 2017. Thirty-six cities with a small number of schizophrenia hospitalizations (n < 50) were excluded. Data analysis for this study was performed from January to March 2024. Daily absolute concentrations of fine particulate matter (PM2.5), inhalable particulate matter (PM10), nitrogen dioxide, sulfur dioxide, ozone, and carbon monoxide were collected. Air pollution increases between neighboring days (APINs) were generated as the differences in absolute air pollution concentrations on the current day minus that on the previous day. Sustained increases (APIN ≥5 μg/m3 for PM2.5 and PM10, APIN ≥1 μg/m3 for nitrogen dioxide and sulfur dioxide, and APIN ≥0.05 mg/m3 for carbon monoxide) lasting for 1 or more to 4 or more days were defined for different air pollutants. Patients with schizophrenia episodes were identified by principal discharge diagnoses of schizophrenia. A conditional logistic regression model was used to capture the associations of absolute concentrations, APINs, and sustained increase events for different air pollutants with risks of schizophrenia hospitalizations. The study included 817 296 hospitalization records for schizophrenia across 259 Chinese cities (30.6% aged 0-39 years, 56.4% aged 40-64 years, and 13.0% aged ≥65 years; 55.04% male). After adjusting for the absolute concentrations of respective air pollutants, per-IQR increases in 6-day moving average (lag0-5) APINs of PM2.5, PM10, nitrogen dioxide, sulfur dioxide, and carbon monoxide were associated with increases of 2.37% (95% CI, 0.88%-3.88%), 2.95% (95% CI, 1.46%-4.47%), 4.61% (95% CI, 2.93%-6.32%), 2.16% (95% CI, 0.59%-3.76%), and 2.02% (95% CI, 0.39%-3.68%) in schizophrenia hospitalizations, respectively. Greater risks of schizophrenia hospitalizations were associated with sustained increases in air pollutants lasting for longer durations up to 4 or more days. This case-crossover study of the association between ambient air pollution increases and schizophrenia hospitalizations provides novel evidence that short-term increases in ambient air pollution levels were positively associated with an elevated risk of schizophrenia episodes. Future schizophrenia prevention practices should pay additional attention to APINs, especially sustained increases in air pollution levels for longer durations, besides the absolute air pollution concentrations.

Four-year Outcomes of Class III and IV Anterior Restorations Based on a Subset of German Health Insurance Data.

Numerous studies report on the outcome performance of posterior composite restorations. However, there are fewer studies providing data for anterior restorations. The aim of this study was to evaluate the clinical outcome performance of anterior permanent restorations by analyzing a large dataset from a German national health insurance company. Routine claims data from a major German national health insurance company were assessed. Fee codes were used for tracing restoration careers on a day-count basis. The treatment was defined as a placed restoration (Class III and IV) on a mesial or distal tooth surface, irrespective of the extension. The restorations were placed between January 1, 2010 and December 31, 2013. Statistical analyses were conducted using Kaplan-Meier survival analysis to determine cumulative 4-year survival rates. The primary outcome was re-intervention on the same surface. Secondary outcomes were crowning and extraction which were analyzed separately. A total of 2,417,791 restorations involving mesial surfaces and a number of 2,409,031 restorations involving distal surfaces were observed. At 4 years, the cumulative survival rates concerning the primary outcome 're-intervention' were 79.9% for mesial and 80.9% for distal restorations. The respective annual failure rates (AFR) were 5.5% and 5.2%. Four-year survival rates for the secondary outcome 'crown' were 93.8% for mesial and 94.1% for distal anterior restorations. The respective AFRs were 1.6% and 1.5%. For the secondary outcome 'extraction,' the respective rates were 94.6% for mesial and 93.9% for distal restorations. The respective AFRs were 1.4% and 1.6%. The performance of permanent anterior restorations which were placed in general dental practices in Germany can be rated as acceptable.

Reducing Medical Costs of Health Insurance: The COVID-19 Stress Testing and Portfolio Effects

Reducing medical costs is one of the three strategic aims of U.S. health care reform. This research quantifies potential expense reductions of U.S. health insurers and examines portfolio effects on expenses of differential health insurance mixes. We use the coronavirus disease 2019 (COVID-19) pandemic as a natural stress test for potential savings in medical services. We employ a two-stage residual inclusion generalized linear model and uncover differential expense reductions for four major health insurance markets: individual, group, Medicaid managed care, and Medicare Advantage. Our results could serve as a benchmark for reducing medical costs through redesigning insurance coverages following the most effective group insurance model. The results also provide policy implications on restructuring health insurance markets to increase efficiency. We empirically examine mutual impacts among major health insurance markets, and document explicitly three optimal health insurance portfolios in reducing expenses of health care: Medicaid managed care and individual plans, exclusively group plans, and Medicaid managed care and Medicare Advantage plans.

Digital patient care program following successful ablation or cardioversion of patients with atrial fibrillation

Abstract Background The current ESC guidelines on atrial fibrillation recommend the assessment of disease burden and the rigorous management of cardiovascular risk factors. A digital patient care program (Digital Health Program Atrial Fibrillation) was offered to patients following pulmonary vein isolation or cardioversion in cooperation with a major German statutory health insurer and a leading cardiology clinic. The 12 month program consists of the following functions: (1) self-recording of 1-channel-ECGs by patients with the possibility to receive short-term assessment by a teledoctor; (2) Patient education on health literacy, management of risk factors and lifestyle optimization via an App; (3) Monitoring of blood pressure and body weight; (4) Medication management via the App; und (5) videoconsultations on demand. When needed, medication was optimized by the teledoctors, or patients were referred to their family practice or cardiologists. Results an interim analysis of 72 patients that have participated in the first 6 months of the program showed: 1.) Over 20,000 ECGs were written, or a mean of approx. 1.5 ECGs/patient/day. Based on the teledoctor assessment of the ECGs and the videoconsultation over the platform recurring atrial fibrillation could be detected early and with high reliability, and patients could be advised. 2.) Figure A.: In patients with known, but insufficiently controlled arterial blood pressure at baseline (systolic blood pressure &amp;gt; 130 mmHg), blood pressure was reduced by 7.2 ±7.8 mmHg (mean ± std); n = 20. 3.) Figure B.: In obese patients at baseline (BMI ≥ 30) the body weight was reduced by 3.03 ±4.71 KG (mean ± std); n = 26. Summary: The combination self-recorded ECGs with high adherence, the feedback by the App and the possibility to book a short-term teledoctor appointment made it possible to perform quick and reliable assessment and give concrete recommendations to the patient. Furthermore, the accompanying education program led to reduced blood pressure and body weight. This systematic analysis of a real world digital patient care program indicates that the program is feasible and effective. These results need to be confirmed in a controlled study.Figure 1

Ethics of patients losing insurance coverage due to hospital-insurer contract disagreements Frank H. Netter MD School of Medicine at QuinnipiacUniversity, North Haven, Conneticut

Despite most Americans having healthcare coverage, coverage does not equate to access. For many, healthcare coverage is being threatened by contractual disagreements between major health insurers and hospitals. In New York, in efforts to control costs, Aetna and United Healthcare have recently engaged in contentious contract negotiations with NewYork-Presbyterian and Mount Sinai medical centers, resulting in unprecedented ripples in patients’ health plans and access. These disruptions have been shown to negatively impact patient health and result in patients managing their treatment at steep out-of-pocket rates or scrambling to find new providers in-network. We discuss the ethical implications of fallouts between insurance companies and hospitals and their impacts on patients.

Rise in complications of acute otitis media during and after the COVID-19 pandemic

PurposeAfter the lifting of nonpharmaceutical interventions (NPIs) during the COVID-19 pandemic, clinical observation showed an increase in complications of acute otitis, followed by a rise in the number of mastoidectomies performed. The aim of this study was to record the number of mastoidectomies performed before, during and after the COVID-19 pandemic as an indicator for complications of acute otitis media.MethodsData were collected from a tertiary hospital in a university setting, as well as from four major public health insurance companies in Germany. The data of 24,824,763 German citizens during a period from 2014 until 2023 were analyzed.ResultsAccording to the data, during the COVID-19 pandemic, the number of mastoidectomies performed dropped by 54% for children aged 0–6 and by 62% for children aged 7–18. For adults, there were 30% fewer mastoidectomies performed between 2020 and 2022. After the lifting of most NPI’s in the season from July 2022 to June 2023, there was a sharp increase in the number of mastoidectomies performed on patients of all ages.ConclusionsDuring the COVID-19 pandemic, a decrease in the number of mastoidectomies performed was seen, suggesting a lower incidence of complicated acute otitis, most likely linked to the general decrease of upper airway infections due to NPI’s. In contrast, a sharp increase in the incidence of complicated otitis occurred after the hygiene measures were lifted. The current development causes a more frequent performance of mastoidectomies, thus entailing a change in the challenges for everyday clinical practice.

Implementation and Evaluation of a Breast Cancer Disease Model Using Real-World Claims Data in Germany from 2010 to 2020.

Breast cancer is the leading cause of cancer-related mortality among women in Germany and worldwide. This retrospective claims data analysis utilizing data from AOK Baden-Wuerttemberg, a major statutory German health insurance provider, aimed to construct and assess a real-world data breast cancer disease model. The study included 27,869 female breast cancer patients and 55,738 age-matched controls, analyzing data from 2010 to 2020. Three distinct breast cancer stages were analyzed: Stage A (early breast cancer without lymph node involvement), Stage B (early breast cancer with lymph node involvement), and Stage C (primary distant metastatic breast cancer). Tumor subtypes were estimated based on the prescription of antihormonal or HER2-targeted therapy. The study established that 77.9% of patients had HR+ breast cancer and 9.8% HER2+; HR+/HER2- was the most common subtype (70.9%). Overall survival (OS) analysis demonstrated significantly lower survival rates for stages B and C than for controls, with 5-year OS rates ranging from 79.3% for stage B to 35.4% for stage C. OS rates were further stratified by tumor subtype and stage, revealing varying prognoses. Distant recurrence-free survival (DRFS) analysis showed higher recurrence rates in stage B than in stage A, with HR-/HER2- displaying the worst DRFS. This study, the first to model breast cancer subtypes, stages, and outcomes using German claims data, provides valuable insights into real-world breast cancer epidemiology and demonstrates that this breast cancer disease model has the potential to be representative of treatment outcomes.

Dental injuries in Swiss children - an analysis of Swiss national health insurance data from the year 2019.

This study, the first to analyze accident data from a major compulsory Swiss health insurer (Concordia), reviewed 5,063 dental accident reports of 122,370 children under the age of 16. The predominant cause of injury was a "fall," with "playing" being the foremost activity mentioned and "ground" identified as the primary object of impact. The analysis of the involved objects showed that dental injuries occur most frequently with scooters, bicycles, and stairs. In 2019, 8.14% of children aged one and insured by Concordia suffered a dental injury. By age 16, 58.8% of all children had experienced a dental injury. 0.72% had suffered a primary dentition crown fracture with pulp involvement. Regarding their permanent teeth, 0.21% suffered an avulsion, 0.84% another luxation injury, 0.65% a crown fracture with pulp involvement, and 0.16% a root fracture. A significant increase in injuries per day was observed after the summer holidays. On weekends, there were 28% fewer injuries per day on average than on weekdays. Despite differences among the cantons, the dataset can be considered to be representative for Switzerland. Accident descriptions were often too brief for detailed prevention strategies. Detailed accident information is essential for effective structural measures, which are more effective than promoting behavioural changes. A detailed recording could also be used to draw up a list of the objects frequently involved in accidents. An updated insurance form with an improved nomenclature, the option of digital submission, photo uploads and AI-supported data recording could greatly improve the quality and interpretability of injury data.

Predictive Tool Use and Willingness for Surgery in Patients With Knee Osteoarthritis

Despite the increasing number of tools available to predict the outcomes of total knee arthroplasty (TKA), the effect of these predictive tools on patient decision-making remains uncertain. To assess the effect of an online predictive tool on patient-reported willingness to undergo TKA. This parallel, double-masked, 2-arm randomized clinical trial compared predictive tool use with treatment as usual (TAU). The study was conducted between June 30, 2022, and July 31, 2023. Participants were followed up for 6 months after enrollment. Participants were recruited from a major Australian private health insurance company and from the surgical waiting list for publicly funded TKA at a tertiary hospital. Eligible participants had unilateral knee osteoarthritis, were contemplating TKA, and had previously tried nonsurgical interventions, such as lifestyle modifications, physiotherapy, and pain medications. The intervention group was provided access to an online predictive tool at the beginning of the study. This tool offered information regarding the likelihood of improvement in quality of life if patients chose to undergo TKA. The predictions were based on the patient's age, sex, and baseline symptoms. Conversely, the control group received TAU without access to the predictive tool. The primary outcome measure was the reduction in participants' willingness to undergo surgery at 6 months after tool use as measured by binomial logistic regression. Secondary outcome measures included participant treatment preference and the quality of their decision-making process as measured by the Knee Decision Quality Instrument. Of 211 randomized participants (mean [SD] age, 65.8 [8.3] years; 118 female [55.9%]), 105 were allocated to the predictive tool group and 106 to the TAU group. After adjusting for baseline differences in willingness for surgery, the predictive tool did not significantly reduce the primary outcome of willingness for surgery at 6 months (adjusted odds ratio, 0.85; 95% CI, 0.42-1.71; P = .64). Despite the absence of treatment effect on willingness for TKA, predictive tools might still enhance health outcomes of patients with knee osteoarthritis. Additional research is needed to optimize the design and implementation of predictive tools, address limitations, and fully understand their effect on the decision-making process in TKA. ANZCTR.org.au Identifier: ACTRN12622000072718.

Sex differences in cardiologic medication provision for adults with coronary heart disease: an analysis of health claims data from 2018 to 2020 in Saxony-Anhalt, Germany

BackgroundCoronary heart diseases (CHDs) have experienced the largest increase worldwide as a cause of death, accounting for 16% of all deaths. In Saxony-Anhalt, a federal state in Germany, both CHD morbidity and acute myocardial infarction mortality rates are particularly high. Several risk factors associated with CHDs have been studied in Saxony-Anhalt, but sex differences in service use and medication have not been investigated. This study therefore aimed to investigate sex differences in the quality and quantity of cardiological care provided to adults with CHD.MethodsThis study used health claims data from 2018 to 2020 to analyse the utilisation of healthcare services and adherence to medication-related guideline recommendations in primary and specialist care. The sample included 133,661 individuals with CHD from a major statutory health insurance company (Germany).ResultsAlmost all CHD patients (> 99%) received continuous primary care. Continuous cardiologist utilisation was lower for females than for males, with 15.0% and 22.2%, respectively, and sporadic utilisation showed greater differences, with 33.5% of females and 43.4% of males seeking sporadic cardiologist consultations. Additionally, 43.1% of the identified CHD patients participated in disease management programmes (DMPs). The study also examined the impact of DMP participation and cardiologist care on medication uptake and revealed that sex differences in medication uptake, except for statin use, were mitigated by these factors. Statins were prescribed to 42.9% of the CHD patients eligible for statin prescription in accordance with the QiSA indicator for statin prescription eligibility. However, there were significant sex differences in statin utilisation. Female CHD patients were less likely to use statins (35.2%) than male CHD patients were (50.1%). The difference in statin utilisation persisted after adjustment for DMP participation and cardiologist consultation.ConclusionsThis study highlights sex differences in the utilisation of cardiological healthcare services for patients with CHD in the Saxony-Anhalt cohort. These findings underscore the continuing need for interventions to reduce sex inequalities in accessing healthcare and providing health care for patients with CHD. Factors at the health care system, patient, and physician levels should be further investigated to eventually improve statin prescription in people with CHD, especially women.

Medicaid Enrollment and Service Use Among Adults With Down Syndrome

Down syndrome is the leading genetic cause of intellectual disability and automatically qualifies individuals for Social Security Insurance. Therefore, Medicaid is the major health insurance provider for a population at high risk for dementia, obesity, and premature mortality. Despite the importance of Medicaid for adults with Down syndrome, little is known about how this population uses Medicaid. To describe enrollment in, health care use in, and cost to Medicaid for adults with Down syndrome compared with adults with intellectual disability and a random sample of adults enrolled in Medicaid. In this cohort study, the data are from a claims cohort of adults aged 18 years or older enrolled in Medicaid at any point between January 1, 2011, and December 31, 2019. Participants were enrollees with 1 or more inpatient claim or 2 or more other claims with an International Classification of Diseases, Ninth Revision code or an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code for Down syndrome or intellectual disability as well as a random sample of those without developmental disability. Analyses were conducted from June 2022 to February 2023. Data were linked across 2 data reporting systems. Main outcomes were enrollee demographic characteristics, enrollment characteristics, cost, and service use. This cohort study included 123 024 individuals with Down syndrome (820 273 person-years of coverage; mean [SD] age, 35 [14.7] years; median age, 33 years [IQR, 21-48 years]; 51.6% men; 14.1% Black individuals; 16.7% Hispanic individuals; and 74.6% White individuals), 1 182 246 individuals with intellectual disability (mean [SD] age, 37.1 [16.8] years; median age, 33 years [IQR, 22-50 years]; 56.5% men; 22.0% Black individuals; 11.7% Hispanic individuals; and 69.5% White individuals), and 3 176 371 individuals with no developmental disabilities (mean [SD] age, 38 [18.6] years; median age, 33 years [IQR, 21-52 years]; 43.8% men; 23.7% Black individuals; 20.7% Hispanic individuals; and 61.3% White individuals). Median enrollment in Medicaid for a person with Down syndrome was 8.0 years (IQR, 5.0-9.0 years; mean [SD], 6.6 [2.6] years). Costs were higher for the Down syndrome group (median, $26 278 per person-year [IQR, $11 145-$55 928 per person-year]) relative to the group with no developmental disabilities (median, $6173 per person-year [IQR, $868-$58 390 per person-year]). Asian, Black, Hispanic, Native American, and Pacific Islander adults with Down syndrome had fewer costs and claims per person-year compared with White adults with Down syndrome. This cohort study of individuals with Down syndrome enrolled in Medicaid found consistent enrollment and high use of health care in a population with high health care needs. Results were similar comparing individuals with Down syndrome and those with intellectual disability, with both groups differing from a sample of Medicaid enrollees with no developmental disabilities. Medicaid data are a useful tool for understanding the health and well-being of individuals with Down syndrome.

Disparities in Social Insurance Participation and Urban Identification Among In-situ Urbanized Residents in China

China’s in-situ urbanization implies a phenomenon where rural populations become new urbanites as their land was reclassified as urban. While studies have suggested that social insurance may play a role in encouraging urban identification, empirical evidence in this field remains scarce. Highlighting the identity construction experience of in-situ urbanized residents, this study assesses the efficacy of major health and pension insurance in promoting a sense of urban identity in the context of China’s rapid urbanization. We analyze data from the 2018 Urbanization and Quality of Life Survey (N = 3,229) conducted in 40 localities that undergo in-situ urbanization. Results of multi-level modelling show that those participating in urban insurance schemes such as the Urban Employee Basic Medical Insurance (UEBMI) are more likely to identify as urban. Enrollment in the New Rural Social Pension Scheme (NRSPS), however, is negatively associated with urban identification. There are also variations associated with the interaction of social insurance and hukou status. To promote future urban integration of in-situ urbanized residents, it is vital to build an equitable, efficient, and equal-access social insurance system in urbanizing China.

EPH115 Medical Cost and Prevalence of Diseases Across Different Health Insurance Systems in Japan

Japan has a compulsory insurance system ensuring citizens the universal access to affordable healthcare. Although the government runs the National Database incorporating all public health insurance systems, its poor accessibility eludes researchers. Alternative commercial claims databases have limitations in their generalizability. This research, using major commercial claims databases, assessed the characteristics of major health insurance systems; employee-based health insurance (EHI) for employees in mid-large companies and their families and the citizens’ health insurance (NHI) for non-/self-employed workers.

Associations of early childhood medication exposure and molar incisor hypomineralization (MIH): A routine data analysis

ObjectivesMolar incisor hypomineralization (MIH) has become a major oral health problem of widely unknown origin. Besides genetic predisposition, exposure to certain drugs in early childhood are suspected to be associated with MIH. Aim of this routine data analysis was to examine associations of MIH and exposure to medication as well as perinatal factors. MethodsIndividuals with MIH were identified in claims data using a validated predefined specific treatment pattern. The database was a comprehensive routine data set of a major national health insurance company (BARMER, Germany). Based on this treatment pattern a MIH group and an unaffected control group were formed for analysis. Various medical data including medical diagnoses and prescriptions were available. Associations were examined comparing results for a set of variables in both groups. Differences between the groups were tested for significance using T-tests (P<0.01). ResultsBetween 2010 to 2019, a total of 298,502 children between 6 and 9 years of age were included in this analysis. 22,947 were assigned to the MIH group. For individuals in this group, significantly larger prescription quantities in the main ATC (Anatomical, Therapeutic, Chemical) groups J (antiinfectives for systemic use), R (respiratory system) and S (sensory organs) were found in the first 4 years of life compared to MIH unaffected individuals. With antibiotics, there were both significantly larger prescription quantities and significantly higher numbers of respective prescriptions in the first 4 years of life. The differences amounted up to about 10.62% in frequently used antibiotics to be found in ATC J01D (other beta-lactam antibacterials) for the number of prescriptions in the 4th year of life. No association was found for premature birth, mode of delivery or the use of antipyretic or anti-inflammatory medication. ConclusionsWhile perinatal factors do not seem to be associated with MIH development, early life exposure to antibiotics might play a role. Clinical Significance StatementAlthough causal relations can still not be proven, a responsible use of the unquestionably beneficial antibiotics is encouraged from a clinical point of view.

An economic evaluation of knee osteoarthritis treatments in Thailand.

Objective: The objective of this study is to evaluate the cost-effectiveness of different knee OA care sequences compared to standard treatment reimbursed by the major health insurance payer in Thailand. Method: We used decision analytical modeling to evaluate the effect of either adding etoricoxib or crystalline glucosamine sulfate compared to standard treatment from a societal perspective over patients’ lifetimes. Data were analyzed based on efficacy, whereas adverse events were considered as a substate. Model input data were retrieved from relevant published literature and the Standard Cost Lists for Health Technology Assessment, Thailand. All health outcomes were measured in a unit of quality-adjusted life-year (QALY). An incremental cost-effectiveness ratio (ICER) was applied to examine the costs and QALYs. Sensitivity analysis was performed to investigate the robustness of the model. Result: The results demonstrated that adding crystalline glucosamine sulfate (before diclofenac plus proton pump inhibitors, PPI) into the standard care sequence was a dominant strategy compared to the standard care sequence. Adding etoricoxib alone or including crystalline glucosamine sulfate (after diclofenac plus PPI) was dominated by adding crystalline glucosamine sulfate (before diclofenac plus PPI), whereas in a willingness-to-pay (WTP) threshold in Thailand, adding of both crystalline glucosamine sulfate (before diclofenac plus PPI) and etoricoxib were cost-effective when compared to adding crystalline glucosamine sulfate alone with ICER of 125,547 Thai baht/QALY (3,472 US dollars/QALY). Conclusion: The addition of crystalline glucosamine sulfate and etoricoxib into standard knee OA treatment were cost-effective at the WTP threshold in Thailand. In addition, early initiation of crystalline glucosamine sulfate would be less costly and more effective than delayed treatment or the use of standard treatment alone.

Longitudinal changes of mental health problems in children and adolescents treated in a primary care-based health-coaching programme – results of the PrimA-QuO cohort study

BackgroundIn Germany, 19.1% of boys and 14.5% of girls are affected by mental health problems (MHP). Paediatricians are usually the first in line to be contacted but they often do not feel adequately trained to diagnose and treat MHP in primary care. A major statutory health insurance fund introduced a health coaching (HC) programme to strengthen primary care consultation for MHP. The HC includes a training concept for paediatricians, standardised guidelines for actions and additional payments. The aim of this study was to investigate the potential effects of the HC programme on the change of MHP in children and adolescents.MethodsA prospective cohort study was conducted in Bavaria, Germany, in 2018 and 2019. Data were collected at 2 points 1 year apart using an online questionnaire. Parents of patients with developmental disorder of speech and language, head/abdominal pain, conduct disorder or non-organic enuresis were approached by their health insurance. Families treated according to the HC programme form the intervention group while all others serve as controls. MHP was assessed using the Strengths and Difficulties Questionnaire (SDQ) as a child self-assessment (SDQ-S)/or external assessment by parents (SDQ-P). Determinants of SDQ total score were analysed using linear mixed effects models.ResultsCross-sectional (n = 1090) and longitudinal analyses (n = 599) were performed. At baseline, a total of 23.5% had an SDQ total score “at risk” (SDQ-S > 15/SDQ-P > 13). There were no significant differences between intervention and controls. After full adjustment for all potential confounders, higher SDQ scores indicating more problems were significantly associated with male sex (2.000, p < 0.001) whereas a high parental education level was significantly associated with decreased SDQ scores (-2.127, p =0.034). There was a significant improvement in the control group over time (-0.814, p = 0.001) while the SDQ scores in the intervention group remained stable (-0.012, p = 0.020).ConclusionThis evaluation of the HC programme could not prove a clinically relevant intervention’s effect on the MHP developmental course. Nevertheless, (HC) paediatricians have crucial potential to improve the care of MHP patients. Targeting families with less access to support measures might help reduce the burden of MHP and be a step towards continuous improvement of care.

State subsidized reinsurance programs: Impacts on efficiency, premiums, and expenses of the U.S. health insurance markets

In the U.S., states are allowed to apply for the Affordable Care Act section 1332 waiver to explore innovative strategies in providing quality and affordable health insurance. Most approved waivers seek to establish state subsidized reinsurance programs, which help offset potential losses of high-cost enrollees in individual markets. State subsidized reinsurance programs are expected to reduce premiums, but may induce moral hazard and adverse selection issues. In response, this research examines state reinsurance programs’ impacts on premiums, expenses, and efficiency in individual and other major health insurance markets. We use the non-oriented slacks-based efficiency model and the entropy-balancing difference-in-differences regression model. We pool all the states with reinsurance programs and use insurer-level data and a rich set of predictors for our outcome variables. We find that, overall, state reinsurance programs reduce premiums and do not decrease consumer efficiency in individual markets. However, their impacts are differential across states, with no significant effects in at least half of the states. We find mixed effects on expenses and medical utilization efficiency in individual markets, and there are no significant spillover effects in other major health insurance markets. This research informs the public and provides insights for the U.S. individual health insurance operations in implementing, regulating, and evaluating state reinsurance programs and refining premium benchmarking.

Differences in the Outcome of Colonic Atresia with and without Abdominal Wall Defects.

Colonic atresia (CA) is a very rare disease. Two entities of CA can be differentiated: primary CA and CA with abdominal wall defects (AWD). This study aimed to investigate the differences between these two entities, especially for long-term outcomes. Data from the major health insurance company (AOK) were analyzed. Sixty-two patients with ICD-10 codes Q42.1-2 and Q42.8-9 (atresia of the colon and rectum) who underwent surgery within 10 days after their first admission between 2007 and 2016 were obtained. Twenty-nine patients had an AWD, and 33 patients had primary colonic atresia (PCA). Significant differences between patients with PCA and AWD were found regarding prematurity but not for other concomitant malformations. Ostomy was the initial therapy of choice for 87.9% (29/33) of patients with PCA and 65.5% (19/29) with AWD. Central venous access was significantly more often in patients with AWD. Overall, patients with CA have an excellent short-term outcome. The 1-year mortality was 3% (1/33) in PCA and 6.9% (2/29) in AWD. Delayed management did not lead to higher mortality. Higher number of admission days and higher hospital costs were related to gastrostomy and short bowel in the long term. The long-term outcome of CA is related to short bowel and need for initial gastrostomy but not related to AWD, prematurity, or associated anomalies.

Health insurers: evolving into ecosystem-based service companies

PurposeThis study aims to investigate whether health insurers are transforming from pure payers into ecosystem-based health service companies. The authors discuss the findings’ impact on health insurers’ business model approach and their sources of competitive advantage.Design/methodology/approachThe authors conducted a multiple case study of 25 incumbent and rising health insurers from the USA, Europe and Asia-Pacific. The selection of firms was based on databases from Forbes, S&P Global Market Intelligence and Crunchbase. By performing a review of financial reports, app descriptions, corporate websites and media coverage, the authors analyzed health insurers’ digital service offerings and underlying strategic approaches for providing those services.FindingsThis study demonstrates that major health insurers are transforming into ecosystem-based health service companies. They expand the traditional insurance value chain by offering value-adding health services along the patient journey. The analysis results are summarized in a table displaying 18 digital service categories along core patient journey phases with corresponding examples of health insurers and underlying strategic approaches.Originality/valueThe role of digital services and ecosystems has been explored for many industries. This study investigates this subject area with a focus on the health insurance sector, advancing a young field of research. The analysis gives insights into the latest digital service offerings and strategic approaches of an internationally diverse set of incumbents and rising ventures.

Tooth loss in periodontally treated patients: A registry- and observation-based analysis.

According to retrospective clinical studies, periodontal treatment retains teeth. However, evidence on the effectivity of periodontal treatment stemming from the general population is lacking. We analysed data of periodontally treated patients from routine data of a major German national health insurance (BARMER-MV; sub-sample of the Federal State of Mecklenburg-Vorpommern) and from a clinical cohort (Greifswald Approach to Individualized Medicine, GANI_MED), as well as periodontally untreated and treated participants of the Study of Health in Pomerania (SHIP-TREND) with either ≥2 or ≥4 teeth with pocket depths ≥4 mm. Yearly tooth loss (YTL) estimates and incidence rates were evaluated. For moderately to severely affected groups, YTL and incidence rates were higher in BARMER-MV patients (0.35 and 0.18, respectively) than in untreated SHIP-TREND controls (0.19 and 0.08, respectively). In line, treated SHIP-TREND participants exhibited higher YTL rates than untreated SHIP-TREND controls (0.26 vs. 0.19). For severely affected groups, results with respect to tooth loss were inconclusive regarding the beneficial effects of periodontal treatment conducted either in the university (GANI_MED data) or in the general practice. Until 2021, periodontal treatment performed in German general dental practices within the national health insurance system was probably not efficient in retaining more teeth in the short- to mid-term. Since reimbursement schemes were changed in 2021 and now cover periodontal treatment to a much larger extent, the future will show whether these new reimbursement codes will improve the quality of periodontal treatment and whether they will lead to more long-term tooth retainment.