Medical Scheme Research Articles

Incorporating familial risk, lifestyle factors, and pharmacogenomic insights into personalized noncommunicable disease (NCD) reports for healthcare funder beneficiaries participating in the Open Genome Project.

An ethics-guided decision-making framework was developed for applying pathology-supported genetic testing, a multifaceted pharmacodiagnostic approach that translates population risk stratification into clinical utility. We introduce this service, supported by the Open Genome Project, which aligns with the beneficence principle in personalized medicine. Genetic testing of six noncommunicable disease pathways was conducted as part of a pilot program, benchmarked against a readiness checklist for implementation of genomic medicine in Africa. Patient referral criteria were determined using healthcare funder claims data, employing the Adjusted Clinical Groupers and Resource Utilization Band risk rating structure to identify potential nonresponders to treatment. Three of the 135 doctors (2.2%) invited expressed immediate disinterest in the pilot, while 24 (17.8%) actively participated. Inherited, lifestyle-triggered, and therapy-related pathologies were simultaneously assessed in case reports, with special medical scheme reimbursement tariff codes applied to 25 patient referrals. The findings were used by the participating genetic counselor to select three patients for whole exome sequencing, utilizing a novel, level-up data processing algorithm for adaptive reporting. This study demonstrated the implementation of genomics into an evolving workflow for patients with a history of frequent clinic visits. Eliminating the cost barrier provided valuable insights to guide future reimbursement policy decisions.

Epigenetic aging and fecundability: the Norwegian Mother, Father and Child Cohort Study.

Is there an association between male or female epigenetic age acceleration (EAA) or deceleration (EAD) and fecundability? We do not find compelling evidence of an association between EAA or EAD and fecundability. Prior research has shown that female accelerated epigenetic aging is associated with unfavorable clinical fecundity outcomes and use of in vitro fertilization, and that epigenetic aging in sperm cells is associated with unfavorable sperm parameters. Studies of epigenetic aging and fecundability among individuals who conceive naturally are lacking. This study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa), a population-based pregnancy cohort which recruited pregnant couples between 1999 and 2008. We used data from 1657 couples (women and men) with planned naturally conceived pregnancies and available blood samples. Methylation levels were measured in DNA from blood samples taken recruitment (at ∼18 gestational weeks) from pregnant women and their partners using the Illumina Methylation EPIC Array. To obtain a measure of EAA/EAD, we performed a linear regression of each of seven different established epigenetic biomarkers (DNAmAge by Horvath, DNAmAge by Hannum et al., PhenoAge by Levine et al., DunedinPoAm by Belsky et al., DunedinPACE by Belsky et al., DNAmTL by Lu et al., and GrimAge by Lu et al.) against chronological age. We fitted proportional probability regression models to obtain fecundability ratios (FRs) for each standard deviation increase in epigenetic aging, and obtained crude and adjusted (for body mass index, smoking, and education level) estimates. Results were evaluated at a false discovery rate (FDR) of 5%. We evaluated all models for non-linear associations using categories of epigenetic age where appropriate. Although the DunedinPACE clock in males demonstrated slightly increasing fecundability with increasing EAA (adjusted FR 1.05 per one standard deviation increase in EAA, 95% CI 1.00-1.10), this was not robust when evaluated at an FDR of 5%. We found evidence of non-linearity between biological aging and fecundability in two models in females and three models in males, but non-linear associations were weak and conflicting. As MoBa is a pregnancy cohort, our findings may not be generalizable to all couples attempting conception. Fecundability is a couple-level measure, and any impacts of epigenetic aging in each partner may be obscured by effects of the other partner. Our findings contrast with those of prior studies, which have indicated an association between EAA and unfavorable clinical fertility outcomes in populations using fertility treatments, possibly due to less important effects of epigenetic aging among couples who conceive naturally. More research is needed on the association between blood-based EAA and clinical fertility parameters in both sexes. The study was supported by the Research Council of Norway through its Medical Student Research Program funding scheme (project number 271555/F20), its Centres of Excellence funding scheme (project number 262700), and a grant from the Women's Health Program (320656). Co-funding was also received from the Strategic Research Council (SRC), FLUX consortium, decision numbers 345130 and 345131; the National Institute on Aging (R01AG075208); grants to the Max Planck-University of Helsinki Center from the Max Planck Society (decision number 5714240218), Jane and Aatos Erkko Foundation, Faculty of Social Sciences at the University of Helsinki, and Cities of Helsinki, Vantaa, and Espoo; and the European Research Council; and the European Research Council (ERC Synergy, BIOSFER, grant number 101071773, and the Horizon 2020 research and innovation program, grant number 947684). The authors declare no conflicts of interest. N/A.

Analyzing supply-side moral hazard behaviors in Botswana's health care market: A qualitative study

This paper aims to analyse the behaviours and practices of health care service providers that constitute supply-side abuse of the medical health insurance schemes premised on the notion that patients visit doctors precisely to learn what amount and type of care is medically necessary. Using qualitative methods, individual in-depth interviews were carried on private health service practitioners and thematic analysis via SPSS. The study identifies systemic abuses like overcharging, billing for services not provided, and over prescription. Implication of these findings show that Fee-for-Service Payment Models incentivize providers to deliver more services, leading to potential over-utilization and increased costs in Botswana’s healthcare; due to information asymmetry providers may prioritize quantity over quality of care exploiting patients’ lack of knowledge to recommend unnecessary tests or treatments to maximize on revenue but also costs. On how to minimize supply side moral hazards, the propositions is for pursuance of cost containment strategies to ensure the smooth operation of the schemes like price listings, educate beneficiaries on cost implications and sustainability threats. These propositions can be instituted through an industry led bench-marking, on nationally through regulatory frameworks since moral hazards are an economic cost as inefficiencies brings mis-allocation of resources to enhance the sustainability of medical aid-based health care provisioning.

The contribution of non-communicable and infectious diseases to the effect of depression on mortality: a longitudinal causal mediation analysis

Background: The increased prevalence of physical diseases among individuals with mental illness contributes to their increased risk of mortality. However, the mediating role of specific diseases in the effect of mental illness on mortality is not well understood. Method: We conducted a longitudinal causal mediation analysis using data from beneficiaries of a South African medical insurance scheme from 2011-2020. We estimated the overall effect of major depressive disorder (MDD) on mortality and evaluated reductions in this overall effect through hypothetical interventions on the risks of mediating physical diseases using an interventional effects approach. A Monte Carlo simulation-based g-computation was used for estimation. Results: Among 981,540 individuals, 143,314 (14.6%) were diagnosed with MDD. Mortality risk after 8 years was 6.5% under MDD, and 5.3% under no MDD (risk ratio 1.23, 95% CI 1.19-1.26). Overall, 43.4% of this disparity could be attributed to higher rates of physical comorbidities due to MDD. Cardiovascular diseases accounted for 17,8%, followed by chronic respiratory diseases (8.6%), cancers (7.5%), diabetes and chronic kidney disease (5.8%), tuberculosis (4.3%), and HIV (2.7%). Conclusion: Within the privately insured population of South Africa, MDD is associated with increased mortality. We estimate that the increased risks of non-communicable diseases under MDD, rather than infectious diseases, are important mediators of the effect of MDD on mortality.

Medicine needs of children not addressed in the National Cancer Strategic Framework: insights from a triangulation study

Aim A better understanding of the scope of the National Cancer Strategic Framework (NCSF) could lead to improvements aiding the framework’s ultimate objective of reducing the burden of cancer. Accordingly, this report evaluates whether the 2017-2022 NCSF adequately addressed issues related to childhood cancer treatment, in particular paediatric oncology medicines. Methods To identify determinants of current access to childhood oncology medicines in South Africa, in-depth interviews were conducted with 29 stakeholders in South Africa’s public and private healthcare sectors. Key health system stakeholders included policy makers and regulators, medical insurance scheme informants, medicine suppliers, healthcare providers and civil society stakeholders. Identified barriers were categorised according to the components of the pharmaceutical value chain, and combined with a health systems approach to acknowledge the linkages of medicines with other building blocks of the health system. Identified barriers were then compared to the limitations and interventions as discussed in the 2017-2022 NCSF to identify areas for improvement in the framework. Findings Three recurrent gaps in the NCSF in relation to childhood cancers were identified, representing a range of issues throughout the pharmaceutical value chain: 1) childhood cancers are neglected compared to adult cancers, in both the policy arena and the organisation of healthcare services; 2) there are particular challenges for childhood cancers due to their rarity, thus requiring targeted interventions (e.g., regulatory incentives, tailored pricing solutions, and customised evidence requirements by decision-making bodies); and 3) children must be accompanied by a caregiver during treatment, causing several social and financial issues for their families. Conclusions There is a pressing need for a strategic cancer plan that makes proper provisions for children. Such an endeavour must commence with acknowledging the areas in which childhood cancers are different from adult cancers, and which demand targeted intervention in an update of the NCSF.

Optometrists’ experience of healthcare fraud, waste and abuse (FWA) and strategies to combat it

Background: South African private healthcare is funded through medical aids and out-of-pocket payments. Annually, R22 billion is lost to medical fraud, waste and abuse (FWA) threatening the sustainability of healthcare delivery. Healthcare providers are often accused of unethical practices and various forms of FWA.Aim: To assess the optometrists’ experience of FWA and the strategies to combat FWA.Methods: A quantitative study was conducted amongst optometrists using a structured questionnaire and data was analysed using descriptive statistics.Results: Most (75%) respondents were aware of FWA. About 41% of respondents were audited for FWA, of whom two-thirds were Black males. The Preferred provider Negotiators conducted 27% audits, followed by Discovery (16.5%), Government Employees Medical Scheme (7.8%) and Medscheme (5%). Iso Leso and Opticlear networks conducted 3.9% each. About 7.8% were found guilty of FWA, of whom 87.5% were Black practitioners and 12.5% Indian practitioners. Claiming for spectacles but dispensing sunglasses (5.9%) and over-servicing (4%) were highest ranked offences. Common sanctions were claw-back (75%) and indirect payment (37.5%). Practitioners implement identity checks (94%–96%), coding training (89%) and accurate record keeping (93%) as anti-FWA strategies. Excessive codes and lack of standardised tariffs were challenges to fighting FWA.Conclusion: Optometrists use identity checks, coding and billing training as anti-FWA strategies. Coding and billing complexities are the main sources of FWA cases. Black and Indian practitioners were more likely to be identified for FWA and found guilty than White practitioners.Contribution: The study highlights the forms of FWA and suggest integration of controls to effectively curb FWA.

Courier delivery of antiretroviral therapy: a cohort study of a South African private-sector HIV programme.

Courier delivery has become a popular antiretroviral therapy (ART) distribution method in some HIV care settings, yet data on ART courier delivery and how it relates to ART outcomes are scarce. We studied the differences in viral suppression rates between individuals from a South African private sector HIV programme receiving ART by courier delivery and those receiving ART through traditional retail dispensing. Individuals aged 15 years or older who were actively enrolled in the Aid for AIDS programme between January 2011 and July 2022 were eligible for the analysis. The outcome of interest was viral suppression defined as a viral load (VL) <400 copies per ml. We calculated adjusted odds ratios (OR) for the association between the ART distribution method and viral suppression, comparing those receiving refills through courier pharmacies versus retail dispensing at the time of the VL testing. We used generalized estimating equations to account for repeated VL testing of the same individual. The models were adjusted for age, sex, calendar year, ART regimen, history of mental illness and medical insurance scheme. We computed adjusted ORs for the calendar periods 2011-2013, 2014-2016, 2017-2019, 2020-2022 and overall. We extracted 442,619 VL measurements from 68,720 eligible individuals, 39,406 (57.3%) were women. The median number of VL measurements per individual was 6 (IQR 3-10). VL suppression was detected in 398,901 (90.1%) tests, and 185,701 (42.0%) of the tests were taken while the individual was receiving ART by courier delivery. Overall, courier delivery was associated with 5% higher odds of viral suppression than retail dispensing (adjusted OR 1.05, 95% CI 1.02-1.08). The strength and direction of this association varied by calendar period, with an adjusted OR of 1.37 (95% CI 1.27-1.48) in 2011-2013 and 1.02 (95% CI 0.97-1.07) in 2020-2022. Courier delivery of ART is a viable alternative to retail dispensing in the South African private sector, as it was associated with higher viral suppression until 2016 and similar suppression rates in recent years. Further research is needed to investigate the potential benefits and drawbacks of courier delivery of ART in both private and public healthcare settings.

How hospital autonomy affects provider payment reform effectiveness.

Provider payment reforms (PPRs) have demonstrated mixed results for improving health system efficiency. Since PPRs require health care organisations to interpret and implement policies, the organizational characteristics of hospitals may affect the effectiveness of PPRs. Hospitals with more autonomy have the flexibility to respond to PPRs more efficiently, but they may not if the autonomy previously facilitated behaviours that counter the PPR's objective. This study examines whether hospitals with higher autonomy responds to PPRs more effectively. We used data from a matched-pair, cluster randomized controlled PPR intervention in a resource-limited Chinese province between 2014 and 2018. The intervention reformed the reimbursement method from the publicly administered New Cooperative Medical Scheme (NCMS) from fee-for-service to global budget. We interacted measures of hospital autonomy over surplus, hiring, and procurement (drugs, consumables, equipment, and overall index) with the difference-in-difference estimator to examine how autonomy moderated the intervention's effect. Autonomy over surplus (p<0.01) and procurement of equipment (p<0.01) were associated with relatively faster NCMS expenditure growth, demonstrating worse PPR response. They were also associated with higher expenditure shifting to out-of-pocket expenditures (p>0.05). Post hoc analysis suggests that hospitals with surplus autonomy had higher OOP per admission (p<0.01), suggesting profiteering tendencies. Other dimensions of autonomy demonstrated imprecise association. Hospitals with more autonomy may not necessarily respond more effectively to PPRs that incentivise efficiency when they had previously been encouraged to maximise profit. Policymakers should assess the extent of perverse incentives before granting autonomy and adjust the incentives accordingly.

Visually security privacy medical data protection scheme using compressive sensing and improved duffing chaotic system

Health and medical data frequently contain sensitive patient information that must be protected. Existing visual security schemes for medical images exhibit limitations in the imperceptibility of cipher images and the performance of image reconstruction. This paper introduces and evaluates a novel approach called Visual Meaningful Image Encryption (VMIE) for securing medical images. The proposed VMIE scheme employs a chaotic system based on the Duffing equation for initial encryption. Medical images are processed and encrypted in a sparse domain. A Bidirectional Chaotic Magic Transformation (BCMT) algorithm is then applied to scramble the sparse medical images. The scrambled data undergoes compression and diffusion. An adaptive embedding strategy employing the Discrete Cosine Stockwell Transform (DCST) integrates confidential data into the host image. The performance of the proposed chaotic system is validated through theoretical analysis and numerical simulation. Simulation results, along with comparisons to existing schemes, demonstrate the efficacy of the VMIE method in enhancing visual security and its suitability for natural images. The VMIE approach presented in this paper offers a promising solution for securing medical images, effectively addressing the limitations of current visual security schemes.

Cervical Cancer Screening: An Analysis of Three Large South African Medical Schemes

Cervical cancer poses a considerable public health challenge in South Africa, necessitating effective screening programs for early detection and prevention. However, the COVID-19 pandemic has disrupted healthcare services, including cervical cancer screening, posing challenges to disease management efforts. This study aimed to assess cervical cancer incidence and screening practices among beneficiaries within three major South African medical schemes, analysing trends from 2017 to 2022. Retrospective data were collected to evaluate incidence rates and screening coverage, considering the impact of the pandemic. Screening coverage declined during the epidemic, recovering in 2021 but declining again in 2022. Different health plans showed a more than forty per cent fall in cervical cancer screening rates between 2021 and 2022, with 2022 having the lowest level, even lower than the COVID-19 era. The trends indicate COVID-19 interruptions have a negative impact post-COVID-19. Recommendations include targeted outreach, telemedicine options, and strengthened collaboration to enhance screening programs and mitigate pandemic-related disruptions. This study contributes valuable insights into cervical cancer management, highlighting the need for proactive measures to ensure the continuity of essential healthcare interventions amid public health emergencies.

Effectiveness of Kathmandu University School of Medical Sciences Medical Evaluation Scheme

Background: Evaluation analysis the learning capabilities and check the knowledge with skills that students have gained during study period. Good evaluation scheme is a key issue in medical education. Evaluation scheme currently in use are reviewed with attention to their strength and weaknesses. The purpose of the present study was to determine perception of medical students regarding effectiveness of Kathmandu University School of Medical Sciences (KUSMS) medical evaluation scheme which may enhance the competency of the medical students as well as quality of medical education. Materials and Methods: This study was cross sectional questionnaire based study which consisted of 250 (165 male and 85 female) medical students who have already appeared in university examination. A Google Form Questionnaire was generated and shared to the student in order to acquire their perception regarding KUSMS medical evaluation scheme. Data was collected and statistical analysis was done. Results: Majority of the participants had shown their strongly agreement that KUSMS medical evaluation scheme is one of the best tool which help them to support in improving their learning skills and in obtaining good mark in their examination. Most of them also agreed that formative assessments give them the best opportunity to improve the weakness in their studies. Similarly, they preferred more integrated pattern of examination (current) rather than discipline based (subject wise) examination. Conclusion: The assessment methods should match the competencies being learnt and the teaching methods being used. Several assessment methods are used longitudinally to assess the student’s learning needs and to identify optimal performance by the faculties.

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

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

Dynamical analysis of high-order Hopfield neural network with application in WBANs

Given the increasing demand for privacy preservation of medical data, a novel medical image encryption scheme is proposed based on Invertible Neural Network (INN) in this paper. Firstly, a new High-Order Hopfield Neural Network (HOHNN) is designed to yield a cipher flow as the conditional input, thereby regulating the encryption process. Moreover, its intrinsic properties as well as various dynamic behaviors are both demonstrated through theoretical analysis and two-parameter Lyapunov exponential charts. Secondly, guided by a multi-objective loss function and a known prior distribution, the original medical image is encrypted into a noise-like cipher image through the proposed encryption scheme. Besides, it is worth mentioning that unlike the existing deep learning-based data encryption schemes, the decryption network shares the identical weight matrix and network structure with the corresponding encryption one in this work. Finally, extensive simulation experiments have validated the feasibility as well as the security of the proposed scheme.

Design and Analysis of a Novel Fractional-Order System with Hidden Dynamics, Hyperchaotic Behavior and Multi-Scroll Attractors

The design of chaotic systems with complex dynamic behaviors has always been a key aspect of chaos theory in engineering applications. This study introduces a novel fractional-order system characterized by hidden dynamics, hyperchaotic behavior, and multi-scroll attractors. By employing fractional calculus, the system’s order is extended beyond integer values, providing a richer dynamic behavior. The system’s hidden dynamics are revealed through detailed numerical simulations and theoretical analysis, demonstrating complex attractors and bifurcations. The hyperchaotic nature of the system is verified through Lyapunov exponents and phase portraits, showing multiple positive exponents that indicate a higher degree of unpredictability and complexity. Additionally, the system’s multi-scroll attractors are analyzed, showcasing their potential for secure communication and encryption applications. The fractional-order approach enhances the system’s flexibility and adaptability, making it suitable for a wide range of practical uses, including secure data transmission, image encryption, and complex signal processing. Finally, based on the proposed fractional-order system, we designed a simple and efficient medical image encryption scheme and analyzed its security performance. Experimental results validate the theoretical findings, confirming the system’s robustness and effectiveness in generating complex chaotic behaviors.

Availability and pricing of insulin and related diagnostics in South Africa.

In South Africa (SA), most patients rely on the government for free healthcare. Some choose to subscribe to a medical insurance scheme. If insulin is unavailable in government or otherwise unaffordable, non-adherence may occur, which can increase complications of the disease. Data on availability and pricing of insulin and related diagnostics was collected from SA pharmacies via an online survey. Co-payments levied on insulin by the biggest medical aids were extracted from formularies. Affordability of these items was then assessed. An adapted methodology from the World Health Organization/Health Action International tool was used. There was fairly high availability of insulin in the public sector, with the exception of long-acting insulin which respondents claimed was difficult to find; however, long-acting insulin glargine was available in most private sector pharmacies. Point-of-care (POC) blood glucose testing was free in the public sector but offered in only 31.25% of pharmacies. Patients pay a minimum of USD 40.4 (over 3 days' wages for the lowest paid government worker (LPGW)) for a months' supply of the cheapest insulin, needles and test strips. Insulin in SA was cheaper than 5 other countries, except Australia. Overall, there is a good availability of insulin and related diagnostics in SA. Even though insulin is cheaper than other countries, it is unaffordable to the LPGW. This highlights the importance of ensuring a constant availability of insulin in the free public sector. Whilst human insulins are cheaper than newer analogue insulins and SA faces cost constraints, important variables in favour of newer insulins, such as ease-of-use, long term outcomes and value should be considered when treatment guidelines are updated. Annual POC testing should be available and offered free to all patients to detect diabetes early.

Death trends for 2010 - 2022 for members of a large private medical scheme in South Africa.

In the absence of more recent national data on underlying causes of death in South Africa (SA), we examined mortality trends from 2010 to 2022 among members of a large private medical scheme. This analysis sheds light on the health profile of this specific demographic. To investigate trends in Discovery Health Medical Scheme (DHMS) members' death rates and underlying cause of death patterns between 2010 and 2022. All-cause deaths were compared across years accounting for demographic changes, by analysing age- and sex-standardised rates using 2019 age and sex population weightings. We used underlying cause-of-death data from death notifications. The 2019 age- and sex-standardised death rate was lower than the 2010 rate by 10%, with a steady decline experienced between 2010 and 2019. We have seen reduced age- and sex-standardised death rates from HIV/AIDS during this period, and despite the high prevalence, reduced age- and sex-standardised death rates from non-communicable diseases. Malignant neoplasms and cardiovascular disease have been and remained the two leading causes of death for Discovery Health Medical Scheme (DHMS) clients between 2012 and 2022. Age- and sex- standardised death rates, however, reached historic high levels during the first 2 years of the COVID-19 pandemic in SA. In 2020, overall age- and sex-standardised death rates for DHMS members increased to 542 deaths per 100 000 life years, which was higher than pre-pandemic levels. Age- and sex-standardised death rates went on to reach their highest level in the history of the scheme in 2021, at 767 deaths per 100 000 life years. Age- and sex-standardised death rates, however, had returned to near 2019 (pre-pandemic) levels by 2022, at 477 deaths per 100 000 life years. Males experienced a higher increase in age-standardised death rates during 2020 and remained at an increased risk of death in 2022 compared with pre-pandemic levels. When COVID-19 -related deaths are excluded, the age-standardised rates for both females and males in 2022 was lower than observed in the pre-pandemic years. While the low mortality experience could be related to competing causes and mortality displacement, further analysis over a longer period is needed to confirm this. DHMS experienced the highest level of age- and sex-standardised death rates during 2020 and 2021, the initial 2 years of the COVID-19 pandemic. Most of this increase was explained by COVID-19 deaths.

Time-Aware Missing Healthcare Data Prediction Based on ARIMA Model.

Healthcare uses state-of-the-art technologies (such as wearable devices, blood glucose meters, electrocardiographs), which results in the generation of large amounts of data. Healthcare data is essential in patient management and plays a critical role in transforming healthcare services, medical scheme design, and scientific research. Missing data is a challenging problem in healthcare due to system failure and untimely filing, resulting in inaccurate diagnosis treatment anomalies. Therefore, there is a need to accurately predict and impute missing data as only complete data could provide a scientific and comprehensive basis for patients, doctors, and researchers. However, traditional approaches in this paradigm often neglect the effect of the time factor on forecasting results. This article proposes a time-aware missing healthcare data prediction approach based on the autoregressive integrated moving average (ARIMA) model. We combine a truncated singular value decomposition (SVD) with the ARIMA model to improve the prediction efficiency of the ARIMA model and remove data redundancy and noise. Through the improved ARIMA model, our proposed approach (named MHDP SVD_ARIMA) can capture underlying pattern of healthcare data changes with time and accurately predict missing data. The experiments conducted on the WISDM dataset show that MHDP SVD_ARIMA approach is effective and efficient in predicting missing healthcare data.

Prescribed Minimum Benefits complaints: a five-year retrospective review.

No matter which benefit option members have chosen, medical schemes are required by the Medical Schemes Act no. 131 of 1998 to pay costs associated with the diagnosis, treatment, or care of a specified set of benefits known as Prescribed Minimum Benefits (PMBs). Medical scheme beneficiaries have the right to lodge complaints with the Council for Medical Schemes (CMS) when their claims are denied. To determine and describe the pattern of PMBs complaints received by CMS from January 2014 to December 2018. This was a cross-sectional study that utilised the CMS' clinical complaints. Data for PMBs, complainants, medical scheme types, and reasons for payment denial were extracted. The CMS' lists of chronic conditions, PMBs, and registered schemes were used to confirm PMBs and to categorise schemes as either restricted (i.e., to only members of specific organisations) or open (i.e., to all South Africans). Extracted and coded data were analysed using SAS v.9.4 software. A total of 2141 complaints were retrieved and 1124 PMBs complaints were included in the study. The median of PMBs complaints per year was 225. Most of the complaints (43.6%, n=490/1124) were lodged by members themselves. Non-Communicable Diseases (NCDs) constituted most of the PMBs conditions that members complained about. Medicine and surgery were the services that were mostly denied full payment by medical schemes. Open medical schemes accounted for more (73.8%, n=830/1124) of the complaints. Chronic conditions are the main diseases that medical scheme members complained about. Member education and clear definition of PMBs should be prioritised by medical schemes and the Council for Medical Schemes.

Micro-analysis of earnings and its determinants in eastern cape province of South Africa

Earnings disparities in South Africa, and specifically the Eastern Cape region are influenced by a complex interplay of historical, socio-economic, and demographic factors. Despite significant progress since the end of apartheid, persistent disparities in earnings continue to raise questions about the effectiveness of policies aimed at reducing inequality and promoting equitable social system. Individual-level dataset from the 2021 South African general household survey were subjected to exploratory analysis, while Heckman selection model was used to investigate the determinants of earnings disparities in the study area. The results showed that majority of the population are not working for a wage, commission or salary, which also pointed to the gravity of unemployment situation in the area of study. Most of the working population (both male and female) are lowest earners (R ≤ 10,000), and this also cuts across all age-group categories. Majority of working population have no formal education, are drop out, or have less than grade-12 certificate, and very few working populations with higher education status were found in the moderate and relatively high earnings categories. While many of the working population are engaged in the informal sector, those in the formal sector are in the lowest earners group. Compared to any other race, the Black African group constituted the majority of non-wage earners, and most in this group were found in the lowest earners group. Some of the working population who were beneficiaries of social grants and medical aids scheme were found in the lowest, low, and moderate earnings categories. The findings significantly isolated the earnings-effect of age, marital status, gender, race, education, geographic indicators, employment sector, and index of health conditions and disabilities. The study recommends interventions addressing racial, gender, and geographic wage gaps, while also emphasizing the importance of equitable access to education, health infrastructure, and skills development.

Does Medical Insurance Integration Reduce Frailty Risk? Evidence From Rural Older Adults in China.

This study aimed to assess the impacts of China's health insurance integration reform on frailty among rural older adults. Nationally representative longitudinal data with 2,751 adults aged ≥60 years were analyzed from the China Health and Retirement Longitudinal Study 2011-2015. The integration of the rural New Cooperative Medical Scheme and urban Resident Basic Medical Insurance into the unified Urban and Rural Resident Basic Medical Insurance (URRBMI). Frailty Index (FI) summarizes 32 health deficits, quantifying frailty severity with a range of 0-1. Frailty is defined as FI ≥ 0.25, prefrailty as FI: 0.10-0.25, and robustness as FI < 0.10. Frailty worsening, stability, and improvement from 2011 to 2015 were assessed. Difference-in-differences and propensity score matched difference-in-differences models assessed URRBMI integration effects on frailty severity and risk (FI ≥ 0.25) among rural older adults. URRBMI integration significantly reduced frailty severity by 15.16% and risk by 9.60% points among rural older adults. Reductions were greatest among initially prefrail individuals, with 27.49% lower frailty severity and a 17.62% point reduction in subsequent frailty onset risk after URRBMI integration. In contrast, no significant benefits were observed for initially robust or frail subgroups following integration. Analyses of frailty transitions corroborated selective benefits, with URRBMI integration lowering the risks of worsening frailty among prefrail but no significant reversal of frailty status among those initially frail or prefrail. China's URRBMI integration selectively ameliorated frailty progression among rural older adults with prefrail status. Targeting integrated medical insurance policies toward high-risk populations may optimize frailty prevention effects.