Point Of Service Research Articles

An Optimization Framework for Waste Treatment Center Site Selection Considering Nighttime Light Remote Sensing Data and Waste Production Fluctuations

As urbanization accelerates, the management of urban solid waste poses increasingly intricate challenges. Traditional urban metrics, such as GDP and per capita consumption rates, have become inadequate for accurately reflecting the realities of waste generation; moreover, the linear correlation between these metrics and waste production is progressively diminishing. Consequently, this study introduces a novel methodology leveraging nighttime light remote sensing data to enhance the precision of urban solid waste production forecasts. By processing remote sensing data to mitigate noise and integrating it with conventional urban datasets, an innovative index system and predictive model were developed. Using Beijing as a case study, the gradient boosting regression algorithm yielded a prediction accuracy of 92%. Furthermore, in light of the substantial costs associated with waste recovery route planning and site selection for treatment facilities, this research further devised a location and distribution framework for waste treatment centers based on high-precision predictions of waste production while employing multi-objective evolutionary algorithms (MOEAs) alongside the non-dominated sorting genetic algorithm II (NSGA-II) for optimization. Distinct from prior studies, this study suggests that service point waste quantities are not fixed values but rather adhere to a normal distribution within specified ranges and thus provides a more realistic simulation of fluctuations in waste production while enhancing both the robustness and predictive accuracy of the model. In conclusion, by incorporating nighttime light remote sensing data along with advanced machine learning techniques, this study markedly improves forecasting accuracy for waste production while offering effective optimization strategies for site selection and recovery route planning—thereby establishing a robust data foundation aimed at refining urban solid waste management systems.

Early Effects of Information Revolution Interventions on Health Information System Performance in Ethiopia.

Health information systems (HISs) are essential to a country's health system as they provide critical support to health policymaking, management, financing, and service delivery. A well-functioning HIS should produce timely and reliable data that are available and easily accessible to decision-makers throughout the health system. Ethiopia has transitioned from a fragmented, paper-based health management information system (HMIS) to a harmonized, digital system used at points of collection and service delivery.In 2016, the Federal Ministry of Health (MOH) launched the Information Revolution (IR), a transformative agenda aimed at enhancing the culture of data use, scaling priority HIS tools and systems, and strengthening HIS governance. Between 2016 and 2022, the MOH, Data Use Partnership, and other partners implemented a series of IR interventions that supported this agenda. These interventions included deploying and harmonizing digital HIS systems; strengthening HIS leadership, coordination, and governance; implementing the IR pathway strategy; enhancing capacity through supportive supervision, mentorship, and training; and improving performance monitoring teams. This article aims to synthesize the key HIS interventions implemented in Ethiopia as part of the IR and document the effects of these interventions on HIS performance.Early studies indicate promising improvements in HIS performance across health facilities in Ethiopia. However, challenges remain. To ensure sustainable progress, it is essential to continue addressing key challenges, such as system interoperability, HIS workforce, and capacity for data use at all levels. By building on the successes of the first Health Sector Transformation Plan and addressing these gaps, Ethiopia can advance its vision of a robust, data-driven health system capable of improving health outcomes and driving evidence-based decision-making.

Should viscoelastic testing be a standard point-of-care test on all intensive care units?

Viscoelastic tests (VETs) have transformed assessment of haemostasis and transfusion practices in trauma, cardiac and liver transplantation centres. Impaired haemostasis is a common problem on the general intensive care unit (ICU), but routine use of VETs is rare. We have accordingly reviewed the evidence to determine whether there is evidence to support the use of VETs as a standard point of care test on all ICUs in assessing and managing patients. The benefits of using VETs in the management of major haemorrhage, namely faster identification of a coagulopathy, in particular early detection of fibrinolysis, and reduced transfusion requirements for blood products have been seen in the general ICU. Validation of treatments algorithms is now required to standardise practice. There is also emerging evidence to support the use of VETs to guide urgent treatment decisions in patients with a coagulopathy or in patients taking anti-coagulants or anti-platelet therapies. We recommend that departments independently review the feasibility of setting up a viscoelastic point of care service which considers the applicability to their patient cohort, the financial cost and the personnel required.

Learning from innovative staff practices that led to virtual disability services using the lens of Complex Adaptive Systems

This paper draws on a Complex Adaptive Systems lens to develop an understanding of the staff practices that supported the development of Virtual Disability Services in Ireland amid the COVID-19 pandemic. The study involved twelve interviews with service providers, which were analysed using Reflexive Thematic Analysis, leading to two overarching themes. The first theme focuses on the logistics of constructing the response. This includes dynamic adaptiveness, technological readiness, a positive attitude towards technology, resource availability, digital skills, and the level of take-up. The second theme centres on the enacted response, which encompasses sensemaking, developing technological expertise, managing upward, fostering creative innovation, cultivating a systems sensibility, and creating conditions for psychological safety and authentic engagement. We conclude that staff practices are key for creating conditions conducive to safe spaces, sustaining well-being, and reshaping power dynamics and emphasise the importance of embracing technology as a tool for innovation within complex operating environments. POINTS OF INTEREST Virtual Services offered a good alternative to face-to-face services for some disabled people during COVID-19: they supported people to stay connected while self-isolating. Even though some staff and disabled people did not have many technology skills before COVID-19, they learned in real-time, using the resources available to them. Online relationships were seen as more equal as everyone was learning as they went. People with disabilities developed new skills and sometimes co-facilitated sessions. This gave them greater choice and control over how they interacted with services and changed power relationships within services. Having choices about how to access services is in line with enhancing rights and choice under the Convention of the Rights of People with Disabilities. Promoting digital inclusion may protect people against future societal disruptions.

A Systems and Innovation Approach to Attune Grantmaking for Early Childhood to What Matters Most at the Point of Service

A Systems and Innovation Approach to Attune Grantmaking for Early Childhood to What Matters Most at the Point of Service

Initiating medical abortion in an emergency department in the United States

ObjectivesThe primary objective of this study was to assess the feasibility of initiating medical abortions in a large, academic emergency department (ED) in the United States.MethodsA retrospective case series analysis...

Experiences of maternal healthcare delivery in South Africa: Perinatal women's viewpoints.

Becoming a mother should be an exciting experience in woman's life. No mother should have to endure adverse encounters. while seeking healthcare in any maternal services facility. this is a phenomenon occurring globally. Delivery of these maternal healthcare services has a bearing on the obstetrical outcomes of mothers from preconception until six weeks after delivery. The study aims to understand the experiences of perinatal women regarding maternal healthcare services in the public hospitals of Gauteng province in South Africa. This study followed an exploratory and descriptive qualitative approach using a purposive sampling method. The study was conducted in three selected public hospitals representing different levels of care namely, district, tertiary provincial, and academic in the Gauteng province. A total of forty-six perinatal women were selected to take part in six focus groups. Data were thematically analysed following the six steps given by Braun and Clarke (2013). Three themes emerged as follows: 1) individual 2) interpersonal reasons and 3) impact of poor complaints procedure on maternal healthcare. The study showed that maternity services rendered to perinatal women in the three selected public hospitals are affected by several factors, such as midwives' attitudes, knowledge and skills, professional ethics, communication, and delayed maternal healthcare. These findings demonstrate an urgent need for practice and policy interventions that go beyond just a routine service but quality and organised maternal healthcare services provided in public hospitals, for improved healthcare outcomes at the point of service.

Pengaruh Kualitas Pelayanan, Athmosphere Store, Bundling Product dan Point Of Purchase terhadap Impulsive Buying Melalui Corporate Image Sebagai Variabel Intervening

This research aims to examine the influence of service quality, Atmosphere Store, bundling product and point of purchase to Impulsive buying through Corporate image as an intervening variable. The study was conducted on Alfamart Members in the North Ciamis Region. Sampling is carried out using techniques propotioned stratified random sampling, with a total sample size of 210 samples, spread across 16 Alfamart stores in the North Ciamis Region. The research instrument used was a questionnaire with a Likert scale. The analysis technique used is structural equation modeling with the smartPLS application. The results of this research show that, 1) Service quality is in good condition, whereas Atmosphere Store, Bundling product, Point of purchase, Corporate image and Impulsive buying in very good condition; 2) Quality of service, Atmosphere Store, Bundling product and Point of purchase positive and significant effect on Corporate image; 3) Quality of service, Atmosphere Store, Bundling product and Point of purchase positive and significant effect on Impulsive buying; 4) Corporate image positive and significant effect on Impulsive buying; 5) Quality of service, Atmosphere Store, Bundling product and Point of purchase influence on Impulsive buying through Corporate image as an intervening variable.

Borne of necessity: pharmacy-based harm reduction and express sexually transmitted infection services

BackgroundHIV, hepatitis C virus (HCV), Sexually Transmitted Infections (STIs), and substance use disorder are interrelated epidemics. Augmented services to respond to this “syndemic” are hampered by shortages of health care workers, especially in rural areas. In an Indian Health Service hospital in rural Minnesota, the pharmacy sought to integrate harm reduction and express STI services into its scope of practice. ObjectivesProvide pharmacy-based harm reduction and express STI services to increase access to care for community members, especially those without a primary care provider. MethodsThe program was designed with input from tribal counterparts and internal medical staff. The pharmacy window was made the intake point for services for patient education, harm reduction materials, and STI testing and treatment. Collaborative practice agreements and standing orders greatly expanded the pharmacy’s ability to deliver care. Later in the program, the pharmacy was able to introduce patient incentives. ResultsFrom October 2022 to November 2023, the program had 500 visits from 101 unique patients with a median age of 36. Among users of the service, 71% did not have a primary care provider. Once patient incentives were introduced, express STI testing increased over 10-fold. The laboratory panels had a 44% positivity rate for either an STI or HCV. ConclusionsPharmacy can be an accessible and effective means of delivering harm reduction, STI, and HCV services. Patient incentives may greatly increase testing and detection of infectious diseases among patients who may otherwise not seek care.

E-Commerce Delivery Optimization with Bicycle Deliveryman and Dual Autonomous Robots

The rapid growth of e-commerce has led to a surge in package deliveries, particularly during promotional events, resulting in increased workload for deliveryman. To address this challenge, this paper explores traveling salesman problem with bike and two autonomous delivery robots-referred to as 2TSPBR. The robots, each with three different-sized cargo compartments, are responsible for delivering packages of varying sizes. When their inventory is low, they restock from the bicycle’s service points. The Variable Neighborhood Search (VNS) algorithm is employed to generate and optimize delivery routes for the bicycle and robots. The results indicate that the VNS algorithm significantly outperforms the CPLEX solver in terms of computational time, providing rapid convergence to near-optimal solutions. This study demonstrates the efficiency and effectiveness of the proposed VNS algorithm in delivering accurate solutions for the integrated delivery system.

Employer-Sponsored Medicare Advantage Plans and the 2018 Therapy Cap Repeal: Reduced Overall Spending Does Not Constrain Out-of-Pocket Costs.

Policy impacting traditional Medicare beneficiaries may have unintended effects for privately insured patients. After the repeal of a longstanding $1500 outpatient therapy cap in 2018, we aimed to evaluate if this policy change was associated with differences in use of cost of postoperative therapy after common hand surgeries, including carpal tunnel release, trigger finger release, ganglion cyst excision, De Quervain tenosynovitis release, carpometacarpal arthroplasty, and distal radius fracture open reduction/internal fixation or percutaneous pinning. The Medicare Supplement and Coordination of Benefits files from Marketscan were used. Frequency of therapy appointments, overall costs, and out-of-pocket costs were obtained. A segmented interrupted time series with Poisson and log-transformed linear regression was performed. No significant monthly change in odds of therapy use was found in the postpolicy period for patients who underwent trigger finger release, carpal tunnel release, Ganglion cyst excision, De Quervain tenosynovitis release, carpometacarpal arthroplasty, or distal radius fracture, pinning, or open reduction/internal fixation. Overall cost decreased in the postpolicy period by 2% for comprehensive plans (95% confidence interval [CI]: -0.03 to -0.01, P < 0.001), by 7% for those with exclusive provider organizations (95% CI: -0.10 to -0.04, P < 0.001), by 1% for HMOs (95% CI: -0.01 to 0.002, P = 0.01), and by 3% for preferred provider organizations (95% CI: -0.03 to -0.02, P < 0.001). In the postpolicy period, no monthly change in out-of-pocket cost was observed for patients with comprehensive, exclusive provider organization, health maintenance organization, preferred provider organization, or point of service with capitation insurance plans. Patients with employer-sponsored Medicare Advantage plans experienced increased out-of-pocket costs for therapy despite lower net costs. These data highlight an urgent need for policy ensuring that patients benefit when overall costs of care decrease.

Oregon's Hospital Payment Cap and Enrollee Out-of-Pocket Spending and Service Use

Enrollee cost-sharing and health insurance premiums have grown alongside rising hospital prices. To control prices and price growth, the Oregon State Employee plan instituted a cap on hospital facility payments in October 2019 that was found to reduce hospital prices. Yet the program's association with out-of-pocket spending and use among enrollees is unknown. To assess the association of the Oregon State Employee Plan's hospital payment cap with out-of-pocket spending and changes in service use among state employees enrolled in higher cost-sharing plans. Using data from the Oregon All Payer All Claims database (January 2014 to December 2021), a difference-in-differences analysis was conducted to examine the association of Oregon's hospital payment cap with enrollee out-of-pocket spending and service use. The main analysis focused on the outpatient setting, where there were significant declines in hospital prices. Changes in a subpopulation of employees enrolled in higher cost-sharing plans were also examined. The primary outcome was outpatient out-of-pocket spending per procedure, which included the copayment, coinsurance, and/or deductible paid at the point of service. Changes in service use were also examined by counting the number of outpatient procedures received per enrollee per year. The outpatient sample included 1 094 083 procedures from 92 523 Oregon educators and 4 510 342 procedures from 473 621 control enrollees. During the period before implementation, Oregon educators had higher out-of-pocket spending per outpatient procedure than the control group ($69.26 vs $41.87). The hospital payment cap was associated with a $6.60, or 9.5%, reduction in out-of-pocket spending per procedure (95% CI, -12.7 to -0.5) and a 0.24, or 4.8%, increase in the number of outpatient procedures received per enrollee per year (95% CI, 0.09-0.39) among those in higher cost-sharing plans. Enrollees receiving outpatient services from October 2019 through December 2021 saved an estimated $1.8 million. However, savings for the state were $10.3 million less than they would have been absent increases in service use. The study findings suggest that enrollees may benefit from reduced out-of-pocket spending due to hospital price regulations, but states should be mindful that price regulations may inadvertently increase health care service use.

No Association Between Medicare Advantage Providers' Network Restrictiveness and Star Rating Between 2013 and 2017: An Observational Study.

Medicare beneficiaries are increasingly enrolling in Medicare Advantage (MA), which employs a wide range of practices around restriction of the networks of providers that beneficiaries visit. Though Medicare beneficiaries highly value provider choice, it is unknown whether the MA contract quality metrics which beneficiaries use to inform their contract selection capture the restrictiveness of contracts' provider networks. We evaluated whether there are meaningful associations between provider network restrictiveness (across primary care, psychiatry, and endocrinology providers) and contracts' overall star quality rating, as well as between network restrictiveness and contracts' performance on access to care measures from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Medicare Advantage contracts with health maintenance organization (HMO), local preferred provider organization (PPO), and point of service (POS) plans with available data. A cross-sectional analysis using multivariable linear regressions to assess the relationship between provider network restrictiveness and contract quality scores in 2013 through 2017. Statistical significance in the relationship between network restrictiveness and contract performance on quality measures. Across all study years, we included 562 unique contracts and 2801 contract-years. We find no evidence of consistent relationships between MA physician network restrictiveness and contract star rating. For primary care, psychiatry, and endocrinology, respectively, a 10 percentage point increase in restrictiveness was associated with a 0.02 (95% confidence interval [CI] -0.01 to 0.04), 0.0008 (95% CI, -0.01 to 0.02), and -0.01 (95% CI, -0.01 to 0.001) difference in star rating (p-value > 0.05 for all). Similarly, we find no evidence of consistent relationships between network restrictiveness and access to care measures. Our findings suggest that existing MA contract quality measures are not useful for indicating differences in network restrictiveness. Given the importance of provider choice to beneficiaries, more specific metrics may be needed to facilitate informed decisions about MA coverage.

Exploring the correlation between courier workload, service density and distance with the success of last-mile and first-mile reverse logistics

AbstractGiven the recent surge in online sales, particularly accentuated by the health crisis in 2020 and 2021, companies operating in the retail sector have increasingly recognised the importance of business-to-consumer (B2C) distribution. Consequently, last-mile logistics optimization has garnered increased attention in both academic and industry contexts. In this study, we examine the relationship between the workloads of couriers and their proficiency in executing assigned services in a B2C last-mile and first-mile reverse logistics environment. Additionally, we evaluate the connection between service density in an area and the distance between warehouses and service points with completion rates among couriers. By analysing a dataset corresponding to the deliveries and collections made in Madrid in 2021, we identify significant and moderate correlations between the couriers’ workloads and service completion rate. It should be noted that the correlations of completion rate with distance and visit frequency to each area are weak, yet statistically significant.

An investigation of an outbreak of Salmonella Typhimurium infections linked to cantaloupe – United States, 2022

In 2022, the Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC), and state health and regulatory partners investigated an outbreak of Salmonella enterica serovar Typhimurium infections linked to cantaloupes from southwest Indiana, resulting in 87 ill persons and 32 hospitalizations reported in 11 states. Epidemiologic and traceback evidence confirmed cantaloupe as the vehicle for these infections. Based on records collected by FDA, traceback of cantaloupe exposures for 14 ill people converged on a packing house in southwest Indiana, which supplied cantaloupe to eight of the 11 points of service where ill people purchased cantaloupe. Salmonella isolates were recovered from environmental samples collected by FDA from three growers and a packing house in southwest Indiana. Whole genome sequencing analyses of these isolates found that isolates collected from one grower matched the Salmonella Typhimurium outbreak strain, and samples collected from the other two growers and the packing house matched a 2020 Salmonella Newport outbreak strain. State and federal public health and agricultural partners identified potential conditions and practices that could have possibly resulted in the contamination of cantaloupe, including the presence of Salmonella spp. in on-farm, post-harvest, and off-farm environments. This is the third outbreak of salmonellosis confirmed to be linked to melons, sourced from southwest Indiana in the last decade. The 2012, 2020, and 2022 outbreaks of reoccurring and persisting strains of Salmonella illustrate the need for additional efforts to determine the source and extent of environmental contamination in the melon growing region of southwest Indiana and for outreach and education to help promote practices to reduce contamination of melons.

Clients’ Satisfaction with the Services of the National Health Insurance Scheme at the Moddibo Adama University Teaching Hospital, Yola, Adamawa State

Background: Worldwide, patient satisfaction is one of the cardinal indices for evaluating the quality of healthcare service delivery and the effectiveness of a healthcare system. As consumers of healthcare services, patients have expectations that need to be met. Objective: To assess clients’ satisfaction with the quality of care rendered through the National Health Insurance Scheme in a Nigerian Specialist Medical facility. Methods: This was a descriptive, cross-sectional study of 403 respondents selected randomly from NHIS enrolees attending the Federal Medical Centre, Yola. The study assessed the enrolee's level of satisfaction at the various service points using a self-administered, semi-structured questionnaire. Results: The overall average satisfaction score was 61.0.%. The satisfaction score on the various aspects of service was as follows: hospital environment/cleanliness (87.9%), doctors’ consultation (74.2%), reception/registration (69.5%), laboratory services (64.3%), waiting time (64.2%), staff attitude (60.5%), and availability of prescribed drugs (48.2%) been the lowest. Conclusion: Overall, patients' satisfaction with the services provided was good, with the hospital environment/cleanliness rated highest and the availability of prescribed drugs the lowest. The current level of patient satisfaction needs to be improved by making drugs more available in the NHIS pharmacy and improving the attitude of staff to work and clients.

The Influence of Office Layout, Work Facilities, and Work Environment on Work Effectiveness of SPX Express Service Point Employees Tangerang Branch

This study aims to analyze the influence of office layout, work facilities, and work environment on work effectiveness. This study used quantitative descriptive approach as a method. The population in this study were employees of SPX Express Service Point Tangerang Branch, which consisted of 40 people. The sampling method used was saturated sample. The data was collected using survey, with the questionnaire as the instrument. The data were analyzed by using the SEM-PLS method with the SmartPLS program. The result of this study proves that office layout and work environment have a positive and significant effect on work effectiveness. Meanwhile, work facilities do not have a significant effect on work effectiveness.

Capacity Planning to Increase Mechanic Availability in After-Sales Service at PT. Elang

After-sales service is critical in selling products such as heavy equipment, which require maintenance from mechanics who understand the product. PT. Elang is one of Indonesia’s heavy equipment distributors and provides service support after purchase. The company currently struggles to manage the mechanics for repair requests from customers. Most of the time, the mechanics are already dispatched for regular maintenance, so repair requests are challenging to respond quickly to because of the unpredictable nature of the case. Complaints and bad reviews on after-sales service lead to lost customers and significant revenue loss. This study aims to identify the gap between current and ideal capacity, look for the root causes through the business process review to find where improvement is needed and provide a suitable solution for the company. The qualitative and quantitative methods were used in this study. The qualitative method was through interviews and discussions with the head of service support and the branch operation head to understand the situation and process. The business process related to the issue was then analysed with Business Process Modeling and Notation (BPMN) and the root cause was found using the Current Reality Tree (CRT) method. The quantitative method was through the sales and capacity data collected from the company. The best alternative solution was selected using the Analytic Hierarchy Process (AHP) using XLSTAT. This study showed that the problem happened because of two root causes: an inadequate number of mechanics and no sufficient integrated system to support the information flow through related divisions. Three alternative solutions were proposed based on the root causes. After the AHP calculation and analysis, the results were confirmed with the head of service support, and it was concluded that the solution that could be implemented in the company is providing service points with a priority result of 71.03%. The next alternative is to implement the cloud ERP system with a result of 15.04% and outsource mechanics with a result of 13.93%. With this solution, the company considered a long-term approach with more sustainability and scalability criteria than ease of implementation. The order of criteria priorities are cost, effectiveness, sustainability, scalability, and ease of implementation, with a consecutive result of 47.87%, 24.3%, 12.64%, 6.6%, and 8.59%.

INTEGRATION OF THE TRANSPORT SYSTEM OF LVIV OBLAST INTO THE EUROPEAN IN THE CONTEXT OF FORCED POPULATION MIGRATION

Transport logistics is designed to promote accessibility and mobility in society. When all the links in the system are in place, the movement of goods and services can be launched without additional intervention. However, sometimes situations arise that destabilise the logistics scheme in a particular transport network in one way or another. In Ukraine, this became apparent after the start of the full-scale Russian invasion. The article reveals the system of factors that influence the process of integration of the transport system in a cross-border region and identifies indicators of transport infrastructure integration. The Russian-Ukrainian war has led to mass migration towards the European Union. Border crossing points became overloaded, which slowed down traffic during the crossing. Further, the number of trucks used to transport imports, such as military and humanitarian aid, increased. Queues to neighbouring countries, including Poland, also formed. The study describes the spatial aspects of the functioning of crossing points on the Ukrainian-Polish border, as well as the road and railway network of Lviv Oblast and Subcarpathian Voivodeship. Border crossing points for road transport are constantly loaded with heavy vehicles. The road and railway networks of the Lviv region are more extensive, which ensures high accessibility not only to close but also to remote points. The article examines motorways from the territory of Lviv Oblast to Poland. These motorways are laid to the Subcarpathian and Lublin voivodeships. The authors identify separate motorways and logistics hubs to speed up and make the connection between Ukraine and Poland more accessible. The first priority in such planning should be the creation of new border crossing points. Within the region, it is advisable to develop meridional roads from the state border towards mountainous areas. The study examines the number of buses among all international connections to Poland. The most regular is the Lviv – Warsaw Airport (Modlin) connection, which is associated with the active movement of migrants to one of the largest aviation hubs in Eastern Europe. It was determined that the westernmost end point of the bus service is Trier in Germany. There are no bus services from Lviv to Romania. The scientific publication presents railway lines of different categories (single-track diesel and double-track electrified) that connect Ukraine and Poland through the territory of Lviv Oblast. It has been established that the European gauge railway is included in the railway stations Mostyska-2, Rava-Ruska, Khyriv. However, most Ukrainian trains run to stations in Poland without changing wheelsets. This is typical for routes running from Lviv to Przemyśl. The achievement of the Ukrainian and Polish railway operators is to create interchange routes, for example, from Lviv to Warsaw. The potential of the Rava-Ruska railway junction needs to be developed by running other trains. The article mentions that Yurii Borsuk has been actively developing new connections, including Kyiv – Rava-Ruska with a transfer to Warsaw. The authors propose the idea of connecting Lviv and the nearest European cities using the European 1435 mm gauge. The article highlights the benefits of building the Mostyska-2 – Lviv railway. One of the important aspects of this connection could be the acceleration of export cargo transportation to the European Union. Keywords: transport system, railway infrastructure, road transport, integration, Ukraine, Poland.

Health insurance plans offered at NCI-designated cancer centers.

9052 Background: The health insurance landscape in the US represents an expensive and complex challenge to patients and physicians alike. Little is known about health insurance plans (HIPs) offered to physicians, particularly at NCI-designated cancer centers, which represent centers seeking to meet the highest standards. Methods: We collected data on the HIPs offered to physicians at NCI-designated cancer centers by reviewing institution websites from 11/2023 - 01/2024. We abstracted data on the insurance premium, deductible, out-of-pocket (OOP) maximum, and coinsurance for hospitalizations, limited to three HIPs per institution. We derived estimates using the lowest charge. We calculated inpatient stay costs based on standard hospital stay costs ($2,883 per day over an average of 4.5 days). We compared HIPs between public and private cancer centers. We used US Census Bureau population density data and regression models to explore associations among population density and OOP costs. Results: Among 65 NCI-designated cancer centers reviewed, 61 (93.8%) had readily available information about HIPs provided. Most institutions provided HIPs for all hospital employees, while 2 institutions only covered physicians. On average, each cancer center offered 3.67 HIPs, involving 1.67 insurers (54.1% offered a single insurer). Among 153 HIPs overall, 51.6% were preferred provider organization (PPOs) and one-third (33.3%) were health maintenance organization (HMOs). Only 22.9% of HIPs were high-deductible health plans (HDHP). The majority of cancer centers offered PPO plans (75.4%), HMO plans (57.4%), HDHP plans (55.7%), and some (24.6%) offered other plans, such as point of service and exclusive provider organization. Average costs for different kinds of HIPs are presented in the Table. A higher percentage of public cancer centers provided HMOs (60.5% vs. 50.0%, p=0.76) and PPOs (84.3% vs. 60.5%, p=0.09) than private centers, yet differences did not reach significance. Centers located in regions with higher state population density were more likely to have higher HMO OOP costs (beta=2.72; p=.006) and lower PPO OOP costs (beta=-2.98; p=.012). Conclusions: We found that most NCI-designated cancer centers had readily available information about HIPs provided to physicians. For these centers, physicians had limited HIP options offered, particularly in private institutions, which offered fewer HMO and PPO plans. We also demonstrated associations among state population density and OOP max in HMO and PPO plans. Our study provides a current synopsis of HIPs and identifies disparities among them, contributing to a foundation for future research. [Table: see text]