Supplementary Health Insurance Research Articles

Low uptake of gynecological consultation following domestic or sexual violence: A case-control study during pregnancy follow-up

ObjectiveThe aim of this study was to examine the association between exposure to domestic and sexual violence and low uptake of gynecological consultation. Study designBetween October 2021 and October 2022, a case-control studywas conducted in mother andchild centers and sexual health centers in the Paris, France area. The case group included pregnant women who did not have a scheduled gynecological consultation in the past two years. The control group included pregnant women who had a scheduled gynecological consultation in the past two years. Pregnant women were interviewed using a standardized questionnaire about a history of domestic and sexual violence, the date of their last gynecological consultation and the gynecological health. ResultsA total of 405 pregnant women were included in the case group (n = 129) or in the control group (n = 276). After adjustment for age, couple, social security, supplementary health insurance, dyspareunia, abnormal vaginal discharge, dysmenorrhea, regular pelvic pain, mastodynia, vulvodynia and history of difficult delivery, a history of intimate partner violence was associated with the absence of a gynecological consultation in the past two years (OR 2.13; CI95% 1.21–3.73, p = 0.008). A history of sexual violence, regardless of age, was associated with the absence a gynecological consultation in the past two years (OR 1.92; CI95% 1.05–3.49, p = 0.03). The absence of a gynecological consultation was associated with dyspareunia and domestic or sexual violence (p < 0.0001 and p < 0.0001, respectively). ConclusionsThis study highlighted the association between domestic and sexual violence and the absence of gynecological consultations in the past two years. It underlines the importance of screening for domestic and sexual violence during gynecological consultations and its impacts on mental health, in particular psychotraumatic symptoms, and on gynecological health, in particular dyspareunia.

The Role of Supplementary Insurance in Achieving Universal Health Coverage: A Comprehensive Review.

The gradual movement towards universal health coverage (UHC) is an important issue in many countries. The aim of this study is to identify the role of supplementary health insurance in achieving universal coverage. This comprehensive review study was conducted to identify the role of supplementary health insurance in achieving universal health coverage. 4894 articles were found in the search in databases (Scopus, PubMed, and Web Science), and finally42 articles were selected. Considering the criteria of titles and abstracts, the reviewed articles were assessed, and a thematic analysis approach was used to analyze the collected data. The review showed 52 Sub dimensions in 7 dimensions. Policymakers can draw on international experiences to ensure that private health insurance contributes to achieving universal health coverage by Providing clarity within the national health financing policy framework regarding the role of private health insurance. Enhancing understanding of how supplementary health insurance impacts the performance of the healthcare system. They are improving oversight of private health insurance, regulating financial protection and consumer support, and implementing thorough market surveillance and proper allocation of health subsidies between the private and public sectors. Supplementary insurance holds promise as a complementary tool in achieving universal health coverage. Addressing gaps in primary insurance and providing additional financial protection can contribute to enhanced access, improved quality of care, and reduced financial barriers to healthcare services. However, careful attention must be given to affordability, equity, regulation, and coordination with primary insurance schemes to ensure its effective implementation and prevent unintended consequences.

Willingness to pay for an mRNA-based anti-cancer treatment: results from a contingent valuation study in Israel.

mRNA technology is currently being investigated for a range of oncology indications. We assessed the willingness to pay (WTP) of the general population in Israel for a hypothetical novel mRNA-based treatment for oncology indications. We used a contingent valuation methodology to elicit WTP using a web-based questionnaire. A sample of adult participants were presented with a hypothetical scenario in which an mRNA-based intervention increased the likelihood of a cure for various cancer types from 20% to 40% (half of the sample), or 60% (the other half of the sample). 531 respondents completed the questionnaire. The mean, median and mode WTP for the proposed hypothetical treatment in both scenarios were ILS65,000 (± ILS114,000), ILS20,000 and ILS50,000, respectively (1USD = 3.4ILS). The WTP was skewed towards zero, and 9.6% of the respondents were not willing to pay any amount. WTP higher amounts was significantly associated with higher income (p < 0.01), self-reported good health (p < 0.05), supplementary health insurance (p < 0.05), Jews compared to other populations (p < 0.01), interest in technology (p < 0.001) and a tendency to adopt medical innovations (p < 0.001). No statistical difference between the 40% vs. the 60% potential cure scenarios was found. Logistic and OLS regressions indicated that age, religion, income, and interest in adopting medical innovations were the best predictors of respondents' WTP. Despite the scientific breakthroughs in oncology treatment over the last few decades, many types of cancer are still incurable. Given the expected development of innovative mRNA-based treatments for cancer, these results should inform policymakers, the pharmaceutical industry and other stakeholders on the future coverage and reimbursement of these technologies incorporating patients' and societal views. To date, WTP considerations have not been given much weight in prioritization of drug reimbursement processes, neither in Israel nor in other countries. As a pioneer in adoption of the mRNA technology, Israel can also lead the incorporation of WTP considerations in this field.

Effect of supplementary private health insurance on out-of-pocket inpatient medical expenditure: evidence from Malaysia.

The vital role of healthcare financing in achieving universal health coverage is indisputable. However, most countries, including Malaysia, face challenges in establishing an equitable and sustainable healthcare financing system due to escalating healthcare costs, an ageing population and a growing disease burden. With desirable pre-payment and risk pooling features, private health insurance (PHI) is considered an alternative financing option to reduce out-of-pocket (OOP) medical expenditure. However, ongoing theoretical and empirical debates persist regarding the adequacy of financial risk protection provided by PHI largely because it depends on its role, the benefit design and the regulations in place. Our study aimed to investigate the effect of supplementary PHI on OOP inpatient medical expenditure in Malaysia. Secondary data analysis was conducted using the Malaysian National Health and Morbidity Survey 2019 dataset. A total of 983 respondents with a history of inpatient hospitalization in the past 12 months were included in the study. Instrumental variable analysis using a two-stage residual inclusion was performed to address endogeneity bias, with wealth status and education level as the instrumental variables. Tobit regression model was used in the second stage considering the censored distribution of the outcome variable. Missing data were handled using multiple imputation. About one-fifth of the respondents had PHI. In this study, we found that having PHI significantly increased OOP inpatient medical expenditure in all three marginal effects. Additionally, age, residential location, ethnicity (citizenship), being covered by government guarantee letter, government funding and employer-sponsored health insurance were other significant factors associated with OOP inpatient medical expenditure. Our findings undermine a key justification to advocate PHI uptake among the population, with a need for the Malaysian government to reassess the role of PHI in healthcare financing and reconsider PHI subsidization policy. Regulations should also be strengthened to enhance the financial risk protection provided by PHI.

Identifying, Prioritizing, and Assessing Factors Influencing Customer Satisfaction Covered by Supplemental Insurance: A Mixed-Method Study

Background: With increasing specialization in various sectors of the market environment, it has become essential to identify customer satisfaction indicators and prioritize them to enhance the provision of supplementary health insurance services. Objectives: This study aimed to identify, prioritize, and assess satisfaction indicators among individuals covered by supplemental insurance. Methods: This exploratory mixed-method study involved 20 participants, including university faculty members, managers, and insurance experts in Khuzestan province. In the qualitative phase, a scoping review of relevant literature was initially conducted using electronic databases such as Scopus and Web of Science to extract key axes. Subsequently, in two stages of fuzzy Delphi, relevant indicators were extracted and then prioritized by a panel of experts using the fuzzy AHP method. Results: A total of 33 articles were retrieved through the database search. Following semi-structured interviews, 11 indicators were identified, including premium, insurance obligations limit, timely payment of expenses, provision of online services, respectful treatment, reasonableness of required documents, waiting period, complaint handling, franchising information, and discrimination in service provision. Among these factors, the premium had the highest priority, with a final weight of 0.190. Conclusions: The results highlight the significance of premium as the most influential factor in the study. Therefore, insurance company managers should focus on increasing insured individuals' satisfaction and enhancing their companies' overall perception.

Dopunsko zdravstveno osiguranje u funkciji doprinosa razvoju održivog sistema zdravstvene zaštite u Republici Srbiji

Law on Health Insurance regulates three types of voluntary health insurance - complementary, supplementary and private health insurance. These are promising insurance products and the author selected supplementary health insurance. What is the potential of this type of cover? What are conditions for its development? Are the institutional prerequisites for creating a sustainable healthcare system fulfilled in our legislation? After analyzing the relationship between supplementary and voluntary health insurance, the author singles out the health literacy of citizens, potential service users as a prevailing factor in the current regulatory framework. By promoting supplementary health insurance as a product directly linked to compulsory health insurance a message is being sent that the healthcare cost risk in one part of compulsory healthcare can be transferred to insurers offering voluntary health insurance. Author proves that this encourages the inclusion of private insurers in financing the costs of compulsory healthcare, thus achieving cooperation between the private and state sectors with the aim of sustainable development of the healthcare system.

Insurance coverage during transitions: Evidence from Medicaid automatic enrollment for children receiving supplemental security income.

To analyze relationships between Medicaid automatic enrollment for child Supplemental Security Income (SSI) recipients and health insurance coverage during transitions. Medical Expenditure Panel Study, 2000-2020 and National Survey for Children with Special Health Care Needs, 2001-2010. Leveraging variation in SSI-Medicaid automatic enrollment status across regions and over time, we estimate a regression model to quantify associations between automatic enrollment and insurance coverage. We validate our findings in the NS-CSHCN. Our sample includes children receiving SSI for a disability. We also analyze a subsample of children newly enrolled in SSI. Automatic enrollment is associated with a statistically significant increase in insurance coverage. Expanding automatic enrollment to all states is associated with increases in Medicaid enrollment of 3% (CI 0.9%-6.7%) among all SSI children and 7% (CI 1.1%-13.9%) among children newly enrolled in SSI. We find similar decreases in uninsurance. Analysis in the NS-CSHCN replicates these findings. Medicaid automatic enrollment policies are associated with increased insurance coverage for SSI children, particularly those transitioning into the program. Medicaid policy defaults could play an important role in reducing administrative burdens to improve children's coverage and access to care.

Investigating the level of satisfaction of policyholders with supplementary health insurance in Iran

The importance of customer satisfaction in business prosperity is undeniable, so many organizations consider customer satisfaction as the main driver of their business growth and try to keep their customers satisfied. The business market has never been so competitive in most areas. This is the reason why things like customer experience and customer loyalty are more and more important and are considered an indicator to measure the success of the business. Based on this, in this research, we will examine the level of satisfaction of insurance policyholders with supplementary health insurance services in Iran using the SERVQUAL model. This model is one of the most common models used in the field of quality assessment in the service sector. The method of conducting this research is a descriptive survey. The sampling method in the current research is simply random the statistical population is insurance policyholders and the sample number is 686 people from the society. The findings of the current research showed that there is a negative and significant gap in all dimensions of service quality.

Effects of private health insurance on medical expenditure and health service utilization in South Korea: a quantile regression analysis

BackgroundDespite universal health insurance, South Korea has seen a sharp increase in the number of people enrolled in supplemental private health insurance (PHI) during the last decade. This study examined how private health insurance enrollment affects medical expenditure and health service utilization.MethodsUnbalanced panel data for adults aged 19 and older were constructed using the 2016–2018 Korea Health Panel Survey. Quantile regression for medical cost, and quantile count regression for health service utilization were utilized using propensity score-matched data. We included 17 variables representing demographic, socioeconomic, and health information, as well as medical costs and use of outpatient and inpatient care.ResultsWe discovered that PHI enrollees’ socioeconomic and health status is more likely to be better than PHI non-enrollees’. Results showed that private health insurance had a greater effect on the lower quantiles of the conditional distribution of outpatient costs (coefficient 0.149 at the 10th quantile and 0.121 at the 25th quantile) and higher quantiles of inpaitent care utilization (coefficient 0.321 at the 90th quantile for days of hospitalization and 0.076 at the 90th quantile for number of inpatient visits).ConclusionsPHI enrollment is positively correlated with outpatient costs and inpatient care utilization. Government policies should consider these heterogeneous distributional effects of private health insurance.

The Health Insurance Situation in Iran: A Brief Overview

The financing process of the health system includes the collection, accumulation, and management of financial resources to purchase health services. Sustainable financing of the health system is a core function, which can enable progress towards universal health coverage (UHC). There are multiple funding sources to finance health care services in Iran, including out-of-pocket payment, government funds, general taxation, health insurance, and individual donations. Inefficiency in health insurance systems has led to an increase in out-of-pocket payments, and ultimately catastrophic expenditures. According to the results of the household income-expenditure survey in 2017, about 17% of the population faced catastrophic expenditures by spending more than 10% of their total consumption expenditure on health, and 75% of exposure to catastrophic expenditures (equivalent to 13% of population) was only due to paying out of pocket to receive medical services. (1) According to the health insurance coverage in 2010, about 84% of the total population in Iran was covered by various insurance plans and supplementary health insurance included 20% of the total population. (2) After the recent reforms entitled as the "Health Transformation Plan" launched in 2014, more than 90% of the population was covered by health insurance. However, the services were not fully covered by insurance benefits and only included inpatient health services. In addition, the insurance share was free for patients, which increased moral hazard from patients and induced demand from providers. Finally, this reform plan was stopped due to the instability of resources. Among the disadvantages of this type of insurance, the following can be mentioned: 1. All people could register in this insurance without any limitation. 2. The insurance premium was very small and negligible. So, it was not considered as an insurance because there was not the accumulation of risk, which is one of the main characteristics of any insurance industry. 3. Considering that many people were covered in this type of insurance, the depth and level of service coverage were reduced due to limited resources. In this insurance type, financing was from the government and there was no assessment for individuals; and it was a kind of support fund or support package. So, it was stopped at some point after the health transformation plan. Although Article 10 of the General Insurance Law in Iran refers to determining the scope and medical services and drugs, (3) there are no criteria to evaluate the covered packages. Despite the UHC's goal of increasing the number and variety of services for patients, many services for specific diseases, palliative care, etc. are not covered by the basic insurance. Also, some services such as dental and optometric services are considered a luxury service and are not covered by basic insurance. The lack of resources to provide proper services to the insured people and the impossibility of receiving the services from the private sector using health insurance benefits are other challenges of this type of insurance. Finally, Iran has not been able to achieve UHC due to the lack of proper management capacity in the insurance sector. To realize universal health coverage and improve outcomes, policymakers must consider several demand and supply factors. In this regard, expansion of infrastructure, human resources, and health services can be effective from the supply perspective. Meanwhile, increasing health insurance coverage, expanding health benefits package, and reducing the contribution of people in paying expenses using payment methods with a certain ceiling such as per capita and quality-based payment can be effective from the demand perspective. Also, the existence of comprehensive and transparent information systems, especially the system for identifying vulnerable and low-income groups, can greatly contribute to the successful implementation of UHC. Finally, designing suitable financial and non-financial incentives can also lead to increasing the satisfaction of professionals and health sector employees.

The 2023 Impact of Inflammatory Bowel Disease in Canada: Indirect (Individual and Societal) and Direct Out-of-Pocket Costs.

People living with inflammatory bowel disease (IBD) and their caregivers are faced with indirect and out-of-pocket costs that they would not otherwise experience. These costs impact one's ability to contribute to the economy to their fullest potential. The indirect costs of IBD in Canada are estimated to be at least $1.51 billion in 2023 and include costs associated with lost productivity resulting from a combination of missed work (absenteeism), decreased workplace productivity (presenteeism), unemployment, premature mortality, and caregiving costs. Unemployment is the largest contributor to indirect costs ($1.14 billion), followed by costs of absenteeism and presenteeism ($285 million). Caregiving costs for children with IBD are estimated to be nearly $58 million. Canadians with IBD also pay $536 million every year for care that is not covered by universal or supplemental private health insurance; this includes allied healthcare (e.g., care provided by psychologists), medication, and other supportive therapy. Combined, the indirect and out-of-pocket costs of IBD in Canada are estimated at more than $2 billion CAD in 2023. This is substantially higher than the estimate of $1.29 billion in Crohn's and Colitis Canada's 2018 Impact of IBD report with differences attributable to a combination of rising prevalence, inflation, and the addition of presenteeism and caregiving costs to the total indirect costs.

Utilization of public and private healthcare facilities: patient choice

Healthcare system in Russia lets patients choose where they want to get medical services: at public or private healthcare facilities. This choice may depend on several factors. According to Andersen’s healthcare utilization model, these factors can be divided into three groups: predisposing, enabling and need factors. The purpose of this study is to identify factors determining patient choice between public and private healthcare providers in Russia. Statistical and regression analysis was carried out using 2019 Rosstat data. We found that men and people from older age groups were more likely to attend public facilities, while people with higher education, employed and living in larger cities were more likely to attend private clinics. Higher income, having supplemental health insurance, and receiving medical services outside one’s city were associated with an increase in probability of using private healthcare providers. Analysis of need factors showed that worse health in individuals was associated with increased probability of choosing private medical organizations, whereas disability was associated with decreased probability of making the same choice.

Unintended consequences of healthcare reform in South Korea: evidence from a regression discontinuity in time design

BackgroundTo address concerns over the financial stability of South Korea’s National Health Insurance (NHI) programme, the government transitioned from an outpatient copayment system to a coinsurance system in 2007. This policy aimed to reduce healthcare overutilization by increasing patients’ financial responsibility for outpatient services.MethodsUsing comprehensive data on NHI beneficiaries, this study employs a regression discontinuity in time (RDiT) design to assess the policy’s impact on outpatient healthcare utilization and expenditures. We focus on changes in overall outpatient visits, average healthcare cost per visit and total outpatient healthcare expenditures.ResultsOur findings indicate that the transition from outpatient copayment to coinsurance led to a substantial increase in outpatient healthcare utilization (up to 90%) while decreasing medical expenditures per visit by 23%. The policy shift incentivized beneficiaries to seek more medical treatments during the grace period and enroll in supplemental private health insurance, which provided access to additional medical services at lower marginal costs.ConclusionsThe policy change and the emergence of supplemental private insurance contributed to moral hazard and adverse selection issues, culminating in South Korea becoming the country with the highest per capita utilization of outpatient health services worldwide since 2012. This study underscores the importance of carefully considering the unintended consequences of policy interventions in the healthcare sector.

The LACE index and risk factors of 14-day versus 30-day readmissions in children.

Risk factors for readmissions in children differ from those for adults, yet little is known about whether the LACE index (Length of stay, Acute admission, Charlson comorbidity index, Emergency department visits in the previous 6 months) developed for adults retains its validity when applied to the prediction of readmissions in children or within shorter intervals of time after discharge. In this retrospective cohort analysis of 4 256 patients aged≤18 hospitalized at one academic medical center in Taiwan, 2019, we first evaluated the performance of a LACE index model and the three other multivariate logistic regression models in their predictions of hospital readmissions in children using the same time intervals of 30 days. We then used multinomial logistic regression to analyze the characteristics and risk factors for readmissions that occur in the first 14 days with those that occur between 15 to 30 days after discharge. The optimal cutoff of LACE index score for children in the current study was 7, which is less than the optimal score of 10 in the original derivation for adults. The predictive model with the least discriminatory power was based on LACE score alone, whereas our model that included only two variables (length of stay and the number of admissions in the past one year) was found to outperform LACE index. Multinomial logistic regression results revealed that children who had supplemental private health insurance had lower readmission rates than those insured by National Health Insurance program only, suggesting a disparity by insurance status. Some risk factors of readmission within 14 days such as acute admissions and supplemental private health insurance were not found to be relevant for longer-term predictions, while age, which was a valid predictor of readmission within 15 to 30 days, did not affect the prediction of shorter-term readmissions. Prior healthcare utilizations and a higher illness burden were found to be greater contributors to readmissions beyond 14 days. Our simpler model outperformed the more complex LACE tool in identifying children at risk of readmission. Shorter-term readmissions can be attributed to different causes than 30-day readmissions, suggesting a need for different screening tools, interventions, and care support. There remains some socioeconomic disparity associated with readmission rates in the current healthcare system.

In Case You Haven't Heard…

Fully 73% of Generation Z employees and 74% of millennial employees have utilized mental health benefits offered by their employers, while 58% of Generation X employees and 49% of baby boomer employees have used the benefits, the news release service, Business Wire, reported on March 6. Securian Financial, a leading provider of group life and supplemental health insurance benefits, conducted a survey of 2,500 employees of American organizations between Aug. 30 and Sept. 9, 2022. Among the findings, Gen Z, the youngest generation of professionals who are still early in their careers or just entering the workforce, expect access to mental health services and any historical barriers to access to be fixed already. Leveraging mental wellness resources is normalized for this generation. Millennials were raised to believe mental health challenges are problematic but fixable. They're inclined to have the attitude of rolling up their sleeves and getting to work. Gen X recognizes access to mental health services can be problematic but just tries to get through it. Baby boomers, the oldest generation with representation still in the workforce, were taught to tough it out and not talk about mental health challenges.

Effect of supplementary private health insurance on inpatient utilisation: Evidence from Malaysia

Supplementary private health insurance (PHI) provides better access to healthcare, improves health outcomes, potentially lowers the costs for health systems and supports the social security system. Improperly regulated PHI, however, may aggravate inequity of access towards preferential care and encourage moral hazard among PHI purchasers, altering the health-seeking behaviour, which is often observed through the pattern of health care utilisation. We investigated the effect of PHI ownership on private inpatient care utilisation, its frequency of admission and length of stay by conducting secondary data analysis of the Malaysian National Health Morbidity Survey (NHMS) 2015 data, a nationally representative community health survey. Malaysian adults 18 years of age and above who utilised inpatient healthcare facilities were included. In this cross-sectional study, we addressed the endogeneity effect of health insurance by employing instrumental variable estimation and a two-stage residual inclusion analysis. We found a significant increase in private inpatient utilisation among those who owned PHI compared to those who did not (β = 4.39, p < 0.001). There was no significant difference in the frequency of admission and length of stay. The increase in private inpatient utilisation among PHI owners may reflect the demand for timely care and hospitality provided by the private sector, potentially exacerbating the moral hazard behaviour among PHI owners. Further exploration of this issue could impact future healthcare systems financing designs and PHI regulation.

Medo da COVID-19 ao vivenciar a gestação ou parto na pandemia: quais os fatores associados?

ABSTRACT Objective: to identify factors associated with fear of COVID-19 among women who experienced pregnancy or childbirth during the pandemic. Methods: a cross-sectional study, nested within a prospective cohort, using an online survey, from August 2021 to February 2022, based on descriptive data analysis. Results: of the 431 participants, 52.8% were postpartum women and 20.1% were pregnant women. With regard to fear of COVID-19, a mean score of 20.46 was obtained (moderate fear). The highest fear scores were present in women whose newborns were admitted to hospital in neonatal critical units (p=0.032), and the lowest among those covered by supplementary health (insurance) (p=0.016). Conclusion: among pregnant and postpartum women, high fear of COVID-19 translated into the possibility of having newborns admitted to hospital in a critical unit. The importance of supporting actions to support pregnant/postpartum women’s mental health in relation to COVID-19 or other threats that may influence the neonatal outcome stands out.

Healthcare resource use in myasthenia gravis: a US health claims analysis.

There are limited data on the impact of myasthenia gravis (MG) on real-world healthcare resource use (HCRU) and patient burden in the United States. This study aims to assess HCRU in patients with MG using data from a US health claims database. A retrospective, database study of adult patients newly diagnosed with MG, using the IBM® MarketScan® Commercial Claims and Encounters and Medicare supplemental health insurance claims database. Patients with ⩾2 MG International Classification of Disease diagnosis codes ⩾3 months apart were followed from the date of their first MG diagnosis record or start of treatment. HCRU and use of immunoglobulins and plasma exchange during follow-up was assessed, as well as comorbidities, hospitalizations, emergency room (ER) visits, intensive care unit (ICU) admissions, and specialist visits per year after diagnosis, and compared with age- and sex-matched non-MG controls. During 2010-2019, 7194 patients were followed for up to 10 years (median = 2.3 years). During follow-up, patients with MG were 2.6-fold more likely than controls to be hospitalized, and 4.5-fold more likely to be admitted to an ICU. Risk and numbers of ER admission, hospitalization, and ICU visits were the highest in the 12 months post-diagnosis of MG and were consistently higher than controls during follow-up. MG was the main cause for most hospitalizations. Patients with MG have higher HCRU, compared with the age- and sex-matched non-MG controls. The early years after MG diagnosis are a period of particularly high healthcare burden, with many patients requiring hospitalization and ICU care to manage serious exacerbations.

Discrimination towards Youth in Goods and Services Markets: Evidence from Field Experiments in France

In this study, we carried out seven distinct and independent rounds of correspondence tests to detect discriminatory behavior in domains and markets in France that have not previously been subjected to much investigation in the literature. The study areas included: purchasing a used car; purchasing an auto insurance policy; applying for a car loan; purchasing supplemental health insurance; enrolling in an adult training program; purchasing an existing small business; and renting vacation accommodations. Access to these items and services are associated with either potential pathways to a middle-class job or hallmarks of a middle-class living standard. We seek to discern evidence of discriminatory behavior according to the criteria of age, gender, ethnic origin, and the reputation of the neighborhood of residence (advantaged or disadvantaged). We discern statistically significant patterns in our observed statistical outcome (callback rates) in all seven markets, which we interpret as possibly indicative of discriminatory behavior; however, the criteria, the magnitudes, and the signs differ from one market to another. One finding is that differential treatment based on ethnicity and the reputation of the neighborhood (i.e., neutral or disadvantaged) might not be as systematic and mutually reinforcing as they are frequently perceived to be in the domains of labor and housing markets.

Predicting non-response in patient-reported outcome measures: results from the Swiss quality assurance programme in cardiac inpatient rehabilitation.

Quality assurance programmes measure and compare certain health outcomes to ensure high-quality care in the health-care sector. The outcome of health-related quality of life is typically measured by patient-reported outcome measures (PROMs). However, certain patient groups are less likely to respond to PROMs than others. This non-response bias can potentially distort results in quality assurance programmes. Our study aims to identify relevant predictors of non-response during assessment using the PROM MacNew Heart Disease questionnaire in cardiac rehabilitation. This is a cross-sectional study based on data from the Swiss external quality assurance programme. All patients aged 18 years or older who underwent inpatient cardiac rehabilitation in 16 Swiss rehabilitation clinics between 2016 and 2019 were included. Patients' socio-demographic and basic medical data were analysed descriptively by comparing two groups: non-responders and responders. We used a random intercept logistic regression model to estimate the associations of patient characteristics and clinic differences with non-response. Of 24 572 patients, there were 33.3% non-responders and 66.7% responders. The mean age was 70 years, and 31.0% were women. The regression model showed that being female was associated with non-response [odds ratio (OR) 1.22; 95% confidence interval (CI) 1.14-1.30], as well as having no supplementary health insurance (OR 1.49; 95% CI 1.39-1.59). Each additional year of age increased the chance of non-response by an OR of 1.02 (95% CI 1.02-1.02). Not being a first language speaker of German, French or Italian increased the chance of non-response by an OR of 6.94 (95% CI 6.03-7.99). Patients admitted directly from acute care had a higher chance of non-response (OR 1.23; 95% CI 1.10-1.38), as well as patients being discharged back into acute care after rehabilitation (OR 3.89; 95% CI 3.00-5.04). Each point on the cumulative illness rating scale total score increased the chance of non-response by an OR of 1.05 (95% CI 1.04-1.05). Certain diagnoses also influenced the chance of non-response. Even after adjustment for known confounders, response rates differed substantially between the 16 clinics. We have found significant non-response bias among certain patient groups, as well as across different treatment facilities. Measures to improve response rates among patients with known barriers to participation, as well as among different treatment facilities, need to be considered, particularly when PROMs are being used for comparison of providers in quality assurance programmes or outcome evaluation.