Universal Health Care Insurance Research Articles

Relative risks of childhood developmental vulnerabilities in three Australian communities with exposure to per- and polyfluoroalkyl substances: data linkage study.

Aqueous film forming foams (AFFF) containing per- and polyfluoroalkyl substances (PFAS) caused local environmental contamination in three Australian residential areas: Katherine in the Northern Territory (NT), Oakey in Queensland (Qld) and Williamtown in New South Wales (NSW). We examined whether children who lived in these areas had higher risks of developmental vulnerabilities than children who lived in comparison areas without known contamination. All children identified in the Medicare Enrolment File-a consumer directory for Australia's universal healthcare insurance scheme-who ever lived in exposure areas, and a sample of children who ever lived in selected comparison areas, were linked to the Australian Early Development Census (AEDC). The AEDC data were available from four cycles: 2009, 2012, 2015 and 2018. For each exposure area, we estimated relative risks (RRs) of developmental vulnerability on each of five AEDC domains and a summary measure, adjusting for sociodemographic characteristics and other potential confounders. We included 2,429 children from the NT, 2,592 from Qld and 510 from NSW. We observed lower risk of developmental vulnerability in the Communication skills and general knowledge domain in Katherine (RR = 0.74, 95% confidence interval (CI) 0.57 to 0.97), and higher risks of developmental vulnerability in the same domain (RR = 1.49, 95% CI 1.18 to 1.87) and in the Physical health and wellbeing domain in Oakey (RR = 1.31, 95% CI 1.06 to 1.61). Risks of developmental vulnerabilities on other domains were not different from those in the relevant comparison areas or were uncertain due to small numbers of events. There was inadequate evidence for increased risks of developmental vulnerabilities in children who ever lived in three PFAS-affected areas in Australia.

Determinants of effective treatment coverage for posttraumatic stress disorder: findings from the World Mental Health Surveys

BackgroundPosttraumatic stress disorder (PTSD) is associated with significant morbidity, but efficacious pharmacotherapy and psychotherapy are available. Data from the World Mental Health Surveys were used to investigate extent and predictors of treatment coverage for PTSD in high-income countries (HICs) as well as in low- and middle-income countries (LMICs).MethodsSeventeen surveys were conducted across 15 countries (9 HICs, 6 LMICs) by the World Health Organization (WHO) World Mental Health Surveys. Of 35,012 respondents, 914 met DSM-IV criteria for 12-month PTSD. Components of treatment coverage analyzed were: (a) any mental health service utilization; (b) adequate pharmacotherapy; (c) adequate psychotherapy; and (d) effective treatment coverage. Regression models investigated predictors of treatment coverage.Results12-month PTSD prevalence in trauma exposed individuals was 1.49 (S.E., 0.08). A total of 43.0% (S.E., 2.2) received any mental health services, with fewer receiving adequate pharmacotherapy (13.5%), adequate psychotherapy (17.2%), or effective treatment coverage (14.4%), and with all components of treatment coverage lower in LMICs than HICs. In a multivariable model having insurance (OR = 2.31, 95 CI 1.17, 4.57) and severity of symptoms (OR = .35, 95% CI 0.18, 0.70) were predictive of effective treatment coverage.ConclusionThere is a clear need to improve pharmacotherapy and psychotherapy coverage for PTSD, particularly in those with mild symptoms, and especially in LMICs. Universal health care insurance can be expected to increase effective treatment coverage and therefore improve outcomes.

Severe Maternal Morbidity and Mortality Among Immigrant and Canadian-Born Women Residing Within Low-Income Neighborhoods in Ontario, Canada

Evidence indicates that immigrant women and women residing within low-income neighborhoods experience higher adversity during pregnancy. Little is known about the comparative risk of severe maternal morbidity or mortality (SMM-M) among immigrant vs nonimmigrant women living in low-income areas. To compare the risk of SMM-M between immigrant and nonimmigrant women residing exclusively within low-income neighborhoods in Ontario, Canada. This population-based cohort study used administrative data for Ontario, Canada, from April 1, 2002, to December 31, 2019. Included were all 414 337 hospital-based singleton live births and stillbirths occurring between 20 and 42 weeks' gestation, solely among women residing in an urban neighborhood of the lowest income quintile; all women were receiving universal health care insurance. Statistical analysis was performed from December 2021 to March 2022. Nonrefugee immigrant status vs nonimmigrant status. The primary outcome, SMM-M, was a composite outcome of potentially life-threatening complications or mortality occurring within 42 days of the index birth hospitalization. A secondary outcome was SMM severity, approximated by the number of SMM indicators (0, 1, 2 or ≥3 indicators). Relative risks (RRs), absolute risk differences (ARDs), and odds ratios (ORs) were adjusted for maternal age and parity. The cohort included 148 085 births to immigrant women (mean [SD] age at index birth, 30.6 [5.2] years) and 266 252 births to nonimmigrant women (mean [SD] age at index birth, 27.9 [5.9] years). Most immigrant women originated from South Asia (52 447 [35.4%]) and the East Asia and Pacific (35 280 [23.8%]) regions. The most frequent SMM indicators were postpartum hemorrhage with red blood cell transfusion, intensive care unit admission, and puerperal sepsis. The rate of SMM-M was lower among immigrant women (2459 of 148 085 [16.6 per 1000 births]) than nonimmigrant women (4563 of 266 252 [17.1 per 1000 births]), equivalent to an adjusted RR of 0.92 (95% CI, 0.88-0.97) and an adjusted ARD of -1.5 per 1000 births (95% CI, -2.3 to -0.7). Comparing immigrant vs nonimmigrant women, the adjusted OR of having 1 SMM indicator was 0.92 (95% CI, 0.87-0.98), the adjusted OR of having 2 indicators was 0.86 (95% CI, 0.76-0.98), and the adjusted OR of having 3 or more indicators was 1.02 (95% CI, 0.87-1.19). This study suggests that, among universally insured women residing in low-income urban areas, immigrant women have a slightly lower associated risk of SMM-M than their nonimmigrant counterparts. Efforts aimed at improving pregnancy care should focus on all women residing in low-income neighborhoods.

Comprehensive Assessment of the Universal Healthcare System in Dentistry Japan: A Retrospective Observational Study.

Japan's universal healthcare insurance is facing economic challenges due to the advanced aging society, however, objective data of dental expenditure has never been introduced. This study aimed to identify the associated factors with dental expenditures using government-provided digitized insurance claims data and calculated the spending in the context of dental cost per person (DCPP). Seven associated factors analyzed were age, demographic, geographic, socioeconomic, regional wealth, the impact of the 8020-national campaign implementation (keep 20 teeth at age 80), and the effect of the home-visit dentistry for the elders. The average DCPP was high in older populations (75+) in all prefectures. The prefectures with the highest and lowest DCPP were significant compared to other states and retained their respective places in the cost hierarchy over the four years. The prefectures with more citizens participating in government assistance programs (GAP) had greater DCPPs. Dental costs were significantly related to geographic regions, age, per capita income, government assistance program prevalence, office complete denture frequency, and home visit care per patient. With a growing aging population, dental care costs will continue to increase, burdening its fiscal future. Associated factors identified should be considered to control the contentious increase of healthcare cost.

Socioeconomic disadvantage and its impact on colorectal cancer in Australia: a scoping review.

Social disparities in cancer survival have been demonstrated in Australia despite a universal healthcare insurance system. Colorectal cancer is common, and reasons for survival disparities related to socioeconomic status need to be investigated and addressed. The aim is to evaluate the current Australian literature concerning the impact of socioeconomic status on colorectal cancer survival and stage at presentation. A systematic search of PUBMED, EMBASE, SCOPUS and Clarivate Web of Science databases from January 2010 to March 2022 was performed. Studies investigating the impact of socioeconomic status on colorectal stage at presentation or survival in Australia were included. Data were extracted on author, year of publication, state or territory of origin, patient population, other exposure variables, outcomes and findings and adjustments made. Of the 14 articles included, the patient populations examined varied in size from 207 to 100 000+ cases. Evidence that socioeconomic disadvantage was associated with poorer survival was demonstrated in eight of 12 studies. Evidence of effect on late stage at presentation was demonstrated in two of seven studies. Area-level measures were commonly used to assess socioeconomic status, with varying indices utilized. There is limited evidence that socioeconomic status is associated with late-stage at presentation. More studies provide evidence of an association between socioeconomic disadvantage and poorer survival, especially larger studies utilizing less clinically-detailed cancer registry data. Further investigation is required to analyse why socioeconomic disadvantage may be associated with poorer survival.

Access to Hematopoietic Stem Cell Transplant in Canada for Patients with Acute Myeloid Leukemia

Hematopoietic stem cell transplant is a complicated intervention only offered in specialized centers. Access to transplants may vary based on the location of primary residence, income levels, age, and reported race or ethnicity. Using data from the Canadian Institute of Health (CIH) Discharge abstract database (DAD), all non-Quebec Canadians under the age of 65 with a diagnosis of AML between 2004 and 2015 were included in this study. Descriptive statistics were produced for the variables of interest: time period, age, sex, rurality, transplant status, proportion of visible minorities, proportion identifying as indigenous, and proportion of low-income families. Transplant rates were compared and reported using univariable and multivariable analysis. In multivariable analysis, time period, province of residence, gender, and age were significantly associated with the receipt of an allogeneic hematopoietic stem cell transplant. However, differences in transplant rates observed in indigenous patients, low-income families, and visible minorities were not found to be statistically significant. In non-Quebec Canada, transplant rates vary significantly with province of residence, with the highest rates recorded in Alberta. Contrary to findings previously reported in studies exploring access to transplant in the United States, a low-income level was not associated with lower rates of transplants. This might suggest that Canada’s universal health care insurance program is protective against socioeconomic barriers that impact access to health care services.

Mortality, Temperature, and Public Health Provision: Evidence from Mexico

We examine the impact of temperature on mortality in Mexico using daily data over the period 1998–2017 and find that 3.8 percent of deaths in Mexico are caused by suboptimal temperature (26,000 every year). However, 92 percent of weather-related deaths are induced by cold (<12°C) or mildly cold ( 12–20°C) days and only 2 percent by outstandingly hot days (>32°C). Furthermore, temperatures are twice as likely to kill people in the bottom half of the income distribution. Finally, we show causal evidence that the Seguro Popular, a universal health care policy, has saved at least 1,600 lives per year from cold weather since 2004. (JEL I12, I13, I14, O13, O15, Q54)

The Persistence and Change in China's Healthcare Insurance Reform: Clues from Fiscal Subsidy Policies Made for Settling COVID-19 Patients' Medical Costs.

BackgroundThe system studied in this article is set in the development and reform of China’s healthcare insurance, the time mentioned in this article is during the COVID-19 period and the issues are about healthcare insurance fiscal subsidy policies for COVID-19 patients’ medical costs.MethodsMethod of comparison and method of case study are used. This article compares the healthcare insurance systems, fiscal subsidy policies during the COVID-19 period and takes Yulin’s healthcare insurance reform and Nanjing healthcare insurance administration’s measures to fight against COVID-19 pandemic as specific cases to analyze.AimThis article presents the advantages of the coverage of China’s healthcare insurance as well as the insufficiency of the commercial healthcare insurance and market-oriented medical institutions to show the persistence and change in China’s healthcare insurance reform.ConclusionSoon after the outbreak of COVID-19 pandemic, the National Healthcare Security Administration and the Ministry of Finance of PRC jointly issued an announcement on how to guarantee the medical security of the novel coronavirus pneumonia pandemic. More specific policies were made by each province to secure that the total medical costs of the COVID-19 confirmed and suspected patients were almost borne by healthcare insurance and government finance subsidy. These policies reveal two basic points ahead China’s healthcare reform: one is that China shall persist in positively promoting the universal healthcare insurance coverage program, which will break down barriers between urban and rural areas; the other is that the commercial medical insurance shall be a supplementary to social healthcare insurance and the market-oriented medical institutions shall be encouraged. The two basic points stand for the persistence and change in China’s healthcare reform. China’s healthcare insurance reform should accord with the requirement in specific age and stage.

Monthly trends and seasonality of hemodialysis treatment and outcomes of newly initiated patients from the national database (NDB) of Japan.

The numbers of patients treated with hemodialysis (HD) in Japan are currently quantified by manual survey. As this method requires much effort from medical institutions and cannot achieve 100% response, a more practical method is required. We aimed to establish a novel method for determining the static and dynamic numbers of patients treated with HD. This observational study used the national medical billing database (termed NDB) of Japan, based on the records of the universal healthcare insurance system. Medical billing data registered in the NDB between April 2011 and March 2015 were analyzed. From 130 billion records, we extracted and analyzed records of patients who had undergone HD at least once per month. Patients' monthly condition was classified as newly initiated HD, chronic HD, or presumed death, using conditional expressions. We also investigated renal outcome and presumed survival in newly initiated HD patients. In the last month of the study period, 274,100 patients were identified as receiving chronic HD, which is estimated as > 95% of the number of these patients identified in the manual survey so far. The monthly data showed clear seasonality in the incidence of transient HD, which increased in winter and decreased in summer. Analysis of a large national database revealed a significant increase in transient HD in winter and decrease in summer. Applied to additional epidemiological exploratory studies or clinical research, this analytical technique would enable collection of the dynamics of almost all HD patients nationwide.

Providing Care by Telephone to Refugees and Asylum Seekers: An Evaluation of Telephone Mode-of-Care in Monash Health Refugee Health and Wellbeing Clinic in Victoria, Australia.

An evaluation of accessibility, appropriateness, acceptability and efficiency of telephone consultations, implemented at Monash Health Refugee Health and Wellbeing (MH RHW) throughout the COVID-19 pandemic, was conducted. A convergent mix-methods design was used, with both patients (n = 50) and clinicians (n = 11) participating in a survey, and two focus groups (n = 14) involving clinicians being conducted. Service utilization data was sourced from the MH RHW database. During May to December 2020, 61% (n = 3012) of the consultations were conducted by telephone, 42% (n = 11) of these required interpreters in a 3-way conversation Most patients were satisfied with telephone as a medium for providing care and with the quality of telephone-based care. Similarly, clinicians considered telephone consultations to be an acceptable mode-of-care for most patients during the pandemic, however, expressed caution in relation to certain patient cohort. Finally, the provision of care by telephone was considered no more efficient than face-to-face service provision, as reflected in the time required for each consultation, with some clinicians reporting adverse workload outcomes. This study highlighted the benefits and challenges of telephone consultations from patient and clinician perspectives. It also highlighted the types of patients that may not be suited to telephone consultations. Overall, this study showed that telephone service delivery is a feasible option in providing care to people of refugee background and should be considered in future decisions as an ongoing Medicare (Australia's universal healthcare insurance scheme) billing item. However, clinical discretion should prevail in determining the most appropriate means of delivering care.

When the Masks Come Off in Canada and Guatemala: Will the Realities of Racism and Marginalization of Midwives Finally Be Addressed?

This article addresses the effects of COVID-19 in Eastern and Northern Ontario, Canada, with a comparative glimpse at the small province of Totonicapán, Guatemala, with which Canadians have been involved in obstetric and midwifery care in particular over the last 5 years. With universal health care coverage since 1966 and well-integrated midwifery, Canada's system would be considered relatively well set up to deal with a disaster like COVID-19 compared to low resource countries like Guatemala or countries without universal health care insurance (like the USA). However, the epidemic has uncovered the fact that in Ontario, Indigenous, Black, and People of Color (IBPOC), as elsewhere, may have been hardest hit, often not by actually contracting COVID-19, but by suffering secondary consequences. While COVID-19 could be an issue through which health care professionals can come together, there are signs that the medical hierarchies in many hospitals in both Ontario and Totonicapán are taking advantage of COVID-19 to increase interventive measures in childbirth and reduce midwives' involvement in hospitals. Meanwhile, home births are on the rise in both jurisdictions. Stories from a Jamaican Muslim woman in Ottawa, an Indigenous midwifery practice in Northern Ontario, registered midwives in Eastern Ontario, and about the traditional midwives in Guatemala reveal similar as well as unique problems resulting from the lockdowns. While this article is not intended to constitute an exhaustive analysis of social justice and human rights issues in Canada and Guatemala, we do take this opportunity to demonstrate where COVID-19 has become a catalyst that challenges the standard narrative, exposing the old ruts and blind spots of inequality and discrimination that our hierarchies and inadequate data collection—until the epidemic—were managing to ignore. As health advocates, we see signs that this pandemic is resulting in more open debate, which we hope will last long after it is over in both our countries.

Factors Associated With Nonreceipt of Recommended COPD Medications: A Population Study

COPD medications reduce exacerbations and improve quality of life. Despite this, some individuals do not receive medications recommended by practice guidelines. How common is nonreceipt of recommended medications among people with COPD, and what factors are associated with nonreceipt? This population cohort study was conducted in Ontario, Canada, a province with universal health care insurance and medication coverage for those aged≥ 65 years. Health administrative data were used to identify people aged≥ 66 years with physician-diagnosed COPD as of 2018 and group them into cohorts of lower or higher risk for future COPD exacerbations. Proportions of patients in each group who did not receive medications recommended by COPD guidelines were determined. Generalized estimating equation modeling was used to determine associations between patient and physician factors and nonreceipt of recommended medications. About 54%and 88%of people with COPD received sufficient recommended medications in the low and high risk of exacerbation groups, respectively. Longer duration of COPD, higher comorbidity, dementia, and older physician age were associated with nonreceipt of recommended medications in both groups. People who had a co-diagnosis of asthma, who received care by a pulmonologist and who received spirometry were more likely to receive recommended medication. COPD medications seem underused by the COPD population, and various factors are associated with suboptimal receipt. Targeting these factors would help improve the care and health of people with COPD.

Health insurance utilisation after ischaemic stroke in Sweden: a retrospective cohort study in a system of universal healthcare and social insurance

BackgroundStroke is one of the largest single-condition sources of the global burden of non-communicable disease in terms of disability-adjusted life-years and monetary costs, directly as well as indirectly in terms...

Regional Disparity in Dental Care Utilization in Japan: Ecological Study Using the National Database of Health Insurance Claims

Background: We examined regional disparities in dental care utilization and their associations with dental care utilization and socioeconomic factors in Japan. Methods: Using the Fourth NBD Open Data Japan, a database for the universal healthcare insurance claims, we conducted an ecological study by analyzing 216 million pieces of aggregated data from April 2017 to March 2018. We used nine indicators to represent dental care utilization: outpatient visits, outreach services, cavity fillings, pulpectomies, dental calculus removals, periodontal surgeries, tooth extractions, dental bridges, and dentures. Standardized claim ratios (SCRs) for these indicators were calculated for Japan’s 47 prefectures, each of which was divided into three groups based on socioeconomic factors (i.e., average income per capita and the proportion of university enrollments). Kruskal-Wallis tests were performed among the three groups to examine the associations between the supply-adjusted nine indicators and the socioeconomic factors. Findings: The ratios between the maximum and minimum SCRs were 1·4 for outpatient visits, 19·3 for outreach services, and 17·6 for periodontal surgeries. Income level was negatively associated with dental bridges and dentures. Educational level was positively associated with outreach services and dental calculus removals, and negatively associated with pulpectomies, tooth extractions, dental bridges, and dentures. Interpretation: In Japan, regional disparities in dental care utilization exist for periodontal care and outreach services but are smaller for urgent and substantial dental care. Educational level appears to be a more important determining factor than income level in dental care utilization. Funding Statement: This work was supported in part by a Health and Labour Sciences Research Grant (Multidisciplinary research project on measures against lifestyle-related diseases such as cardiovascular diseases and diabetes mellitus) “Research study aimed at the development of new evaluation indices and new evaluation methods for the preservation of dental and oral health: Health service research aimed at reducing health disparities in Japan” received by the principal investigator, Nanako Tamiya (Grant number: H31-19FA1001). Declaration of Interests: Takahiro Mori: His appointment as an associate professor at the University of Tsukuba was sponsored by JMDC Inc. in the financial year 2018 (i.e., April 2018 – March 2019), by SMS CO., LTD. in the financial year 2019 (i.e., April 2019 – March 2020), and by FAST DOCTOR CO., LTD in the financial year 2020 (i.e., April 2020 – present). JMDC Inc., SMS CO., LTD, and FAST DOCTOR CO., LTD did not play any role in the conception, design, conduct, or reporting of this study. Sakata Nobuo: His appointment as an associate professor at the University of Tsukuba was sponsored by JMDC Inc. in the financial year 2020 (i.e., April 2020 – present). JMDC Inc. did not play any role in the conception, design, conduct, or reporting of this study. The other authors declare they have no competing interests. Ethics Approval Statement: This study was approved by the University of Tsukuba Medical Ethics Committee (date of approval: December 17, 2019; approval number: 1446).

Climate migration and health system preparedness in the United States

ABSTRACT Every country will have to prepare for climate change. Despite obvious risks to national security in terms of safety, food, and infrastructure as well as impending economic losses, countries like the United States (US) have declined to pursue meaningful federal action. The human impact of climate change – specifically climate migration and its health implications – has been largely neglected at a policy level. Yet climate migration is predicted to have tremendous consequences for people in the next 30 years and beyond, and with it comes a host of difficulties – political, cultural, economic, and structural. Preparedness will be of great importance to potential migrants and how they adapt to their receiving (host) locations. Health systems are one of the most significant institutions impacting long-term migration and these systems’ strengths and weaknesses will determine the integration and well-being of migrants for years to come. A critical analysis of existing literature exposes that there is little current research on health system preparedness as it relates to climate migration, especially in the US. To help address this gap, this paper focuses on how the American health system, already fraught with limitations, can prepare for the expected increase in mostly internal migrants in the face of climate change. Key policy insights Climate migration in the US will pose huge challenges for health systems because of the American health system’s unique, pre-existing weaknesses. To prepare for climate migration, federal, state, local, tribal, and territorial governments should focus on adopting a universal healthcare policy, shifting primary care tasks away from physicians and towards other qualified and more ubiquitous professionals, and investing in telemedicine, retail clinics, and a national electronic health record system. A ‘health in all policies’ approach, which applies a health lens to legislation, needs to be applied in the context of health system strengthening for climate migration since countless environmental determinants of health and infrastructural decisions shape the vulnerability of communities.

An Australian reflects on the Collings report 70 years on.

The publication of ‘General Practice in England Today — a Reconnaissance’ in the Lancet of 25 March 1950 made its Australian author, Dr Joseph Silver Collings, the National Health Scheme’s first whistleblower.1 It also ruined any chance of an academic or administrative career in the UK. Its unflattering description of English general practice angered the medical profession, particularly the British Medical Association (BMA). The Nuffield Provincial Hospital Trust who had funded it were not prepared to have their name associated with it. The Ministry of Health and the Chief Medical Officer who had directed the research underlying it remained silent. Joe Collings, as he preferred to be called, conducted the first evaluative research on general practice published in the English world.2 Challenging the smugness of British medicine, Collings was denied due recognition with his approach labelled unorthodox, and his sampling of English general practice considered fatally skewed. Joe was portrayed as a brash, inexperienced Australian influenced by American concepts with limited experience of British medicine. All those with direct knowledge of those times are now dead, so we must rely on records to ascertain what happened. Joe was a meticulous archivist and his wife Bett preserved his papers in the National Library of Australia.3 Extensive Rockefeller Foundation archive documents add to our knowledge of his activities.4 Joe had experienced general practice in two pioneering universal healthcare insurance systems, New Zealand and Manitoba, Canada, where the reformers sought his opinions. The Rockefeller Foundation funded him for 3 months in 1948 to explore medical educational developments in …

P1490MONTHLY TREND AND SEASONALITY IN ACUTE AND CHRONIC HEMODIALYSIS; RESULT FROM NATIONWIDE DATABASE OF MEDICAL BILLS OF UNIVERSAL HEALTH CARE INSURANCE SYSTEM IN JAPAN

Abstract Background and Aims Although knowing the accurate number of patients of hemodialysis important, data collection is a hard task. Establishing a simplified and prompt method of data collection for perspective hemodialysis is strongly needed. In Japan, there is a universal health care insurance system that covers almost all population. This study aimed to know a seasonal variation of hemodialysis patients using the big database of medical bills in Japan. Method Japanese Ministry of Health, Labour and Welfare established a big database named National Database (NDB), that consists of medical bills data in Japan. All bills data were sent to the data server from The Examination and Payment Agency, the organization that receives all medical bills from each medical institution and judge validity for payment. Each record of the database consists of bill data of one patient of a month for each medical institution. All data were anonymized before saved in the server and gave virtual patient identification number (VPID) that is unique for each patient. VPID is a hash value calculated by patient’s individual data such as name, date of birth, so that the value cannot be duplicate. Calculation of VPID is executed by an irreversible way to make it difficult to decrypt VPID into patient’s individual data. This database includes all information about medical care of whole population in Japan except for patients not under the insurance system (patients under public assistance system, victims of the war, or any other specified people under the public medical expense). Using this database, we investigated monthly number of patients who were recorded to be undergone hemodialysis (HD, includes hemodiafiltration). We searched chronic HD patients who have undergone HD on the month and continued it for 3 months, and acute HD patients who have discontinued HD within 3 months. Results In NDB, the number of chronic HD patients under public insurance system who confirmed to have undergone HD in December 2014 was 284 433. In contrast, the number of HD patients identified from the year-end survey by Japanese Society of Dialysis Therapy in the same year was of 311 193, but this number includes patients not under insurance system. Incidence rate of acute HD in Japan was persisted at 30-39 per million per month. There is a reproducible seasonal variation in number of acute HD patients, that increases in every winter and decreasing in every summer. The significantly highest frequency was observed in February(38.5/million/month) compared with September(30.6/million/month), the lowest month of the year (p<0.01). Conclusion We could show the trend in number of HD patients using nationwide bills data. Seasonality in some clinical factors in patients under chronic hemodialysis such as blood pressure, intradialytic body weight gain, morbidity of congestive heart failure, and, mortality, has been reported in many observational studies. Also, there are a few former reports about seasonality in AKI. However, a report about acute RRT is few. From our knowledge, this is the first report that revealed monthly dynamics of HD in a whole nation and rising risk of acute HD in winter. The true mechanism of this seasonality remains unclear. We have to establish a method to collect clinical data such as prevalence of CKD, causative diseases of AKI, kinds of precedent operations, and medications in connection with billing data.

Chronic lung disease-associated PH: PAH-approved drugs and established universal healthcare insurance in Japan

Chronic lung disease-associated PH: PAH-approved drugs and established universal healthcare insurance in Japan

Beautiful Harmony of the Japanese Precious Healthcare Legacies for the New Imperial Era.

The new Imperial era, Reiwa, started in May, 2019. After World War II, Reiwa is the third Imperial era following Showa and Heisei. In each era, we had specific healthcare problems in cardiovascular medicine and implemented preventive strategies against them. Furthermore, nationwide healthcare policies such as a universal healthcare insurance system (kaihoken) and health check-up system largely contribute to overcoming these problems. Here, we summarize the specific issues in cardiovascular medicine and nationwide strategies policies against them in each era. We also describe what we should do in the new Imperial era from the cardiovascular viewpoint.

The Ethics of Universal Health Insurance

The Ethics of Universal Health Insurance