Universal Insurance Research Articles

70: HEALTH INSURANCE AND THE UTILIZATION OF HEALTH CARE: A SYSTEMATIC REVIEW

Background and aims:All the countries are moving towards universal coverage insurance. in their ability to achieve universal coverage, it is likely that they would have similar effects on the health...

Answering the call to accessible quality health care for all using a new model of local community not-for-profit charity clinics: A return to Christ-centered care of the past.

This article uses studies and organizational trends to understand available solutions to the lack of quality health care access, especially for the poor and needy of local U.S. communities. The U.S. healthcare system seems to be moving toward the World Health Organization's recommendation for universal health coverage for healthcare sustainability. Healthcare trends and offered solutions are varied. Christian healthcare traditionally implements works of mercy guided by a Christian ethos embracing the teachings of human dignity, solidarity, the common good, and subsidiarity. Culture of Life Ministries is one of many new sustainable U.S. healthcare models which implements Christ-centered health care to meet the need of quality and accessible health care for the local community. Culture of Life Ministries employs a model of charity care through volunteerism. Volunteer workers not only improve but also transform the local healthcare system into a personal healing ministry of the highest quality for every person. Summary: The lack of access to quality health care is a common problem in the U.S. despite various solutions offered through legislative and socioeconomic works: universal healthcare models, insurance models, and other business models. U.S. health care would be best transformed by returning to the implementation of a traditional system founded on the Christian principles of human dignity, solidarity, subsidiarity, and the common good. Culture of Life Ministries is an example of such a local ministry in Texas, which has found success in practically applying these Christ-centered, healthcare principles into an emerging not-for-profit, economically sustainable, healthcare model.

China's Health Reform Update.

China experienced both economic and epistemological transitions within the past few decades, greatly increasing demand for accessible and affordable health care. These shifts put significant pressure on the existing outdated, highly centralized bureaucratic system. Adjusting to growing demands, the government has pursued a new round of health reforms since the late 2000s; the main goals are to reform health care financing, essential drug policies, and public hospitals. Health care financing reform led to universal basic medical insurance, whereas the public hospital reform required more complex measures ranging from changes in regulatory, operational, and service delivery settings to personnel management. This article reviews these major policy changes and the literature-based evidence of the effects of reforms on cost, access, and quality of care. It then highlights the outlook for future reforms. We argue that a better understanding of the unintended consequences of reform policies and of how practitioners' and patients' interests can be better aligned is essential for reforms to succeed.

Oral and maxillofacial tumours in children and adolescents: Clinicopathologic audit of 75 cases in an academic medical centre, Sokoto, Northwest Nigeria.

Background:Maxillofacial tumours in children and adolescents have been documented worldwide; however, few studies were reported from Africa, especially sub-Saharan Africa. In Nigeria, most of the studies emanated from the Southwest region.Aim:To present an audit of clinicopathologic features and treatment of orofacial tumours in children and adolescents in Sokoto, Northwest Nigeria.Patients and Methods:Clinicopathologic records of the Departments of Dental and Maxillofacial Surgery, Paediatrics and Histopathology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria, were reviewed for all the oral and maxillofacial tumours managed in children <19 years from January 2011 to December 2015.Results:Two hundred and twenty-two tumours were noted in all age groups during the study duration and 75 (33.8%) of these occurred in children and adolescents. A total of 45 (60%) males and thirty (40%) females constitute the patient population with a male to female ratio of 1.5:1. There are 32 (42.7%) benign tumours and 43 (57.3%) malignant tumours. Burkitt's lymphoma was the most common malignant tumour in 24 cases (55.8%), whereas pleomorphic adenoma was the most common benign soft tissue tumour in 4 cases (30.8%) and fibro-osseous lesions were the most common benign jaw tumours in 10 cases (52.6%). Chemotherapy alone was the treatment modality in 24 cases of malignant tumour whereas 13 cases had combination chemotherapy and irradiation.Conclusions:Our findings established that oral and maxillofacial tumours in children and adolescents are quite common in Sokoto, Northwest region of Nigeria, particularly the malignant types. There is a need for improved universal healthcare insurance for all citizens to adequately manage these children effectively.

Association Between Race and Postoperative Outcomes in a Universally Insured Population Versus Patients in the State of California.

To compare disparities in postoperative outcomes for African Americans after surgical intervention in the universally insured military system, versus the civilian setting in California. Health reform proponents cite the reduction of disparities for African Americans and minorities as an expected benefit. The impact of universal health insurance on reducing surgical disparities for African Americans has not previously been examined. We used Department of Defense health insurance (Tricare) data (2006-2010) to measure outcomes for African Americans as compared with Whites after 12 major surgical procedures across multiple specialties. The experience of African Americans in the Tricare system was compared with a similar cohort undergoing surgery in the state of California using the State Inpatient Database (2007-2011). No significant difference in postoperative complications [odds ratio (OR) 0.91; 95% confidence interval (CI) 0.81, 1.03] or mortality (OR 0.98; 95% CI 0.43, 2.25) were encountered between African Americans and Whites receiving surgery at hospitals administered by the Department of Defense. African Americans in California who were uninsured or on Medicaid had significantly increased odds of mortality (OR 4.76; 95% CI 2.82, 8.05), complications (OR 1.67; 95% CI 1.34, 2.08), failure to rescue (OR 2.72; 95% CI 1.25, 5.94), and readmission (OR 1.78; 95% CI 1.45, 2.19). In the equal access military healthcare system, African Americans have outcomes similar to Whites. Disparities were evident in California, especially among those without private insurance. These facts point toward the potential benefits of a federally administered system in which all patients are treated uniformly.

Emergency Department Visits and Hospitalizations for the Uninsured in Illinois Before and After Affordable Care Act Insurance Expansion.

We describe changes in emergency department (ED) visits and the proportion of patients with hospitalizations through the ED classified as Ambulatory Care Sensitive Hospitalization (ACSH) for the uninsured before (2011-2013) and after (2014-2015) Affordable Care Act (ACA) health insurance expansion in Illinois. Hospital administrative data from 201 non-federal Illinois hospitals for patients age 18-64 were used to analyze ED visits and hospitalizations through the ED. ACSH was defined using Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs). Logistic regression was used to test the effect of time period on the odds of an ACSH for uninsured Illinois residents, controlling for patient sociodemographic characteristics, weekend visits and state region. Total ED visits increased 5.6% in Illinois after ACA implementation, with virtually no change in hospital admissions. Uninsured ED visits declined from 22.9% of all visits pre-ACA to 12.5% in 2014-2015, reflecting a 43% decline in average monthly ED visits and 54% in ED hospitalizations. The proportion of uninsured ED hospitalizations classified as ACSH increased from 15.4 to 15.5%, a non-significant difference. Older uninsured female, minority and downstate Illinois patients remained significantly more likely to experience ACSH throughout the study period. ED visits for the uninsured declined dramatically after ACA implementation in Illinois but over 12% of ED visits are for the remaining uninsured. The proportion of visits resulting in ACSH remained stable. Providing universal insurance with care coordination focused on improved access to home and ambulatory care could be highly cost effective.

Disparities in receipt of a laparoscopic operation for ectopic pregnancy among TRICARE beneficiaries

Racial disparities in receipt of a laparoscopic operation for ectopic pregnancy are attributed to inequalities in access to care. This study sought to determine if racial disparities in laparoscopic operation for ectopic pregnancy exist among a universally insured population. Using 2006-2010 TRICARE (insurance for members of the United States Armed Services and their dependents) data, patients who received a laparoscopic operation or laparotomy for ectopic pregnancy were stratified into direct/military or purchased/civilian system of care. Odds of receipt of a laparoscopic operation in each racial group were compared adjusting for patient demographics, system of care, and severity of ectopic pregnancy. Among 3,041 patients in the study sample, 1,878 (61.7%) received laparotomy and 1,163 (38.2%) received a laparoscopic operation within 30days of diagnosis. Overall, 42.4% of white women received a laparoscopic operation compared with 33.1% of Asian women and 34.9% of black women (P<.001). On multivariable analysis, black women had a 33% lesser odds of receiving a laparoscopic operation (odds ratio: 0.67; confidence interval: 0.55-0.83) compared with white women. These disparities were absent within direct care (odds ratio: 0.93; confidence interval: 0.71-1.21) but were present within purchased care (odds ratio: 0.54; confidence interval: 0.40-0.73). Racial minority patients are less likely to receive a laparoscopic operation for ectopic pregnancy despite universal insurance coverage within civilian/purchased care. Further work is warranted to better understand the factors other than insurance access that may contribute to racial disparities in selection of operative approach.

Healthcare reform.

Catholic social teaching provides the essential framework for thinking clearly about societal problems, but it cannot be applied like a recipe in a cookbook. It is the responsibility of informed citizens to take what Catholic social teaching offers and use their own knowledge and reason to advance concrete approaches for addressing complex issues of public policy. Lay Summary: In health care, full governmental control would lead to a decline in the quality of services provided to all patients. It is possible to build a market-driven system of universal insurance enrollment that provides full protection to the lowest income households while also providing space for private initiative and innovation.

The dynamic role of specific experience in the selection of self-employment versus wage-employment

What drives an individual to choose self-employment over a more traditional wage-earning job, or vice-versa? Expected earnings, income variability and other non-monetary aspects such as independence and job satisfaction are possible answers. This type of decision-making may be inherently dynamic as choices affect the accumulation of specific experience and, thus, the evolution of a worker’s skills and compensation. This paper models an individual’s decision over employment type by estimating a dynamic, stochastic, discrete choice, optimization problem using panel data from Chile. We simulate choices of employment type in the hypothetical scenario of a proposed mandatory universal unemployment insurance structure under different categories of education and experience. We find a slight increase in the number of workers selecting self-employment due to the reform. Consistent with theories of accumulation of specific experience and specialization, we observe stronger movements the lower (higher) the amount of experience workers have in the departing (destination) sectors.

Differential access to care: The role of age, insurance, and income on race/ethnicity-related disparities in adult perforated appendix admission rates

Differences in perforated appendix admission rates (PAAR) are an ambulatory-sensitive measure of access to care. While pediatric studies report disparities in PAAR, initial adult investigations suggest a lack of racial/ethnic inequity. The objectives of this study were to (1) assess for risk-adjusted, racial/ethnic differences in PAAR among adults on a national scale, (2) consider the extent to which variations (or lack thereof) are explained by age, insurance, and income, and (3) compare results within the United States population to a national segment of the population who are completely insured. According to the Agency for Healthcare Research and Quality definition of PAAR, adults (aged 18-64 years) in the 2006-2010 Nationwide Inpatient Sample were queried for the occurrence and perforation of acute appendicitis. Risk-adjusted differences were compared by race/ethnicity over 5-year age increments using logistic regression with reweighted estimating equations. Noting disparate outcomes between younger (aged 18-34 years) versus older (aged 35-64 years) adults, age-stratified variations were further considered. Results were compared relative to differences among national military/civilian-dependent patients with universal insurance and were assessed for the extent to which disparities could be explained by variations in insurance and income. A total of 129,257 (weighted: 638,452) patients were included. Despite a lack of differences overall, significantly worse outcomes among younger (odds ratio point-estimates ranged from 1.11-1.32) and better outcomes among older (0.78-0.93) minority patients were found. This observation contrasted a lack of differences among completely insured military/civilian-dependent patients (n=12,154). A total of 22.4% (non-Hispanic black versus non-Hispanic white) and 39.0% (Hispanic versus non-Hispanic white) of younger adult differences were explained by insurance-12.2% and 13.6% by income, 29.8% and 44.0% combined. This national assessment of differences in access to care among adults with acute appendicitis demonstrated the existence of racial/ethnic disparities in PAAR that varied with age and were partially, although incompletely, explained by variations in insurance and income.

The Religious Perspective of Takaful as Ethical Insurance

Ethics is crucial in every part of human life irrespective of religion, race, place, and time. Every religion teaches its followers to be good and enjoin virtue. Ethical conduct is a mission central to any religion and ethical behaviour is highly demanded in any part of the world. As a result of the global financial crisis, regulators and related authorities are realising the importance of ethics as a defensive measure to avoid the recurrence of financial crises. Religions such as Islam, Christianity, Judaism Hinduism, Sikhism, and Buddhism condemn the practice and involvement in interest, gambling, and uncertainty as they are tools of injustice and create an atmosphere of inequality. Unfortunately, insurance involves the elements of interest, gambling, and uncertainty. Human beings seek an ethical and just business environment where they can finance, participate, and invest their capital without being involved in prohibited activities and elements. The objectives of this paper are to provide the reasons behind the prohibition of insurance not only from Islam but also from other religious perspectives and to show that the suitability of Takaful as an ethical insurance in all aspects of religious teachings. Takaful is a cooperative, mutual, and solidarity product that can be used as a risk management tool. The main advantage of Takaful over conventional insurance is that it is free from religiously forbidden elements and promotes a spirit of caring and sharing in the society. This knowledge should be disseminated to ensure that Takaful becomes the universal ethical insurance product. DOI: 10.5901/mjss.2016.v7n4p96

Development of a conceptual framework for understanding financial barriers to care among patients with cardiovascular-related chronic disease: a protocol for a qualitative (grounded theory) study.

Patients with cardiovascular-related chronic diseases may face financial barriers to accessing health care, even in Canada, where universal health care insurance is in place. No current theory or framework is adequate for understanding the impact of financial barriers to care on these patients or how they experience financial barriers. The overall objective of this study is to develop a framework for understanding the role of financial barriers to care in the lives of patients with cardiovascular-related chronic diseases and the impact of such barriers on their health. We will perform an inductive qualitative grounded theory study to develop a framework to understand the effect of financial barriers to care on patients with cardiovascular-related chronic diseases. We will use semistructured interviews (face-to-face and telephone) with a purposive sample of adult patients from Alberta with at least 1 of hypertension, diabetes, heart disease or stroke. We will analyze interview transcripts in triplicate using grounded theory coding techniques, including open, focused and axial coding, following the principle of constant comparison. Interviews and analysis will be done iteratively to theoretical saturation. Member checking will be used to enhance rigour. A comprehensive framework for understanding financial barriers to accessing health care is instrumental for both researchers and clinicians who care for patients with chronic diseases. Such a framework would enable a better understanding of patient behaviour and nonadherence to recommended medical therapies and lifestyle modifications.

Factors Influencing Basic and Complementary Health Insurance Purchasing Decisions in Iran: Analysis of Data From a National Survey

Expanding the coverage of health-care insurance is a tool toward achieving universal health coverage and reducing financial barriers to care. Therefore, understanding the factors that affect the expansion of health insurance is important for policymakers. The study aimed at assessing the variables that affected the decisions to purchase health insurance in Iran. We analyzed data gathered from a national survey of health-care utilization in Iran that covered over 23,000 households. We identified subsets of the data that represented purchasing decisions. Increase in age, education, income, wealth, and the opportunity of working in the governmental sector increased the probability of purchasing BHI and CHI coverage. Past utilization of inpatient and outpatient care increased the probability of purchasing BHI and CHI, respectively. Evidence of adverse selection and wide socioeconomic differences in insurance purchase decisions were observed throughout the study. However, most significant factors were not easily influenced by policy decisions. The findings suggest that it might be very difficult to achieve universal insurance coverage unless nation-wide nonvoluntary policies are implemented.

Increased risk of anxiety among patients with urolithiasis: A nationwide population-based cohort study

Objectives To investigate whether patients with urolithiasis are at an increased risk of anxiety and depression. Methods We used universal insurance claims data in Taiwan from 2000 to 2011 to identify patients with newly diagnosed urolithiasis (n = 32 617) and those without urolithiasis (n = 130 465). Incidences, hazard ratios, and incidence rate ratios of anxiety and depression were determined in both cohorts in terms of baseline demographic characteristics and comorbidities until December 2011. Results The urolithiasis cohort yielded a higher incidence of anxiety (11.9 vs 6.91 per 1000 person-years) with an adjusted hazard ratio of 1.5 (95% confidence interval 1.42–1.57) than the non-urolithiasis cohort. The urolithiasis cohort also showed a higher incidence of depression (5.79 vs 3.95 per 1000 person-years) with an adjusted hazard ratio of 1.26 (95% confidence interval 1.18–1.35) than the non-urolithiasis cohort. Regardless of the patients' baseline comorbidities, patients with urolithiasis showed a higher incidence rate ratio of anxiety and depression than those without urolithiasis (with no comorbidities: adjusted hazard ratio 1.62, 95% confidence interval 1.49–1.76] for anxiety and adjusted hazard ratio 1.37, 95% confidence interval 1.23–1.54 for depression). Conclusion Urolithiasis is recurrent, and significantly associated with anxiety and depression. Therefore, urologists should diagnose patients suspected with this disease and provide proper medical care.

Comparison of the risk of de novo cardiovascular disease between hemodialysis and peritoneal dialysis in patients with end-stage renal disease

BackgroundThe purpose of the study was to compare the risk of de novo cardiovascular disease (CVD) between hemodialysis (HD) and peritoneal dialysis (PD) in patients with incident end-stage renal disease (ESRD). MethodsFrom a Taiwanese universal insurance claims database, we identified 45309 incident ESRD patients without preexisting CVD from 2000 to 2010. Using the propensity score matching method, we included 6516 patients in HD and PD groups, respectively. All patients were followed up until the end of 2011. The Cox proportional hazards regression model was employed to calculate the impact of dialysis modality on the risk of new onset cardiovascular events including ischemic heart disease, and congestive heart failure (CHF). ResultsNo difference was observed in the overall risk of de novo ischemic heart disease between the propensity score-matched HD and PD groups (HD versus PD, adjusted hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 0.86–1.22). However, HD was associated with a higher risk of de novo CHF (adjusted HR: 1.29, 95% CI: 1.13–1.47) than PD was. The risk of de novo CHF was particularly high in the first year under dialysis treatment for propensity score-matched HD patients, compared to PD patients. ConclusionsNo difference was observed in the overall risk of de novo major ischemic heart events between HD and PD patients. However, HD was associated with a higher risk of de novo CHF than PD in the first year under dialysis treatment.

Injuries to Aboriginal populations living on- and off-reserve in metropolitan and non-metropolitan areas in British Columbia, Canada: Incidence and trends, 1986-2010.

BackgroundDisparities in injury rates between Aboriginal and non-Aboriginal populations in British Columbia (BC) are well established. Information regarding the influence of residence on disparities is scarce. We sought to fill these gaps by examining hospitalization rates for all injuries, unintentional injuries and intentional injuries across 24 years among i) Aboriginal and total populations; ii) populations living in metropolitan and non-metropolitan areas; and iii) Aboriginal populations living on- and off-reserve.MethodsWe used data spanning 1986 through 2010 from BC’s universal health care insurance plan, linked to vital statistics databases. Aboriginal people were identified by insurance premium group and birth and death record notations, and their residence was determined by postal code. “On-reserve” residence was established by postal code areas associated with an Indian reserve or settlement. Health Service Delivery Areas (HSDAs) were classified as “metropolitan” if they contained a population of at least 100,000 with a density of 400 or more people per square kilometre. We calculated the crude hospitalization incidence rate and the Standardized Relative Risk (SRR) of hospitalization due to injury standardizing by gender, 5-year age group, and HSDA. We assessed cumulative change in SRR over time as the relative change between the first and last years of the observation period.ResultsAboriginal metropolitan populations living off-reserve had the lowest SRR of injury (2.0), but this was 2.3 times greater than the general British Columbia metropolitan population (0.86). For intentional injuries, Aboriginal populations living on-reserve in non-metropolitan areas were at 5.9 times greater risk than the total BC population. In general, the largest injury disparities were evident for Aboriginal non-metropolitan populations living on-reserve (SRR 3.0); 2.5 times greater than the general BC non-metropolitan population (1.2). Time trends indicated decreasing disparities, with Aboriginal non-metropolitan populations experiencing the largest declines in injury rates.ConclusionsMetropolitan/non-metropolitan residence appears to be a more important predictor than on/off-reserve residence for all injuries and unintentional injuries, and the relationship was even more pronounced for intentional injuries. The persistent disparities highlight the need for culturally sensitive and geographically relevant injury prevention approaches.

Obstetric Care in the U.S. Military

INTRODUCTION: Pregnant women with TRICARE (universal insurance coverage to members of US Armed Services and their dependents) can receive obstetric care under direct care/salary-based (DC) or purchased care/fee-for-service (PC) system. The objective of this study was to compare intra-partum obstetric care between direct and purchased care systems in TRICARE. METHODS: TRICARE (2006–2010) claims data were used to identify deliveries. Patient demographics, frequency of types of delivery (normal vaginal, cesarean and instrumental vaginal) and co-morbid conditions (gestational diabetes and hypertension) along with complications, including post-partum hemorrhage (PPH), lacerations, infection and thrombotic events were compared between two systems of care. RESULTS: A total of 440,138 deliveries were identified. The mean age of mothers in DC and PC was 26.7 years and 27.3 years, respectively (P<.001). A higher proportion of mothers in DC had gestational diabetes (6.9% vs 4.9%, P<.001) and gestational hypertension (5.8% vs 4.7%, P<.001). Proportion of cesarean delivery (25.8% vs 30.9%, P<.001) and instrumental vaginal delivery (5.3% vs 6.4%, P<.001) was lower in DC compared to PC. Complications such as PPH (4.9% vs 3.4%, P<.001) and perineal lacerations (8.3% vs 6.4%, P<.001) were significantly higher in DC as compared to PC. CONCLUSION: We found that the direct/military (salary-based) system had fewer interventions (such as operative deliveries) and higher complication rates. Study of the direct and purchased care systems in TRICARE may have potential use as a surrogate for comparing obstetric care between salary-based systems and fee-for-service systems in the US.

Primary care in Ontario, Canada: New proposals after 15 years of reform

Primary care has proven to be extremely difficult to reform in Canada because of the original social compact between the state and physicians that led to the introduction of universal medical care insurance in the 1960s. However, in the past decade, the provincial government of Ontario has led the way in Canada in funding a suite of primary care practice models, some of which differ substantially from traditional solo and group physician practices based on fee-for-service payment. Independent evaluations show some positive improvements in patient care. Nonetheless, the Ontario government's large investment in the reform combined with high expectations concerning improved performance and the deteriorating fiscal position of the province's finances have led to major conflict with organized medicine over physician budgets and the government's consideration of an even more radical restructuring of the system of primary care in the province.

Utilization of hospital services for cancer care in Mexico.

To analyze the utilization of hospital services for cancer care by location, sex, age group and care institution in Mexico from 2004-2013. Time series study from 2004-2013, based on administrative records of hospital discharges for cancer in the health sector, including the private sector. The utilization rate increased significantly from 290 to 360 per 100 000 inhabitants. A total of 62% of hospital discharges related to malignant tumors were concentrated in eight types of cancer. Leukemia, breast and colorectal cancers almost doubled in the period. While lung cancer showed a decline among men, it increased among women. A total of 63.1% of cancer patients were women, and 81% of cases occurred in the public sector. From 2011, the Ministry of Health was the main provider of hospital services for cancer care. Increases in utilization were mainly found in the Ministry of Health, quite possibly as a result of the implementation of universal insurance.

Consommations de soins des bénéficiaires de la couverture maladie universelle complémentaire (CMUC) ou de l’aide pour une complémentaire santé (ACS) en 2012

BackgroundThe objective was to investigate healthcare use among people covered by one of the two complementary healthcare insurance schemes available for people with low annual income: CMUC (universal complementary healthcare insurance) and, for people whose income exceeds the CMUC ceiling, ACS (aid for complementary healthcare insurance). Comparisons were made between CMUC and ACS beneficiaries versus CMUC and ACS non-beneficiaries and between CMUC beneficiaries and ACS beneficiaries. MethodsUsing the national health insurance information system (SNIIRAM), people less than 60 years old covered by the general national health insurance (86% of the 66 million inhabitants) and with ACS or CMUC coverage in 2012 were selected. Diseases were identified using hospital diagnosis, drugs refunds and long-term chronic disease status. Hospital related diagnoses were categorized in major hospital activity groups. Sex- and age-standardized relative risk (RR) were calculated. ResultsThere were 4.4 million (9.6%) CMUC beneficiaries and 732,000 (1.6%) ACS beneficiaries (56% and 54% women; mean age: 24 years and 29 years respectively versus 52% and 30 years for CMUC or ACS non-beneficiaries). CMUC or ACS beneficiaries had more often cardiovascular diseases (RR=1.4;2.1) and diabetes (RR=2.2;2.4). Their sex- and age-standardized hospitalisation rates for all diagnosis were higher (18%; 17%, RR=1.3;1.4) than CMUC or ACS non-beneficiaries (13%). This was especially the case for the following major groups: toxicology, intoxications, alcohol major group (RR=3.8;4.0); psychiatry (RR=2.8;4.1); respiratory disease (RR=1.9;2.3); infectious disease (RR=1.9;2.7). Compared with CMUC beneficiaries, ACS beneficiaries had more often cancer (RR=1.5), cardiovascular disease (RR=1.5), neurological disease (RR=2.7), psychiatric illness (RR=2.6), end-stage renal disease (RR=2.8), hemophilia (RR=1.4) or cystic fibrosis (RR=1.6) and they received also more often disability allowance (20%, 4%). ConclusionThe disease and hospitalisation rates of ACS beneficiaries are similar or higher than those of CMUC beneficiaries, especially for disabling diseases. Both CMUC and ACS beneficiaries received healthcare for chronic diseases that can be targeted by prevention and screening programs for more optimal healthcare.