Application of Smart Healthcare in LTCI, Outpatient Mutual-Aid Guarantee Mechanism, and Sustainability of Medical Insurance Fund for Urban Employees

With the aggravation of population aging and the increase of life expectancy, long-term care insurance (LTCI) system has been established to meet the medical and long-term care needs of the increasing elderly population. In China, LTCI system is currently not a stand-alone insurance, but it is attached to the national basic medical insurance fund for urban employees (MIUE). As a result, the expenditure of LTCI is a part of the expenditure of the MIUE, which has an impact on the sustainability of the MIUE. By modeling the income and expenditure of MIUE, especially including the expenditure of LTCI, this study optimized an LTCI system with a higher individual out-of-pocket payment ratio of LTCI and implementation of the outpatient mutual-aid guarantee mechanism (OMAGM), which could improve the sustainability of the MIUE. The study also reveals the following: (i) solely increasing individual out-of-pocket payment ratio of LTCI to 20%–50% can only postpone the deficit on Social Pooling Accounts (SPAs) by 1 or 2 years, and the effect is very limited. (ii) Besides a higher individual out-of-pocket payment ratio, further implementation of a partial OMAGM from 2022 will postpone the deficit on SPAs by 7–9 years, and the implementation of a complete OMAGM from 2022 will postpone the deficit by 14–18 years. Accordingly, China should implement OMAGM as soon as possible to enhance the solvency of MIUE fund, and, in the long run, an independent LTCI scheme should be established to ensure the stability and sustainability of the LTCI fund and the MIUE fund.

Simple Excel and ICD-10 based dataset calculator for the Charlson and Elixhauser comorbidity indices

Background The Charlson and Elixhauser Comorbidity Indices are the most widely used comorbidity assessment methods in medical research. Both methods are adapted for use with the International Classification of Diseases, which 10th revision (ICD-10) is used by over a hundred countries in the world. Available Charlson and Elixhauser Comorbidity Index calculating methods are limited to a few applications with command-line user interfaces, all requiring specific programming language skills. This study aims to use Microsoft Excel to develop a non-programming and ICD-10 based dataset calculator for Charlson and Elixhauser Comorbidity Index and to validate its results with R- and SAS-based methods. Methods The Excel-based dataset calculator was developed using the program’s formulae, ICD-10 coding algorithms, and different weights of the Charlson and Elixhauser Comorbidity Index. Real, population-wide, nine-year spanning, index hip fracture data from the Estonian Health Insurance Fund was used for validating the calculator. The Excel-based calculator’s output values and processing speed were compared to R- and SAS-based methods. Results A total of 11,491 hip fracture patients’ comorbidities were used for validating the Excel-based calculator. The Excel-based calculator’s results were consistent, revealing no discrepancies, with R- and SAS-based methods while comparing 192,690 and 353,265 output values of Charlson and Elixhauser Comorbidity Index, respectively. The Excel-based calculator’s processing speed was slower but differing only from a few seconds up to four minutes with datasets including 6250–200,000 patients. Conclusions This study proposes a novel, validated, and non-programming-based method for calculating Charlson and Elixhauser Comorbidity Index scores. As the comorbidity calculations can be conducted in Microsoft Excel’s simple graphical point-and-click interface, the new method lowers the threshold for calculating these two widely used indices. Trial registration retrospectively registered.

E-Participation in Developing Countries

This chapter on e-participation in developing countries uses Cameroon as a case study to demonstrate the realities of practicing Web 2.0 and social media tools to drive collaborative initiatives between government agencies and citizens in developing countries. The case study was guided by the incentives for e-participation using social media technologies, the tools used by a government to drive such initiatives, the level of participation from citizens, and the challenges and risks faced in implementing these technologies. A study of Cameroon's National Social Insurance Fund (NSIF) confirmed the main incentives of e-participation initiatives in developing countries and the major challenges they face in implementing them.

Organization of medical and economic control of the volume and cost of medical care in the system of compulsory health insurance in 2021

The article is devoted to the current problem of interaction in fulfilling the obligations of all participants of compulsory health insurance to pay for and provide medical care in accordance with the amendments made to Federal Law No. 326-FL of 29 November 2010 (as amended on 08 December 2020) «On Compulsory Health Insurance in the Russian Federation» and entered into force on January 1, 2021. The authors focus on the issue of granting of the territorial compulsory health insurance fund new powers to conduct medical and economic control and abolishing these powers from medical insurance organizations. According to the amendments, all volumes of medical care provided to the insured population of the subject of the Russian Federation, both on the territory of insurance and outside it, as well as medical care provided outside the territory of insurance, are the subject of medical and economic control by the territorial fund. Starting from 2021, the form of the contract for the provision and payment of medical care for compulsory health insurance, approved by Order of the Ministry of Health of the Russian Federation No. 1417n of 30 December 2020, has also changed. Unlike the previous form of contract concluded between an insurance medical organization and a medical organization, the current document provides for the participation of three parties in contractual relations: the territorial fund, insurance medical organizations, medical organizations. The agreement contains provisions providing for the obligation of the territorial fund to carry out medical and economic control of registers of accounts and accounts submitted by medical organizations to pay for medical care provided within the framework of the basic and territorial compulsory health insurance programs. The article presents the results of the control carried out with the analysis of the identified violations in the provision by medical organizations of the Ryazan region of invoices and registers of invoices for payment of medical care provided for January 2021, identifies problematic points in the information interaction between participants of compulsory insurance in the implementation of this function of the territorial fund.

SUPPLEMENTARY PARENTAL BENEFIT – THE MUM 4 + PROGRAMME – EXPECTATIONS AND REALITY

In this article the regulations of the act on parental supplementary benefit of January 30, 2019 are thoroughly analysed. Supplementary parental benefit is granted to a person who gave birth to and raised or only raised at least four children and did not acquire the right to a pension or a pension paid to this person by the pension authority is smaller than the lowest pension. One is entitled to the benefit mentioned herein only in the case of not having means of subsistence because of not pursuing or discontinuing employment as a result of raising minimum four children. Supplementary parental benefit is in no way related to making social security contributions, it is a benefit financed by the state budget, which in a supplementary or substitutional way is linked to old age. In the legal sense, it is not a pension, but a special non-contributory monetary benefit of discretionary nature, which is granted only on request of the person of interest based on the administrative decision of the president of the Polish Social Insurance Institution (ZUS) or the Agricultural Social Insurance Fund (KRUS).

Increase in the Length of Lung Cancer Patient Pathway Before First-Line Therapy: A 6-Year Nationwide Analysis From Hungary

Objective: This study aimed to examine the characteristics of the lung cancer (LC) patient pathway in Hungary during a 6-years period.Methods: This nationwide, retrospective study included patients newly diagnosed with LC (ICD-10 C34) between January 1, 2011, and December 31, 2016, using data from the National Health Insurance Fund (NHIF) of Hungary. The following patient pathway intervals were examined: system, diagnostic and treatment interval by age, gender, tumor type, study year and first-line LC therapy.Results: During the 6-years study period, 17,386 patients had at least one type of imaging (X-ray or CT/MRI) prior to diagnosis, and 12,063 had records of both X-ray and CT/MRI. The median system interval was 64.5 days, and it was 5 days longer among women, than in men (68.0 vs. 63.0 days). The median system interval was significantly longer in patients with adenocarcinoma compared to those with squamous cell carcinoma or small cell lung cancer (70.4 vs. 64.0 vs. 48.0 days, respectively). Patients who received surgery as first-line treatment had significantly longer median system intervals compared to those receiving chemotherapy (81.4 vs. 62.0 days). The median system interval significantly increased from 62.0 to 66.0 days during the 6-years study period.Conclusion: The LC patient pathway significantly increased in Hungary over the 6-years study period. There were no significant differences in the length of the whole LC patient pathway according to age, however, female sex, surgery as first-line treatment, and adenocarcinoma were associated with longer system intervals.

Quality of life of ostomates at a teaching and referral hospital in Kenya

Background: Ostomy surgery is performed to maintain gastrointestinal function. However, there is a lack of knowledge and experience about ostomies among patients and clinicians in public hospitals in Kenya. The issue is compounded by the social isolation and stigma ostomates face in the wards and in the community after discharge. Although it is not easy to identify the exact number of ostomates in Kenya and other African countries, there is need to shift the focus from curing symptoms in ostomates to maximising patients’ quality of life (QoL) and integrating services for ostomates in mainstream public hospitals. Aim: To understand the effects of ostomies on patients’ QoL, with a focus on nutrition, psychosocial aspects and challenges around sexuality after ostomy creation. Method: A descriptive study was undertaken using an interviewer-administered QoL questionnaire with 81 patients. Results: Most patients were male (54%); the largest age group was 35–44 years (24.7%). Colorectal carcinoma, intestinal obstruction and traumatic injuries were the main indications for ostomy. Ostomates resumed sexual activity, but did not find it fulfilling (P=0.002). Most reported feeling depressed, with suicidal attempts that negatively correlated with QoL. Ostomates adjusted their diets regardless of whether their level of QoL was poor, fair, good or excellent after ostomy creation (P=0.564). Conclusion: Ostomates experience low QoL. Patients’ lives can be improved by focusing on providing individualised ostomy care services after discharge. Enhancing stoma therapy training for nurses and running ostomy clinics alongside mainstream services, as well as support for ostomates towards enrolment into the country’s National Hospital Insurance Fund, will also improve patients’ QoL.

TREATMENT COSTS FOR COVID-19 PATIENTS IN A TERTIARY HOSPITAL FROM SERBIA

ABSTRACTIntroductionAim of our study was to identify total costs of COVID-19 inpatients treatment in an upper-middle income country from Southeast Europe.MethodsThis retrospective, observational cost of illness study was performed from National Health Insurance Fund perspective and included a cohort of 118 males and 78 females admitted to COVID-19 ward units of a tertiary center, during the first wave of epidemics.ResultsThe median of total costs in the non-survivors’ subgroup (n=43) was 3279.16 Euro (4023.34, 355.20, 9909.61) which is higher than in the survivors (n=153) subgroup 747.10 Euro (1088.21, 46.71, 3265.91). The odds ratio of Charlson Comorbidity Index total score and every 100-Euros increase of patient’s total hospital treatment costs for fatal outcome were 1.804 (95% confidence interval 1.408-2.311, p<0.001) and 1.050 (1.029-1.072, p<0.001), respectively.ConclusionsDirect medical treatment costs for COVID-19 inpatients represent significant economic burden. The link between increased costs and unfavorable final outcome should be further explored.

Regional hematology service registration system for the Russian Federation

Introduction. The hematology service registration system describes actual indicators of hematology service infrastructure and target objects of both assigned and affiliated organizations of Russian Federation regions along with its correlations. This system data base makes it possible to collect, save, and analyze information, creating a data storage library about all current existing resources and taking into account concrete, specific conditions of specialized and high-tech hematological medical assistance organizations at the local levels and formed quality and availability optimization proposals.Aim — description and justification of the need to create a unified, complex, available to all users, informational reference system with the possibility of up-to-date maintenance and accounting that allows for the keep and control of the regional characteristics and hematology service indicators of the Russian Federation.General findings. The creation of and development of the hematology service registration system began in 2018, and work on the project continues. Four main phases were selected as the key stages of the hematology service pasportisation: analyses of the current data, verification of information, creation of a user-friendly tool, system updating. Objects to monitor: medical key and related institutions, universities, affiliated organizations, laboratory service. The data working stages: data collection, manual updating, package uploading. The information sources: official websites, data high-tech medical treatment web portal, web portals of the public health authorities, Compulsory Medical Insurance Fund website, The Unified Data Health Care System, license register of the Federal Service for Healthcare Surveillance, data of the Federal State Statistics Service, official documents of Ministry of Public Health. Based on the developed checklists and forms for entering additional information for specialists of the subjects of the Russian Federation, a reference book of the Ministry of Defense (Excel file format) was created. However, in the course of further remote interaction and conducting field events in the regions of the Russian Federation during 2019–2020 new data needs for evaluating hematology services were determined. The increase of additional data inputs and its structure complication became the main reasons for further developing a new platform design concept and data conversion in database framework of the hematology service registration system (Access file format). The current objectives are as follows: authentication of the internal objects identifiers, implementation of the relational database codifier, modification of cartographic display and objects routing. The hematology service registration system contains data both for the key infrastructure nodes of Russian Federation hematology service and correlations within routing of all key system objects. Based on the positive results, the hematology service registration system is planned to be used by experts of specialized medical organizations, regional executive authorities on public health and professional communities, who will be able to accumulate all changes and indicators in dynamics within one system. The expected result is to provide the Ministry of Defense of the Russian Federation regions with methodological and informational support in specialized and high-tech medical care administration.