Association Between Dynamic Trends of Functional Disability and Poverty Among People Aged 45 and Over

BackgroundThe disability problem has become prominent with the acceleration of the global aging process. Individual disability is associated with economic conditions and contributes to family poverty. As disability will change over a long period of time and may even show distinct dynamic trends, we aimed to focus on activities of daily living (ADL) and classify functional disability trends. Moreover, we aimed to highlight and analyze the association between functional disability trends and economic conditions and explore the influencing factors.Materials and MethodsA total of 11,222 individuals who were 45 years old or older were included in four surveys conducted by the China Health and Retirement Longitudinal Study in 2011, 2013, 2015, and 2018. Samples were analyzed after excluding those with missing key variables. The latent class growth model was used to classify the ADL trends. Two binary logistic regressions were established to observe the association between the ADL trends and follow-up economic conditions or catastrophic health expenditure trends.ResultsADL trends of older adults were classified into improving (25.4%), stabilizing (57.0%), and weakening ADL (17.6%). ADL trend was associated with follow-up poverty (p = 0.002) and catastrophic health expenditure trends (p < 0.001). Compared with the improving ADL trend, the stabilizing ADL may have a negative influence on individuals' economic conditions (OR = 1.175, 95%CI = 1.060–1.303). However, a stabilizing ADL trend was less likely to bring about catastrophic health expenditures (OR = 0.746, 95%CI = 0.678–0.820) compared with an improving ADL trend.ConclusionThe improvement of functional disability would make the medical expense burden heavier but would still be beneficial for the prevention of poverty. A significant association was found between socioeconomic factors and poverty. Preventing the older adults from developing disability and illness, improving the compensation level of medical insurance, and optimizing the long-term care insurance and the primary healthcare system can potentially contribute to the prevention of poverty. Meanwhile, focusing on people who are poor at early stages, women, middle-aged, low-educated, and in rural areas is important.

US Medical Expense Analysis Through Frequency and Severity Bootstrapping and Regression Model

For the purpose of control health expenditures, there are some papers investigating the characteristics of patients who may incur high expenditures. However fewer papers are found which are based on the overall medical conditions, so this chapter was to find a relationship among the prevalence of medical conditions, utilization of healthcare services, and average expenses per person. The authors used bootstrapping simulation for data preprocessing and then used linear regression and random forest methods to train several models. The metrics root mean square error (RMSE), mean absolute percent error (MAPE), mean absolute error (MAE) all showed that the selected linear regression model performs slightly better than the selected random forest regression model, and the linear model used medical conditions, type of services, and their interaction terms as predictors.

Traditional Chinese Medicine Reduces Hospitalization Risk of Osteoarthritis Patients: A 13- Year Population-based Cohort Study

Introduction：Osteoarthritis (OA) is a chronic musculoskeletal disorder of the movable joints. TCM has been widely used as complementary therapy for OA in Chinese. Traditional Chinese medicine (TCM) including Duhuojishi decoction, Shujing Huoxue decoction, Angelica Niantong decoction, Guilu Erxian glue et al are widely used in the clinical of osteoarthritis treatment. However there are very few large-scale studies about long-term effect of TCM on OA treatment. This study determined the long-term effects of TCM on reducing OA patients hospitalization risk.Material and methods: This study was a population-based retrospective cohort study. Patient data were collected from the claim-based Taiwan National Health Insurance Research Database from 2000 to 2012. We enrolled 67737 TCM treated cohort and 67737 non-TCM comparison of newly diagnosed OA patients. Propensity score matching was done on age, sex and possible confounders to ensure baseline comparability. Outcomes were medical utility, including hospitalization rate, emergency visits and direct medical expense. Logistic regression was conducted to compare the differences o between TCM and non-TCM groups. Subgroup analyses were also performed by age, gender, income and urbanization.Results: TCM group had an overall higher medical expense than non-TCM group. Although Logistic regression analysis results showed that there was no difference of emergency rate in TCM group and non-TCM group, TCM treatment reduced hospitalization rate of OA significantly.Conclusions: The usage of TCM was associated with a reduced risk of hospitalization of OA patients. TCM might play a complementary role in OA treatment.

COVID-19 policy and insurance coverage

Major medical expense insurance is an investment that covers most of the expenses incurred by medical intervention or treatment. Given the panorama of the new reality derived from SARS-CoV2 (COVID-19), it puts people and their rights in a state of vulnerability and risk; it is important to analyze the role of policies and their coverage in major medical expenses due to COVID-19. This document identifies the landscape of insurance companies in Mexico, which in the wake of the coronavirus included or strengthened their mechanisms for indemnification, deductible, and coinsurance. This was because the Asociación Mexicana de Instituciones de Seguros (AMIS), the Comisión Nacional de Seguros y Fianzas (CNSF) and the Secretaría de Hacienda, agreed on care measures for policyholders. According to AMIS, Mexico had a 10% increase in the contracting of insurance for major medical expenses and a 3% increase in life insurance premiums; although there is talk of an increase that represents a smaller number of people who are unaware or are not interested in the acquisition of insurance for major expenses, they must foresee that it is an investment that provides security and certainty of protection in the future not only in the individual (family) aspect but also in a collective -group way (public institutions and companies) due to the impact it has on all sectors.

Exploratory Study on Constructing an Evaluation Index System of Value-based Healthcare Delivery in China

Background The current healthcare model is challenged by fewer concerns with healthcare quality and its sustainable development, affecting all participants involved in the healthcare system.Value-based healthcare (VBHC) delivery refers to a new management paradigm that prioritizes patients’ health outcomes at lower healthcare costs.The use of value payments can effectively control the increases in medical costs and reduces the cost of health systems, presenting pieces of evidence in improving the diagnosis and treatment results as well as creating value for patients. Extant studies have investigated VBHC preparation and formulated a set of evaluation indices in the West context. However, a dearth of VBHC-related research conducted in China was noted wherein the VBHC’s evaluation system has not yet been explored. Thus, this study aims at developing China’s medical service attitude appraisal evaluation framework by adopting VBHC delivery. Results Two rounds of surveys found the authority degree coefficient of experts (0.805 and 0.812), degree of positivity (93.75% and 100%), the range of arithmetic means for the importance (3.30–5.0 and 4.05–5.0), the range of full-score frequency (16–94% and 23–100%), the range of variable coefficient (0.11–0.29 and 0.0–0.12), and the coordination coefficient (0.39 and 0.79; p༜0.5 for all). The final evaluation index system comprises 35 items with three, nine, and 23 first-, second-, and third-level indicators, respectively. The three first-level indicators and their weight coefficients are data collection and sharing of treatment cost and curative effect for specific diseases (0.409), medical expense payers (0.245), and healthcare providers (0.346). Conclusions This study constructs an evaluation index system on the basis of the VBHC delivery, the study methods are reasonable, the experts representativeness are high, the positivity degree and authority degree of experts are high, the concentration degree and coordination degree of experts’ opinions are good, and the weight of the indicators was calculated, which is scientific and can be used as a tool to evaluate the implementation of the VBHC delivery in China.

Does integrated medical insurance system alleviate the difficulty of using cross-region health Care for the Migrant Parents in China-- evidence from the China migrants dynamic survey

Background Many internal migrants during the urbanization process in China are Migrant Parents, the aging group who move to urban areas to support their family involuntarily. They are more vulnerable economically and physically than the younger migrants. However, the fragmentation of rural and urban health insurance schemes divided by “hukou” household registration system limit migrant’s access to healthcare services in their resident location. Some counties have started to consolidate the Urban Resident Basic Medical Insurance (URBMI) and the New Rural Cooperative Medical Scheme (NRCMS) as one Integrated Medical Insurance Schemes (IMIS) from 2008. The consolidation aimed to reduce the disparity between different schemes and increase the health care utilization of migrants. Results Using the inpatient sample of migrant parents from China Migrants Dynamic Survey in 2015, we used Ordinary Least Squares (OLS) for regression models. We found that the migrant parents covered by the IMIS are more likely to choose inpatient services and seek medical treatment in the migrant destination. We further subdivide Non-IMISs into NCMSs and URBMIs in the regression to alleviate the doubt about endogenous. The results revealed that the migrant parents in IMIS use more local medical services than both of them in URBMI and NCMS. Conclusions The potential mechanisms of our results could be that IMIS alleviates the difficulty of seeking medical care in migrant destinations by improving the convenience of medical expense reimbursement and enhancing health insurance benefits.

Hospital Selection Factors of Sleep Disorder: Sleep Apnea Versus Other Sleep Disorders

Objectives: The hospital selection factor is the criterion based on the judgment of the patients’ decision process. We investigated the hospital selection factors of patients with sleep disorders and compared that for patients with sleep apnea and other sleep disorders. Methods: This is a questionnaire-based cross-sectional study that evaluated patients with a sleep disorder at the sleep unit of a tertiary referral center. We investigated the patients’ demographic information, occupational status, diagnosis of sleep disorders, and hospital-related and patient-related factors associated with hospital selection. Results: A total of 138 patients with a sleep disorder were analyzed. Internet information was the primary data source for sleep apnea patients to select a hospital, while it was acquaintances for patients with other sleep disorders. None with sleep apnea gathered information from broadcast or print media. Patients gave the highest score for the least waiting time and recency of the hospital’s facility. Unlike patients with other sleep disorders, those with sleep apnea valued the hospital’s popularity, accessibility, availability of appointments at desired dates, and medical expense benefits. Conclusions: This is the first study to analyze the hospital selection factors of patients with sleep disorders in South Korea. This study might improve the sleep medication as well as the medical system by revealing the medical use behavior of patients with sleep disorders.

Cost-Effectiveness Analysis of Immunotherapy in Patient with Allergic Rhinitis

Background and Objectives All treatments must be effective and affordable. Although it is clear that immunotherapy is effective in patients with allergic rhinitis, no cost-effectiveness analysis has been conducted in Korea.Subjects and Method We compared 10 years of total treatment costs (medical expense+ transportation cost+time cost) with medications and symptoms scores assuming that adult patients with allergic rhinitis are treated only with symptomatic medication (medication model) or immunotherapy (subcutaneous or sublingual) plus symptomatic medication [subcutaneous immunotherapy (SCIT) and sublingual immunotherapy (SLIT) models, respectively]. For cost-effectiveness analysis, related papers and domestic medical statistics were used.Results The total treatment costs for the first 3 years were ₩3330199, ₩6605557, and ₩7130467 for the Medication model, SCIT model and SLIT model, respectively. The total treatment costs for the 10-year period were ₩7996087, ₩8588624, and ₩9113534 for the medication model, SCIT model, and SCIT model, respectively. The cumulative symptoms plus medications scores decreased 0.44 times in both immunotherapy models compared to the medication model. Conclusion The initial cost of immunotherapy is more expensive than symptomatic medication, but the total cost for 10 years is similar. In addition, immunotherapy can reduce symptoms by more than half. Therefore, it is a cost-effective treatment for allergic rhinitis.

Fee-For-Service Health Insurance and Moral Hazard of Hospitals

The supply-side contribution to the surge of medical expense is overlooked in the Korean health insurance market. Commonly, the demand-side is accounted for the excessive increase in medical consumption. Previous studies suggest the moral hazard or adverse selection of Fee-For-Service Health Insurance (FFS) policyholders as the source of the problem. However, this paper focuses on the moral hazard of medical institutions using Korea Health Panel (KHP) Data version 1.5 from year 2008–2016. This study finds the medical usage difference between FFS holders and non-holders were greater for clinics and local hospital visits than the visits to general hospitals or special hospitals. This implies that supply-side contributes to the ex-post moral hazard of health insurance.

The Impact of Pharmaceutical Home Care on Medical Utilization for Frequent Users of Outpatient Services in Taiwan

Due to the high-accessibility and low-copayment of healthcare system in Taiwan, the clinical visit frequency of people is relatively high, which often leads to an excessively high healthcare expenditure. The aim of this research was to explore the effectiveness of pharmaceutical home care for frequent users of outpatient service and to analyze the impact of pharmaceutical home care on medical utilization. The study was based on the Taiwan National Health Insurance Research Database. Patients with over 100 clinical visits during 2010 to 2012 were selected as subjects. Whether these patients participate the experimental plan of pharmaceutical home care in the following year and the medical utilization of the research subjects were analyzed to compare the difference between participating group and non-participating group in this plan. The generalized estimating equation was employed to examine the difference of medical utilization. A total of 3943 subjects were included in this study, including 591 patients (14.99%) participating in the experimental plan. The average number of physician visits during the following year of the participating group was higher than that of the non-participating group by 0.12 visits, and the outpatient medical expense was lower than the non-participating group by 18,302 points (1 point = 0.03 US dollars). After participating in the plan, the average number of clinical visits of frequent users of outpatient services was significantly reduced by 6.63 visits, and the outpatient expense was significantly decreased by 9871 points. After joining the experimental plan of pharmaceutical home care, the average number of outpatient visits decreased significantly and the medical expense was lower when compared with those who did not participate in the plan.