The Development of a Nationwide, Multicenter Electronic Database for Spinal Instrumentation Surgery in Japan: Japanese Spinal Instrumentation Society Database (JSIS-DB)

(1) Background: Despite the number of complicated and expensive spine surgery procedures maintained by the national health insurance system in Japan, until now there has been no large-scale multicenter clinical database for this field to understand and improve healthcare expenditure and treatment outcomes. The purpose of this report is to announce the establishment and methodology of a nationwide registry system for spinal instrumentation surgeries by the Japanese Spinal Instrumentation Society (JSIS), and to report the progress over the first 1.5 years of this database’s operation. (2) Methods: The JSIS recently produced an online database with an electronic server. The collected information included patient background, surgery information, and early complications of primary and revision cases. Analysis included data from February 2018, when registration began, to August 2019. (3) Results: As of August 2019, 73 facilities have completed the required paperwork to start, and 55 facilities have registered cases. Of the total 5456 registered cases, 4852 were valid and 2511 were completed. (4) Conclusions: JSIS-DB, the nationwide web-based registry system for spinal instrumentation surgery in Japan, was launched for the purpose of research, healthcare policy regulation, and improved patient care, and its methodology and progress in the first 1.5 years are reported in this study.

The Indonesian Strategy to Achieve Universal Health Coverage through National Health Insurance System: Its Challenges in Human Resources

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Initial assessment of a cancer genomic profile test for patients with metastatic breast cancer: a retrospective study

Comprehensive cancer genomic profile (CGP) tests are being implemented under Japanese universal health insurance system. However, the clinical usefulness of CGP test for breast cancer patients has not been evaluated. Of the 310 patients who underwent CGP testing at our institution between November 2019 and April 2021, 35 patients with metastatic breast cancer whose treatment strategy was discussed by our molecular tumor board within the study period were investigated after exclusion of 2 cases that could not be analyzed. The turn-around time, drug accessibility, and germline identification detection were evaluated. The subtype was luminal in 20 patients (57.1%), triple-negative in 12 patients (34.3%), and luminal-HER2 in 3 patients (8.6%). Actionable gene mutations were detected in 30 patients (85.7%), and 7 patients (20.0%) were recommended for clinical trial participation, with the drug administered to 2 patients (5.7%). Three patients (8.6%) died due to disease progression before the test results were disclosed. We report the results of an initial assessment of the utility of CGP testing for patients with metastatic breast cancer under Japanese universal health insurance system. Conducting CGP tests at a more appropriate time could provide patients with greater benefit from treatments based on their specific gene mutations.

Evaluating the activity of dispensing opioid analgesic medication

Objectives. The purpose of this paper was to evaluate the drug dispensing activity of analgesic opioids in pharmacies. Materials and methods. The study was conducted in an observational and retrospective manner, based on a questionnaire distributed in different pharmacies across Romania. Results. The dispensing activity of opioid analgesics is conducted in 71 out of the 100 pharmacies that have received the questionnaire. These pharmacies are located in 12 out of the 41 counties, mostly in the urban area and 96% of them are community pharmacies. The most prescribed and dispensed pharmaceutical forms are solid forms, the injectable products and transdermic systems being dispensed in a high percentage, up to 40% respectively, only in 25% of the questioned pharmacies. The average time spent by a pharmacist for the entire activity of dispensing an opioid analgesic prescribed by a doctor was estimated at 17.82± 0.58 minutes. Conclusions. The activity regarding opioid analgesics in the community pharmacy is limited by the low rentability, high costs and time consumption. The results of the study impose a further analysis on the impact that this service has upon public health, in order to this activity be sustained by the national health insurance system. Measures must be implemented to ensure that patients from rural or unprivileged areas are able to get their analgesics from the nearest community pharmacy constantly.

The pattern of health insurance economic resilience in the Covid 19 pandemic shock

Objective Health insurance is based on people’s significant risks in receiving health services that they cannot afford alone. Since the outbreak of the corona epidemic, the health insurance system has suffered many economic problems. Designing a model of a health insurance system based on the requirements of a resilient economy can improve the functions of this system in the corona crisis. Results In this research 12, structural components were obtained in the form of 4 conceptual components. The 4 main conceptual components are Knowledge-based economy, Economic stability, Economic resilience, and justice. The knowledge-based economy is the basis for the formation of economic resilience in the health insurance systems. Health insurance systems will achieve two crucial intermediate results, namely economic resilience, and economic stability, by building the basic infrastructure of a knowledge-based economy. In the long run, maintaining such intermediate results is the foundation of justice in the health insurance system.

FOR SOME POSSIBLE ASPECTS OF MEDIATION IN HEALTH INSURANCE RELATIONS

The work analyzes some possible aspects of the application of mediation in health insurance relations, by deriving on the one hand typical problems in the functioning of the health insurance system, and on the other - by options for solving them through the methods of out-of-court voluntary procedure. Based on the systematics, specific proposals and exemplary practices for the introduction of mediation procedures are derived.