Does Social Medical Insurance Achieve a Poverty Reduction Effect in China?

This paper aims to explore the impact of social medical insurance (SMI) on poverty reduction (PR) in China. Considering the time-varying characteristics of factors, this paper uses the bootstrap Granger full sample causality and subsample rolling window model to find the relationship between SMI and PR. The results highlight that in some periods, there is a bidirectional causal link between SMI and PR. Influenced by the medical insurance reform and medication measures. Social medical insurance does not have a positive impact on poverty reduction in some periods. These results are supported by the Utility Maximization Model of Insurance Consumption, which highlights that individuals make utility maximization choices when choosing insurance. The effect of medical insurance on poverty alleviation depends on whether an individual's investment in medical insurance can maximize its utility. If the proportion of social medical insurance reimbursement is too low, individuals will give up buying social medical insurance. Thus, the anti-poverty effect of social medical insurance is difficult to achieve. Therefore, authorities need to pay attention to specific contexts and social medical insurance policies and further improve the social medical insurance system to promote the realization of the anti-poverty of social medical insurance.

Insurance payment for artificial intelligence technology: Methods used by a stroke artificial intelligence system and strategies to qualify for the new technology add-on payment

The first ever insurance reimbursement for an artificial intelligence (AI) system, which expedites triage of acute stroke, occurred in 2020 when the Centers for Medicare and Medicaid Services (CMS) granted approval for a New Technology Add-on Payment (NTAP). Key aspects of the AI system that led to its approval by the CMS included its unique mechanism of action, use of robotic process automation, and clear linkage of the system’s output to clinical outcomes. The specific strategies employed encompass a first-case scenario of proving reimbursable value for improved stroke outcomes using AI. Given the rapid change in utilization of AI technology in stroke care, we describe the economic drivers of stroke AI systems in healthcare, focusing on concepts of reimbursement for value added by AI to the stroke care system. This report reviews (1) the successful approach used by the first NTAP-approved AI system, (2) economic variables in insurance reimbursement for AI, and (3) resultant strategies that may be utilized to facilitate qualification for NTAP reimbursement, which may be adopted by other AI systems used in stroke care.

Nationwide Data on the Characteristics of Linked-to-Care Chronic Hepatitis B in Korea

Linkage-to-care rate of chronic hepatitis B (CHB) is less well characterized. We aimed to evaluate the proportion, characteristics of CHB patients who are linked to care. We retrospectively analyzed insurance reimbursement claims data provided by the Korean National Health Insurance Service. CHB patients who had at least two clinic or hospital visits that were associated with a CHB diagnostic code during 2002–2006 were included. Those without a history of malignancy at baseline were followed up until 2018. Mean follow-up period was 14.5 ± 2.9 years. Among the participants, 553,085 patients (35.8%) were found to be linked to care. The rates were lower in men than women (35.7% vs. 36.0%, p = 0.006). By age, it was highest for the 40′s age group at 44.8% and lowest at 29.4% for the 20′s age group (All p < 0.0001). The linkage-to-care rate was higher in rural area than metropolitan area (p < 0.0001). The 15-year cumulative incidence of hepatocellular carcinoma and overall survival rates among linked-to-care CHB patients were 18.2% and 93.8%, respectively. Two thirds of CHB patients were not linked to care. Those who are male, dwelling in metropolitan areas, and not in life transition periods need to be targeted to improve the linkage-to-care rate in Korea.

Health professionals' perceptions of maggot debridement therapy

Background: Maggot debridement therapy (MDT), or the use of maggots in dead tissue removal, has been shown to be beneficial in wound healing. Yet MDT in the US is often only used once conventional debridement methods have failed. Method: In this study, nine health professionals, experienced in MDT, were interviewed in order to identify and analyse the perceived societal barriers to MDT acceptance and usage in the US. Results: Through qualitative analysis, using the grounded theory framework, this study found that among those interviewed, insurance reimbursement restrictions and stigmatisation of medicinal maggots were the factors driving resistance to MDT use. Conclusion: Specifically, the ‘yuck’ factor and the perception of MDT as an ‘ancient’ modality contributed towards MDT stigma; in addition, lack of outpatient insurance coverage deterred MDT use. These findings provide useful information regarding the perceptual and systemic barriers that prevent greater acceptance of MDT. Ultimately, these barriers must be understood if we are to facilitate MDT implementation and improve MDT usage in the future.

365Disease burden of mumps in Japan: descriptive epidemiology based on the health insurance reimbursement database

Background In Japan, mumps vaccination coverage is low, since it is a voluntary vaccination. In this situation, the number of mumps cases as reported by pediatric sentinel hospitals suggests the occurrence of periodical mumps outbreaks. Methods To examine the annual incidences of mumps and mumps-related complications, we analyzed data from the health insurance reimbursement database for subscribers aged 0-64 years between 2005 and 2017. Cases with mumps and mumps-related complications including meningitis, orchitis, deafness, were extracted according to ICD-10 codes entered into the disease section for health insurance reimbursement. Results During the 13 year period, 68,307 of 5,209,660 subjects were reimbursed for mumps, with an incidence of 325 per 100,000 person-years (95% confidence interval (CI): 323-328). Among the 68,307 mumps cases, 787 were reimbursed for mumps-related complications, with an incidence of 11.5 per 1,000 mumps cases (95% CI: 10.7-12.4). Incidence of mumps-related complications (per 1,000 mumps cases) was highest for orchitis (6.6), followed by meningitis (5.8), deafness (1.3), pancreatitis (0.5), and encephalitis (0.3). Mumps incidence was highest among children aged 0-5 years, while incidence of mumps-related complications was highest among adults aged 26-35 years. Conclusions In Japan, the disease burden of mumps remains high among adults, as well as children. Key messages To reduce the disease burden of mumps among all ages in Japan, immunization in childhood is required. A national immunization program for children would result in high vaccination coverage and lower disease burden.

Mental health professionals discussing spiritual care for psychiatric outpatients: a qualitative study of multidisciplinary meetings

Aim: To explore how mental health professionals address spiritual care for outpatients in weekly multidisciplinary care meetings (MDM), and to explore the barriers and facilitators in the ways health professionals address spiritual care in those meetings. Method: Two teams of mental health professionals providing care for psychiatric outpatients are included. Qualitative data were collected from audio recordings of multidisciplinary meetings and from focus-group interviews afterwards. Data were analysed using ‘open coding’. Results: Spiritual care was not frequently addressed mostly due to the requirements of the health insurance reimbursement system. Aspects of spirituality addressed in these meetings pertained mainly to meaningful daily activities. Addressing spiritual care was facilitated, on the other hand, by a holistic focus on health and recovery-oriented care. Conclusion: In ambulatory mental healthcare spirituality is sparsely addressed and, when addressed, few aspects of spirituality come into view. Facilitating healthcare professionals’ awareness of their clinical perspective is an essential step to improve spiritual care for psychiatric outpatients.

Perception of telemedicine among medical practitioners in Malaysia during COVID-19

The novel Coronavirus Disease 2019 (COVID-19) has brought unprecedented changes in the way conventional health care is delivered. This study examined if clinicians’ perceptions regarding telemedicine and its barriers to implementation in Malaysia have changed during this pandemic. A cross-sectional survey was conducted among Malaysian medical doctors of various specialties in four urban healthcare facilities between June 2020 and July 2020. A total of 146 (41.7%) out of 350 responses were obtained. 62% of doctors reported a reduction greater than 50% in outpatient visits during the COVID-19 pandemic. The majority of doctors either found telemedicine useful in situations similar to COVID-19 (34.2%) or that it is essential to their daily practice (42.5%). However, only 22% reported using telemedicine for consultation during the COVID-19 pandemic. 74% of doctors felt that telemedicine would only benefit up to 30% of their patient population. Significantly more female doctors (80%) felt that telemedicine would benefit their patients compared to male doctors (45.8%) (P=0.03). Physicians (51.3%) were more inclined to adopt telemedicine in comparison to surgeons (32.4%) (P=0.03). The majority cited medico-legal issues and consent (80.6%), billing and charges (66.7%) and insurance reimbursement (62.5%), technical difficulties (62.5%) as their barrier to the adoption of telemedicine. Female doctors and physicians were more willing to adopt telemedicine when compared to male doctors and surgeons. Although the COVID-19 pandemic appeared to improve the perception, significant barriers should be resolved before many can incorporate it into their practice.

The long-term effects of the biolicit procedure for original and biosimilar GCSF and EPO products in Hungary

Aim: We aimed to analyse the long-term effects of the biosimilar bids of NEAK regarding GCSF and EPO drugs. Data and Methods: Our analysis is based on the data derived from the nationwide pharmaceutical database of NEAK. The treatment days and reimbursement figures of 12 months periods has been compared, from 01.07.2011-30.06.2014. and 01.07.2017.-30.06.2019. Results: In the 12 months preceding the price competition bid of biosimilar products 13974 patients received G-CSF, 7.49 billion HUF health insurance reimbursement has been paid, 5 years later the turnover of the product increased (314760, 340100 DOT value), whereas the reimbursement decreased (2.03 billion HUF, 1.95 billion HUF respectively). 12 months before the biosimial price competition, 4167 patients were treated with erythropoietin, resulting in 2.33 billion HUF of reimbursements, in the last 2 years the turnover increased (48727, 50813 DOT value respectively) with decreased reimbursement (1.004 billion HUF, 1.002 billion HUF respectively). Conclusions: The long-range analyses price competition bid of biosimilar products revealed that in case of products the health insurance reimbursement decreased despite the elevated turnover in a longer period as well. During the years following the start of the price competition bid the switch from original products to biosimilars could be observed.

Downstream Complications and Healthcare Expenditure after Invasive Procedures for Lung Lesions in Taiwan

This study aimed to estimate the downstream complications and healthcare expenditure after invasive procedures for lung lesions, which in turn could be used for future cost-effectiveness analyses of lung cancer screening in Taiwan. We interlinked the Taiwan National Beneficiary Registry with the National Health Insurance Reimbursement databases to identify non-lung cancer individuals aged 50–80 years who underwent invasive lung procedures within one month after non-contrast chest computed tomography between 2014 and 2016. We directly matched one individual with 10 controls by age, gender, calendar year, residence area, comorbidities, and the past one-year healthcare expenditure to calculate incremental one-month complication rates and attributable costs. A total of 5805 individuals who underwent invasive lung procedures were identified and matched with 58,050 controls. The incremental one-month complication rates were 13.4% (95% CI: 10.9% to 15.8%), 10.7% (95% CI: 9.2% to 12.1%), and 4.4% (95% CI: 2.0% to 6.7%) for thoracic surgery, bronchoscopy, and needle biopsy, respectively. The incremental one-month healthcare expenditure for minor, intermediate, and major complications were NT$1493 (95% CI: NT$-3107 to NT$6092), NT$18,422 (95% CI: NT$13,755 to NT$23,089), and NT$58,021 (95% CI: NT$46,114 to NT$69,929), respectively. Individuals aged 60–64 years incurred the highest incremental costs. Downstream complications and the healthcare expenditure after invasive procedures for lung lesions would be substantial for non-lung cancer individuals 50–80 years of age. These estimates could be used in modeling the cost-effectiveness of the national lung screening program in Taiwan.