Risk adjustment in the Netherlands; an analysis of insurers' health care expenditures

As of 2006, the Dutch healthcare system will be run by regulated competition. An important part of regulated competition is a system of risk adjustment. This paper presents an empirical analysis of the effects of risk adjustment in the Dutch social health insurance system covering the years 1991-2001. By comparing insurers' health care expenditures with their risk adjusted premiums, our analysis estimates the impact of risk adjustment over a number of years. Results indicate that the risk-adjustment system has improved substantially. Whereas in the beginning of the nineties prospective risk adjustment could explain about 20% of the variation in health care expenditure differentials between insurers, this figure rose to 55% in 2001. The explanation of the same variation after retrospective payments did not show a clear upward or downward trend, and has varied since 1995 around 85%. The remaining variation in insurers' health care expenditure differentials are determined more by structural than random factors. One such factor may be related to the low ex-ante projections of the government's total health care expenditures, which favour insurers with a population of relatively good health risks. Results show that new entrants in the Dutch health insurance market had significantly lower health care expenditures. Furthermore, economies of scale do not seem to have played a role during the sample period: the expenditures of large insurers were not significantly lower than those of the smaller insurers.

Environmental Health Risk Analysis Exposure to Nitrogen Dioxide (No2) and Sulfur Dioxide (So2) on Street Vendor in Ampera Terminal Palembang 2015

Background: Terminal is a location that generates air pollution as a result of transport activity performed. The use of motorized transport will produce a wide range of gases including NO2 and SO2. At certain concentrations of NO2 and SO2 can have an effect on health disorders for example respiratory problems, throat irritation and eye irritation.Methods: This study was a descriptive study of environmental health risk analysis method. Eighty four traders were sampled in this study. Simple random sampling was used as sampling technique. The variable used is the concentration of NO2, SO2 concentration, Inhalation Rate (R), exposure time, frequency of exposure, duration of exposure, weight, time period average-average, RFC, risk level. Univariate data analysis techniques. And then the data is presented in tabular form and narrative to interpret the data. Result: The street vendors in Terminal Palembang Ampera has a weight of less than 65.57 kg by 54.8%, exposure time ≤8 hours/day by 54.8%, the frequency of exposure ≤362 days/year amounted to 98.8 %, duration of exposure ≤10 years of 57.1%, intake NO2 ≤0.00132 mg/kg/day by 50%, SO2 intake 0.00677 mg/kg/day by 50%, NO2 RQ>1 at 0%, SO2 RQ>1 amounted to 11.9%, SO2 RQ>1 male sex-men by 80%, and SO2 RQ>1 is derived from the four measurement points by 40%. Conclution: This research concluded that exposure to Nitrogen Dioxide (NO2) to street vendors at Terminal Ampera Palembang does not pose a risk, whereas exposure to Sulfur Dioxide (SO2) provides risk to 10 street vendors in Terminal Ampera Palembang

Blood Sugar, Your Pancreas, and Unicorns: The Development of Health Education Materials for Youth With Prediabetes

Background. The obesity epidemic has led to an increase in prediabetes in youth, causing a serious public health concern. Education on diabetes risk and initiation of lifestyle change are the primary treatment modalities. There are few existing age-appropriate health education tools to address diabetes prevention for high-risk youth. Aim. To develop an age-appropriate health education tool(s) to help youth better understand type 2 diabetes risk factors and the reversibility of risk. Method. Health education tool development took place in five phases: exploration, design, analysis, refinement, and process evaluation. Results. The project resulted in (1) booklet designed to increase knowledge of risk, (2) meme generator that mirrors the booklet graphics and allows youth to create their own meme based on their pancreas’ current mood, (3) environmental posters for clinic, and (4) brief self-assessment that acts as a conversation starter for the health educators. Conclusion. Patients reported high likability and satisfaction with the health education tools, with the majority of patients giving the materials an “A” rating. The process evaluation indicated a high level of fidelity and related measures regarding how the health education tools were intended to be used and how they were actually used in the clinic setting

Risk Equity: A New Proposal

What does distributive justice require of risk regulators? Various executive orders enjoin health and safety regulators to take account of “distributive impacts,” “equity,” or “environmental justice,” and many scholars endorse these requirements. But concrete methodologies for evaluating the equity effects of risk regulation policies remain undeveloped. The contrast with cost-benefit analysis--now a very well developed set of techniques --is stark. Equity analysis by governmental agencies that regulate health and safety risks, at least in the United States, lacks rigor and structure. This Article proposes a rigorous framework for risk-equity analysis, which I term “probabilistic population profile analysis” (PPPA). PPPA is both novel, yet firmly grounded in the social-welfare-function tradition in welfare economics. The PPPA framework conceptualizes both the status quo, and possible policies, as probability distributions across population profiles -- where each population profile is, in turn, a concatenation of lifetime health-longevity-income histories, one for each member of the population. A utility function transforms each such profile into a utility vector. An equity-regarding social welfare function (SWF) is then specified. Policy analysts can employ the equity-regarding SWF both (1) to determine how policies compare purely as a matter of equality; and (2) to determine how they compare all-things-considered, considering both equality and overall welfare. The proposal may seem utopian, but is not. Scholars in the field of optimal tax policy already use SWFs to evaluate policies. Characterizing policies as distributions across population health-longevity-income profiles builds on existing risk assessment and general-equilibrium-modeling techniques. Utility functions can be specified through survey research and, in the interim, by building on standard functional forms. Plausible normative axioms considerably narrow the possible forms of the SWF, and survey research or thought experiments narrow the field further. Part I of the Article describes and criticizes existing approaches to risk equity that have been proposed in the scholarly literature: the environmental justice conception of risk equity; “individual risk” approaches; QALY-based equity analysis; incidence analysis; inclusive equality measurement; and cost-benefit analysis with distributive weights. Part II describes and defends PPPA. PPPA has many virtues. It recognizes that well-being is multidimensional, a function of both income and health/longevity; furnishes a metric for inequality; provides a framework for making tradeoffs between equality and overall well-being; and understands that distributive justice includes (but is not limited to) inequalities between high and low-status social groups

Inequity: Risk or Impact of Mental Health? Analysis of 2007 Indonesian Basic Health Survey

Background: It is well received that poor mental health can lead to social disparity and mequity indicated by unemployment and low education. However, the association between emotional distress with social disparity and in equity in population-based studies has not been well characterized. Using 2007 Riskesdas data, this analysis intend to examme reciprocal association between emotional distress with education and employment. Method: There were 659,672 respondents age above 14 in the survey which was carried out in the 33 provinces across Indonesia using probability proportion to size sample representing population until sub district level. First emotional distress is treated as risk for low education and employment. Then, emotional distress is treated as impact of unemployment and low education Four hypotheses are tested. Result: All the hypotheses confirmed reciprocal relationship between emotional distress and social disparity. Integrative intervention among ministries is necessary to improve mental health status and alleviating disparity and in equity for Indonesian

Health Risk of Heating Fuel Choice: A Simultaneity Causality Analysis

Combustion-generated pollutants, principally those from solid-fuels including biomass and coal when cooking and heating, bring out a significant public health hazard in both developed and developing countries. Most of the existing studies addressing this issue focus on developing countries, and on exposure when cooking rather than heating. By using Kentucky rural data, this research explores the health risk associated with heating fuel choice. Given the simultaneity between heating fuel choice and prevalence of asthma and allergy, we obtain the instrumental variable (IV) estimate for Logit models through the Generalized Method of Moments (GMM). After correcting for simultaneity bias, we do not find strong evidence supporting the causal relationship between polluting heating use and the prevalence of asthma, allergy, and other respiratory disease. Some demographic and lifestyle factors do have significant effects on the prevalence of these diseases.combustion-generated pollutants, indoor air pollution, heating fuel choice, health risk, GMM-IV Estimation, Environmental Economics and Policy, Health Economics and Policy, Q53, I18,

Double-standards in reporting of risk and responsibility for sexual health: a qualitative content analysis of negatively toned UK newsprint articles

Background: The need to challenge messages that reinforce harmful negative discourses around sexual risk and responsibility is a priority in improving sexual health. The mass media are an important source of information regularly alerting, updating and influencing public opinions and the way in which sexual health issues are framed may play a crucial role in shaping expectations of who is responsible for sexual health risks and healthy sexual practices. Methods: We conducted an in-depth, qualitative analysis of 85 negatively toned newspaper articles reporting on sexual health topics to examine how risk and responsibility have been framed within these in relation to gender. Articles published in 2010 in seven UK and three Scottish national newspapers were included. A latent content analysis approach was taken, focusing on interpreting the underlying meaning of text. Results: A key theme in the articles was men being framed as a risk to women's sexual health, whilst it was part of a women's role to "resist" men's advances. Such discourses tended to portray a power imbalance in sexual relationships between women and men. A number of articles argued that it was women who needed to take more responsibility for sexual health. Articles repeatedly suggested that women and teenage girls in particular, lacked the skills and confidence to negotiate safer sex and sex education programmes were often presented as having failed. Men were frequently portrayed as being more promiscuous and engaging in more risky sexual health behaviours than women, yet just one article drew attention to the lack of focus on male responsibility for sexual health. Gay men were used as a bench mark against which rates were measured and framed as being a risk and at risk Conclusions: The framing of men as a risk to women, whilst women are presented at the same time as responsible for patrolling sexual encounters, organising contraception and preventing sexual ill health reinforces gender stereotypes and undermines efforts to promote a collective responsibility for sexual health. This has implications for sexual ill health prevention and could continue to reinforce a negative culture around sex, relationships and sexual health in the UK

Cues and knowledge structures used by mental-health professionals when making risk assessments

Background: Research into mental-health risks has tended to focus on epidemiological approaches and to consider pieces of evidence in isolation. Less is known about the particular factors and their patterns of occurrence that influence clinicians’ risk judgements in practice. Aims: To identify the cues used by clinicians to make risk judgements and to explore how these combine within clinicians’ psychological representations of suicide, self-harm, self-neglect, and harm to others. Method: Content analysis was applied to semi-structured interviews conducted with 46 practitioners from various mental-health disciplines, using mind maps to represent the hierarchical relationships of data and concepts. Results: Strong consensus between experts meant their knowledge could be integrated into a single hierarchical structure for each risk. This revealed contrasting emphases between data and concepts underpinning risks, including: reflection and forethought for suicide; motivation for self-harm; situation and context for harm to others; and current presentation for self-neglect. Conclusions: Analysis of experts’ risk-assessment knowledge identified influential cues and their relationships to risks. It can inform development of valid risk-screening decision support systems that combine actuarial evidence with clinical expertise