Do financial incentives for supplementary private health insurance reduce pressure on the public system? Evidence from Australia, CHERE Working Paper 2006/11

In many developed countries, budgetary pressures have made government investigate private insurance to reduce pressure on their public health system. Between 1997 and 2000 the Australian government implemented a series of reforms intended to increase enrollment in private health insurance and reduce public health care costs. Using the ABS 2001 National Health Survey, we examine the impact of increased insurance coverage on use of the hospital system, in particular on public and private admissions and lengths of stay. We model probability of hospital admission and length of stay for public (Medicare) and private patients. We use Propensity Score Matching to control for selection in the insurance decision and estimate a two-part model for hospital admission and length of stay on the matched sample. Our results indicate that there is selection associated with insurance choice. We also find that unconditional public patient and private patient lengths of stay in 2001 differ markedly depending on insurance duration. Those with shorter periods of insurance coverage behave more like the uninsured than those insured prior to the insurance incentives. While the insurance incentives substantially increased the proportion of the population with supplementary cover, the impact on use of the public system appears to be quite modest. Increased private usage outweighs reduced public usage and the insurance incentives appear to be an extremely costly way of reducing pressure on the public hospital system.Private Health Insurance, Australia

Psychiatric Disorders and Labor Market Outcomes: Evidence from the National Latino and Asian American Study

This paper investigates to what extent psychiatric disorders and mental distress affect labor market outcomes among ethnic minorities of Latino and Asian descent, most of whom are immigrants. Using data from the National Latino and Asian American Study, we examine the labor market effects of meeting diagnostic criteria for any psychiatric disorder in the past 12 months as well as the effects of psychiatric distress in the past year. Among Latinos, psychiatric disorders and mental distress are associated with detrimental effects on employment and absenteeism, similar to effects found in previous analyses of mostly white, American born populations. Among Asians, we find mixed evidence that psychiatric disorders and mental distress detract from labor market outcomes.

Does the new cooperative medical scheme reduce inequality in catastrophic health expenditure in rural China?

Background In 2003, the New Cooperative Medical Scheme (NCMS) was introduced in China to re-establish health insurance for the country’s vast rural population. In addition, the coverage of NCMS has been expanding after the new health care reform launched in 2009. This study aims to examine whether the NCMS and its recent expansion have reached the goal of reducing the risk and inequality of catastrophic health spending for rural residents in China. Methods We conducted a face-to-face household survey in three counties of the Shandong province in 2009 and 2012. Using this unique panel data, we examined the changes in the incidence and intensity of catastrophic health expenditures (CHEs) before and after NCMS reimbursement. We used concentration index (CI) and decomposition method to study the changes in inequality in CHEs. Results We found that NCMS reimbursement played a role of reducing both the incidence and intensity of CHEs, and that this impact was stronger after the new health care reform was launched. After reimbursement, the concentration indices for CHEs were 0.073 and 0.021 in 2009 and 2012, indicating that the rich had a greater tendency to incur CHEs and there existed less inequality in the incidence of CHEs after reimbursement in 2012 compared with 2009. The decomposition analysis results suggested that changes in CHE inequality between 2009 and 2012 were attributed to changes in economic status and household size rather than reimbursement levels. Conclusions Our results indicated that inequality was shrinking from 2009 to 2012, which could be a result of fewer rich people having CHEs in 2012 compared with 2009. The impact of NCMS in alleviating the financial burden of rural residents was still limited, especially among the poor. Health care reform policies in China that aim to reduce CHEs must continue to place an emphasis on improving reimbursement, cost containment, and reducing income inequalities

Twelve Novel Atm Mutations Identified in Chinese Ataxia Telangiectasia Patients

Ataxia telangiectasia (A-T) is an autosomal recessive disease characterized mainly by progressive cerebellar ataxia, oculocutaneous telangiectasia, and immunodeficiency. This disease is caused by mutations of the ataxia telangiectasia mutated (Atm) gene. More than 500 Atm mutations that are responsible for A-T have been identified so far. However, there have been very few A-T cases reported in China, and only two Chinese A-T patients have undergone Atm gene analysis. In order to systemically investigate A-T in China and map their Atm mutation spectrum, we recruited eight Chinese A-T patients from six unrelated families nationwide. Using direct sequencing of genomic DNA and the multiplex ligation-dependent probe amplification, we identified twelve pathogenic Atm mutations, including one missense, four nonsense, five frameshift, one splicing, and one large genomic deletion. All the Atm mutations we identified were novel, and no homozygous mutation and founder-effect mutation were found. These results suggest that Atm mutations in Chinese populations are diverse and distinct largely from those in other ethnic areas

Strengths and Barriers to Coding Hospital Chart Information from Health Information Manager Perspectives: A Qualitative Study

Introduction It is essential that clinical documentation and data coding be of high quality for the production of healthcare data for research or administrative purposes. However, there is a limited understanding of the facilitators and barriers of coded data quality and strategies to improve it. Objectives and Approach Our objective was to qualitatively assess what influences coded data quality from the perspective of health information managers who are responsible for the work of coding specialists. Nine health information managers and/or coding quality coordinators who oversee coding specialists were identified and recruited from nine provinces across Canada to participate in this study. Semi-structured interviews were conducted which asked questions on participant demographics, responsibilities, data quality, costs and budget of coding, continuing education for Health Information Management (HIM), suggestions for quality improvement, and barriers to quality improvement. Interviews were recorded and transcribed, and analyzed using Directed Content Analysis methodology. Results Interviewees were primarily responsible for managing staff, quality assurance, audits, reporting, budget, data collection, and transcription. Managers reported that the experienced coders under their employ strengthened coding quality. Common barriers to coding quality included incomplete and unorganized chart documentation, which led to undercoding, and lack of communication and access to physicians for clarification when needed. Further, coding quality suffered as a result of limited resources (e.g. staffing and budget) being available to HIM departments for an ever-expanding workload, that was commonly due to increasingly complex charts and additional project data. Managers unanimously reported that coding quality improvements can be made by 1) making interactive training programs available to coding specialists, and 2) streamlining sources of information from charts (i.e., transitioning to standardized electronic charting). Conclusion/Implications Although coding quality is generally regarded as high across Canada, quality can be hampered by incomplete and inconsistent chart documentation, lack of resources (e.g. financial support, staff, education), and inconsistent coding standards across hospitals and provinces. This study presents novel evidence for coding quality improvement across Canada

The Economic Impacts of ICD-9 to ICD-10 Health Indicator Coding System Transition in the Calgary Region

Introduction Coded data serves a critical part in the process of identifying the resource allocation required for each department in a hospital and for research purposes. This paper attempts a cost-benefit analysis of the transition from ICD-9 health indicator coding system to ICD-10 coding system and quantify the economic impacts. Objectives and Approach The hypothesis adopted by this paper is that the transition from ICD-9 to ICD-10 has been beneficial for the health system due better disease management, resulting in cost savings and facilitation of high quality health research. Analyzing the inflation-adjusted costs compared with the benefits accrued from implementing the new coding system would enable informed decision making for the stakeholders at government and other levels of health provision. The methodology involves constructing ‘benefit scenarios’ via analysis of existing literature and interviewing coding managers; costs are evaluated using data collected on re-training coders and productivity losses during the transition phase. Results An example of a benefit scenario would take the form of cost savings associated with correctly identifying people with diabetes (due to coded charts), hence resulting in a decline in blood sugar (HbA1c) levels via better disease management. This in turn may cause reductions in other high blood-sugar related diseases and thus increase efficiency for government funding in the health care sector. Improved data quality in ICD-10 is expected to have resulted in gains from specificity due to increased sensitivity of data classification and grouping. Actual cost of re-training of coders and ICD-10 software provider fees are expected to be higher than the costs anticipated before ICD-10 implementation. Productivity losses in the transition phase are expected to have declined as coders became more adept at coding. Conclusion/Implications An economic evaluation proves to be a vital part of eliciting whether the transition to the newer method of coding, ICD-10, has been beneficial to the end users of the data. It is important to understand the efficiency of resource allocation to healthcare and the financial implications such investments entail

Modelling and optimisation on scroll expander for waste heat recovery organic Rankine cycle

Scroll expander has demonstrated high efficiency at low power range. In this paper, a generic model of a scroll expander has been developed. It can calculate the ideal expander parameters to give the optimal efficiency and prevent under- or over-expansion at any given operating conditions or fluids. The dynamic model was validated by predicting the ideal volumetric expansion ratio with ideal expansion ratio of 4.03 at 0.7 MPa pressure, and showed agreement with experimental data. The results suggested that the rate of scroll increase K in the geometric model has little effect on volumetric expansion ratio or ideal scroll length of the expander, but when expansion ratio is kept constant, lower K value results in lower leakage losses

Transcriptional profiles of different states of cancer stem cells in triple-negative breast cancer

Abstract Breast cancer stem cells (BCSCs) are thought to be responsible for tumor initiation, metastasis and relapse. Our group and others have described markers useful in isolating BCSCs just as aldehyde dehydrogenase positive (ALDH+) or CD24−CD44+. In fact, cells which simultaneously express both sets of markers have the highest tumor initiating capacity. Although the transcriptomic profile of cells expressing each BCSC marker alone has been reported, the profile of the most tumorigenic population expressing both sets of markers has not. Here we used the biomarker combination of ALDH and CD24/CD44 to sort four populations isolated from triple-negative breast cancer (TNBC) patient-derived xenografts, and performed whole-transcriptome sequencing on each population. We systematically compared the profiles of the three states of BCSCs (ALDH+CD24−CD44+, ALDH+non-CD24−CD44+ and ALDH−CD24−CD44+) to that of the differentiated tumor cells (ALDH−non-CD24−CD44+). For the first time, we compared the ALDH+CD24−CD44+ BCSCs with the other two BCSC populations. In ALDH+CD24−CD44+ BCSCs, we identified P4HA2, PTGR1 and RAB40B as potential prognostic markers, which were virtually related to the status of BCSCs and tumor growth in TNBC cells.https://deepblue.lib.umich.edu/bitstream/2027.42/142395/1/12943_2018_Article_809.pd