Adverse selection and moral hazard in health insurance.

In this paper, we want to characterize the optimal health insurance contract with adverse selection and moral hazard. We assume that policyholders differ by the permanent health status loss and choose an unobservable preventive effort in order to reduce the probability of illness which is ex-ante identical. The difference in illness'after-effect modifies policyholders' preventive actions. By the way, they differ in probabilities of illness leading to a situation close to Rothschild and Stiglitz 'model. In this case, we show that the optimal contract exhibits a deductible for the high health risk type since a higher after effect implies a higher preventive effort and then a lower probability of illness rather than for the low health risk type.Health insurance; risk; policyholders;

The preventive and treatment effect of Urtica dioica on astrocyte density in the CA1 and CA3 subfields of hippocampus in STZ induced diabetic rats

Several animal model studies have shown that Diabetes mellitus can affect on the activity of hippocampus astrocytes, but these studies reported controversial findings. This study was done to evaluate the preventive and treatment effect of Urtica dioica (U. dioica) on astrocytes density in the CA1 and CA3 subfields of hippocampus of streptozotocin (STZ) induced diabetic rats. Twenty-eight male albino Wistar rats were randomly allocated equally into control, diabetic, U. dioica treatment and U. dioica preventive groups. Hyperglycemia was induced by STZ (80 mg/kg/BW). One week after injection of the streptozotocin, animals in treatment group were received hydroalcoholic extract of U. dioica (100 mg/kg/BW /day) for 4 weeks by intraperitoneally. In preventive group, diabetic rats were received 100 mg/kg/BW/ daily hydroalcoholic extract of U. dioica for 5 days before STZ injection. Then, animals were sacrificed and coronal sections were taken from the right dorsal hippocampus, stained with PTAH. The area densities of the astrocytes were measured. The number of astrocytes in CA1 of controls, diabetic treatment and preventive groups was 19.00±5.5, 17.14±6.4, 21±8.1 and 16.48±3.2, respectively. The densities of astrocytes in CA3 of controls, diabetic, treatment and preventive groups were 25.45±7.60, 21.54±7.5, 23.75±5.6 and 19.89±3.8, respectively. The density of astrocytes in diabetic rats reduced in comparison with controls (P<0.05). In CA1 and CA3, in spite of preventive administration, treatment of diabetic rats with U. dioica significantly increased the astrocytes. This study showed that treatment with U. dioica extract can help compensate for the CA1 and CA3 subfields of hippocampus astrocytes in diabetic rats

How High Is Too High? Implications of High-Deductible Health Plans

Assesses high deductible health plans, and the likelihood that they would have a substantial effect on either health costs or coverage. Suggests legislative modifications to protect lower wage adults and ensure access to early preventive and primary care

Physiology and prevention of heel ulcers: The state of science

The prevalence of heel ulcers across settings is high and is increasing. Prevention of ulcers requires knowledge of their etiology and the scientific basis for preventive care. The interaction between external pressure and the heel vasculature is central to the prevention of heel ulcers. This article focuses on the prevention of heel pressure ulcers. The physiology of heel tissue perfusion, the effect of external pressure on heel perfusion, as well as what is known about strategies to reduce external pressure and approaches to improve heel skin blood flow will be discussed. It is only through understanding of the physiology of heel tissue perfusion and its relation to external pressure that effective preventive measures to reduce heel skin breakdown can be adapted in clinical practice

Preventive effect of vitamin B6 on developmental toxicity of carbamazepine in mice

Objective(s): Carbamazepine (CBZ) is an antiepileptic drug that is used widely for the treatment of epileptic seizures. Neural tube defects (NTDs), growth retardation, and nail hypoplasia are the most common features of teratogenic effects of this drug. The purpose of this study was to examine the effect of vitamin B6 on the developmental toxicity of CBZ on mice. Materials and Methods: Sixty BALB/c pregnant mice were divided into four experimental and two control groups. Two experimental groups received daily intraperitoneal injection (IP) of 30 mg/kg (I) or 60 mg/kg (II) of CBZ on gestational days (GD) 6 to 15. Two other experimental groups received daily IP injection of 30 mg/kg (III) or 60 mg/kg (IV) of CBZ with 10 mg/kg/day vitamin B6 by gavage 10 days prior to gestation and on GD 6 to 15. Two control groups received normal saline or Tween 20. Dams underwent Cesarean section on GD 18 and embryos were harvested. External/macroscopic observation of fetuses was done by stereomicroscope and external examination for malformations was recorded. Data analyzed by ANOVA and X 2 test using SPSS software. Results: The mean weight and crown-rump of the fetuses in both CBZ-treated experimental groups were significantly reduced compared with those of the control groups. Various malformations were detected such as brachygnathia, eye malformations, NTDs, vertebral deformity, brachydactyly and growth retardation. Vitamin B6 treatment significantly reduced various CBZ-induced malformations. Conclusion: This study showed that vitamin B6 has a preventive effect on the developmental toxicity of CBZ in mice that can be pursued further for clinical research

Metformin Decreases the Incidence of Pancreatic Ductal Adenocarcinoma Promoted by Diet-induced Obesity in the Conditional KrasG12D Mouse Model.

Pancreatic ductal adenocarcinoma (PDAC) is a particularly deadly disease. Chronic conditions, including obesity and type-2 diabetes are risk factors, thus making PDAC amenable to preventive strategies. We aimed to characterize the chemo-preventive effects of metformin, a widely used anti-diabetic drug, on PDAC development using the KrasG12D mouse model subjected to a diet high in fats and calories (HFCD). LSL-KrasG12D/+;p48-Cre (KC) mice were given control diet (CD), HFCD, or HFCD with 5 mg/ml metformin in drinking water for 3 or 9 months. After 3 months, metformin prevented HFCD-induced weight gain, hepatic steatosis, depletion of intact acini, formation of advanced PanIN lesions, and stimulation of ERK and mTORC1 in pancreas. In addition to reversing hepatic and pancreatic histopathology, metformin normalized HFCD-induced hyperinsulinemia and hyperleptinemia among the 9-month cohort. Importantly, the HFCD-increased PDAC incidence was completely abrogated by metformin (p &lt; 0.01). The obesogenic diet also induced a marked increase in the expression of TAZ in pancreas, an effect abrogated by metformin. In conclusion, administration of metformin improved the metabolic profile and eliminated the promoting effects of diet-induced obesity on PDAC formation in KC mice. Given the established safety profile of metformin, our findings have a strong translational potential for novel chemo-preventive strategies for PDAC

Paying primary health care centers for performance in Rwanda

Paying for performance (P4P) provides financial incentives for providers to increase the use and quality of care. P4P can affect health care by providing incentives for providers to put more effort into specific activities, and by increasing the amount of resources available to finance the delivery of services. This paper evaluates the impact of P4P on the use and quality of prenatal, institutional delivery, and child preventive care using data produced from a prospective quasi-experimental evaluation nested into the national rollout of P4P in Rwanda. Treatment facilities were enrolled in the P4P scheme in 2006 and comparison facilities were enrolled two years later. The incentive effect is isolated from the resource effect by increasing comparison facilities'input-based budgets by the average P4P payments to the treatment facilities. The data were collected from 166 facilities and a random sample of 2158 households. P4P had a large and significant positive impact on institutional deliveries and preventive care visits by young children, and improved quality of prenatal care. The authors find no effect on the number of prenatal care visits or on immunization rates. P4P had the greatest effect on those services that had the highest payment rates and needed the lowest provider effort. P4P financial performance incentives can improve both the use of and the quality of health services. Because the analysis isolates the incentive effect from the resource effect in P4P, the results indicate that an equal amount of financial resources without the incentives would not have achieved the same gain in outcomes.Health Monitoring&Evaluation,Population Policies,Health Systems Development&Reform,Disease Control&Prevention,Adolescent Health

Association between health insurance literacy and avoidance of health care services owing to cost

Importance: Navigating health insurance and health care choices requires considerable health insurance literacy. Although recommended preventive services are exempt from out-of-pocket costs under the Affordable Care Act, many people may remain unaware of this provision and its effect on their required payment. Little is known about the association between individuals\u27 health insurance literacy and their use of preventive or nonpreventive health care services. Objective: To assess the association between health insurance literacy and self-reported avoidance of health care services owing to cost. Design, Setting, and Participants: In this survey study, a US national, geographically diverse, nonprobability sample of 506 US residents aged 18 years or older with current health insurance coverage was recruited to participate in an online survey between February 22 and 23, 2016. Main Outcomes and Measures: The validated 21-item Health Insurance Literacy Measure (HILM) assessed individuals\u27 self-rated confidence in selecting and using health insurance (score range, 0-84, with higher scores indicating greater levels of health insurance literacy). Dependent variables included delayed or foregone preventive and nonpreventive services in the past 12 months owing to perceived costs, and preventive and nonpreventive use of services. Covariates included age, sex, race/ethnicity, income, educational level, high-deductible health insurance plan, health literacy, numeracy, and chronic health conditions. Analyses included descriptive statistics and bivariate and multivariable logistic regression. Results: A total of 506 of 511 participants who began the survey completed it (participation rate, 99.0%). Of the 506 participants, 339 (67.0%) were younger than 35 years (mean [SD] age, 34 [10.4] years), 228 (45.1%) were women, 406 of 504 who reported race (80.6%) were white, and 245 (48.4%) attended college for 4 or more years. A total of 228 participants (45.1%) had 1 or more chronic health condition, 361 of 500 (72.2%) who responded to the survey item had seen a physician in the outpatient setting in the past 12 months, and 446 of the 501 (89.0%) who responded to the survey item had their health insurance plan for 12 or more months. One hundred fifty respondents (29.6%) reported having delayed or foregone care because of cost. The mean (SD) HILM score was 63.5 (12.3). In multivariable logistic regression, each 12-point increase in HILM score was associated with a lower likelihood of both delayed or foregone preventive care (adjusted odds ratio [aOR], 0.61; 95% CI, 0.48-0.78) and delayed or foregone nonpreventive care (aOR, 0.71; 95% CI, 0.55-0.91). Conclusions and Relevance: This study\u27s findings suggest that lower health insurance literacy may be associated with greater avoidance of both preventive and nonpreventive services. It appears that to improve appropriate use of recommended health care services, including preventive health services, clinicians, health plans, and policymakers may need to communicate health insurance concepts in accessible ways regardless of individuals\u27 health insurance literacy. Plain language communication may be able to improve patients\u27 understanding of services exempt from out-of-pocket costs