Chinese herbal medicine decreases incidence of hepatocellular carcinoma in diabetes mellitus patients with regular insulin management

BACKGROUND Type 2 diabetes mellitus(DM)is an independent risk factor for hepatocellular carcinoma(HCC),while insulin is a potent mitogen.Identifying a new therapeutic modality for preventing insulin users from developing HCC is a critical goal for researchers.AIM To investigate whether regular herbal medicine use can decrease HCC risk in DM patients with regular insulin control.METHODS We used data acquired from the Taiwan,Chinaese National Health Insurance research database between 2000 and 2017.We identified patients with DM who were prescribed insulin for>3 months.The herb user group was further defined as patients prescribed herbal medication for DM for>3 months per annum during RESULTS We initially enrolled 657144 DM patients with regular insulin use from 2000 to 2017.Among these,46849 patients had used a herbal treatment for DM,and 140547 patients were included as the matched control group.The baseline variables were similar between the herb users and nonusers.DM patients with regular herb use had a 12%decreased risk of HCC compared with the control group[adjusted hazard ratio(aHR)=0.88,95%CI=0.80–0.97].The cumulative incidence of HCC in the herb users was significantly lower than that of the nonusers.Patients with a herb use of>5 years cumulatively exhibited a protective effect against development of HCC(aHR=0.82,P<0.05).Of patients who developed HCC,herb users exhibited a longer survival time than nonusers(aHR=0.78,P=0.0001).Additionally,we report the top 10 herbs and formulas in prescriptions and summarize the potential pharmacological effects of the constituents.Our analysis indicated that Astragalus propinquus(Huang Qi)plus Salvia miltiorrhiza Bunge(Dan Shen),and Astragalus propinquus(Huang Qi)plus Trichosanthes kirilowii Maxim.(Tian Hua Fen)were the most frequent combination of single herbs.Meanwhile,Ji Sheng Shen Qi Wan plus Dan Shen was the most frequent combination of herbs and formulas.CONCLUSION This large-scale retrospective cohort study reveals that herbal medicine may decrease HCC risk by 12%in DM patients with regular insulin use.

Does community-based health insurance affect lifestyle and timing of treatment seeking behavior?Evidence from Ethiopia

Objectives This paper aims to investigate the effects of enrollment in the Ethiopian community-based health insurance(CBHI)scheme on household preventive care activities and the timing of treatment-seeking behavior for illness symptoms.There is growing concern about the financial sustainability of CBHI schemes in developing countries.However,few empirical studies have identified potential contributors,including ex-ante and ex-post moral hazards.Methods We implement a household fixed-effect panel data regression model,drawing on three rounds of household survey data collected face to face in districts where CBHI scheme is operational and in districts where it is not operational in Ethiopia.Results The findings show that enrolment in CBHI does not significantly influence household behaviour regarding preventive care activities such as water treatment before drinking and handwashing before meals.However,CBHI significantly increases delay in treatment-seeking behaviour for diseases symptoms.Particularly,on average,we estimate about 4-6 h delay for malaria symptoms,a little above 4 h for tetanus,and 10-11 h for tuberculosis among the insured households.Conclusions While there is evidence that CBHI improve the utilization of outpatient or primary care services,our study suggests that insured members may wait longer before visiting health facilities.This delay could be partly due to moral hazard problems,as insured households,particularly those from rural areas,may consider the opportunity costs associated with visiting health facilities for minor symptoms.Overall,it is essential to identify the primary causes of delays in seeking medical services and implement appropriate interventions to encourage insured individuals to seek early medical attention.

微管注入PS与INSURE技术治疗早产儿RDS的临床效果评价

目的探讨微管注入肺表面活性物质(PS)技术与气管插管-PS给药-拔管(INSURE)技术治疗≥30周早产儿呼吸窘迫综合征(RDS)的临床效果。方法选取RDS早产儿80例,按随机数表法分为观察、对照2组各40例。对照组采用INSURE技术,观察组采用微管注入(LISA)技术给与PS治疗。比较2组临床疗效、血气指标(PaO_(2)、PaCO_(2)和pH值)、脑血流动力学参数(PSV、EDV和RI)、临床相关指标和出院前病死率及并发症发生率。结果观察组患儿疗效高于对照组(P<0.05)。观察组患儿治疗后PaO_(2)、pH值均高于对照组,PaCO_(2)低于对照组(P<0.05)。2组患儿T0~T3时PSV、EDV、RI水平比较差异无统计学意义(P>0.05)。观察组患儿氧疗时间、插管用时均短于对照组(P<0.05);2组无创通气时间、住院时间及出院前病死率比较差异无统计学意义(P>0.05)。2组患儿治疗期间并发症发生率比较差异无统计学意义(P>0.05)。结论LISA和INSURE技术给予PS技术治疗早产儿RDS,可显著提高临床疗效,改善患儿血气指标。

China Continues to Be World’s Second Largest Insurance Market

Allianz Group recently released the Allianz Global Insurance Report,predicting that China will consolidate its position as the world’s second largest insurance market in the next decade.The report analyzes the business performance of the global insurance market in 2023 and forecasts the development direction and trends of the global insurance industry in the next decade.2023:A year of significant growth According to the report,in 2023,the global insurance industry grew by an impressive 7.5%,which is the fastest rate since the pre-Global Financial Crisis(GFC)era.

INSURE策略治疗早产儿呼吸窘迫综合征失败的危险因素分析

新生儿呼吸窘迫综合征(RDS)是因缺少肺泡表面活性物质(PS),导致新生儿肺发育不成熟,引起呼吸功能障碍的严重肺部疾病~([1])。该疾病多发于胎龄在34周以下的早产儿,主要症状为呼吸困难逐渐加重等,严重影响患儿生命健康,具有较高的病死率~([2])。

Automated Actuarial Data Analytics-Based Inflation Adjusted Frequency Severity Loss Reserving Model

In this paper, the Automated Actuarial Loss Reserving Model is developed and extended using machine learning. The traditional actuarial reserving techniques are no longer compatible with the increase in technological advancement currently at hand. As a result, the development of the alternative Artificial Intelligence Based Automated Actuarial Loss Reserving Methodology which captures diverse risk profiles for various policyholders through augmenting the Micro Finance services, Auto Insurance Services and Both Services lines of business on the same platform through the computation of the Comprehensive Automated Actuarial Loss Reserves (CAALR) has been implemented in this paper. The introduction of the four further types of actuarial loss reserves to those existing in the actuarial literature seems to significantly reduce lapse rates, reduce the reinsurance costs as well as expenses and outgo. As a matter of consequence, this helps to bring together a combination of new and existing policyholders in the insurance company. The frequency severity models have been extended in this paper using ten machine learning algorithms which ultimately leads to the derivation of the proposed machine learning-based actuarial loss reserving model which remarkably performed well when compared to the traditional chain ladder actuarial reserving method using simulated data.

Telematics as a Transformative Agent for the Zimbabwean Auto Insurance Ecosystem

Zimbabwe has witnessed the evolution of Information Communication Technology (ICT). The vehicle population soared to above 1.2 million hence rendering the Transport and Insurance domains complex. Therefore, there is a need to look at ways that can augment conventional Vehicular Management Information Systems (VMIS) in transforming business processes through Telematics. This paper aims to contextualise the role that telematics can play in transforming the Insurance Ecosystem in Zimbabwe. The main objective was to investigate the integration of Usage-Based Insurance (UBI) with vehicle tracking solutions provided by technology companies like Econet Wireless in Zimbabwe, aiming to align customer billing with individual risk profiles and enhance the synergy between technology and insurance service providers in the motor insurance ecosystem. A triangulation through structured interviews, questionnaires, and literature review, supported by Information Systems Analysis and Design techniques was conducted. The study adopted a case study approach, qualitatively analyzing the complexities of the Telematics insurance ecosystem in Zimbabwe, informed by the TOGAF framework. A case-study approach was applied to derive themes whilst applying within and cross-case analysis. Data was collected using questionnaires, and interviews. The findings of the research clearly show the importance of Telematics in modern-day insurance and the positive relationship between technology and insurance business performance. The study, therefore revealed how UBI can incentivize positive driver behavior, potentially reducing insurance premiums for safe drivers and lowering the incidence of claims against insurance companies. Future work can be done on studying the role of Telematics in combating highway crime and corruption.

Research on Reimbursement Management of Innovative Drugs Abroad and Its Enlightenment to China

Objective To analyze the reimbursement policies of innovative drugs in some developed countries,and to provide reference for future reimbursement management in China.Methods Literature research method was used to study the policies related to the reimbursement management of innovative drugs in Germany,France and Japan,and their successful experience was summarized.Results and Conclusion China should establish an open and transparent value evaluation standard to improve the medical insurance reimbursement management of innovative drugs.Besides,the value of innovative drugs should be taken as an important basis for reimbursement decisions,and an independent third-party value evaluation agency must be established.

Analysis of Drug Medical Insurance Access Pricing Based on the Perspective of Binary Equilibrium

Objective To study the influencing factors in the process of national medical insurance negotiation and drug pricing from the dualistic equilibrium perspective,and to provide reference for the harmonious management of drug pricing in China.Methods Through the literature analysis and policy review,the pricing subject,pricing basis and price control system in the pricing process of medical-accessed medicines were analyzed from the perspective of binary equilibrium and harmonious management.Results and Conclusion It is found that four balances in the drug pricing process,two balances in pricing basis and three balances in price control system need to be considered,respectively.Drug pricing is the key content of national medical insurance access,which is also the hotspot of the policy in the pharmaceutical fields in recent years.Drug pricing not only reflects the value of drugs,but also reflects a lot of top-level designs of binary equilibriums in medical insurance policy.While the rational design of drug pricing requires the joint efforts of the government,pharmaceutical companies and relevant experts to comprehensively consider many equilibriums,so as to improve the relevant systems.

Research on the Establishment of a Long-Term Care System for the Elderly with Alzheimer’s Disease Under the Background of Long-Term Care Insurance: A Literature Review

With the aging of the country’s population structure,the problem of social pensions is becoming more and more serious.As for the issue of social pension,the elderly with Alzheimer’s disease are a special group,and the issue of care services for these elderly has attracted widespread attention from society.However,judging from the current level of social security provided to the elderly with dementia in the country,there is a serious imbalance between supply and demand.Therefore,this problem needs to be solved urgently and is of great significance for further improving the country’s social pension security system.Routine care is limited to hospitals and mainly focuses on the patient’s condition.Patients fail to receive comprehensive care services and the effect is not ideal.Therefore,in order to improve patients’cognitive function and quality of life,and learn from international experience,a“community-institution-home”three-dimensional linkage care model based on long-term care insurance can be established.The application of this model can effectively solve and further improve the country’s elderly care and social security system.

Optimal Insurance with Background Risk under the Ambiguity and Belief Heterogeneity Structure

In this paper, we discuss the optimal insurance in the presence of background risk while the insured is ambiguity averse and there exists belief heterogeneity between the insured and the insurer. We give the optimal insurance contract when maxing the insured’s expected utility of his/her remaining wealth under the smooth ambiguity model and the heterogeneous belief form satisfying the MHR condition. We calculate the insurance premium by using generalized Wang’s premium and also introduce a series of stochastic orders proposed by [1] to describe the relationships among the insurable risk, background risk and ambiguity parameter. We obtain the deductible insurance is the optimal insurance while they meet specific dependence structures.

A Market Model of Risk Transfer and Insurance

We introduce a model of a market where risk-averse consumers pay a fee to transfer their future losses to one or more firms.The future loss of each consumer is stochastic with a unique,known mean and variance.The law of large numbers allows the firms to know with certainty the expected aggregate loss of the consumers to whom they sell.The model could describe the behavior of agents in the market for property insurance where an insurance company sells a single type of policy to a specific group of consumers based upon the expected losses of those consumers and their willingness to pay for coverage.The model demonstrates how a single firm can choose the optimal segment of the market to which they sell a policy and how that choice might change when the distribution of consumers and their risk aversion changes.The model also demonstrates how two firms might engage in a cooperative strategy and share the market.The model shows how a firm entering the market will find it more advantageous to target a segment of the market with consumers that have a lower expected loss.

LISA技术在新生儿呼吸窘迫综合征中的应用

本研究旨在评估微创肺表面活性物质给药(LISA)技术在新生儿呼吸窘迫综合征(NRDS)治疗中的应用价值。方法 在2019年1月至2023年1月期间,收集了100份与新生儿呼吸窘迫综合征(NRDS)相关的病历资料。所有就医资料在细致地整理归档、条理化之后,采用随机数字法确定将病患儿童随机分入两个不同组别:一组由50例组成,这些案例采取了传统INSURE治疗进行处理;而另一组同样由50例构成,却使用了LISA技术来进行治疗。本项研究着力于分析两组对象在使用呼吸机的时间、吸氧时间、住院时间、PS药物剂量以及血液气体分析结果(包括PaCO2、PaO2、SaO2、OI)和心脏与循环系统的性能参数(涉及PVR、EVLW、mPAP、RVSWI)和氧化应激指标(包含AOPPs、8-OHdG)在这些方面的对比差异。结果 LISA组在机械通气时间和住院时间上均显著短于传统组,PS用药剂量亦显著减少。治疗后24小时内,LISA组的PaCO2显著低于传统组,而PaO2、SaO2和OI显著高于传统组。在PVR、EVLW、mPAP降低幅度以及RVSWI提高幅度方面,LISA组亦显著优于传统组。两组治疗后的血清AOPPs和8-OHdG水平均有显著下降,且LISA组降幅更为显著。在心动过缓、机械通气和重复给予PS的发生率方面,LISA组均显著低于传统组。结论 采用LISA技术对新生儿呼吸困难症进行治疗,不仅提升了婴儿的供氧能力和循环效率,还减少了心率缓慢、机械通气依赖以及重复使用肺表面活性物质的需求,进而大幅降低了氧化应激。研究表明,相较于传统的INSURE疗法,LISA手法能带来更佳的治疗成果和更高的患者安全水平,因此,在临床上作为一种新颖且有效的NRDS疗法,其推广应用价值显著。

Cyberattack Ramifications, The Hidden Cost of a Security Breach

In this in-depth exploration, I delve into the complex implications and costs of cybersecurity breaches. Venturing beyond just the immediate repercussions, the research unearths both the overt and concealed long-term consequences that businesses encounter. This study integrates findings from various research, including quantitative reports, drawing upon real-world incidents faced by both small and large enterprises. This investigation emphasizes the profound intangible costs, such as trade name devaluation and potential damage to brand reputation, which can persist long after the breach. By collating insights from industry experts and a myriad of research, the study provides a comprehensive perspective on the profound, multi-dimensional impacts of cybersecurity incidents. The overarching aim is to underscore the often-underestimated scope and depth of these breaches, emphasizing the entire timeline post-incident and the urgent need for fortified preventative and reactive measures in the digital domain.

开展医疗保障经办机构飞行检查的问题及其产生因素的质性研究

目的梳理总结我国开展医疗保障(以下简称“医保”)经办机构飞行检查的问题及其产生因素,为完善我国医保基金飞行检查机制,加强对医保经办机构的监管提供建议和参考。方法于2022年7—9月,采用典型抽样法,选取4个省份的医保专家进行半结构式访谈,样本量的确定以不再出现新的信息为标准,运用colaizzi七步分析法对获取的资料进行归纳分析。结果通过对11名专家访谈资料的分析,归纳提炼开展医保经办机构飞行检查的问题,包括力度不足、队伍构成不健全、缺乏具体内容及标准等,以及导致问题产生的因素,包括选择效应、缺乏标准化做法、区域差异等。结论医保经办机构的行为及工作效率影响着医保基金安全,对其进行监管十分必要,但开展医保经办机构飞行检查的过程中存在诸多问题。建议推进制度建设,加大飞行检查力度;丰富队伍构成,提升飞行检查质量;完善指标建立,规范飞行检查内容。

我国医院远程医疗服务收费情况分析

目的分析我国医院远程医疗服务收费情况,以完善远程医疗服务收费制度,推动远程医疗规范化发展。方法2020年10—11月面向全国26个省(自治区、直辖市)组织开展线上问卷调查。选取问卷中远程医疗服务收费项目及其与医疗保险对接情况、收费标准制定、收费依据、费用支付与结算方式等内容,统计分析不同地区医院远程医疗服务收费情况。结果71.3%的医院开展了远程医疗服务收费,收费项目主要为远程会诊、远程教育、远程病理诊断、远程影像诊断和远程心电诊断。主要按照医院级别和专家职称收费,分别有59.1%的东部地区医院、69.2%的中部地区医院和68.5%的西部地区医院收费标准由行政管理部门统一制定。此外,34.6%的收费医院将远程医疗纳入医疗保险报销范畴。结论大部分医疗机构开展了远程医疗服务收费,但收费机制相对模糊,与医疗保险的对接政策也相对缺乏,应加快远程医疗服务收费政策制定,合理化远程医疗服务收费,建立健全远程医疗服务收费机制,促进远程医疗服务收费工作的规范化发展。

基于史密斯政策执行过程模型的国家医保药品目录准入谈判罕见病药品落地问题及路径研究

目的基于史密斯政策执行过程模型的国家医保药品目录准入谈判(以下简称“国谈”)罕见病药品落地的关键和难点,探索罕见病药品在进入国家基本医疗保险和工伤保险药品目录后政策实施过程中存在的问题并提出对策建议。方法通过文献复习和政策梳理、专家访谈、焦点小组访谈收集资料,结合史密斯政策执行过程模型的理论框架从多角度探索国谈罕见病药品政策执行情况的现状、问题以及解决方案。结果目前我国罕见病药品行业管理尚处于初级阶段;医疗服务提供方在意识、管理等方面仍存在不足;罕见病药品保障渠道有待优化,医疗保险支付机制尚不完善。结论建议进一步加强行业管理,提升罕见病用药保障;加强医疗服务提供方能力建设,取消罕见病用药考核限制;畅通罕见病用药保障渠道,完善医疗保险支付机制。

LISA与INSURE对NRDS早产患儿脑氧代谢、氧合及临床预后的影响

目的探究低侵入性肺表面活性物质给药(LISA)与气管插管-注入肺表面活性物质-拔管(INSURE)对新生儿呼吸窘迫综合征(NRDS)早产儿患脑氧代谢、氧合及临床预后的影响。方法选择2020年1月—2021年12月本院新生儿科收治的124例NRDS早产患儿,分为对照组60例和观察组64例。对照组患儿常规给予INSURE技术治疗,观察组患儿给予LISA技术治疗,分析两组患儿治疗情况、脑氧代谢、全身氧代谢及临床预后。结果观察组患儿插管用时、无创呼吸支持时间短于对照组,72 h内机械通气率低于对照组,差异有统计学意义(P<0.05),而肺表面活性物质二次给药率与对照组比较差异无统计学意义(P>0.05);随着时间推移,两组患儿脑氧饱和度(ScO_(2))水平均先升后降,但观察组用药期间、用药后5 min的ScO_(2)水平低于对照组,差异均有统计学意义(P<0.05);两组患儿治疗前、治疗24 h后的血pH值比较差异均无统计学意义(P>0.05),治疗24 h后的血氧分压(PaO_(2))、氧合指数较治疗前提高,血二氧化碳分压(PaCO_(2))水平降低,且均以观察组更明显,差异均有统计学意义(P<0.05);观察组患儿心动过缓、插管所致损伤的不良反应发生率和颅内出血、支气管肺发育不良的并发症发生率低于对照组,住院时间短于对照组,差异有统计学意义(P<0.05),两组死亡率和其余不良反应、并发症发生率比较差异无统计学意义(P>0.05)。结论相比于INSURE技术,LISA技术治疗对NRDS早产儿脑氧代谢、氧合状况影响更小,更有利于减少患儿机械通气率、不良反应和并发症发生率,改善患儿临床预后。

国家医保谈判对公立医院抗肿瘤药物采购费用、数量及结构的影响:以EGFR-TKI靶向药物为例

目的分析国家医保药品目录准入谈判(以下简称“国谈”)政策对某省公立三级医院非小细胞肺癌EGFRTKI靶向药物采购费用、数量及结构的影响,为相关政策制定提供依据。方法收集2018年1月—2020年12月某省公立三级医院EGFR-TKI靶向药物每月采购数据,利用中断时间序列模型分析采购费用、数量、药品结构及日均费用的变化趋势。结果阿法替尼、奥希替尼、吉非替尼、埃克替尼、厄洛替尼5种EGFR-TKI靶向药物总体采购量及费用以稳定为主,2018年国谈准入品种采购量及费用上升。5种EGFR-TKI靶向药物药品结构变化明显,呈即刻上升趋势;各品种日均费用出现不同程度的下降。结论国谈政策的实施增加了靶向药物的使用,国谈准入药物品种逐步进入临床,患者的用药负担进一步减轻。

普惠型商业医疗保险特定高额药品保障研究

目的研究我国普惠型商业医疗保险目前特定高额药品(以下简称“特药”)保障的范围及水平,为进一步完善普惠型商业医疗保险的保障水平提供参考。方法通过官方公众号、投保小程序收集2022年普惠型商业医疗保险的保障政策,采用政策文本分析法提取和分析参保条件、筹资标准、特药的类别及保障水平等内容。结果2022年普惠型商业医疗保险所包含特药数量的均数为28种,以肿瘤药为主。54.62%的商业医疗保险方案特药起付线设定为0,报销比例的均数为74%、中位数为80%。70.54%的商业医疗保险方案封顶线在100万元及以下。58.04%的商业医疗保险方案保障既往症人群的特药费用,但保障水平在不同程度上有所降低。结论我国普惠型商业医疗保险的特药保障有助于减轻患者的经济负担,满足患者多元化用药需求,但对既往症人群的保障水平较为有限。建议进一步优化特药保障责任,明确特药目录的遴选规则。