scholarly journals Analysing the effects of healthcare payment policies in conjunction with tax-benefit policies: A microsimulation study with real-world  healthcare data

2021 ◽  
Author(s):  
Katri Aaltonen ◽  
Jussi Tervola ◽  
Pekka Heino
Keyword(s):  
Real World ◽  
Social Insurance ◽  
Age Groups ◽  
Relative Poverty ◽  
Healthcare Data ◽  
Universal Healthcare ◽  
Poverty Risk ◽  
Risk Rate ◽  
Health Payment ◽  
Payment Policies

In Europe, many people experience financial hardship due to healthcare payments despite (near-)universal healthcare systems. In Finland, as well as in many other countries, austerity has further widened the gaps in coverage through increases in patient payments. However, the distributional analyses of austerity have concentrated on the effects of tax benefit policies alone. We present a method for examining how health payment policies and tax-benefit policies affect household incomes in conjunction, to evaluate the total effect of implemented and planned policies. We linked the national tax-benefit microsimulation model, SISU, and its nationally representative 15% sample of households in Finland in 2017 (n=826,001) with administrative real-world healthcare data (Finnish Institute for Health and Welfare Care Register for Health Care, HILMO; and Social Insurance Institution of Finland, Kela, National Health Insurance reimbursement registers). As a case example, we analysed the effects on relative poverty risk and poverty gap during two government terms. We found that between 2011 and 2015, tax-benefit policies contributed to decreasing relative poverty, and health payment changes had no measurable effects. In 2015–2019, the poverty risk rate and average gap increased due to tax-benefit policies, and health payment changes strengthened the effects by 10% to 20%. Health payments, and their increases, mainly deteriorated the position of older adults; nevertheless, their poverty risk mostly remained below the population average. Social assistance had an important buffering effect among under 65-year-old population. Health payment increases thus exacerbated the effects of austerity on the oldest age-groups, who, based on tax-benefit analyses alone, were relatively well protected.

scholarly journals Performance in complex life situations: effects of age, cognition, and walking speed in virtual versus real life environments

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Michal Kafri ◽  
Patrice L. Weiss ◽  
Gabriel Zeilig ◽  
Moshe Bondi ◽  
Ilanit Baum-Cohen ◽  
...  
Keyword(s):  
Older Adults ◽  
Heart Rate ◽  
Virtual Environment ◽  
Real World ◽  
Age Groups ◽  
Age Effects ◽  
Shopping Mall ◽  
Complex Task ◽  
The Real ◽  
Gait Parameters

Abstract Background Virtual reality (VR) enables objective and accurate measurement of behavior in ecologically valid and safe environments, while controlling the delivery of stimuli and maintaining standardized measurement protocols. Despite this potential, studies that compare virtual and real-world performance of complex daily activities are scarce. This study aimed to compare cognitive strategies and gait characteristics of young and older healthy adults as they engaged in a complex task while navigating in a real shopping mall and a high-fidelity virtual replica of the mall. Methods Seventeen older adults (mean (SD) age = 71.2 (5.6) years, 64% males) and 17 young adults (26.7 (3.7) years, 35% males) participated. In two separate sessions they performed the Multiple Errands Test (MET) in a real-world mall or the Virtual MET (VMET) in the virtual environment. The real-world environment was a small shopping area and the virtual environment was created within the CAREN™ (Computer Assisted Rehabilitation Environment) Integrated Reality System. The performance of the task was assessed using motor and physiological measures (gait parameters and heart rate), MET or VMET time and score, and navigation efficiency (cognitive performance and strategy). Between (age groups) and within (environment) differences were analyzed with ANOVA repeated measures. Results There were no significant age effects for any of the gait parameters but there were significant environment effects such that both age groups walked faster (F(1,32) = 154.96, p < 0.0001) with higher step lengths (F(1,32) = 86.36, p < 0.0001), had lower spatial and temporal gait variability (F(1,32) = 95.71–36.06, p < 0.0001) and lower heart rate (F(1,32) = 13.40, p < 0.01) in the real-world. There were significant age effects for MET/VMET scores (F(1,32) = 19.77, p < 0.0001) and total time (F(1,32) = 11.74, p < 0.05) indicating better performance of the younger group, and a significant environment effect for navigation efficiency (F(1,32) = 7.6, p < 0.01) that was more efficient in the virtual environment. Conclusions This comprehensive, ecological approach in the measurement of performance during tasks reminiscent of complex life situations showed the strengths of using virtual environments in assessing cognitive aspects and limitations of assessing motor aspects of performance. Difficulties by older adults were apparent mainly in the cognitive aspects indicating a need to evaluate them during complex task performance.

Real world heart failure epidemiology and outcome: a population-based analysis of 1,990,162 heart failure patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Leszek ◽  
M Zaleska-Kociecka ◽  
D Was ◽  
K Witczak ◽  
K Bartolik ◽  
...  
Keyword(s):  
Heart Failure ◽  
Real World ◽  
Age Groups ◽  
Developed Countries ◽  
Funding Source ◽  
Newly Diagnosed ◽  
The European Union ◽  
Ministry Of Health ◽  
The Real ◽  
Incidence Prevalence

Abstract Background Heart failure (HF) is the leading cause of death and hospitalization in developed countries. Most of the information about HF is based on selected cohorts, the real epidemiology of HF is scarce. Purpose To assess trends in the real world incidence, prevalence and mortality of all in-and outpatients with HF who presented in public health system in 2009–2018 in Poland. Methods It is a retrospective analysis of 1,990,162 patients who presented with HF in Poland in years 2009–2018. It is a part of nationwide Polish Ministry of Health registry that collects detailed information for the entire Polish population (38,495,659 in 2013) since 2009. Detailed data within the registry were collected since 2013. HF was recorded if HF diagnosis was coded (ICD-10). Results The incidence of HF in Poland fell down from 2013 to reach 127,036 newly diagnosed cases (330 per 100,000 population) in 2018 that equals to 43.6% drop. This decrease was mainly driven by marked reduction in females (p&lt;0.001; Fig. 1A) and HF of ischaemic etiology (HF-IE vs HF-nonIE, Fig. 1B. p&lt;0.001). The HF incidence per 100,000 population decreased across all age groups with the greatest drop in the youngest (Table 1). The prevalence rose by 11.6% to reach 1,242,129 (3233 per 100,000 population) in 2018 with significantly greater increase in females and HF-IE (both p&lt;0.0001, Fig. 1C and D, respectively). The HF prevalence per 100,000 population increased across all age groups except for the 70–79 years old. (Table 1). Mortality increased by 28.5% to reach 142,379 cases (370 per 100,000 population) in 2018. The rise was more pronounced among females (p=0.015, Fig. 1E) and in HF-IE (p&lt;0.001, Fig. 1F). The HF mortality per 100 000 population increased across all age groups, except for the 50–59 subgroup (Table 1). Conclusions Heart failure incidence plummeted in years 2013–2018 in Poland due to drop in newly diagnosed HF-IE. Despite that fact, the prevalence and mortality increased with rising trends in HF-IE. Figure 1. Incidence, prevalence, mortality trends Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): The project is co-financed by the European Union from the European Social Fund under the Operational Programme Knowledge Education Development and it is being carried out by the Analyses and Strategies Department of the Polish Ministry of Health

scholarly journals Efficacy and Safety of Teriflunomide in Multiple Sclerosis across Age Groups: Analysis from Pooled Pivotal and Real-world Studies

2021 ◽  
Vol 13 ◽  
pp. 117957352110287
Author(s):  
Jiwon Oh ◽  
Sandra Vukusic ◽  
Klaus Tiel-Wilck ◽  
Jihad Said Inshasi ◽  
David Rog ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Real World ◽  
Age Groups ◽  
Phase Iii ◽  
Efficacy And Safety ◽  
Additional Group ◽  
Disability Status ◽  
Scale Scores ◽  
Post Hoc ◽  
Phase Ii And Iii

Background: Evidence suggests that efficacy and safety of disease-modifying treatments for multiple sclerosis may differ with age. We evaluate efficacy and safety of teriflunomide across age subgroups of patients from pooled clinical trials and real-world studies. Methods: Post hoc analyses of patients who received teriflunomide 14 mg in the pooled phase II and III TEMSO, TOWER, TENERE, and TOPIC core and extension studies (n = 1978), and the real-world Teri-PRO (n = 928) and TAURUS-MS I (n = 1126) studies were conducted. Data were stratified by age at study entry: ⩽25, >25 to ⩽35, >35 to ⩽45, and >45 years. In Teri-PRO and TAURUS-MS I, an additional group, >55 years, was assessed. Results: In the pooled core studies, teriflunomide reduced annualized relapse rate (ARR) versus placebo across all ages. Unadjusted ARRs remained low across age groups in pooled extensions (0.18-0.30), Teri-PRO (0.10-0.35), and TAURUS-MS I (0.14-0.35). Baseline Expanded Disability Status Scale scores were higher with age, but stable through core and extension studies (mean increases over 7 years: ⩽25 years, +0.59; >25 to ⩽35 years, +0.46; >35 to ⩽45 years, +0.35; >45 years, +0.81). Across age groups, adverse event (AE) incidences were 78.4% to 90.7% in pooled core and extension studies and Teri-PRO, and 29.2% to 37.7% in TAURUS-MS I; serious AE incidences were ⩽21.3% in all studies. In pooled phase III and Teri-PRO studies, lymphocyte count decreases over 1 year after initiating teriflunomide, and proportions of patients developing lymphopenia, were small across age groups. Conclusions: Teriflunomide efficacy was demonstrated regardless of age. Safety was generally consistent across age groups.

scholarly journals Mortality in Dementia from 1996 to 2015: A National Registry-Based Cohort Study

2021 ◽  
Vol 79 (1) ◽  
pp. 289-300
Author(s):  
Lærke Taudorf ◽  
Ane Nørgaard ◽  
Gunhild Waldemar ◽  
Thomas Munk Laursen
Keyword(s):  
Elderly People ◽  
Age Groups ◽  
Mortality Rates ◽  
Similar Rate ◽  
National Registry ◽  
Healthcare Data ◽  
Appropriate Care ◽  
People With Dementia ◽  
Rate Ratios ◽  
Annual Mortality

Background: It remains unclear whether the increased focus on improving healthcare and providing appropriate care for people with dementia has affected mortality. Objective: To assess survival and to conduct a time trend analysis of annual mortality rate ratios (MRR) of dementia based on healthcare data from an entire national population. Methods: We assessed survival and annual MRR in all residents of Denmark ≥65 years from 1996–2015 using longitudinal registry data on dementia status and demographics. For comparison, mortality and survival were calculated for acute ischemic heart disease (IHD) and cancer. Results: The population comprised 1,999,366 people (17,541,315 person years). There were 165,716 people (529,629 person years) registered with dementia, 131,321 of whom died. From 1996–2015, the age-adjusted MRR for dementia declined (women: 2.76 to 2.05; men: 3.10 to 1.99) at a similar rate to elderly people without dementia. The sex-, age-, and calendar-year-adjusted MRR was 2.91 (95%CI: 2.90–2.93) for people with dementia. MRR declined significantly more for acute IHD and cancer. In people with dementia, the five-year survival for most age-groups was at a similar level or lower as that for acute IHD and cancer. Conclusion: Although mortality rates declined over the 20-year period, MRR stayed higher for people with dementia, while the MRR gap, compared with elderly people without dementia, remained unchanged. For the comparison, during the same period, the MRR gap narrowed between people with and without acute IHD and cancer. Consequently, initiatives for improving health and decreasing mortality in dementia are still highly relevant.

A review on Privacy-Preserving Data Preprocessing

2020 ◽  
pp. 16-30
Author(s):  
Mukesh Soni ◽  
◽  
◽  
◽  
YashKumar Barot ◽  
...  
Keyword(s):  
Health Care ◽  
Information Security ◽  
Social Insurance ◽  
Disease Outbreaks ◽  
Security And Privacy ◽  
Health Care Information ◽  
Privacy And Security ◽  
Healthcare Data ◽  
Security Issues ◽  
Care Information

Health care information has great potential for improving the health care system and also providing fast and accurate outcomes for patients, predicting disease outbreaks, gaining valuable information for prediction in future, preventing such diseases, reducing healthcare costs, and improving overall health. In any case, deciding the genuine utilization of information while saving the patient's identity protection is an overwhelming task. Regardless of the amount of medical data it can help advance clinical science and it is essential to the accomplishment of all medicinal services associations, at the end information security is vital. To guarantee safe and solid information security and cloud-based conditions, It is critical to consider the constraints of existing arrangements and systems for the social insurance of information security and assurance. Here we talk about the security and privacy challenges of high-quality important data as it is used mainly by the healthcare structure and similar industry to examine how privacy and security issues occur when there is a large amount of healthcare information to protect from all possible threats. We will discuss ways that these can be addressed. The main focus will be on recently analyzed and optimized methods based on anonymity and encryption, and we will compare their strengths and limitations, and this chapter closes at last the privacy and security recommendations for best practices for privacy of preprocessing healthcare data.

scholarly journals Emulated Clinical Trials from Longitudinal Real-World Data Efficiently Identify Candidates for Neurological Disease Modification: Examples from Parkinson’s Disease

2020 ◽  
Author(s):  
Daphna Laifenfeld ◽  
Chen Yanover ◽  
Michal Ozery-Flato ◽  
Oded Shaham ◽  
Michal Rozen-Zvi ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Clinical Trials ◽  
Real World ◽  
Late Onset ◽  
Real World Data ◽  
World Data ◽  
Healthcare Data ◽  
Beneficial Effects ◽  
Disease Modifying

AbstractReal-world healthcare data hold the potential to identify therapeutic solutions for progressive diseases by efficiently pinpointing safe and efficacious repurposing drug candidates. This approach circumvents key early clinical development challenges, particularly relevant for neurological diseases, concordant with the vision of the 21stCentury Cures Act. However, to-date, these data have been utilized mainly for confirmatory purposes rather than as drug discovery engines. Here, we demonstrate the usefulness of real-world data in identifying drug repurposing candidates for disease-modifying effects, specifically candidate marketed drugs that exhibit beneficial effects on Parkinson’s disease (PD) progression. We performed an observational study in cohorts of ascertained PD patients extracted from two large medical databases, Explorys SuperMart (N=88,867) and IBM MarketScan Research Databases (N=106,395); and applied two conceptually different, well-established causal inference methods to estimate the effect of hundreds of drugs on delaying dementia onset as a proxy for slowing PD progression. Using this approach, we identified two drugs that manifested significant beneficial effects on PD progression in both datasets: rasagiline, narrowly indicated for PD motor symptoms; and zolpidem, a psycholeptic. Each confers its effects through distinct mechanisms, which we explored via a comparison of estimated effects within the drug classification ontology. We conclude that analysis of observational healthcare data, emulating otherwise costly, large, and lengthy clinical trials, can highlight promising repurposing candidates, to be validated in prospective registration trials, for common, late-onset progressive diseases for which disease-modifying therapeutic solutions are scarce.

scholarly journals Accumulative pension system in Ukraine: theoretical and applied discourse

2021 ◽  
pp. 22
Author(s):  
Lyudmyla Alekseyenko
Keyword(s):  
Social Insurance ◽  
Pension System ◽  
Age Groups ◽  
Active Role ◽  
The Elderly ◽  
Theoretical Concept ◽  
Social Insurance System ◽  
Theoretical Concepts ◽  
Role Of The State ◽  
Working Age

Introduction. The study of theoretical and empirical aspects of the accumulative pension system should help to identify patterns and contradictions of its development in society. In order to conduct an effective economic policy on the introduction of a funded pension system, it is necessary to define a theoretical concept of a model of the active role of the state in socio-economic processes or a moderate liberal model. Reforming the pension system is a rather long process and requires both the definition of the main directions, principles and measures for the development of the funded pension system, and changes in the values, principles and norms of behavior of citizens.The purpose is to substantiate the theoretical concept, trends, problems of the accumulative pension system and the directions of its introduction into society.Research methods are based on the dialectical method of scientific knowledge and a systematic approach to knowledge of economic phenomena and processes, theoretical generalization, systematization, which allowed to reveal the problems of the accumulative pension system based on theoretical concepts and economic-statistical analysis of demographic load of working age and after working age.Results. The indicators influencing the introduction of the second level of the pension system were monitored. The dynamics of indicators of demographic load of the population of pre-working and post-working age is analyzed. The focus is on the peculiarities of wages and final consumer expenditures of households and the general government sector. It was found that in general, citizens belong to the elderly population, so to prevent further deterioration of the ratio between age groups, it is advisable to increase the effectiveness of the social insurance system. The expediency of paying more attention to actuarial statistics to determine the future size of pensions and their exact calculation is substantiated.Prospects. Further research is important to focus on improving the efficiency of the multi-component funded pension system in the context of ensuring compliance with the values, principles and norms of the society.

scholarly journals OR30-01 Real-World Minimed™ 670G System Use and Glycemic Outcomes of Pediatric and Adult Individuals Living with Type 1 Diabetes (T1D) in the United States

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Robert Alan Vigersky ◽  
Michael Stone ◽  
Pratik Agrawal ◽  
Alex Zhong ◽  
Kevin Velado ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Real World ◽  
Adult Population ◽  
Age Groups ◽  
The United States ◽  
System Use ◽  
System Data ◽  
The Mean ◽  
The Impact ◽  
The U.S

Abstract Introduction: The MiniMed™ 670G system was FDA-approved in 2016 for adults and adolescents ≥14yrs, and in 2018 for children ages 7-13yrs with T1D. Since then, use of the system has grown to over 180,000 people in the U.S. The glycemic control benefits of real-world MiniMed™ 670G system Auto Mode use in the U.S. were assessed. Methods: System data (aggregated five-minute instances of sensor glucose [SG]) uploaded from March 2017 to July 2019 by individuals (N=118,737) with T1D and ≥7yrs of age who enabled Auto Mode were analyzed to determine the mean % of overall time spent &lt;54mg/dL/&lt;70mg/dL (TBR); between 70-180mg/dL (TIR); and &gt;180mg/dL/&gt;250mg/dL (TAR). The impact of Auto Mode was further assessed in a sub-group of individuals (N=51,254) with, at least, 7 days of SG data for both Auto Mode turned ON and turned OFF. The % of TIR, TBR and TAR, and the associated glucose management indicator (GMI) were evaluated for the overall OFF (2,524,570 days) and ON (6,308,806 days) periods, and across different age groups. Results: System data TIR was 71.3%; TBR was 0.4% and 1.9%, respectively; and TAR was 26.8% and 6.2%, respectively. User-wise data of Auto Mode OFF versus ON showed a mean of 70.3% of the time spent in Auto Mode, that TIR increased from 60.9% to 69.9%; and that both TBR and TAR decreased. For those 7-13yrs (N=1,417), TIR increased from 48.7% to 61.5%; TBR increased from 0.5% to 0.6% and from 2.0% to 2.2%, respectively; and TAR decreased from 49.3% to 36.3% and from 20.5% to 13.0%, respectively. For those 14-21yrs (N=4,194), TIR increased from 51.0% to 61.5%; TBR decreased from 0.7% to 0.6% and from 2.3% to 2.0%, respectively; and TAR decreased from 46.7% to 36.5% and from 18.5% to 12.5%, respectively. For those ≥22yrs (N=45,643), TIR increased from 62.2% to 70.9%; TBR decreased from 0.7% to 0.5% and from 2.6% to 1.9%, respectively; and TAR decreased from 35.2% to 27.3% and from 9.9% to 6.3%, respectively. The mean GMI decreased by 0.23% (overall), 0.48% (7-13yrs), 0.35% (14-21yrs), and 0.22% (≥22yrs), respectively, with Auto Mode ON versus OFF. Discussion: In over 6 million days of real-world MiniMed™ 670G system Auto Mode use in the U.S., TIR of a large pediatric and adult population with T1D improved by 9% compared to when Auto Mode was OFF, which was comparable to or exceeded the TIR observed in the smaller pivotal trials. These results further support outcomes of the pivotal trials and increased glycemic control with system use.

Implizite und explizite Lohnsteuerbelastung in Deutschland

2009 ◽  
Vol 60 (2) ◽  
Author(s):  
Martin Gasche
Keyword(s):  
Social Security ◽  
Low Income ◽  
Social Insurance ◽  
Age Groups ◽  
Social Security System ◽  
Security System ◽  
Tax Burden ◽  
Older Employees ◽  
Wage Tax ◽  
Specific Tax

SummarySocial insurance contributions include an implicit tax portion if the contributions are higher than the benefits. For the first time, this implicit tax burden is calculated for the entire German social security system regarding income groups, age groups and sex. There is evidence that the implicit tax burden is throughout relatively high. The age-specific tax structure is characterized by an inversely U-shaped curve: The implicit tax burden is weaker for young and older employees subject to social insurance than for employees of the in-between generation. The income-specific tax profiles indicate a negative wage tax for insured with low income and then a strong progressive trend. On a higher level of income, the burden has a regressive course. The combination of implicit wage tax caused by social security system and explicit wage tax caused by income tax system makes the regressive course of tax burden on high income level disappear, so that a progressive wage tax scale with a negative component for lower incomes can be observed.

scholarly journals Long-term trends in the prescription of antidiabetic drugs: real-world evidence from the Diabetes Registry Tyrol 2012–2018

2020 ◽  
Vol 8 (1) ◽  
pp. e001279
Author(s):  
Clemens Engler ◽  
Marco Leo ◽  
Bernhard Pfeifer ◽  
Martin Juchum ◽  
Di Chen-Koenig ◽  
...  
Keyword(s):  
Real World ◽  
Age Groups ◽  
Quality Parameters ◽  
Antidiabetic Drugs ◽  
National Guidelines ◽  
Prescription Patterns ◽  
Diabetes Registry ◽  
Cardiovascular Outcome Trials ◽  
Glucagon Like Peptide 1

IntroductionPrescription patterns of antidiabetic drugs in the period from 2012 to 2018 were investigated based on the Diabetes Registry Tyrol. To validate the findings, we compared the numbers with trends of different national registries conducted in a comparable period of time.Research design and methodsMedication data, prescription patterns, age groups, antidiabetic therapies and quality parameters (hemoglobin A1c, body mass index, complications) of 10 875 patients with type 2 diabetes from 2012 to 2018 were retrospectively assessed and descriptively analyzed. The changes were assessed using a time series analysis with linear regression and prescription trends were plotted over time.ResultsSodium/glucose cotransporter 2 inhibitors (SGLT-2i) showed a significant increase in prescription from 2012 to 2018 (p<0.001), as well as metformin (p=0.002), gliptins (p=0.013) and glucagon-like peptide-1 agonists (GLP-1a) (p=0.017). Significant reduction in sulfonylurea prescriptions (p<0.001) was observed. Metformin was the most frequently prescribed antidiabetic drug (51.3%), followed by insulin/analogs (34.6%), gliptins (28.2%), SGLT-2i (11.7%), sulfonylurea (9.1%), glitazones (3.7%), GLP-1a (2.8%) and glucosidase inhibitors (0.4%).ConclusionsIn this long-term, real-world study on prescription changes in the Diabetes Registry Tyrol, we observed significant increase in SGLT-2i, metformin, gliptins and GLP-1a prescriptions. In contrast prescriptions for sulfonylureas declined significantly. Changes were consistent over the years 2012–2018. Changes in prescription patterns occurred even before the publication of international and national guidelines. Thus, physicians change their prescription practice not only based on published guidelines, but even earlier on publication of cardiovascular outcome trials.

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