Beyond the dichotomy: How ride-hailing competes with and complements public transport.

Since ride-hailing has become an important travel alternative in many cities worldwide, a fervent debate is underway on whether it competes with or complements public transport services. We use Uber trip data in six cities in the United States and Europe to identify the most attractive public transport alternative for each ride. We then address the following questions: (i) How does ride-hailing travel time and cost compare to the fastest public transport alternative? (ii) What proportion of ride-hailing trips do not have a viable public transport alternative? (iii) How does ride-hailing change overall service accessibility? (iv) What is the relation between demand share and relative competition between the two alternatives? Our findings suggest that the dichotomy-competing with or complementing-is false. Though the vast majority of ride-hailing trips have a viable public transport alternative, between 20% and 40% of them have no viable public transport alternative. The increased service accessibility attributed to the inclusion of ride-hailing is greater in our US cities than in their European counterparts. Demand split is directly related to the relative competitiveness of travel times i.e. when public transport travel times are competitive ride-hailing demand share is low and vice-versa.

Private Equity Investments in Women's Health and Obstetrics and Gynecology Practices.

Private equity has evolved into a major force in health care, with deal values and volumes rising year-over-year as these firms purchase hospital systems and physician groups. Historically, these investors have played an outsized role in highly reimbursed specialties such as dermatology and anesthesia. Private equity is relatively new to women's health; when it has invested in this sector, it has typically done so in fertility services. In recent years, however, private equity firms have ventured into general obstetrics and gynecology, drawn by its promise of steady returns, its fragmented landscape, and the potential to integrate related laboratory, ultrasound, and fertility services into obstetric care. Obstetrics and gynecology practices may soon face the prospect of acquisition by private equity firms offering professional management, centralized back-office functions, streamlined customer service, and the capital needed to reach a broader patient base. However, physicians may have concerns about the tradeoffs that accompany private equity acquisitions. Private equity-owned practices have been known to increase the use of lucrative services, deploy advanced practice professionals in place of physicians, and circumvent conflict-of-interest laws, potentially distorting clinical care and driving up costs for consumers. Furthermore, firms generally aim to exit their investment within a 3- to 7-year timeframe, and short-term growth plans may leave physician-owners with uncertain long-term management. As private equity makes headway into women's health, physicians and policymakers must pay closer attention to how this activity can change practice patterns and transform local health care markets while also demanding transparency in the process.

Assessment of the medical expenditure of the basic health insurance in Morocco.

INTRODUCTION: The health care consumption for the population insured by the Basic Health Insurance in Morocco are paid directly to the care providers for the health care or health products from the health insurance funds. The level of expenditure recorded is changing at an accelerated rate than the financial resources. The objective of this study is to evaluate the health care consumption care by the insured population under the Basic Health Insurance. METHODS: This is a cross-sectional study analysis of the economic data collected by the National Moroccan Health Insurance Agency Related to the expenditures from the health insurance fund for both public and private sectors to identify the behavior of the consumption of health care by the insured population under the Basic Health Insurance. RESULTS: The medical expenditure of the covered population by the basic Health Insurance in Morocco has almost doubled from 354800 to 652500 US Dollars between 2009 and 2014 with significant increase in the public sector than the private sector. The share of expenditures in the public ambulatory care sector under Basic Health Insurance is higher relative to the hospital care. Although in the private sector the share of expenditures for both types of care varies. In 2014, the drug item expenditure accounted for 33% of Health Insurance expenses for both sectors. The level of health care consumption among the population in Long-Term Illness (LTI) represents 49,29% of the total expenditure by the Health Insurance whereas its insured covered population does not exceed 2,78%. CONCLUSION: Controlling the medical expenditure of the health insurance requires strengthening and the development of regulatory measures that contribute to the health reforms. For chronic diseases, it is necessary to put in place prevention actions.

From public vs. private to public/private mix in healthcare: lessons from the Israeli and the Spanish cases.

BACKGROUND: Different forms of public/private mix have become a central mode of the privatization of healthcare, in both financing and provision. The present article compares the processes of these public/private amalgams in healthcare in Spain and Israel in order to better understand current developments in the privatization of healthcare. MAIN TEXT: While in both Spain and Israel combinations between the public and the private sectors have become the main forms of privatization, the concrete institutional forms differ. In Spain, these institutional forms maintain relatively clear boundaries between the private and the public sectors. In Israel, the main forms of public/private mix have blurred such boundaries: nonprofit health funds sell private insurance; public nonprofit health funds own private for-profit hospitals; and public hospitals sell private services. CONCLUSIONS: Comparison of the processes of privatization of healthcare in Spain and Israel shows their variegated characters. It reveals the active role played by national and regional state apparatuses as initiators and supporters of healthcare reforms that have adopted different forms of public/private mix. While in Israel, until recently, these processes have been perceived as mainly technical, in Spain they have created deep political rifts within both the medical community and the public. The present article contains lessons each country can learn from the other, to be adapted in each one's local context: The failure of the Alzira model in Spain warns us of the problems of for-profit HMOs and the Israeli private private/public mix shows the risk of eroding trust in the public system, thus reinforcing market failures and inefficient medical systems.

Private health insurance coverage-related lawsuits.

OBJECTIVES: to analyze lawsuits brought by beneficiaries of health insurance operators. METHODS: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015. RESULTS: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment. CONCLUSIONS: the lawsuits were filed because of the operators' refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.

Private Equity in Ophthalmology and Optometry: Analysis of Acquisitions from 2012 through 2019 in the United States.

PURPOSE: To identify temporal and geographic trends in private equity (PE)-backed acquisitions of ophthalmology and optometry practices in the United States. DESIGN: A cross-sectional study using private equity acquisition and investment data from January 1, 2012, through October 20, 2019. PARTICIPANTS: A total of 228 PE acquisitions of ophthalmology and optometry practices in the United States between 2012 and 2019. METHODS: Acquisition and financial investment data were compiled from 6 financial databases, 4 industry news outlets, and publicly available press releases from PE firms or platform companies. MAIN OUTCOME MEASURES: Yearly trends in ophthalmology and optometry acquisitions, including number of total acquisitions, clinical locations, and providers of acquired practices as well as subsequent sales, median holding period, geographic footprint, and financing status of each platform company. RESULTS: A total of 228 practices associated with 1466 clinical locations and 2146 ophthalmologists or optometrists were acquired by 29 PE-backed platform companies. Of these acquisitions, 127, 9, and 92 were comprehensive or multispecialty, retina, and optometry practices, respectively. Acquisitions increased rapidly between 2012 and 2019: 42 practices were acquired between 2012 and 2016 compared to 186 from 2017 through 2019. Financing rounds of platform companies paralleled temporal acquisition trends. Three platform companies, comprising 60% of platforms formed before 2016, were subsequently sold or recapitalized to new PE investors by the end of this study period with a median holding period of 3.5 years. In terms of geographic distribution, acquisitions occurred in 40 states with most PE firms developing multistate platform companies. New York and California were the 2 states with the greatest number of PE acquisitions with 22 and 19, respectively. CONCLUSIONS: Private equity-backed acquisitions of ophthalmology and optometry practices have increased rapidly since 2012, with some platform companies having already been sold or recapitalized to new investors. Additionally, private equity-backed platform companies have developed both regionally focused and multistate models of add-on acquisitions. Future research should assess the impact of PE investment on patient, provider, and practice metrics, including health outcomes, expenditures, procedural volume, and staff employment.

Private health insurance coverage-related lawsuits / Acciones judiciales relacionadas con la cobertura de prestaciones en la salud complementaria / Ações judiciais relacionadas às coberturas assistenciais na saúde suplementar

ABSTRACT Objectives: to analyze lawsuits brought by beneficiaries of health insurance operators. Methods: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015. Results: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment. Conclusions: the lawsuits were filed because of the operators' refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.

RESUMEN Objetivos: analizar las acciones judiciales iniciadas por beneficiarios de planes de salud de prepago. Métodos: estudio descriptivo, transversal, desarrollado en importante operadora de planes de salud de prepago, utilizando datos recopilados por la empresa entre 2015 y 2015. Resultados: fueron impulsadas 96 acciones judiciales por parte de 86 beneficiarios, referentes a procedimientos médicos (38,5%), tratamientos (26,1%), estudios (14,6%), medicación (9,4%), Home Care (6,2%) y 5,2% por otros tipos de internación. La mayoría de acciones por procedimientos correspondió a rizotomía percutánea; en tratamientos, a quimioterapia; en estudios, a tomografía por emisión de positrones; en medicamentos, a antineoplásicos y para tratar la hepatitis C. Conclusiones: motivaron las acciones judiciales interpuestas la negativa de la operadora de planes de salud a cubrir prestaciones no incluidas en el alcance del plan contratado por el beneficiario, así como asuntos no reglados y autorizados por la Agencia Nacional de Salud Complementaria, considerándose, en consecuencia, improcedentes.

RESUMO Objetivos: analisar as ações judiciais demandadas por beneficiários de uma operadora de plano de saúde. Métodos: estudo descritivo de corte transversal desenvolvido em uma operadora de plano privado de saúde de grande porte, utilizando dados compilados pela empresa no período de 2012 a 2015. Resultados: foram movidas 96 ações judiciais por 86 beneficiários, referentes a procedimentos médicos (38,5%), tratamentos (26,1%), exames (14,6%), medicamentos (9,4%), Home Care (6,2%) e 5,2% a outros tipos de internações. O maior número de ações dentre os procedimentos foi rizotomia percutânea; para tratamentos, a quimioterapia; exames solicitados de tomografia por emissão de pósitrons; para medicamentos, os antineoplásicos e para tratamento de Hepatite C. Conclusões: a razão para as demandas judiciais impetradas foi a negativa da operadora em atender os itens não pertencentes ao escopo do que foi contratado pelo beneficiário ou itens não regulamentados e autorizados pela Agência Nacional de Saúde Suplementar, portanto sendo consideradas improcedentes.

Increasing access to fertility care through private foundations.

OBJECTIVE: To characterize the available support for infertility treatment and populations served by private foundations across the United States. DESIGN: Web-based cross-sectional survey. SETTING: Not applicable. PATIENT(S): Not applicable. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Geographies and populations served, dollar-amount and scope of financial assistance provided by private foundations for individuals seeking financial assistance for infertility treatment. RESULT(S): Thirty-seven private foundations were identified, 25 responded (68% response rate). More than one-half of the foundations had awarded grants to lesbian, gay, and transgender individuals, as well as single men and women. Forty percent of the foundations serve only a single state or geographic region. Foundations have provided 9,996 grants for infertility treatment, 1,740 in 2016 alone, with an average value of $8,191 per grant. The Livestrong foundation has provide more than 90% of these grants, and only to patients with a history of cancer. Twelve percent of foundations provide assistance for fertility preservation in patients with cancer, and 20% provide assistance for elective oocyte cryopreservation. CONCLUSION(S): Private foundations significantly increase access to infertility care for individuals and couples affected by cancer who could otherwise not afford treatment. Significant heterogeneity exists regarding the populations served and the services available for grant support by these foundations, and the landscape of options for patients unaffected by cancer is severely limited.

Variation In Health Spending Growth For The Privately Insured From 2007 To 2014.

We examined the growth in health spending on people with employer-sponsored private insurance in the period 2007-14. Our analysis relied on information from the Health Care Cost Institute data set, which includes insurance claims from Aetna, Humana, and UnitedHealthcare. In the study period private health spending per enrollee grew 16.9 percent, while growth in Medicare spending per fee-for-service beneficiary decreased 1.2 percent. There was substantial variation in private spending growth rates across hospital referral regions (HRRs): Spending in HRRs in the tenth percentile of private spending growth grew at 0.22 percent per year, while HRRs in the ninetieth percentile experienced 3.45 percent growth per year. The correlation between the growth in HRR-level private health spending and growth in fee-for-service Medicare spending in the study period was only 0.211. The low correlation across HRRs suggests that different factors may be driving the growth in spending on the two populations.

In-Hospital Management and Outcomes After ST-Segment-Elevation Myocardial Infarction in Medicaid Beneficiaries Compared With Privately Insured Individuals.

BACKGROUND: Medicaid expansion among previously uninsured individuals has led to improved healthcare access. However, considerably lower reimbursement rates of Medicaid have raised concerns on the unintended consequence of lower utilization of life-saving therapies and inferior outcomes compared with private insurance. We examined the rates of revascularization and in-hospital mortality among Medicaid beneficiaries versus privately insured individuals hospitalized with ST-segment-elevation myocardial infarction (STEMI). METHODS AND RESULTS: We queried the National Inpatient Sample from 2012 to 2015 for STEMI hospitalizations with Medicaid or private insurance as primary payer. Hospitalizations with the following criteria were excluded: (1) age <18 or ≥65 years, (2) transfer to another acute care facility, and (3) left against medical advice. Outcomes were compared in propensity score-matched cohort based on demographics, socioeconomic status (income based), clinical comorbidities, including drug and alcohol use, STEMI acuity (cardiac arrest and cardiogenic shock), and hospital characteristics. A total of 42 645 and 171 545 STEMI hospitalizations were identified as having Medicaid and private insurance, respectively. In unadjusted analyses, Medicaid beneficiaries with STEMI had lower rates of coronary revascularization (88.9% versus 92.3%; odds ratio, 0.67; 95% CI, 0.65-0.70) and higher rates of in-hospital mortality (4.9% versus 2.8%; odds ratio, 1.81; 95% CI, 1.72-1.91) compared with privately insured individuals ( P<0.001 for both). In propensity-matched cohort of 40 870 hospitalizations per group, similar results for lower rates of revascularization (89.1% versus 91.1%; odds ratio, 0.80; 95% CI, 0.76-0.84) and higher in-hospital mortality (4.9% versus 3.7%; odds ratio, 1.35; 95% CI, 1.26-1.45) were observed in Medicaid compared with private insurance, despite extensive matching ( P<0.001 for both). CONCLUSIONS: Medicaid beneficiaries with STEMI had lower rates of revascularization, although small absolute difference, and higher in-hospital mortality compared with privately insured individuals. Further studies are needed to identify and understand the variation in STEMI outcomes by insurance status.

A new side of sarcoidosis: medication and hospitalization use in a privately insured patient population.

OBJECTIVE: This study describes patterns of medication prescriptions for sarcoidosis patients in a large commercially insured U.S. population, with specific focus on prescribing practices across medical specialties and their associated hospitalization risk. METHODS: Using the Marketscan Database we selected adult patients with a diagnosis of sarcoidosis by ICD-9 code during the 2012 calendar year. Differences in prescribing practices were evaluated between provider types. A multivariate model controlling for age, sex, and region assessed hospitalization risk associated with provider type, prednisone dose, and use of non-steroid sarcoidosis medications. RESULTS: Using the described criteria, 11,042 total patients were identified. A majority were female, mean age 49.3 years. Of these, 1,792 (16.2%) had one or more hospital admissions (mean 1.6, SD 1.3) with a mean length of stay of 8.1 days (SD 14.5). 25.5% of patients were prescribed prednisone with a 1 year mean cumulative dose of 250mg. Pulmonary/Rheumatology providers prescribed the highest cumulative prednisone dose (961 mg) and were more likely to prescribe methotrexate and monoclonal antibody medications. Sarcoidosis patients receiving a cumulative prednisone dose >500 mg had an increased risk for hospitalization (OR 2.512, 2.210-2.855), while those prescribed methotrexate and azathioprine had decreased risk (OR 0.633, 0.481-0.833 and 0.460, 0.315-0.671). Monoclonal antibody use was associated with increased OR for hospitalization at 1.359. CONCLUSION: Sarcoidosis patients treated by subspecialists were more likely to receive higher doses of prednisone and non-steroid sarcoidosis medications. Higher doses of prednisone and monoclonal antibody use were associated with higher hospitalization risk while methotrexate and azathioprine were associated with lower hospitalization risk.

[Trend analysis of the claim rate and the impact on the reduction of the number of private healthcare providers in Brazil]. / Análise de tendência da sinistralidade e impacto na diminuição do número de operadoras de saúde suplementar no Brasil.

Alarming data on the part of health care providers on the increase of the claim rate and its potential risk has emerged. It is a descriptive study, with the objective of understanding the changes in the healthcare provider sector in recent years, using the temporal analysis of historical series related to the sector. The variables selected for this study were the claim rate, the coverage rate, and the number of private healthcare providers in activity, observed from 2003 to 2014. The method used for evaluation of the temporal trend was Linear Regression. The claim rate and the coverage rate show an upward trend in the period, while the number of operators in Brazil showed a decreasing trend during the same period. These results show that even with the increase in demand, there was a decrease in the number of operators active in the country. The claim rate is one of the possible causes observed this inverse relationship because the increased offers risks of survival and the opening of new operators. Moreover, the decrease in the number of providers, is leading the country to an oligopolistic industry with an increasing demand in the number of beneficiaries. This decrease is also associated with regulatory processes, which regulates the sector's relationship with the beneficiary.

Dados alarmantes vêm surgindo por parte das operadoras de saúde sobre o aumento da sinistralidade e seu potencial risco. Estudo descritivo, com o objetivo de compreender as mudanças ocorridas no setor de saúde suplementar nos últimos anos, através da análise temporal de séries históricas relacionadas ao setor. As variáveis escolhidas para este trabalho foram a sinistralidade, a taxa de cobertura e o quantitativo de operadoras em atividade, observadas de 2003 a 2014. O método utilizado para a avaliação da tendência temporal foi a Regressão Linear. A sinistralidade e a taxa de cobertura apresentaram uma tendência de crescimento no período, enquanto a quantidade de operadoras no Brasil apresentou uma tendência de decrescimento no mesmo período. Esses resultados apontam que, mesmo com o aumento da demanda, houve uma diminuição do número de operadoras em atividade no país. A sinistralidade é uma das possíveis causas de observarmos essa relação inversa, pois o seu aumento oferece riscos à sobrevida e à abertura de novas operadoras. Ademais, a diminuição do número de operadoras está conduzindo o país a uma oligopolização do setor com uma demanda crescente do número de beneficiários. Essa diminuição pode estar também associada aos processos regulatórios que normatizam a relação do setor com o beneficiário.

Análise de tendência da sinistralidade e impacto na diminuição do número de operadoras de saúde suplementar no Brasil / Trend analysis of the claim rate and the impact on the reduction of the number of private healthcare providers in Brazil

Resumo Dados alarmantes vêm surgindo por parte das operadoras de saúde sobre o aumento da sinistralidade e seu potencial risco. Estudo descritivo, com o objetivo de compreender as mudanças ocorridas no setor de saúde suplementar nos últimos anos, através da análise temporal de séries históricas relacionadas ao setor. As variáveis escolhidas para este trabalho foram a sinistralidade, a taxa de cobertura e o quantitativo de operadoras em atividade, observadas de 2003 a 2014. O método utilizado para a avaliação da tendência temporal foi a Regressão Linear. A sinistralidade e a taxa de cobertura apresentaram uma tendência de crescimento no período, enquanto a quantidade de operadoras no Brasil apresentou uma tendência de decrescimento no mesmo período. Esses resultados apontam que, mesmo com o aumento da demanda, houve uma diminuição do número de operadoras em atividade no país. A sinistralidade é uma das possíveis causas de observarmos essa relação inversa, pois o seu aumento oferece riscos à sobrevida e à abertura de novas operadoras. Ademais, a diminuição do número de operadoras está conduzindo o país a uma oligopolização do setor com uma demanda crescente do número de beneficiários. Essa diminuição pode estar também associada aos processos regulatórios que normatizam a relação do setor com o beneficiário.

Abstract Alarming data on the part of health care providers on the increase of the claim rate and its potential risk has emerged. It is a descriptive study, with the objective of understanding the changes in the healthcare provider sector in recent years, using the temporal analysis of historical series related to the sector. The variables selected for this study were the claim rate, the coverage rate, and the number of private healthcare providers in activity, observed from 2003 to 2014. The method used for evaluation of the temporal trend was Linear Regression. The claim rate and the coverage rate show an upward trend in the period, while the number of operators in Brazil showed a decreasing trend during the same period. These results show that even with the increase in demand, there was a decrease in the number of operators active in the country. The claim rate is one of the possible causes observed this inverse relationship because the increased offers risks of survival and the opening of new operators. Moreover, the decrease in the number of providers, is leading the country to an oligopolistic industry with an increasing demand in the number of beneficiaries. This decrease is also associated with regulatory processes, which regulates the sector's relationship with the beneficiary.

SUS: supply, access to and use of health services over the last 30 years. / SUS: oferta, acesso e utilização de serviços de saúde nos últimos 30 anos.

Significant changes have been witnessed in the Brazilian health system over the last 30 years. This article outlines trends in outpatient and hospital care, staffing, and health service use during this period. There was a significant expansion of the public health network, particularly of primary care services, leading to improved access to consultations and a reduction in hospital admissions. However, there is a persistent shortage of health professionals in Brazil's public health system, particularly dentists. Despite improvements in coverage, the public system continues to face serious challenges, particularly with respect to funding, service provision, and its relationship with the private sector.

Ao longo dos últimos 30 anos, o Sistema Único de Saúde brasileiro se caracterizou por importantes mudanças na atenção à saúde. No presente artigo, são apresentados dados relativos à evolução das estruturas ambulatorial e hospitalar, e dos recursos humanos, bem como acerca da utilização dos serviços de saúde. A expansão da rede pública ocorreu principalmente entre as unidades que dão suporte aos programas de atenção básica, ampliando o acesso às consultas médicas e a redução das internações para um conjunto de doenças, mas persiste uma carência de profissionais, especialmente no cuidado odontológico. Entretanto, a despeito do avanço na cobertura, permanecem os desafios à continuidade do SUS e à melhoria da qualidade do cuidado, particularmente no tocante ao financiamento público, oferta de serviços, e na relação com o setor privado.

Obesity Prevention and Management Strategies in Canada: Shifting Paradigms and Putting People First.

PURPOSE OF REVIEW: The purpose of this study was to review public and private sector obesity policies in Canada and to make recommendations for future evidence-based obesity prevention and management strategies. RECENT FINDINGS: Synthesis of obesity prevention and management policies and research studies are presented in three primary themes: (1) Increased awareness about the impact of weight bias and obesity stigma in Canada; (2) Inadequate government obesity prevention and management policies and strategies; and (3) Lack of comprehensive private sector obesity prevention and management policies. Findings suggest that in Canada, obesity continues to be treated as a self-inflicted risk factor, which affects the type of interventions and approaches that are implemented by governments or covered by private health plans. The lack of recognition of obesity as a chronic disease by Canadian public and private payers, health systems, employers, and the public, has a trickle-down effect on access to evidence-based prevention and treatment. Although there is increasing recognition and awareness about the impact of weight bias and obesity stigma on the health and social well-being of Canadians, interventions are urgently needed in education, healthcare, and public policy sectors. We conclude by making recommendations for the advancement of evidence-based obesity prevention and management policies that can improve the lives of Canadians affected by obesity.

Change in Health Insurance Coverage After Liver Transplantation Can Be Associated with Worse Outcomes.

BACKGROUND: Health insurance coverage changes for many patients after liver transplantation, but the implications of this change on long-term outcomes are unclear. AIMS: To assess post-transplant patient and graft survival according to change in insurance coverage within 1 year of transplantation. METHODS: We queried the United Network for Organ Sharing for patients between ages 18-64 years undergoing liver transplantation in 2002-2016. Patients surviving > 1 year were categorized by insurance coverage at transplantation and the 1-year transplant anniversary. Multivariable Cox regression characterized the association between coverage pattern and long-term patient or graft survival. RESULTS: Among 34,487 patients in the analysis, insurance coverage patterns included continuous private coverage (58%), continuous public coverage (29%), private to public transition (8%) and public to private transition (4%). In multivariable analysis of patient survival, continuous public insurance (HR 1.29, CI 1.22, 1.37, p < 0.001), private to public transition (HR 1.17, CI 1.07, 1.28, p < 0.001), and public to private transition (HR 1.14, CI 1.00, 1.29, p = 0.044), were associated with greater mortality hazard, compared to continuous private coverage. After disaggregating public coverage by source, mortality hazard was highest for patients transitioning from private insurance to Medicaid (HR vs. continuous private coverage = 1.32; 95% CI 1.14, 1.52; p < 0.001). Similar differences by insurance category were found for death-censored graft failure. CONCLUSION: Post-transplant transition to public insurance coverage is associated with higher risk of adverse outcomes when compared to retaining private coverage.

Trend of caesarean deliveries in Egypt and its associated factors: evidence from national surveys, 2005-2014.

BACKGROUND: The continued rise in caesarean section (c-section) deliveries raises a major public health concern worldwide. This study assessed the trend of c-section deliveries and examined factors associated with a rise in c-section deliveries among the Egyptian mothers, from 2005 to 2014, by place of delivery. METHODS: This study utilized the 2005, 2008, and 2014 Egypt Demographic and Health Surveys (EDHS). The EDHS reported on the mode of delivery for the last birth occurred within five years preceding each survey including place of delivery and sociodemographic information for a total sample of over 29,000 mothers in the three surveys. To document trend of c-section, the EDHS-2005 was set as a reference in two binary logistic regression models; among all mothers together and for mothers stratified by place of delivery (public or private). P-value for the trend was assessed by entering the year of the survey as a continuous variable. The study followed STROBE statement in reporting observational studies. RESULTS: Institutional-based c-sections increased by 40.7 points from EDHS-2005 to EDHS-2014 (aOR, 3.46, 95%CI: 3.15-3.80, P trend < 0.001). Compared to mothers with low socioeconomic status (SES), mothers with high SES had higher odds (aOR, 1.78, 95%CI: 1.25-2.54, P = 0.001) for c-section, but only in EDHS-2005. The adjusted trend of c-sections was found to be 4.19-time (95%CI: 3.73-4.70, P < 0.001) higher in private sector while that in public sector it was 2.67-time (95%CI: 2.27-3.13, P = 0.001) higher, in EDHS-2014 relative to EDHS-2005. This increase in the private sector is explained by significant increases among mothers who are potentially at low risk for c-sections; mothers aged 19-24 years vs. ≥35 years (aOR: 0.31, 95%CI: 0.21-0.45, in EDHS-2005 vs. 0.43, 95%CI: 0.33-0.56, in EDHS-2014, P < 0.001); primigravida mothers vs. mothers with ≥4 children (aOR: 1.62, 95%CI: 1.12-2.34, in EDHS-2005 vs. 3.76, 95%CI: 2.94-4.80 in EDHS-2014); and among normal compared to high risk birth weight babies (aOR: 0.79, 95%CI: 0.62-0.99 in EDHS-2005 P < 0.05 vs. 0.83, 95%CI: 0.65-1.04 in EDHS-2014, P > 0.05). CONCLUSIONS: Results showed a steady rise in c-sections in Egypt that has reached an alarming level in recent years. This increase appears to be associated with a shift towards delivery in private health care facilities. More vigilance of c-section deliveries, particularly in the private sector, is warranted.

Ageing and the economic life cycle: The National Transfer Accounts approach.

OBJECTIVE: To illustrate the use of National Transfer Accounts (NTA) for understanding ageing and the economic life cycle in Australia. METHODS: The NTA methodology is applied utilising a range of unit record, demographic and administrative data sets from 1981 to 2010. RESULTS: During early and later life, total consumption (public and private) is greater than labour income. On a time series and cohort basis, we show that each successive generation has improved their level of well-being (as measured by consumption) relative to the previous years or previous cohorts from 1981 to 1982 onwards. We also show a substantial increase in labour income earned by mature age workers over this period. International comparisons show Australia to have consumption and labour income age profiles very similar to those of Canada but dissimilar to many other countries, driven by differences in demographic and policy settings. CONCLUSION: The NTA approach provides a powerful framework to track differences in the economic life cycle across age groups, across time, across cohorts and across countries.