BACKGROUND: Complementary and alternative (CAM) cancer treatment is often expensive and not covered by insurance. As a result, many people turn to crowdfunding to access this treatment.
OBJECTIVE: The aim of this study is to identify the rationales of patients with cancer seeking CAM treatment abroad by looking specifically at crowdfunding campaigns to support CAM cancer treatment in Tijuana, Mexico.
METHODS: We scraped the GoFundMe.com and GiveSendGo.com crowdfunding platforms for campaigns referencing CAM cancer clinics in Tijuana, initiated between January 1, 2022, and February 28, 2023. The authors created a coding framework to identify rationales for seeking CAM treatment in Tijuana. To supplement campaign metadata, we coded the beneficiary\'s cancer stage, type, age, specific treatment sought, whether the beneficiary died, gender, and race.
RESULTS: Patients sought CAM cancer treatment in Tijuana because the (1) treatment offers the greatest efficacy (29.9%); (2) treatment offered domestically was not curative (23.2%); (3) the clinic treats the whole person, and addresses the spiritual dimension of the person (20.1%); (4) treatments are nontoxic, natural, or less invasive (18.2%); and (5) clinic offers the newest technology (8.5%). Campaigns raised US $5,275,268.37 and most campaign beneficiaries were women (69.7%) or White individuals (71.1%).
CONCLUSIONS: These campaigns spread problematic misinformation about the likely efficacy of CAM treatments, funnel money and endorsements to CAM clinics in Tijuana, and leave many campaigners short of the money needed to pay for CAM treatments while costing beneficiaries and their loved one\'s time, privacy, and dignity. This study affirms that Tijuana, Mexico, is a very popular destination for CAM cancer treatment.

暂无摘要。

BACKGROUND: There are pre-existing inequities in asthma care.
OBJECTIVE: To evaluate effect modification by race of the effect of insurance on biologic therapy use in patients with asthma and related diseases.
METHODS: We conducted inverse probability weighted (IPW) analyses using electronic health records data from 2011-2020 from a large healthcare system in Boston, MA. We evaluated the odds of not initiating omalizumab or mepolizumab therapy within one year of prescription for an approved indication.
RESULTS: We identified 1,132 individuals who met study criteria. Twenty-seven percent of these patients had public insurance and 12% belonged to a historically marginalized group (HMG). A quarter of patients did not initiate the prescribed biologic. Among patients with asthma, individuals belonging to HMG had higher exacerbation rates in the period before initiation compared to non-HMG individuals, regardless of insurance type. Among HMG patients with asthma, those with private insurance were less likely to not initiate therapy compared to those with public insurance, (Odds Ratio, (OR) 0.67, and 95% Confidence Interval, [CI] 0.56 - 0.79). Among non-HMG with asthma, privately insured and publicly insured individuals had similar rates of not initiating the prescribed biologic (OR: 1.02; 95% CI: 0.95 -1.09). Among those publicly insured with asthma, HMGs had higher odds of not initiating therapy compared to non-HMGs (OR 1.16; 95% CI 1.03 - 1.31), but privately-insured HMG and non-HMG did not differ significantly (OR: 0.99; 95% CI: 0.91 - 1.07).
CONCLUSIONS: Publicly insured individuals belonging to HMG are less likely to initiate biologics when prescribed despite having more severe asthma, while there are no inequities by insurance in individuals belonging to other groups.

Although chatbots are used a lot for customer relationship management (CRM), there needs to be more data security and privacy control strategies in chatbots, which has become a security concern for financial services institutions. Chatbots gain access to large amounts of vital company information and clients\' personal information, which makes them a target of security attacks. The loss of data stored in chatbots can cause major harm to companies and customers. In this study, STRIDE (viz. Spoofing, Tampering, Repudiation, Information disclosure, Denial of service, Elevation of privilege) modelling was applied to identify the data security vulnerabilities and threats that pertain to chatbots used in the insurance industry. To do this, we conducted a case study of a South African insurance organisation. The adopted methodology involved data collection from stakeholders in the insurance organisation to identify chatbot use cases and understand chatbot operations. After that, we conducted a STRIDE-based analysis of the chatbot use cases to elicit security threats and vulnerabilities in the insurance chatbots in the organisation. The results reveal that security vulnerabilities associated with Spoofing, Denial of Service, and Elevation of privilege are more relevant to insurance chatbots. The most security threats stem from Tampering, Elevation of privilege, and Spoofing. The study extends the discussion on chatbot security. It fosters an understanding of security threats and vulnerabilities that pertain to insurance chatbots, which is beneficial for security researchers and practitioners working on the security of chatbots and the insurance industry.

BACKGROUND: Reduction mammaplasty improves the quality of life by providing functional and aesthetic benefits to women with macromastia. This study contributes to the existing literature on socioeconomic and clinical barriers to referral for plastic surgery procedures by focusing specifically on reduction mammaplasty.
METHODS: Patients with macromastia were identified via a chart review in a single institution from 2021-2022. The treatment pathway for each patient was characterized by reception of referral, completion of plastic surgery consultation, and eventual reception of surgery. After controlling for clinical covariates, multivariate logistic regression was applied to quantify the independent impact of race, insurance, and language status on the completion of surgery (p < 0.05).
RESULTS: The final patient cohort included 425 women with macromastia. Among the 151 patients who were first seen by a primary care physician, 64 (42%) completed an initial plastic surgery consultation. Among all patients, 160 (38%) eventually underwent reduction mammaplasty. Multivariate regression predictions indicated a lower likelihood of completing breast reduction surgery in patients with current smoking history (OR: 0.08, 95% CI: 0.01-0.59) and higher body mass index (BMI) (OR: 0.94, 95% CI: 0.90-0.97) (p < 0.05). Minority race and ethnicity, private insurance status, and primary language status were not significant predictors of this outcome (p > 0.05).
CONCLUSIONS: In this study, the socioeconomic variables were not independent predictors of breast reduction surgery completion. However, the association of minority race and ethnicity and nonprivate insurance status with the most common reasons for breast reduction deferral suggest an indirect influence of socioeconomic status on the treatment pathway.

UNASSIGNED: The COVID-19 pandemic led to unemployment and associated health insurance loss, prompting an unprecedented adoption of emergency policies, including economic relief efforts and health insurance coverage expansion. We sought to understand pandemic-related challenges for people with asthma and how emergency policies served families facing both chronic disease management and health insurance loss.
UNASSIGNED: Qualitative interview study.
UNASSIGNED: In 2021, we conducted semi-structured telephone interviews with 21 adults who had asthma and lost employment and employer-sponsored health insurance coverage during the COVID-19 pandemic. We used thematic analysis to assess how health and economic policies affected participants\' ability to access care and manage their asthma.
UNASSIGNED: Participants reported reduced access to care, as well as worry about heightened susceptibility to COVID-19 due to their asthma. While insurance loss exacerbated these challenges, participants indicated that economic relief efforts, including direct stimulus payments, helped them afford needed asthma care. Participants were more critical of enhancements to existing coverage policies such as the Affordable Care Act (ACA) Marketplace and Consolidated Omnibus Budget Reconciliation Act (COBRA) due to difficulty understanding, accessing, and affording such coverage.
UNASSIGNED: Our findings underscore that people affected by asthma and health insurance loss benefit from policies that provide flexible and easy-to-use assistance, such as direct payments, for meeting the diverse challenges posed by living with a chronic disease. Although policies that expand health insurance coverage are critical, more attention is needed to help people with chronic conditions access these programs in a timely way.

UNASSIGNED: Youths who start behavioral health treatment often stop before completing a therapeutic course of care. To increase treatment engagement and quality of care, the Evidence-Based Practice and Innovation Center in Philadelphia has incentivized use of evidence-based practices (EBPs) for mental health care of youths. The authors aimed to compare treatment outcomes between youths who received EBP care and those who did not.
UNASSIGNED: Using EBP-specific billing codes and propensity score matching, the authors compared treatment retention among youths who received trauma-focused cognitive-behavioral therapy (TF-CBT; N=413) or parent-child interaction therapy (PCIT; N=90) relative to matched samples of youths in standard outpatient therapy (N=503).
UNASSIGNED: Youths with a minimum of one session of TF-CBT or PCIT attended a second session at higher rates than did youths in the matched control group (TF-CBT: 96% vs. 68%, p<0.01; PCIT: 94% vs. 69%, respectively, p<0.01). On average, these returning youths attended more sessions in the EBP groups than in the control group (TF-CBT: 15.9 vs. 11.5 sessions, p<0.01; PCIT: 11.2 vs. 6.9 sessions, p<0.01).
UNASSIGNED: These findings indicate that, in addition to improving quality of care, EBP implementation helps address the major challenge that most youths who engage with treatment are not retained long enough for care to have therapeutic effects. Future research should examine the mechanisms through which EBPs can improve treatment retention.

Earthquake insurance is a critical risk management strategy that contributes to improving recovery and thus greater resilience of individuals. Insurance companies construct premiums without taking into account spatial correlations between insured assets. This leads to potentially underestimating the risk, and therefore the exceedance probability curve. We here propose a mixed-effects model to estimate losses per ward that is able to account for heteroskedasticity and spatial correlation between insured losses. Given the significant impact of earthquakes in New Zealand due to its particular geographical and demographic characteristics, the government has established a public insurance company that collects information about the insured buildings and any claims lodged. We thus develop a two-level variance component model that is based on earthquake losses observed in New Zealand between 2000 and 2021. The proposed model aims at capturing the variability at both the ward and territorial authority levels and includes independent variables, such as seismic hazard indicators, the number of usual residents, and the average dwelling value in the ward. Our model is able to detect spatial correlation in the losses at the ward level thus increasing its predictive power and making it possible to assess the effect of spatially correlated claims that may be considerable on the tail of loss distribution.

OBJECTIVE: Positive airway pressure (PAP) compliance is important in treating obstructive sleep apnea. Previous studies have suggested that patients with economic burdens, discomfort using machines, and insufficient education have difficulty tolerating PAP machines. This study explored the factors affecting short-term adherence to PAP in a veterans medical center.
METHODS: The medical records of patients who underwent polysomnography at the Veterans Health Service Medical Center, Seoul, Republic of Korea, between July 2018 and January 2021 were reviewed retrospectively. Patients with an apnea-hypopnea index (AHI) ≥15 were included (n=579). PAP adherence was defined as continuous use for ≥21 days for ≥4 hours daily for 30 consecutive days for 90 days from the date of PAP prescription.
RESULTS: The PAP-adherent group (n=265, age 66.16±11.28 years) was younger and had more years of education, higher body mass indices, and lower scores in the Insomnia Severity Index and Beck Depression Inventory-II (BDI-II) than those of the PAP-nonadherent group (n=314, age 68.93±10.91 years). Patients who tolerated PAP had a higher AHI, longer duration of oxygen desaturation (less than 90%), and less dream enactment behavior (DEB) than that in those who did not. After adjusting for age, years of education, BDI-II, duration of oxygen desaturation, and presence of DEB, there were more patients with National Health Insurance (NHI) in the PAP-adherent group than in the PAP-nonadherent group (p<0.001).
CONCLUSIONS: We showed that patients with NHI recorded significantly higher adherence compared to that in patients without NHI, among other factors.

BACKGROUND: Dizziness/vertigo is one of the most common symptoms for which people seek healthcare. However, the healthcare expenditure attributable to dizziness/vertigo in South Korea remains poorly understood. We investigated the healthcare costs due to six major disorders causing dizziness/vertigo using claims data.
METHODS: The healthcare costs were evaluated using all the claims data submitted to the Health Insurance Review and Assessment Service from January 1 to December 31, 2022. The six major vestibular disorders included for analysis were benign paroxysmal positional vertigo (BPPV), psychogenic/persistent postural perceptual dizziness (PPPD), vascular vertigo/dizziness (VVD), vestibular migraine (VM), Meniere\'s disease (MD), and vestibular neuritis (VN).
RESULTS: During the 1-year study period, 4.1% of adults aged 20 or older visited hospitals due to dizziness/vertigo in South Korea. Compared to the general population, the patients with dizziness/vertigo were more often elderly, female, and residents of small towns. The total healthcare cost for the six major vestibular disorders was ₩547.8 billion (approximately $406.5 million). BPPV incurred the highest annual healthcare cost (₩183.5 billion, 33.5%), followed by VVD (₩158.8 billion, 29.0%), MD (₩82.2 billion, 15.0%), psychogenic/PPPD (₩60.3 billion, 11.0%), VN (₩32.9 billion, 6.0%), and VM (₩30.1 billion, 5.5%). The mean healthcare cost per hospital visit due to dizziness/vertigo was ₩96,524 (95% confidence interval, ₩96,194-₩96,855), 30% higher than the average (₩73,948) of the overall healthcare cost per hospital visit over the same period.
CONCLUSIONS: Owing to higher healthcare costs for dizziness/vertigo and increased prevalence of dizziness/vertigo in the aged population, healthcare costs due to dizziness/vertigo will increase rapidly in South Korea. Thus, a guideline for cost-effective management of dizziness/vertigo should be established to reduce the healthcare costs due to these common symptoms.