The scope of COVID-19 vaccine insurance coverage and possible disputes

In response to the COVID-19 pandemic, many countries have implemented large-scale vaccination programs. In Taiwan, COVID-19 vaccine insurance is available. However, as the COVID-19 vaccine is a new vaccine, there is limited research assessing its safety, and many physicians are not fully informed about its potential risks. Additionally, there is limited recognition of the risks associated with the COVID-19 vaccine by the government and insurance companies, making it difficult for individuals to prove that an injury is a result of the vaccine. This study examined legal elements, insurance coverage, and potential disputes related to COVID-19 vaccine insurance in Taiwan. This study proposed three ways to resolve vaccine insurance disputes: 1. Insurance companies should clarify the scope of insurance policies and the difference between adverse events following vaccination and adverse reactions. 2. The government should proactively update and supplement the information available on the adverse effects of COVID-19 vaccines. 3. The courts should reduce the burden of proof for individuals with vaccine injuries by interpreting insurance contracts and evidence law. (Taiwan J Public Health. 2023;42(2):153-164)

Economics of a Health System's Direct-to-Consumer Telemedicine for Its Employees

Am J Manag Care. 2023;29(6):In Press _____ Takeaway Points The value of direct-to-consumer (DTC) telemedicine services offered by academic health systems is understudied. * DTC telemedicine services for low-acuity or minor illnesses are increasingly offered as an employee benefit, but any per-episode unit cost advantage may be offset by overuse of care. * DTC telemedicine staffed by an academic health system and offered to its employees resulted in lower per-episode unit costs for care within 7 days and only marginally increased the use of services. * DTC telemedicine staffed by an academic health system and offered directly to employees was cost-saving. _____ Employers in the United States have increasingly been offering a direct-to-consumer (DTC) telemedicine benefit for low-acuity or minor illnesses to their employees.1-3 By 2021, more than 95% of employers with 50 or more employees provided some coverage for DTC telemedicine in their largest health plan;more than 75% felt that offering telemedicine was important and nearly 20% either limited or eliminated cost sharing for telemedicine.4 Despite these trends among general employers, few health systems have directly provided DTC telemedicine to their own employees. [...]because these services are easy to access (often available immediately, around the clock, and without travel), they may induce overuse of care, especially for self-limited conditions such as viral upper respiratory infections for which the alternative to in-person care is no care at all, thus increasing the overall cost of care.5-11 Telemedicine will save money relative to in-person care if any unit price advantages are not overwhelmed by the increased use of care overall, induced by its convenience. Employers provide health insurance coverage for 158 million Americans or nearly 50% of the population. Since the COVID-19 pandemic began, telemedicine has represented a significantly larger portion of all medical claims—consistently more than 5% of all medical claims by mid-202112-15—and the estimated value of the global telemedicine industry is projected to reach a quarter of a trillion dollars by 2024.13 Yet, the future of telemedicine remains undetermined with reimbursement rates in debate,16-18 driven in large part because its economic value is understudied and uncertain. Penn Medicine is self-insured and more than 95% of employees use its only employer-sponsored plan—a preferred provider organization (PPO) plan—rather than insurance obtained individually or through a family member. Since 2017, these PPO-insured employees have been offered Penn Medicine OnDemand,19 a 24/7 DTC telemedicine benefit to employees and their adult (≥ 18 years) dependents.

Nigeria's new president ‘must walk the talk on health'

Speed read Nigeria's president-elect eyes 40 per cent health insurance coverage in two years Ambitious target needs funding, human resources Over 75,000 nurses and midwives left Nigeria in five years [LAGOS] Health experts in Nigeria say the country's president-elect who will be inaugurated on 29 May must prioritise health care and refrain from politicising it. While Nigeria committed to achieving universal health coverage (UHC) by 2030, its National Health Insurance Scheme (NHIS) established in 2005 makes health insurance coverage voluntary. [...]in May 2022, after two decades of sustained calls by health professionals, a new Act was passed which aimed to provide health insurance for all Nigerians, through a mandatory mechanism and in collaboration with state health insurance agencies.

Low incidence of HIV infection and decreasing incidence of sexually transmitted infections among PrEP users in 2020 in Germany.

INTRODUCTION: Objectives of this study, as part of a nation-wide HIV pre-exposure prophylaxis (PrEP) evaluation project, were to determine the incidence of infections with HIV, chlamydia, gonorrhea, syphilis, hepatitis A/B/C in persons using PrEP, and to describe the health care funded PrEP use in Germany. Additionally, factors associated with chlamydia/gonorrhea and syphilis infections were assessed. METHODS: Anonymous data of PrEP users were collected at 47 HIV-specialty centers from 09/2019-12/2020. Incidence rates were calculated per 100 person years (py). Using longitudinal mixed models, we analyzed risk factors associated with sexually transmitted infections (STIs). RESULTS: 4620 PrEP users were included: 99.2% male, median age 38 years (IQR 32-45), 98.6% men who have sex with men (MSM). The median duration of PrEP exposure was 451 days (IQR 357-488), totaling 5132 py. Four HIV infections were diagnosed, incidence rate 0,078/100py (95% CI 0.029-0.208). For two, suboptimal adherence was reported and in the third case, suboptimal adherence and resistance to emtricitabine were observed. One infection was likely acquired before PrEP start. Incidence rates were 21.6/100py for chlamydia, 23.7/100py for gonorrhea, 10.1/100py for syphilis and 55.4/100py for any STI and decreased significantly during the observation period. 65.5% of syphilis, 55.6% of chlamydia and 50.1% of gonorrhea cases were detected by screening of asymptomatic individuals. In a multivariable analysis among MSM younger age, PrEP start before health insurance coverage and daily PrEP were associated with greater risk for chlamydia/gonorrhea. Symptom triggered testing and a history of STI were associated with a higher risk for chlamydia/gonorrhea and syphilis. A significantly lower risk for chlamydia/gonorrhea and syphilis was found for observations during the COVID-19 pandemic period. CONCLUSIONS: We found that HIV-PrEP is almost exclusively used by MSM in Germany. A very low incidence of HIV infection and decreasing incidence rates of STIs were found in this cohort of PrEP users. The results were influenced by the SARS-CoV-2 pandemic. Rollout of PrEP covered by health insurance should be continued to prevent HIV infections. Increased PrEP availability to people at risk of HIV infection through the elimination of barriers requires further attention. Investigation and monitoring with a longer follow-up would be of value.

Coding & Documentation

MEDICARE COVERAGE FOR COVID-19 VACCINE ADMINISTRATION POST-PHE ;CODING FOR FRACTURE CARE FOLLOW UP ;MIDPOINT RULE FOR TIME-BASED CPT CODING ;ADMINISTERING COVID-19 VACCINES OBTAINED FREE OF CHARGE

The reform of social protection in Morocco following the coronavirus pandemic

The COVID-19 pandemic has affirmed the importance of social protection. To combat the effects of the pandemic, countries have taken exceptional measures to preserve health and have introduced or adapted measures to provide income support to people who have lost their sources of income. The pandemic has also highlighted the weaknesses of the social protection system in Morocco, introduced in 1940, which is composed of a contributory system whose financing depends on social security contributions and regulations, and a subsidiary system which takes into covers people who do not have access to contributory basic social insurance. The kick-off for the implementation of the social protection reform in Morocco was given in April 2021 and should be spread over five years. The objective of this reform is to reorganize and improve the operation of the various social protection instruments with a view to greater effectiveness and increased efficiency and also to create new components likely to extend coverage. This large-scale reform initiated by Morocco requires an annual envelope estimated at 51 billion dirhams, which constitutes a major challenge for the country's public finances, which have been hit by the COVID-19 crisis.

NASEM on long‐term effects of COVID‐19 on children and families

Probably the most devastating loss to a child is the death of a parent. This happened to more than 265,000 children in the United States due to COVID‐19. But there are other losses too, which have also been devastating – when a parent loses a job, which happened often during the pandemic, and in fact, that is still occurring. And there are many other long‐term effects of COVID‐19, some of which were alleviated by extra money from the federal government. That is now drying up as the federal emergency ends.

Exploring the challenges for medical tourism in the United Arab Emirates during the Covid-19 pandemic era: a stakeholder perspective

PurposeThis paper explores medical tourism development challenges in the United Arab Emirates (UAE) pre- and during Covid-19. Medical tourism is becoming a dynamic, rapid growth area and an engine of economic development.Design/methodology/approachIn-depth interviews were conducted with medical tourism professionals. Fourteen medical tourism stakeholders were interviewed from 1 January to 31 January 2020. Qualitative thematic analysis was applied on medical tourism challenges before and during the pandemic.FindingsThe major themes indicated concerns for medical tourism in the UAE and they included higher medical services costs and a shortage of highly qualified medical expertise. The emerging themes related to the challenges of coping with Covid-19 and strategies to attract medical tourists.Originality/valueThis study contributes towards (1) the theory of medical tourism, (2) the related limited prior published work on this topic relating to the UAE and (3) the importance of medical tourism in today's tourism industry. Additionally, there are theoretical and practical implications for medical tourism stakeholders in terms of attracting inbound medical tourists to the UAE from other countries during the Covid-19 crisis and in the post-pandemic situation.

Differences in Diabetes Control in Telemedicine vs. In-Person Only Visits in Ambulatory Care Setting

Importance: The COVID-19 pandemic has led to increased utilization of telemedicine. Patients with diabetes are a vulnerable population that require regular treatment and monitoring. Little is known about the impact visit modality on diabetes outcomes in an ambulatory setting. Objective: Compare proportions of patients with diabetes with uncontrolled diabetes among those with telemedicine versus in-person only ambulatory visits and examine differences by age, race, gender, ethnicity, and insurance. Design: A retrospective cohort study. Setting : The largest academic healthcare system in the state of Georgia with ambulatory clinics in urban, suburban and rural settings. Participants : Adults with diabetes scheduled for an ambulatory primary or specialty clinic visit between May 2020 and May 2021 were included. Patients were compared among three visit groups: those with all in-person visits, those with one telemedicine visit, and those with 2+ telemedicine visits. Demographics including age, race, ethnicity, gender, insurance status, and comorbidities were extracted from the electronic medical record. Main Outcomes and Measures: The primary clinical outcome was uncontrolled diabetes, defined as HbAlc >= 9.0%. Chi-square test was used to determine crude differences in uncontrolled diabetes between visit groups. Multivariable logistic regression was used to assess differences in uncontrolled diabetes between visit groups following risk adjustment. Results: A total of 18,148 ambulatory clinic visits for patients with diabetes were scheduled during the study period, and 11.6% had uncontrolled diabetes. There was no difference in proportion of patients with uncontrolled diabetes between all in-person visits (834 (11.6%)), one telemedicine visit (558 (11.8%)), or 2+ telemedicine visits (709 (11.4%)) (p = 0.80). Patients with 2+ telemedicine visits had significantly lower odds of uncontrolled diabetes compared to all in-person visits after adjusting for age, gender, race, ethnicity, insurance status, and comorbidities (OR: 0.88;95% CI: 0.79 - 0.99, p = 0.03). Conclusions and Relevance: Telemedicine visits were associated with a lower odds of uncontrolled diabetes. Further work is warranted to explore the relationship between telemedicine visits, equitable access to care, and diabetes outcomes. Copyright © 2023 Annals of Family Medicine, Inc.

The Economic Growth and COVID-19 in the European Union Members and the United States

COVID 19 became a global epidemic with new uncertainties and significant consequences. The highest number of cases was observed in the United States, followed by Europe and Southeast Asia. Many sectors downsized or were otherwise hit hard by the pandemic. Governments focused on fighting the disease and mitigating its effects on their economies and health systems. This study examined how countries in the European region and the U.S. were prepared to cope with COVID-19 and its effects on their economies and health systems. After comparing economic growth, the Global Health Security Index, Stringency Index, and health inputs of these countries, it was found that many European nations and the U.S. were not fully prepared for global epidemics. The study results also show that the sharpest contraction in the national economies occurred in the second quarter of 2020.

Customer's Perspective on Health Insurance Post-Pandemic

India is among the nations most severely impacted by COVID-19, which has affected practically all global industries and sectors, including the insurance sector. The covid pandemic has forced businesses in all industries to alter the way they conduct business, and the health insurance market is no exception. The prolonged lockdown following COVID-19 has forced insurance companies to extensively rely on their digital architecture for everything from selling new policies to customers to handling claims. Many insurance companies create specialised policies to guarantee coverage is not impacted. This essay attempts to explore the effects of COVID-19 on health insurance and how they affect the industry as a whole.

Vulnerability to COVID-19 Infection in Milwaukee: Effects of Individual and Neighborhood Characteristics

This study focuses on variation of the prevalence rate of COVID-19 over time by age and race/ethnicity and how neighborhood social vulnerability affects the COVID-19 prevalence in the whole epidemic as well as its three consecutive sub-waves in Milwaukee County, Wisconsin. It found that the highest prevalence rate was for young adults (18-44). Hispanics and Asians were more likely to be infected than were non-Hispanic whites and African Americans. The high neighborhood social vulnerability was associated with greater risk of infection especially for persons over age 25, for Hispanics and Asians. High prevalence rates were significantly and strongly associated with all major factors of the social vulnerability in early stage of the pandemic, especially with the factor associated with Hispanic and immigrant population. Throughout the epidemic, the Hispanic/immigrant and African American factors had a reduced but still significant effect, but the socioeconomic factor was not significant and the explained variance across neighborhoods was smaller.

Who You Gonna Call?

MSMA has successfully spearheaded additional reforms to reduce lawsuit abuse: expert witness reforms that require testimony to be based on evidence widely accepted by the scientific community, updates to the collateral source rule so plaintiffs can only recover actual monetary damages instead of billed charges and increasing the standard of proof for punitive damage claims. There are many groups, including the state's trial attorneys, the hospitals, integrated healthcare systems, pharmacy benefit managers, pharmacy chains, health insurers, and many others that are in Jefferson City every day often pushing positions that are at odds with what is best for our patients. Select Legislation important for Physicians and Patients that MSMA Passed or Blocked 2010 * Insurance company prompt pay (signed into law) * Naturopath licensure and scope expansion (blocked) * Private Medicaid fraud lawsuits (blocked) * Statute of limitations expansion for medical malpractice cases and weakening of the collateral source rule (blocked) * Tiering of physicians (blocked) * Autism insurance coverage (signed into law) 2011 * Drug testing of surgeons (blocked) * Chiropractors Medicaid payment (blocked) * Allowing professional counselors to diagnose (blocked) * Board of Healing Arts civil penalties (blocked) * Implementation of concussion protocols for student athletes (signed into law) * Preemption of local tobacco laws (blocked) 2012 * Increased use of ignition interlock devices (signed into law) * Regulations on the creation and operation of HIEs (signed into law) * Lay midwife licensure (blocked) * CRNA scope expansion (blocked) * Co-pay equity between primary care physicians and physical therapists (blocked) 2013 * Prompt credentialing improvements (signed into law) * Telehealth reimbursement parity (signed into law) * Repeal of collaborative practice act (blocked) * Volunteer physician malpractice immunity (signed into law) * Updating of newborn screening requirements (signed into law) * Mandatory arbitration for claims over 30 days unpaid (blocked) 2014 * Non-physician clinicians scope expansion (blocked) * Tanning bed parental permission (signed into law) * Establishment of ECHO telehealth distance learning program (signed into law) * Statewide Medicaid managed care implementation (blocked) 2015 * Tort reform (signed into law) * Establishment of direct primary care services (blocked) * Expansion of APRN scope-of-practice (blocked) * Parental notification of immunization exemptions (signed into law) 2016 * Telehealth expansion (signed into law) * Prohibit MOC/MOL for licensure (signed into law) * Licensure not conditioned on participating in any health insurance plan (signed into law) * Step therapy reform (signed into law) * Insurance contracts gag clauses banned (signed into law) * APRN, athletic trainers, physical therapists, radiology technicians scope expansion (blocked) 2017 * Expert witness reform (signed into law) * Collateral source rule updated (signed into law) * Tort reform fix for hospital non-employees (signed into law) * Requirements for medical student mental health and wellbeing (signed into law) * APRN opioid prescriptive authority expansion (blocked) * Implementation of statewide naloxone protocol (signed into law) 2018 * Protection of prudent layperson standard in the ER (signed into law) * Prohibit pharmacy gag clauses (signed into law) * Non-physician clinicians, physical therapists, radiology technicians scope expansion (blocked) * Implementation of workers compensation fee schedule (blocked) * Increased Medicaid post-partum benefits (signed into law) 2019 * Prior authorization reform (signed into law) * Prohibit use of virtual credit cards by insurers (signed into law) * Establishment of pregnancy-associated mortality review board (signed into law) * Implementation of statewide MAT insurance coverage for opioid disorders (blocked) * Defeat of various anti-vaccination requirements for physicians (blocked) * Independent pharmacist prescribing (blocked) 2020 * Punitive damages only for intentional or malicious act (signed into law) * Prompt credentialing to pay from the date of application (signed into law) * Overpayment transparency (signed into law) * Vaping prohibitions (signed into law) * Criminal penalties for gender dysmorphia treatments (blocked)

NON-DAMAGE BUSINESS INTERRUPTION INSURANCE POLICIES DURING THE COVID-19 PANDEMIC *

Pandemic risks, such as Covid-19, are difficult to insure as they are characterized by multiple factor risks and losses and involve different types of businesses and people simultaneously. The scarcity of time series and statistical data prevents insurers from developing correct pricing. We propose a model of catastrophe risk with Non-Damage Business Interruption (NDBI) policies to manage the pandemic risk due to the spread of Covid-19. The model employs a Monte Carlo simulation of different lockdown scenarios: the frequency and severity distributions of losses of Italian SMEs. The main results show the importance of a Covid-19 lockdown exposure NDBI policy, which benefits not only SMEs but also the insurer.

No End in Sight: Business Interruption Insurance Claims in New York After the Second COVID-19 Surge

[...]this Note supports the use of a co/reinsurance policy that protects insurers and insured businesses alike. A. The Current State of the COVID-19 Crisis At the time of writing, the impacts and effects of COVID-19 are ongoing.6 However, the pandemic's effects on New York, particularly New York City (NYC), cannot be overstated.7 While the impacts of COVID-19 are diffuse and variable, almost every effect arising from this pandemic implicates the insurance industry in one way or another, and early estimates indicate insurance claims will total in the billions of dollars.8 In an effort to shore up costs for businesses and the resulting employment impacts of the pandemic, the United States Federal Government (USFG) passed the $2.2 trillion Coronavirus Aid, Relief, and Economic Security Act (CARES Act).9 While the CARES Act did not explicitly target the insurance industry for relief, additional pieces of legislation were introduced that could have impacted the industry early on.10 At the state level, Governor Cuomo officially declared a Disaster Emergency in New York on March 7, 2020.11 As of December 2020, there have been 87 continuations and amendments to the declared Disaster Emergency.12 Of the various measures Governor Cuomo enacted, the most significant for the present study are the non-essential business closure and stay-at-home orders, which ordered many business closures and obliged the population to avoid leaving their homes.13 By September 2020, New York had already seen 6,000 businesses close and a 40% increase in bankruptcy filings.14 In May 2020, Governor Cuomo announced a phased reopening scheme, New York Forward, in which restrictions were linked to local infection rates.15 As New York and the rest of the country began to emerge from what has been the worst of the pandemic so far, hundreds of businesses looked to their insurance policies to mitigate their losses, many insurance companies rejected their claims, and litigation ensued.16 New York courts construe insurance coverage for business losses stringently, and the U.S. District Court for the Southern District of New York has already rejected a business policyholder's request for an injunction, pending the lawsuit result, that would require the insurer to pay most of the amount claimed.17 While the suits are just beginning, the insurance industry will likely see changes of the scale it has not seen since the 9/11 terrorist attacks.18 Estimates put the total national cost of 9/11 between $50 and $100 billion.19 By contrast, the COVID-19 pandemic is estimated to cost the nation tens of trillions of dollars.20 To understand where the legal environment is headed, it is first necessary to understand the current legal environment surrounding BI insurance in New York. "22 Typically, BI is not a separate insurance policy, but rather BI is a supplemental endorsement to a policyholder's property insurance.23 Unlike standard general liability insurance policies, BI supplements do not have standardized language and often contain language that is unique to the specific insurer and industry.24 As a part of commercial property insurance, BI is offered either as an all-risk policy or a named-perils policy.25 Under an all-risk policy, the policyholder may recover for all losses resulting from any cause barring their express exclusion in the policy.26 Alternatively, a named-peril policy only covers a policyholder's losses for specific causes of loss expressly named in the policy.27 Although BI contains the word "interruption," more often than not, the interruption must precipitate from actual property damage or loss.28 1. The second element, loss of covered property, refers to physical losses of, or damage to, commercial or personal property within or touching commercial real estate listed in the policy.35 This element typically addresses what commercial or personal "property" is covered by the terms of the policy, as property is increasingly digital or otherwise intangible by its nature.36 Barring indeterminate language or language to the contrary, New York typically requires physical property damage.37 This element will be of particular importance, as many all-risk policies explicitly exclude viral or bacterial causes of loss, many named peril policies do not name pandemics, and in any event, physical damage may be difficult if not impossible to prove for COVID-19-related business losses.38 While causal links between each element are a requirement, the third element most expressly requires causal analysis to prove the cause of the covered property loss results in an interruption of business.39 Beyond the issue of proving the causal relationship between the damaged and/or lost property and interruption of business, policyholders will frequently be required to prove that the level of interruption experienced rises to the level described by the policy's language.40 As a result, BI can come off as a misnomer because business is

Marketing of Products and Services by Commercial Banks for Financial Inclusion In India -A Decennium Study

In the economic development of a nation, banks occupy an important place. Commercial banks as financial institutions have also emerged as significant sources of funds to industry by virtue of which they constitute an important element of the institutional structure of the capital market in India. Banks assist the establishment and development of well-economic infrastructure for better living standards and are a good source for the procurement of credit to vulnerable groups. They initiated varied financial products and services for inclusive growth at affordable costs. The main purpose of the study is to identify the specific role played by commercial banks in India for achieving financial inclusion. In this research, Firstly, the authors will talk about the significance of financial inclusion in detail;later, the focal point is on the initiatives and role of commercial banks to achieve financial inclusion. The study is based on a systematic review of the literature. The researchers have reviewed the literature of the last decade to realize the financial inclusion growth through the banks. A longitudinal manner literature review has been carried out. The findings of this review paper suggested that various significant contributions rendered by the Indian banking sector towards inclusive growth and to the unbanked populace are Bank branch penetration, Setting up of BC/BF outlets to a large extent, no-frill accounts opening with nil or no balance, Expansion of ATM density in rural and semi-rural areas, Rendering flexible credit facility to MSMEs, SHGs and Villagers to make them economically strong, the introduction of technology-based initiatives such as online banking, Mobile banking, telebanking, Kiosks, and smart cards, simplified KYC norms, distributing General credit cards and Kisan credit cards, and enhancing the financial literacy among the public. The study also concentrates on the performance of banks for financial inclusion before and after the adoption of ICT technology in India.

Health Insurance Patterns of Older Veterans: Evidence from the Health and Retirement Study

With the increased availability of community care to veterans from the VA MISSION Act, policymakers and providers need to understand how older veterans are insured, particularly before Medicare eligibility at age 65. Using data from 1996 to 2018, this study examines the insurance patterns of veterans prior to the expansion of access to community care through the VA and compares those patterns to nonveterans. This study finds that veterans are more likely to have insurance than nonveterans and that they are less likely to rely on Medicaid and Medicare before age 65. Regression estimates also suggest that veterans with at least some college education are less likely to have private insurance and are more likely to be uninsured than nonveterans with the same educational attainment.