Patient cost-sharing for ambulatory neuropsychiatric services in Abu Dhabi, UAE.

BACKGROUND AND OBJECTIVES: Neuropsychiatric disorders are of high concern and burden of disease in the United Arab Emirates (UAE). The aim of this study is to describe patient cost-sharing patterns, insurance coverage of ambulatory neuropsychiatric disorders, and utilization of neuropsychiatric services in Abu Dhabi. METHODS: The study utilized the data published by Health Authority-Abu Dhabi (HAAD) and the American Center for Psychiatry and Neurology (ACPN) records in Abu Dhabi. The data were collected from the ACPN to describe patterns of insurance coverage and patient cost-sharing. The data included information on patient visits to the ACPN from January 1, 2010 till May 16, 2013. The data also included insurance coverage, total cost of treatment for each patient and the amount of coinsurances and deductibles paid by each patient. Additionally, the study utilized data published by HAAD on health services utilization, and health insurance plans in 2014. The percentage of total costs paid by patients and insurance were calculated by insurance groups and health service. Insurance plans with different patient cost-sharing arrangements for mental health treatment benefits were divided into three groups. ANOVA and MANOVA analyses were performed to test for differences among three categories of neuropsychiatric services (neurology, psychiatry and psychotherapy) in terms of the total costs and patient cost-sharing. The data were analysed using STATA version 12. RESULTS: About 36 % of the total costs on ambulatory neuropsychiatric services was paid directly by patients; 1 % of total costs was covered by patients as co-insurances and deductibles, and 63 % of total costs was covered by insurance providers. The average cost per visit was about 485 AED ($132), including 304 AED ($83) paid by insurance and 181 AED ($49) paid by patient. About 44 % of total costs was related to psychiatry services, 28 % of total costs was related to neurology services, and 28 % of total costs was related to psychotherapy services. Using ANOVA analyses, statistical differences were found among three categories of neuropsychiatric services in terms of the total costs and patient cost-sharing. These findings provide hint on some degree of association between patient cost-sharing and neuropsychiatry services utilization. CONCLUSIONS: The determination of parities in the coverage and finance between neuropsychiatric and physical health services will help policymakers make informed decisions on regulations of health insurance plans. Given the level of unmet need for neuropsychiatric services in Abu Dhabi, there is a need to fully include neuropsychiatric services in all basic and enhanced insurance plans. The study provided a description of patient cost-sharing and coverage of neuropsychiatric services in order for policymakers to recognize the disparities of the coverage and the degree of economic burden on households.

Road safety impact of Ontario street racing and stunt driving law.

OBJECTIVE: The purpose of this study was to conduct a process and outcome evaluation of the deterrent impact of Ontario's street racing and stunt driving legislation which came into effect on September 30, 2007, on collision casualties defined as injuries and fatalities. It was hypothesized that because males, especially young ones, are much more likely to engage in speeding, street racing and stunt driving, the new law would have more impact in reducing speeding-related collision casualties in males when compared to females. METHODS: Interrupted time series analysis with ARIMA modelling was applied to the monthly speeding-related collision casualties in Ontario for the period of January 1, 2002 to December 31, 2010, separately for young male drivers 16-25 years of age (primary intervention group), mature male drivers 26-65 years of age (secondary intervention group), young female drivers 16-25 years of age (primary comparison group) and mature female drivers 26-65 years of age (secondary comparison group). A covariate adjustment using non-speeding casualties was included. RESULTS: A significant intervention effect was found for young male drivers with, on average, 58 fewer collision casualties per month, but not for mature male drivers, when non-speeding casualties were controlled for. No corresponding effect was observed in either comparison (females) group. CONCLUSION: These findings indicate a reduction in speeding-related casualties among young males of 58 fewer casualties per month subsequent to the introduction of Ontario's street racing and stunt driving legislation and suggest the presence of a general deterrent effect.

Evaluation of deterrent impact of Ontario's Street Racing and Stunt Driving Law on extreme speeding convictions.

OBJECTIVE: The purpose of this study was to conduct a process and outcome evaluation of the deterrent impact of Ontario's street racing and stunt driving legislation, introduced in September 2007, on extreme speeding convictions. It was hypothesized that because males are much more likely to engage in speeding, street racing, and stunt driving, the new law would have more impact in reducing extreme speeding in males compared to females. METHODS: Descriptive statistics and time series plots were used for the suspensions data. Interrupted time series analysis with autoregressive integrated moving average (ARIMA) modeling was applied to the monthly extreme speeding convictions in Ontario for the period of January 1, 2003, to December 31, 2011, to assess the impact of the new legislation, separately for male drivers (intervention group) and female drivers (comparison group). RESULTS: The results indicated that per licensed driver, 1.21 percent of 16- to 24-year-old male drivers and 0.37 percent of 25- to 64-year-old male drivers had their licenses suspended between September 2007 and December 2011. This is in contrast to female drivers: 0.21 percent of 16- to 24-year-old female drivers and 0.07 percent of 25- to 64-year-old female drivers had their licenses suspended during the same time period. A significant intervention effect of reduced extreme speeding convictions was found in the male driver group, though no corresponding effect was observed in the female driver group. The findings of this study are consistent with previous research on demographics of street racers and stunt drivers. CONCLUSIONS: These findings are congruent with deterrence theory that certain, swift, and severe sanctions can deter risky driving behavior and support the hypothesis that legal sanctions can have an impact on the extreme speeding convictions of the intervention group.

Cardiovascular disease in kidney donors: matched cohort study.

OBJECTIVE: To determine whether people who donate a kidney have an increased risk of cardiovascular disease. DESIGN: Retrospective population based matched cohort study. PARTICIPANTS: All people who were carefully selected to become a living kidney donor in the province of Ontario, Canada, between 1992 and 2009. The information in donor charts was manually reviewed and linked to provincial healthcare databases. Matched non-donors were selected from the healthiest segment of the general population. A total of 2028 donors and 20,280 matched non-donors were followed for a median of 6.5 years (maximum 17.7 years). Median age was 43 at the time of donation (interquartile range 34-50) and 50 at the time of follow-up (42-58). MAIN OUTCOME MEASURES: The primary outcome was a composite of time to death or first major cardiovascular event. The secondary outcome was time to first major cardiovascular event censored for death. RESULTS: The risk of the primary outcome of death and major cardiovascular events was lower in donors than in non-donors (2.8 v 4.1 events per 1000 person years; hazard ratio 0.66, 95% confidence interval 0.48 to 0.90). The risk of major cardiovascular events censored for death was no different in donors than in non-donors (1.7 v 2.0 events per 1000 person years; 0.85, 0.57 to 1.27). Results were similar in all sensitivity analyses. Older age and lower income were associated with a higher risk of death and major cardiovascular events in both donors and non-donors when each group was analysed separately. CONCLUSIONS: The risk of major cardiovascular events in donors is no higher in the first decade after kidney donation compared with a similarly healthy segment of the general population. While we will continue to follow people in this study, these interim results add to the evidence base supporting the safety of the practice among carefully selected donors.