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基于Kano-Better Worse模型的博物馆数字盲盒设计研究
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作者 范姁晗 《包装工程》 北大核心 2026年第2期169-178,共10页
目的解决博物馆数字盲盒设计的Z世代用户需求识别不精准、功能优先级判定缺乏理论依据等具体问题,系统解决其设计过程中缺乏数据支撑等关键技术难题。方法结合用户访谈、用户旅程图与文献分析的方法,建立功能、文化、情感和社会4个维度... 目的解决博物馆数字盲盒设计的Z世代用户需求识别不精准、功能优先级判定缺乏理论依据等具体问题,系统解决其设计过程中缺乏数据支撑等关键技术难题。方法结合用户访谈、用户旅程图与文献分析的方法,建立功能、文化、情感和社会4个维度需求框架,依据Kano-Better Worse组合模型的分类原理,重点解决传统需求研究中的维度单一问题。结果确定Z世代需求优先级排序。以天津博物馆数字盲盒APP设计实践为例,提出针对性的设计流程,结论构建“功能-文化-情感-社会”四维需求模型,提出关键体验阶段流程和平台核心特色流程,通过设计验证,得出该模型能显著提升设计效能,优化用户体验,有效推动文化遗产的现代转化与传播。 展开更多
关键词 交互设计 Kano-better Worse模型 博物馆数字盲盒 Z世代用户
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Health Insurance:Better Safe than Sorry!
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《ChinAfrica》 2013年第10期61-61,共1页
If your employer is sending you to China, chances are you will enjoy the status of an expatriate and all the benefits that come with it, including health insurance. However, if you're not that lucky, you'll have to ... If your employer is sending you to China, chances are you will enjoy the status of an expatriate and all the benefits that come with it, including health insurance. However, if you're not that lucky, you'll have to deal with this painfully expensive matter on your own, unless, of course, you decide not to purchase health insurance. But in a country where serious or even fatal accidents and health emergencies can and do happen, you would literally be taking your life into your own hands. 展开更多
关键词 Health insurance:better Safe than Sorry
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Analysis of health insurance reform strategies from a risk-sharing perspective based on the Markov model 被引量:1
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作者 XU Pengyu ZHAO Lindu 《Journal of Southeast University(English Edition)》 2025年第1期118-126,共9页
China’s healthcare system faces increasing challenges,including surging medical costs,resource allocation imbalances favoring large hospitals,and ineffective referral mechanisms.The lack of a unified strategy integra... China’s healthcare system faces increasing challenges,including surging medical costs,resource allocation imbalances favoring large hospitals,and ineffective referral mechanisms.The lack of a unified strategy integrating standardized coverage with personalized payment compounds these issues.To this end,this study proposes a risk-sharing reform strategy that combines equal coverage for the same disease(ECSD)with an individualized out-of-pocket(I-OOP)model.Specifically,the study employs a Markov model to capture patient transitions across health states and care levels.The findings show that ECSD and I-OOP enhance equity by standardizing disease coverage while tailoring costs to patient income and facility type.This approach alleviates demand on high-tier hospitals,promoting primary care utilization and enabling balanced resource distribution.The study’s findings provide a reference for policymakers and healthcare administrators by presenting a scalable framework that is aligned with China’s development goals with the aim of fostering an efficient,sustainable healthcare system that is adaptable to regional needs. 展开更多
关键词 equal coverage for the same disease(ECSD) individualized out-of-pocket(I-OOP) health insurance reform risk sharing Markov model
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In-depth Analysis of the Development of China's Insurance Industry in the Post-Pandemic Era:Transformation,Challenges,and Strategic Reconfiguration
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作者 Wang Yaojie 《Journal of Humanities and Nature》 2025年第2期124-139,共16页
The COVID-19 pandemic,as a global public health crisis,has had profound and lasting effects on the world economy and social operating models,fundamentally changing individuals',enterprises',and governments'... The COVID-19 pandemic,as a global public health crisis,has had profound and lasting effects on the world economy and social operating models,fundamentally changing individuals',enterprises',and governments'perceptions of risk and risk management paradigms.The Chinese insurance industry has experienced short-term pain due to the impact of the pandemic,but in the long term,the pandemic has served as a"catalyst"and"accelerator"for the industry's development,greatly enhancing societal awareness of risk protection and,with unprecedented strength,promoting the industry's digital revolution and supply-side structural reform.This article aims to conduct a comprehensive and systematic analysis of the macro environment,technological background,and demand changes faced by the Chinese insurance industry in the post-pandemic era,and to deeply explore the historical opportunities inherent in key areas such as health insurance,pension insurance,digital transformation,and green insurance.Additionally,this article will objectively examine the severe challenges the industry faces in the sustainability of profit models,structural mismatches in supply and demand,rebuilding trust systems,new risk management,and regulatory adaptation.Lastly,based on the above analysis,this article will propose strategic pathways and policy recommendations from three levels:national policy,industry regulation,and corporate strategy to promote the high-quality and sustainable development of the Chinese insurance industry,better serving the needs of national governance modernization and the well-being of the people. 展开更多
关键词 Post-pandemic Era Chinese insurance Industry Health insurance Digital Transformation Insurtech Inclusive insurance Sustainable Development Risk Management
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The Evolution Logic,Realistic Dilemma and Promotion Path of the Sustainable Operation of Huimin Insurance
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作者 Zhang Yu 《Journal of Humanities and Nature》 2025年第2期63-72,共10页
As a city-customized supplementary medical insurance bridging basic medical insurance and commercial health insurance,Huimin Insurance has expanded to 30 provinces and served 168 million people within four years,emerg... As a city-customized supplementary medical insurance bridging basic medical insurance and commercial health insurance,Huimin Insurance has expanded to 30 provinces and served 168 million people within four years,emerging as a phenomenal success in China's inclusive insurance landscape.This paper examines its evolution,operational mechanisms,and effectiveness,identifying core challenges including declining participation and renewal rates,adverse selection,uneven benefit compensation,and insufficient information disclosure.It proposes sustainable development pathways across five dimensions:government role,financing and payment,product stratification,service value-added,and technology empowerment.The study demonstrates that the future of Huimin Insurance will likely evolve towards a model characterized by provincial-level co-ordination,stratified benefit design,dynamic pricing,and integrated health management.Its success or failure will ultimately determine the integration depth of China's multi-tiered medical security system and significantly impact the realization of common prosperity goals. 展开更多
关键词 Huimin insurance Inclusive insurance Multi-level Medical insurance Adverse Selection Sustainable Development
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Beyond numbers: Public health insurance and oesophageal cancer mortality risk
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作者 Divya K Huilgol Brandon Lucke-Wold 《World Journal of Gastrointestinal Oncology》 2025年第7期463-467,共5页
In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focu... In this article,we comment on the work put forth by Wu et al regarding the investigation of oesophageal cancer-specific mortality for a cohort of patients from Chongqing University Cancer Hospital.We specifically focused on the implications of public health plans such as Urban Employee Basic Medical Insurance(UEBMI)and Urban Resident Basic Medical Insurance as well as out-of-pocket ratios on patient treatment plans regarding whether they pursue surgical interventions or therapeutic treatments such as chemotherapy.While Wu et al put forth potential explanations for why patients with the UEBMI plan surprisingly had a 23.30%increased risk of oesophageal cancer-specific death,more analysis is needed to alleviate cancer burden within this group.Although it is likely that patients covered by Urban Resident Basic Medical Insurance and higher out-ofpocket ratios have stronger self-recovery awareness,more work must be done to improve outcomes for people with the UEBMI plan while simultaneously implementing international and domestic initiatives to better emphasize cancer prevention and early detection.Lastly,future research must explore the relationship between Serious Illness Medical Insurance as well as the New Rural Cooperative Medical System on the mortality rate of oesophageal cancer patients in rural China,where disease burden is significantly higher than urban areas.By unifying these public health insurance schemes,officials can significantly alleviate economic burden of treatment and better prognosis for patients with oesophageal cancer. 展开更多
关键词 Urban Employee Basic Medical insurance Urban and Rural Basic Medical insurance Urban Resident Basic Medical insurance New Rural Cooperative Medical System Oesophageal cancer Public health insurance
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The Insurance Industry Promotes High-quality Development
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作者 Xuan Shi 《Proceedings of Business and Economic Studies》 2025年第2期313-320,共8页
With the rapid development of China's insurance market,the high-quality development of the insurance market is faced with many different challenges and various problems.This paper aims to deeply analyze the actual... With the rapid development of China's insurance market,the high-quality development of the insurance market is faced with many different challenges and various problems.This paper aims to deeply analyze the actual problems in China's insurance market and put forward supporting countermeasures.First,by understanding the background of highquality insurance development,we can explain the research significance of this paper in combination with the existing national policies.Secondly,by summarizing the current situation of high-quality insurance development,the paper puts forward the shortage of insurance talents in the expansion of insurance scale,the continuous improvement of insurance density and depth,and the growth of insurance compensation in the development of high-quality insurance.Finally,from the perspective of differentiated customized insurance products,training professionals,and providing financial subsidies,we will put forward the corresponding suggestions for the problem and look forward to the future development prospects. 展开更多
关键词 insurance High-quality development insurance technology Risk management
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Applying the Methodology of Quantitative and Qualitative Changes to Analyze the Impact of Huimin Insurance on the Sustainable Development of Basic Medical Insurance
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作者 Huang Pengcheng 《Journal of Humanities and Nature》 2025年第2期38-46,共9页
Marxist and social science methodologies provide scientific conceptual tools and analytical perspectives for research across various disciplines.Among these,the methodology of quantitative and qualitative changes reve... Marxist and social science methodologies provide scientific conceptual tools and analytical perspectives for research across various disciplines.Among these,the methodology of quantitative and qualitative changes reveals the fundamental laws governing the development of things,offering significant guidance for exploring the relationship between Huimin Insurance and basic medical insurance,and for promoting the sustainable development of the medical security system.Based on this methodology and the practical context of the medical security field,this paper provides an in-depth analysis of the impact of Huimin Insurance on the sustainable development of basic medical insurance. 展开更多
关键词 Huimin insurance Basic Medical insurance SUSTAINABILITY
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A Study on The Factors Affecting Flexible Employment Personnel's Participation in Urban And Rural Residents'Pension Insurance
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作者 Yang Shudong 《Journal of Humanities and Nature》 2025年第2期47-57,共11页
The purpose of this paper is to study the influencing factors of flexible employment personnel's participation in urban-rural residents'pension insurance.After reading a large number of literature and research... The purpose of this paper is to study the influencing factors of flexible employment personnel's participation in urban-rural residents'pension insurance.After reading a large number of literature and research results on flexible employment personnel and analyzing and interpreting the urban-rural residents'pension insurance policy of Zhuhai,we take the flexible employment personnel of Zhuhai City as the object of the study,combined with questionnaire survey method,and analyze the difficulties of the flexible employment personnel's participation in the insurance by analyzing the collected data,and find out that Zhuhai's flexibly employed people have cognitive bias towards urban and rural residents'pension insurance,the government's business personnel have a vague understanding of the insurance,and some of the flexibly employed people think that the subsidy is low,etc.The government of Zhuhai City has provided the suggestions of expanding the scope of the publicity of the urban and rural residents'pension insurance,increasing publicity efforts,and providing regular training for the counterpart service personnel in order to increase the rate of the flexibly employed people's participation in the insurance,and improve the inherent bad impression of the insurance by the flexibly employed people.personnel's inherent bad impression of insurance,and further improve China's insurance system. 展开更多
关键词 Pension insurance Flexibly employed persons Government insurance subsidy
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Analysis of Operational Challenges and Optimization Pathways of Policy-Based Agricultural Insurance System in Chongqing
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作者 Xiaopeng FU 《Asian Agricultural Research》 2025年第11期1-6,24,共7页
This article investigates the development process and current status of policy-based agricultural insurance in Chongqing.Based on recent data-including premium income,compensation amounts,the number of insured househo... This article investigates the development process and current status of policy-based agricultural insurance in Chongqing.Based on recent data-including premium income,compensation amounts,the number of insured households,and insurance penetration,the article analyzes the primary challenges faced in the system's operation and proposes recommendations from two dimensions:institutional optimization and practical interventions.These recommendations include establishing a differentiated participation incentive mechanism,optimizing the composition of insurance products,enhancing risk diversification and reinsurance systems,creating an agricultural disaster risk reserve fund,developing a dynamic fiscal subsidy distribution mechanism based on risk and performance,improving information-sharing platforms,strengthening the rural grassroots power grid infrastructure,and accelerating the adoption of modern technologies in underwriting and claims settlement processes.The findings suggest that the coordinated advancement of institutional optimization and technological empowerment can substantially enhance the inclusiveness,sustainability,and operational efficiency of policy-based agricultural insurance in Chongqing,thereby providing substantial support for agricultural modernization and the Rural Revitalization Strategy. 展开更多
关键词 CHONGQING Policy-based agricultural insurance Challenge Optimization pathway
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Oesophageal cancer-specific mortality risk and public health insurance: Prospective cohort study from China
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作者 Xiang-Lin Wu Xiao-Sheng Li +4 位作者 Jing-Han Cheng Lin-Xin Deng Zu-Hai Hu Jun Qi Hai-Ke Lei 《World Journal of Gastrointestinal Oncology》 2025年第4期274-285,共12页
BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal ... BACKGROUND Oesophageal cancer is a significant health concern worldwide,with high inci-dence and mortality rates.In China,the disease burden is particularly high,accounting for a substantial proportion of oesophageal cancer cases and related deaths worldwide.AIM To explore the relationship between the mortality rate of oesophageal cancer patients and insurance type,out-of-pocket ratio,and the joint effects of insurance type and out-of-pocket ratio.METHODS The χ^(2) test was used to analyze patients’demographic and clinical characteristics.Multivariate logistic regression,the Cox proportional hazard model,and the competitive risk model were used to calculate the cumulative hazard ratios(HRs)of all-cause death and oesophageal cancer-specific death among patients with different types of insurance and out-of-pocket ratios.RESULTS Compared with patients covered by basic medical insurance for urban and rural residents,patients covered by urban employee basic medical insurance for urban workers(UEBMI)had a 23.30%increased risk of oesophageal cancer-specific death[HR=1.233,95%confidence interval(CI):1.093-1.391,P<0.005].Compared with patients in the low out-of-pocket ratio group,patients in the high out-of-pocket ratio group had a 25.80%reduction in the risk of oesophageal cancer-specific death(HR=0.742,95%CI:0.6555-0.84,P<0.005).With each 10%increase in the out-of-pocket ratio,the risk of oesophageal cancer-specific death decreased by 10.10%in patients covered by UEBMI.However,the risk of oesophageal cancer-specific death increased by 26.90%in patients in the high out-of-pocket ratio group.CONCLUSION This study reveals the relationships of the specific mortality rate of patients with oesophageal cancer with the out-of-pocket ratio and medical insurance types as well as their combined effects.This study provides practical suggestions and guidance for the formulation of relevant policies in this area. 展开更多
关键词 Oesophageal cancer Public health insurance PROGNOSIS Mortality risk
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Special Issue:Questions&Data for Better Science and Innovation Call for submissions
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《Journal of Data and Information Science》 2025年第2期I0001-I0001,共1页
Editors Yang Wang,Xi'an Jiaotong University Dongbo Shi,Shanghai Jiaotong University Ye Sun,University College London Zhesi Shen,National Science Library,CAS Topic of the Special Issue What are the top questions to... Editors Yang Wang,Xi'an Jiaotong University Dongbo Shi,Shanghai Jiaotong University Ye Sun,University College London Zhesi Shen,National Science Library,CAS Topic of the Special Issue What are the top questions towards better science and innovation and the required data to answer these questions? 展开更多
关键词 better science innovation top questions science innovation required data
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Innovation navigates industrial evolution,standards underpin a better life
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作者 Zhang He Cao Xinxin(translated) +1 位作者 Jin Jili(translated) Fang Luofan(translated) 《China Standardization》 2025年第5期49-49,共1页
Over the years,Hisense has formed an operation model that integrates production,sales and R&D globally,and built a global collaborative R&D system,which has laid a solid foundation for standardization.Hisense ... Over the years,Hisense has formed an operation model that integrates production,sales and R&D globally,and built a global collaborative R&D system,which has laid a solid foundation for standardization.Hisense keeps including advanced achievements and mature production experience in standards,injecting impetus into the innovation and high-quality development of the industry. 展开更多
关键词 INNOVATION SALES STANDARDS better life industrial evolution operation model PRODUCTION R D
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Insurance coverage and patient outcomes:Understanding changes in esophageal cancer treatment
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作者 Arvind Mukundan Yaswanth Nagisetti +1 位作者 Riya Karmakar Hsiang Chen Wang 《World Journal of Gastrointestinal Oncology》 2025年第7期6-10,共5页
The article by Wu et al highlights the growing incidence of esophageal tumor patients,particularly in China,where the high frequency and death rate are significant problems.The article also examined the impact of heal... The article by Wu et al highlights the growing incidence of esophageal tumor patients,particularly in China,where the high frequency and death rate are significant problems.The article also examined the impact of health insurance on treatment availability and patient outcomes,demonstrating that the type of insurance can affect the financial burden on patients.This study investigates the effects of different types of health care coverage,namely Urban Employee Basic Medical Insurance vs Urban-Rural Resident Basic Medical Insurance,and the personal spending ratio on treatment decisions and survival outcomes.The database used is derived from esophageal tumor patient continuation from Chongqing University Hospital in China.A total of 2543 patients were included in the study,allowing for the formation of research cohorts.Patient information included demographic characteristics.The study followed various processes to maintain consistency,including data sources,inclusion and exclusion criteria,follow-up duration,health insurance,and statistical analysis.The average age at diagnosis ranged from 57-74 years,and predominantly included men,married people,and those of Han ethnic background,comprising 2088 and 2519 individuals,respectively.Upon controlling for age,sex,relationship status,country of origin,pathological evaluation,tumor stage,and biochemical indicators,individuals who had Urban Employee Basic Medical Insurance exhibited a higher propensity to opt for radiotherapy,chemotherapy,immunotherapy,and targeted therapy compared to those covered by the Urban-Rural Resident Basic Medical Insurance.During the follow-up phase of the study,a total of 1438 deaths were documented,with 1106 ascribed to esophageal cancer.Additionally,individuals with Urban-Rural Resident Basic Medical Insurance had a significantly elevated risk of esophageal cancer,particularly mortality,compared to those without Urban-Rural Resident Basic Medical Insurance. 展开更多
关键词 Esophageal cancer Public health insurance PROGNOSIS Mortality risk
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Actuarial Pricing of UAV Insurance for Thin Data Scenarios
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作者 Wang Yang Li Dayu +1 位作者 Wang Dinglin Ren Feixiao 《Journal of Humanities and Nature》 2025年第2期106-123,共18页
Driven by both market demand and policies,the drone insurance industry is facing new development opportunities.This study focuses on exploring an innovative hybrid data integration method,which uses public datasets of... Driven by both market demand and policies,the drone insurance industry is facing new development opportunities.This study focuses on exploring an innovative hybrid data integration method,which uses public datasets of drones and small manned aircraft for hybrid data integration and severity scaling,and conducts simulation tests to ensure the reproducibility of the method.A two-part hybrid model approach is adopted to separate the frequency model from the severity model,and a hierarchical modeling method is used for each part to deal with the occurrence of extreme losses.Monte Carlo simulation is performed on the fused data to calculate the net premium.Innovatively,a no-claim discount system is introduced,and the impact of operators'behaviors on claim frequency is quantified,with comprehensive consideration given to the inclusion and quantification of risk factors.The application of Tweedie GLM in total loss modeling is constructed and analyzed,and the advantages and disadvantages of different modeling methods are compared,aiming to provide more comprehensive decision-making basis for insurance companies.This report is intended to construct and evaluate a robust actuarial rate-making model for the rapidly developing drone insurance market,and to develop more accurate,fair and market-competitive drone insurance products. 展开更多
关键词 Mixed Data Rate-Making Model Drone insurance
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Interregional Population Flow and Open Growth of Insurance——Empirical Analysis Based on Provincial Panel Spatial Econometrics
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作者 Shen Yupeng Yang Shudong Jiang Dawei 《Journal of Humanities and Nature》 2025年第1期32-52,共21页
With China being gradually transformed into an open society where population can flow freely,it deserves more attention that interregional population flow will bring about the interactive growth of insurance.Based on ... With China being gradually transformed into an open society where population can flow freely,it deserves more attention that interregional population flow will bring about the interactive growth of insurance.Based on the traditional insurance growth theory,this paper focuses on the internal mechanism how interregional population flow can affect insurance growth,uses the provincial panel data from 2012 to 2015 to construct a flow spatial weighting matrix based on the interregional population flow scale,and sets up a spatial econometric model for empirical analysis.Results show that,if the population flow increases by 1 percentage point,the region's insurance industry will grow 0.0794 percentage points,and other regions'insurance will grow 0.184 percentage points,making the national insurance industry increase by 0.264 percentage points.,which is to say,the indirect effects of spatial knowledge spillover on insurance growth account for more than two thirds of the overall effects.This conclusion provides the policy enlightenment for promoting the interregional population flow,adjusting the product structure and marketing strategy in time by insurance companies,and promoting the balanced and coordinative development of the insurance industry in China. 展开更多
关键词 Population Flow insurance Growth Spatial Spillover
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Creating a Better Future
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作者 谢子强 林聪(指导) 《中学生英语》 2025年第7期8-8,共1页
According to the situation of our society,we all know that better students can have better future.As a middle school student,I know the importance of knowledge.When I was chosen to the class of self-improving,I was pr... According to the situation of our society,we all know that better students can have better future.As a middle school student,I know the importance of knowledge.When I was chosen to the class of self-improving,I was proud to join it.For me,staying with other students in my original class will make me lazy.Therefore,I am grateful for this chance. 展开更多
关键词 self improving class better future importance knowledge middle school student
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Behavioral Characteristics and Influencing Factors of Young Consumers in the Insurance Market
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作者 Ren Junru 《Journal of Humanities and Nature》 2025年第2期78-84,共7页
Against the backdrop of the Healthy China strategy,the insurance behavior of young consumers presents new characteristics such as enhanced autonomy,a shift toward proactive risk management,stronger personalized demand... Against the backdrop of the Healthy China strategy,the insurance behavior of young consumers presents new characteristics such as enhanced autonomy,a shift toward proactive risk management,stronger personalized demands,and higher expectations for online experiences.In response to changes in young consumers'risk awareness and consumption philosophy,this paper analyzes influencing factors from four dimensions:economic income,risk perception,social environment,and internet penetration.It proposes that insurance companies should focus on digital innovation,precise product development,social platform marketing,and popularization of insurance education,to promote the transformation of young people’s insurance demand from passive risk transfer to proactive long-term planning,and to help the insurance industry and young groups achieve win-win development. 展开更多
关键词 Young Consumers insurance Behavior Risk Management Digital Marketing
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Professional construction of forensic medicine and insurance perso nal injury claims under the background of the new normal
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作者 Li Mengying 《Journal of Humanities and Nature》 2025年第1期2-11,共10页
Objective:With the continuous changes in social production,the consumption th inking of the masses obviously cannot keep up with the speed of social developmen t,and insurance disputes are increasingly emerging.Among ... Objective:With the continuous changes in social production,the consumption th inking of the masses obviously cannot keep up with the speed of social developmen t,and insurance disputes are increasingly emerging.Among them,the shortcomings of personal injury claims are not prominent,and the theoretical knowledge is not co mplete.In order to improve the quality of professional talents and reduce claims dis putes,the feasibility of integrating forensic medicine into personal injury claims is ex plored.Methods:The professional attributes,subject attributes,knowledge system an d employment data of forensic medicine are analyzed and compared with the actual work of personal injury claims.Main results:Forensic medicine has its uniqueness i n on-site investigation,injury-disease relationship analysis,and resolution of doubts.I t is irreplaceable by other subjects.The subject attributes are consistent with the pe rsonal injury claims major,and personal injury claims itself has basic medical courses,so it is easier to accept forensic medicine.Conclusion:Under the current social bac kground,through the study of the forensic medicine system in the personal injury cl aims major,it has positive practical significance for its professional construction and talent training. 展开更多
关键词 insurance education personal injury claims forensic medicine
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Association between private insurance and living donor kidney transplant:Affordable Care Act as a natural experiment
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作者 Kathleen Perry Miko Yu +4 位作者 Joel T Adler Lindsey M Maclay David C Cron Sumit Mohan Syed A Husain 《World Journal of Nephrology》 2025年第2期45-52,共8页
BACKGROUND Private insurance coverage is associated with higher rates of living donor kidney transplantation(LDKT)but whether this is attributable to confounding is not known.AIM To study the association between incre... BACKGROUND Private insurance coverage is associated with higher rates of living donor kidney transplantation(LDKT)but whether this is attributable to confounding is not known.AIM To study the association between increased access to private health insurance and LDKT.METHODS Retrospective cohort study using United States transplant registry data.We identified incident candidates aged 22-29 years who were waitlisted for a kidneyonly transplant from 2005-2014,excluding prior transplant recipients and those with missing data.We calculated the hazard of LDKT after waitlisting for those with private insurance vs other insurance pre-Affordable Care Act(ACA)vs post-ACA,using death and delisting as competing events,for candidates affected by the policy change(age 22-25 years)vs those who were not(age 26-29 years).RESULTS A total of 13817 candidates were included,of whom 46%were age 22-25 years and 54%were age 26-29 years.Among candidates aged 22-25 years at listing,those listed post-ACA were more likely to have private insurance compared to those listed pre-ACA(42%vs 35%),but there was no difference in private insurance coverage between eras among candidates aged 26-29 years at listing.In adjusted competing risk regression,privately insured patients age 22-25 years were less likely to receive a LDKT post-ACA compared to pre-ACA[hazard ratio(HR)=0.88,95%CI:0.78-1.00],as were those aged 22-25 years old with other insurance types(HR=0.80,95%CI:0.69-0.92).These associations were not seen among candidates age 26-29 years.CONCLUSION Candidates age 22-25 years were likelier to have private insurance post-ACA,without an increased rate in LDKT.Demonstrations of associations between insurance and LDKT are likely attributable to residual confounding. 展开更多
关键词 Kidney transplant End-stage kidney disease Health policy Health insurance TRANSPLANTATION
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