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1.
Objective
Tort reform may affect health insurance premiums both by reducing medical malpractice premiums and by reducing the extent of defensive medicine. The objective of this study is to estimate the effects of noneconomic damage caps on the premiums for employer-sponsored health insurance.Data Sources/Study Setting
Employer premium data and plan/establishment characteristics were obtained from the 1999 through 2004 Kaiser/HRET Employer Health Insurance Surveys. Damage caps were obtained and dated based on state annotated codes, statutes, and judicial decisions.Study Design
Fixed effects regression models were run to estimate the effects of the size of inflation-adjusted damage caps on the weighted average single premiums.Data Collection/Extraction Methods
State tort reform laws were identified using Westlaw, LEXIS, and statutory compilations. Legislative repeal and amendment of statutes and court decisions resulting in the overturning or repealing state statutes were also identified using LEXIS.Principal Findings
Using a variety of empirical specifications, there was no statistically significant evidence that noneconomic damage caps exerted any meaningful influence on the cost of employer-sponsored health insurance.Conclusions
The findings suggest that tort reforms have not translated into insurance savings. 相似文献2.
Joel C. Cantor Sc.D. Alan C. Monheit Ph.D. Derek DeLia Ph.D. Kristen Lloyd M.P.H. 《Health services research》2012,47(5):1773-1790
Research Objective
To evaluate one of the first implemented provisions of the Patient Protection and Affordable Care Act (ACA), which permits young adults up to age 26 to enroll as dependents on a parent''s private health plan. Nearly one-in-three young adults lacked coverage before the ACA.Study Design, Methods, and Data
Data from the Current Population Survey 2005–2011 are used to estimate linear probability models within a difference-in-differences framework to estimate how the ACA affected coverage of eligible young adults compared to slightly older adults. Multivariate models control for individual characteristics, economic trends, and prior state-dependent coverage laws.Principal Findings
This ACA provision led to a rapid and substantial increase in the share of young adults with dependent coverage and a reduction in their uninsured rate in the early months of implementation. Models accounting for prior state dependent expansions suggest greater policy impact in 2010 among young adults who were also eligible under a state law.Conclusions and Implications
ACA-dependent coverage expansion represents a rare public policy success in the effort to cover the uninsured. Still, this policy may have later unintended consequences for premiums for alternative forms of coverage and employer-offered rates for young adult workers. 相似文献3.
Objectives
The purpose of this study is to examine and explain the extent of income-related inequity in health care utilization and expenditures to compare the extent in 2005 and 2010 in Korea.Methods
We employed the concentration indices and the horizontal inequity index proposed by Wagstaff and van Doorslaer based on one- and two-part models. This study was conducted using data from the 2005 and 2010 Korean National Health and Nutrition Examination Survey. We examined health care utilization and expenditures for different types of health care providers, including health centers, physician clinics, hospitals, general hospitals, dental care, and licensed traditional medical practitioners.Results
The results show the equitable distribution of overall health care utilization with pro-poor tendencies and modest pro-rich inequity in the amount of medical expenditures in 2010. For the decomposition analysis, non-need variables such as income, education, private insurance, and occupational status have contributed considerably to pro-rich inequality in health care over the period between 2005 and 2010.Conclusions
We found that health care utilization in Korea in 2010 was fairly equitable, but the poor still have some barriers to accessing primary care and continuing to receive medical care. 相似文献4.
K. John McConnell 《Health services research》2013,48(5):1634-1652
Objective
To determine whether comprehensive behavioral health parity leads to changes in expenditures for individuals with severe mental illness (SMI), who are likely to be in greatest need for services that could be outside of health plans'' traditional limitations on behavioral health care.Data Sources/Study Setting
We studied the effects of a comprehensive parity law enacted by Oregon in 2007. Using claims data, we compared expenditures for individuals in four Oregon commercial plans from 2005 through 2008 to a group of commercially insured individuals in Oregon who were exempt from parity.Study Design
We used difference-in-differences and difference-in-difference-in-differences analyses to estimate changes in spending, and quantile regression methods to assess changes in the distribution of expenditures associated with parity.Principal Findings
Among 2,195 individuals with SMI, parity was associated with increased expenditures for behavioral health services of $333 (95 percent CI $67, $615), without corresponding increases in out-of-pocket spending. The increase in expenditures was primarily attributable to shifts in the right tail of the distribution.Conclusions
Oregon''s parity law led to higher average expenditures for individuals with SMI. Parity may allow individuals with high mental health needs to receive services that may have been limited without parity regulations. 相似文献5.
Etsuji Okamoto 《Journal of epidemiology / Japan Epidemiological Association》2013,23(4):262-269
Background
Evidence is lacking on whether health guidance for metabolic syndrome reduces health care expenditures. The author used propensity-score matching to evaluate the effects of health guidance on health care expenditure.Methods
Men who did and did not receive health guidance from a health insurance society (approximately 60 000 covered lives) were matched (n = 397 respectively) using propensity scores. Health insurance claims were compared using cumulative health care expenditures for metabolic syndrome-related outpatient medical care and drug costs for the period from the initial consultation to 3 years later.Results
No difference was observed between intervention and control groups in cumulative outpatient charges or drug costs related to metabolic syndrome. However, regression analysis using the Tobit model showed that health guidance resulted in a small, nonsignificant reduction in health care expenditure.Conclusions
Health guidance for metabolic syndrome did not reduce outpatient charges or drug costs related to metabolic syndrome during the 3-year period after the intervention. Findings from Tobit regression suggest that health guidance might eventually result in savings, but this hypothesis remains untested.Key words: health guidance, health insurance claims, propensity-score matching, PDM (proportional distribution method), metabolic syndrome 相似文献6.
Octavio G��mez-Dant��s Veronika J Wirtz Michael R Reich Paulina Terrazas Maki Ortiz 《Bulletin of the World Health Organization》2012,90(10):788-792
Problem
As countries expand health insurance coverage, their expenditures on medicines increase. To address this problem, WHO has recommended that every country draw up a list of essential medicines. Although most medicines on the list are generics, in many countries patented medicines represent a substantial portion of pharmaceutical expenditure.Approach
To help control expenditure on patented medicines, in 2008 the Mexican Government created the Coordinating Commission for Negotiating the Price of Medicines and other Health Inputs (CCPNM), whose role, as the name suggests, is to enter into price negotiations with drug manufacturers for patented drugs on Mexico’s list of essential medicines.Local setting
Mexico’s public expenditure on pharmaceuticals has increased substantially in the past decade owing to government efforts to achieve universal health-care coverage through Seguro Popular, an insurance programme introduced in 2004 that guarantees access to a comprehensive package of health services and medicines.Relevant changes
Since 2008, the CCPNM has improved procurement practices in Mexico’s public health institutions and has achieved significant price reductions resulting in substantial savings in public pharmaceutical expenditure.Lessons learnt
The CCPNM has successfully changed the landscape of price negotiation for patented medicines in Mexico. However, it is also facing challenges, including a lack of explicit indicators to assess CCPNM performance; a shortage of permanent staff with sufficient technical expertise; poor coordination among institutions in preparing background materials for the annual negotiation process in a timely manner; insufficient communication among committees and institutions; and a lack of political support to ensure the sustainability of the CCPNM. 相似文献7.
Papar Kananurak 《Applied health economics and health policy》2014,12(3):299-313
Background
The dramatic changes occurring in the age structure of the Thai population make providing healthcare services for the elderly a major challenge for decision makers. Because the number of the elderly will be increasing, together with the number of retired workers, under the Social Health Insurance (SHI) scheme, there will be the unmet needs for healthcare use after retirement. The SHI scheme does not cover workers after retirement unless they could use free healthcare for the elderly. In addition, the government budget is tight regarding the support of universal healthcare and long-term care services for all of the elderly. Therefore, the government could support retired workers who have the ability to pay by facilitating voluntary health insurance.Objective
The main objectives of the present study are to analyze the characteristics of workers that need health insurance after retirement and to identify the factors explaining healthcare use to offer healthcare services to meet the workers’ needs and expectations.Methods
Four hundred insured workers under the Social Health Insurance (SHI) Scheme in Thailand were interviewed using a structured questionnaire. The Anderson–Newman model of healthcare use is the conceptual framework used in this study to understand the factors that explain healthcare use patterns of workers. Multiple regressions are employed extensively to evaluate the variables that predict healthcare use.Results
According to the survey, a person that purchases voluntary health insurance is likely to be female, have a higher personal income, and healthy. The characteristics related to healthcare use were poor health status, a high personal income, and peeople afflicted by chronic illness.Conclusions
There is a gap between healthcare service use and the demand for voluntary health insurance. People that have a high income are more likely to purchase voluntary health insurance, while people in worse health and afflicted by chronic illness may have greater difficulty purchasing voluntary health insurance because they face higher premiums or are denied coverage by insurers. 相似文献8.
Jeanette W. Chung Min‐Woong Sohn Ryan P. Merkow Elissa H. Oh Christina Minami Bernard S. Black Karl Y. Bilimoria 《Health services research》2014,49(2):751-766
Objective
To develop a composite measure of state-level malpractice environment.Data Sources
Public use data from the National Practitioner Data Bank, Medical Liability Monitor, the National Conference of State Legislatures, and the American Bar Association.Study Design
Principal component analysis of state-level indicators (paid claims rate, malpractice premiums, lawyers per capita, average award size, and malpractice laws), with indirect validation of the composite using receiver-operating characteristic curves to determine how accurately the composite could identify states with high-tort activity and costs.Principal Findings
A single composite accounted for over 73 percent of total variance in the seven indicators and demonstrated reasonable criterion validity.Conclusion
An empirical composite measure of state-level malpractice risk may offer advantages over single indicators in measuring overall risk and may facilitate cross-state comparisons of malpractice environments. 相似文献9.
Harkonmäki K Rahkonen O Martikainen P Silventoinen K Lahelma E 《Occupational and environmental medicine》2006,63(8):558-563
Objective
To examine the associations of mental health functioning (SF‐36) and work and family related psychosocial factors with intentions to retire early.Methods
Cross sectional survey data (n = 5037) from the Helsinki Health Study occupational cohort in 2001 and 2002 were used. Intentions to retire early were inquired with a question: “Have you considered retiring before normal retirement age?” Mental health functioning was measured by the Short Form 36 (SF‐36) mental component summary (MCS). Work and family related psychosocial factors included job demands and job control, procedural and relational justice, conflicts between work and family, and social network size. Multinomial regression models were used to analyse the data.Results
Poor mental health functioning, unfavourable psychosocial working conditions, and conflicts between work and family were individually related to intentions to retire early. After adjustments for all work and family related factors the odds ratio for low mental health functioning was halved (from OR = 6.05 to 3.67), but nevertheless the association between poor mental health functioning and strong intentions to retire early remained strong.Conclusions
These findings highlight not only the importance of low mental health and unfavourable working conditions but also the simultaneous impact of conflicts between work and family to employees'' intentions to retire early. 相似文献10.
Determinants of Coverage Decisions in Health Insurance Marketplaces: Consumers' Decision‐Making Abilities and the Amount of Information in Their Choice Environment
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Andrew J. Barnes M.P.H. Ph.D. Yaniv Hanoch Ph.D. Thomas Rice Ph.D. 《Health services research》2015,50(1):58-80
Objective
To investigate the determinants and quality of coverage decisions among uninsured choosing plans in a hypothetical health insurance marketplace.Study Setting
Two samples of uninsured individuals: one from an Internet-based sample comprised largely of young, healthy, tech-savvy individuals (n = 276), and the other from low-income, rural Virginians (n = 161).Study Design
We assessed whether health insurance comprehension, numeracy, choice consistency, and the number of plan choices were associated with participants'' ability to choose a cost-minimizing plan, given their expected health care needs (defined as choosing a plan costing no more than $500 in excess of the total estimated annual costs of the cheapest plan available).Data Collection
Primary data were collected using an online questionnaire.Principal Findings
Uninsured who were more numerate showed higher health insurance comprehension; those with more health insurance comprehension made choices of health insurance plans more consistent with their stated preferences; and those who made choices more concordant with their stated preferences were less likely to choose a plan that cost more than $500 in excess of the cheapest plan available.Conclusions
Increasing health insurance comprehension and designing exchanges to facilitate plan comparison will be critical to ensuring the success of health insurance marketplaces. 相似文献11.
12.
Benjamin Lê Cook Ph.D. M.P.H. Colleen L. Barry Ph.D. M.P.P. Susan H. Busch Ph.D. 《Health services research》2013,48(1):129-149
Objective
To examine trends in disparities in children''s mental health care.Data
2002–2007 Medical Expenditure Panel Survey.Study Design
We used the Institute of Medicine (IOM) definition of health care disparities and estimated two-part expenditure models to examine disparity trends in any mental health care use, any outpatient care, and psychotropic drug use, as well as expenditures in these three categories, conditional on use. We used 2-year longitudinal panel data to determine disparities in care initiation among children with unmet need.Principal Findings
Assessing trends over time between 2002 and 2007, we identified that disparities persist for blacks and Latinos in receipt of any mental health care, any outpatient care, and any psychotropic drug use. Among those with positive mental health care expenditures, Latino–white disparities in overall mental health care expenditures increased over time. Among children with unmet need, significant disparities in initiation of an episode of mental health care were found, with whites approximately twice as likely as blacks and Latinos to initiate care.Conclusions
Disparities in children''s mental health care use are persistent and driven by disparities in initiation, suggesting policies to improve detection or increase initial access to care may be critical to reducing disparities. 相似文献13.
Au N 《Health services research》2012,47(2):655-676
Objective
To investigate whether childhood overweight at age 4–5 increases publicly funded health care costs during childhood, and to explore the role of timing and duration of overweight on health costs.Data Sources
The Longitudinal Study of Australian Children (2004–2008) and linked records from Medicare, Australia''s public health insurance provider (2004–2009).Study Design
The influence of overweight status on non-hospital Medicare costs incurred by children over a 5-year period was estimated using two-part models and one-part generalized linear models (GLM). All models controlled for demographic, socioeconomic, and parental characteristics.Principal Findings
Being overweight at age 4–5 is associated with significantly higher pharmaceutical and medical care costs. The results imply that for all children aged 4 and 5 in 2004–2005, those who were overweight had a combined 5-year Medicare bill that was AUD$9.8 million higher than that of normal weight children. Results from dynamic analyses show that costs of childhood overweight occur contemporaneously, and the duration of overweight is positively associated with medical costs for children who became overweight after age 5.Conclusions
This study reveals that the financial burden to the public health system of childhood overweight and obesity occurs even during the first 5 years of primary school. 相似文献14.
Jennifer “J. J.” Davis 《American Health & Drug Benefits》2008,1(7):9-16
Background
Every year, employers around the country evaluate their company benefits package in the hopes of finding a solution to the ever-rising cost of health insurance premiums. For many business executives, the only logical choice is to pass along those costs to the employee.Objectives
As an employer, our goal in Delaware has always been to come up with innovative solutions to drive down the cost of health insurance premiums while encouraging our employees to take responsibility for their own health and wellness by living a healthy and active lifestyle, and provide them with the necessary tools.Methods
The DelaWELL program (N = 68,000) was launched in 2007, after being tested in initial (N = 100) and expanded (N = 1500) pilot programs from 2004 to 2006 in which 3 similar groups were compared before and after the pilot. Employee health risk assessment, education, and incentives provided employees the necessary tools we had assumed would help them make healthier lifestyle choices.Results
In the first pilot, fewer emergency department visits and lower blood pressure levels resulted in direct savings of more than $62,000. In the expanded pilot, in all 3 groups blood pressure was significantly reduced (P <.001) from preprogram to postprogram; body fat reduction was also significant (P <.001); and glucose levels dropped (P <.001) in 2 groups. The overall saving was about $450,000. And in only about 4 months this year, 729 employees participating in DelaWELL had a combined weight loss of 5162 lb.Conclusions
Decision makers in the State of Delaware have come up with an innovative solution to controlling costs while offering employees an attractive benefits package. The savings from its employee benefit program have allowed the state to pass along the savings to employees by maintaining employee-paid health insurance contributions at the same level for the past 3 years. DelaWELL has already confirmed our motto, “Although it may seem an unusual business investment to pay for healthcare before the need arises, in Delaware we concluded that this makes perfect sense.” This promising approach to improving health and reducing healthcare costs could potentially be applied to other employer groups.Employers around the country evaluate their company benefits package every year in the hopes of finding solutions to the ever-rising costs of health insurance premiums. For many business executives, however, the only logical choice is to pass along those increased costs to the employee. This is a matter of simple economics, especially when we consider that health insurance expenses are the fastest growing cost component for employers.1 “Health insurance premiums have increased rapidly over the recent past, growing a cumulative 78% between 2001 and 2007 and far outpacing cumulative wage growth of 19% over the same period.”1 The price of health insurance can be a heavy burden for families, as premiums for employer-sponsored health insurance in the United States have been rising 4 times faster on average than workers'' earnings since 2000.2 In Delaware alone, as an employer the state paid approximately $433 million in healthcare expenditures for fiscal year 2008.3Not only is the cost of health insurance premiums increasing exponentially, but more Americans are dealing with chronic and sometimes preventable conditions.4 We have all read the headlines regarding the nation''s obesity epidemic, and as our waistlines are expanding, more Americans are dealing with the consequences of living an unhealthy lifestyle. This is evident by the rise in high-risk diseases such as asthma, congestive heart failure, and coronary artery disease.4KEY POINTS
- ▴ Health insurance expenses are the fastest growing cost component for employers today. Many employers deal with this cost escalation by shifting some of the cost to the employee.
- ▴ As employers, we need to come up with innovative solutions to drive down the cost of health insurance premiums while encouraging our employees to lead a healthy and active lifestyle.
- ▴ Findings from 2 pilot programs in the State of Delaware, applying employee incentives and motivation techniques, showed that empowering employees to take charge of their own health can improve their health and cut overall healthcare costs to employers.
- ▴ Preliminary findings from the DelaWELL program, launched in 2007 based on the principles used in the pilot studies, further show the success of this approach. In only about 4 months, a group of 729 employees had a combined weight loss of 5162 lb.
- ▴ A key component of DelaWELL is the electronic health risk assessment, completed to date by more than 10,000 employees. This is followed by tools that address personalized lifestyle and disease management issues.
15.
Fabiana Maluf Rabacow Olinda do Carmo Luiz Ana Maria Malik Alex Burdorf 《Revista de saúde pública》2014,48(6):949-957
OBJECTIVE
To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil.METHODS
In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors.RESULTS
Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs.CONCLUSIONS
Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population. 相似文献16.
Objectives
The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review.Methods
The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients (R2) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost.Results
Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%).Conclusions
As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care. 相似文献17.
Background
Leadership competences play an important role for the success of effective leadership. The purpose of this study was to examine leadership competences of managers in the healthcare sector in Slovenia.Methods
Data were collected in 2008. The research included 265 employees in healthcare and 267 business managers. Respondents assessed their level of 16 leadership relevant competences on a 7-point Likert-type scale.Results
Test of differences between competences and leader position of health care professionals yielded statistically significant differences between leader and non-leader positions. Leaders gave strongest emphasis to interpersonal and informational competences, while regarding decision making competences, the differences between leaders and other employees are not that significant. When comparing competences of healthcare managers with those of business managers, results show that healthcare managers tend to give weaker emphasis to competences related to all three managerial roles than business managers.Conclusions
The study showed that in Slovenian health care, leaders distinguish themselves from other employees in some leadership competences. In addition, all three dimensions of leadership competences significantly distinguished the group of healthcare managers from the business managers, which indicates a serious lag in leadership competences among leaders in Slovenian healthcare. 相似文献18.
Ballard TJ Romito P Lauria L Vigiliano V Caldora M Mazzanti C Verdecchia A 《Occupational and environmental medicine》2006,63(1):33-38
Aims
The authors investigated associations of work related risk factors with self perceived health as less than “good” and psychological distress among Italian women flight attendants.Methods
The authors conducted a cross sectional survey on health and mental health among 1955 former and current flight attendants, using a postal questionnaire.Results
More current than former flight attendants reported self perceived health as fair to poor and psychological distress measured as a GHQ‐12 score of six or more. Among current flight attendants, reporting health as fair to poor was associated with low job satisfaction (OR 1.89) and recent experiences of sexual harassment by passengers (OR 2.83). Psychological distress was associated with low job satisfaction (OR 2.38) and frequent tension with partner over childcare (OR 1.79).Conclusions
Perceived health as fair to poor and psychological distress were greater among current flight attendants and were related to job characteristics and family difficulties. Perceived poor health has been shown in the literature to be related to mortality, high job strain, and early retirement, and psychological distress is associated with work absence. The effect of sexual harassment by passengers on perceived health of flight attendants may be relevant to other working women dealing with the public. The health effects of family/work conflicts, low job satisfaction, and sexual harassment should be explored more in depth, using qualitative as well as quantitative methods among working women in various occupations. 相似文献19.
Leiyu Shi Lydie A. Lebrun Jinsheng Zhu Arthur S. Hayashi Ravi Sharma Charles A. Daly Alek Sripipatana Quyen Ngo‐Metzger 《Health services research》2012,47(6):2225-2249
Objective
To describe current clinical quality among the nation''s community health centers and to examine health center characteristics associated with performance excellence.Data Sources
National data from the 2009 Uniform Data System.Data Collection/Extraction Methods
Health centers reviewed patient records and reported aggregate data to the Uniform Data System.Study Design
Six measures were examined: first-trimester prenatal care, childhood immunization completion, Pap tests, low birth weight, controlled hypertension, and controlled diabetes. The top 25 percent performing centers were compared with lower performing (bottom 75 percent) centers on these measures. Logistic regressions were utilized to assess the impact of patient, provider, and institutional characteristics on health center performance.Principal Findings
Clinical care and outcomes among health centers were generally comparable to national averages. For instance, 67 percent of pregnant patients received timely prenatal care (national = 68 percent), 69 percent of children achieved immunization completion (national = 67 percent), and 63 percent of hypertensive patients had blood pressure under control (national = 48 percent). Depending on the measure, centers with more uninsured patients were less likely to do well, while centers with more physicians and enabling service providers were more likely to do well.Conclusions
Health centers provide quality care at rates comparable to national averages. Performance may be improved by increasing insurance coverage among patients and increasing the ratios of physicians and enabling service providers to patients. 相似文献20.
Toshitaka Morishima Yuichi Imanaka Tetsuya Otsubo Kenshi Hayashida Takashi Watanabe Ichiro Tsuji 《Journal of epidemiology / Japan Epidemiological Association》2013,23(1):55-62