The Affordable Care Act (ACA) was promoted with two goals: expanding health insurance coverage and reducing healthcare costs. Expanded coverage is expected to partially reduce costs. Emergency department (ED) visits are costlier than comparable primary care physician visits. If uninsured patients use the local ED more often than insured patients with comparable conditions, insuring them may change usage and lower costs. Some reports in the literature do not fit this model of ED usage.

Absenteeism has been considered as a potential indicator for the early detection of infectious disease outbreaks in population, especially in primary schools. However, in practice this data are often characterized by an excess of zeros and spatial heterogeneity. In a project on integrated syndromic surveillance system (ISSC) in rural China, Random effect zero-inflated Poisson (RE-ZIP) model was applied to simultaneously quantify the spatial heterogeneity for “occurrence” and “intensity” on school absenteeism data.

Objective

The NNDSS is a nationwide collaboration that enables all levels of public health (local, state, territorial, federal and international) to monitor, control, and prevent the occurrence and spread of state-reportable and nationally notifiable diseases and conditions. The NNDSS data are a critical source of information for monitoring disease trends, effectiveness of prevention and control programs, and policy development.