The role of regional health policy for socioeconomic inequality in health services utilization

Abstract Background “J1” is a preventative routine examination in Germany recommended for adolescents at the age of 12-14 years. In contrast to the well-established U1-U9 examinations for younger children, with participation rates above 90%, the attendance of the J1 examination is approximately only 40%. The most frequent reason for not attending J1 is the unawareness of this examination. “Ticket to J1” is an intervention including an information leaflet introduced in Bavaria in 2017 to inform adolescents about J1. The aims of the present analysis are to investigate (1) if the regional policy was effective in increasing the attendance in J1, (2) if the effects vary by family socioeconomic status (SES), and (3) which meso-level characteristics of the healthcare system correlate with attendance rates in J1. Methods We used anonymised data of a large statutory health insurance in Germany for the timeframe of 2016-2018. To investigate the effect of the policy, a difference-in-differences design at the individual level was used. Assuming a parallel trend at the level of federal states, the likelihood of attendance in J1 of 13- and 14-year-olds was compared between Bavaria and other federal German states before and after policy introduction. All analyses were additionally stratified by SES. Results The introduction of “Ticket to J1” increased participation in J1 by 1% after controlling for all confounders. Furthermore, the effect was stronger for children from families with lower SES (an increase of 5%). Density of pediatricians was positively significantly correlated with participation in J1. Discussion Regional health policy intervention had a significant positive impact on attendance of J1 and appears to have the potential to reduce socioeconomic inequalities in healthcare utilization. Informing adolescents about J1 seems to increase the attendance, in particular for children from families with lower SES.

cohort of 11,098 ninth graders (50.5% girls) followed over nine years. Linear panel regression analysis with fixed-effects (FE) was used to explore intra-individual changes in SRH and SWB when moving between different STWT states (school, prevocational program, vocational training, university, employment, unemployment, inactivity). FE impact functions were used to compare trajectories of SRH and SWB by states reached after school-leave. Time-varying control variables were age, household composition, and residential area. Results: School-leave was linked to increases in SRH and SWB, whereas no impact was found for job entry after vocational training or university. Upward transitions (e.g. from a prevocational program to vocational training, from vocational training to university or from unemployment to employment) increased SRH or SWB, while downward transitions (e.g. from vocational training or employment to unemployment) were related to decreases. Over the years after school-leave, we found a decline in SRH and SWB, which was faster in case of transitions to unemployment or prevocational programs directly after school.

Conclusions:
Findings suggest that a smooth STWT is key for good health in youth and adulthood. Health and labour market intervention programs should focus on the time after school-leave, especially on those who are not able to find an academic or vocational training position.
Abstract citation ID: ckac129.584 The role of regional health policy for socioeconomic inequality in health services utilization Heinrich-Heine University Dü sseldorf, Child Health Services Unit, Dü sseldorf, Germany Contact: wiebke.schuettig@tum.de Background: ''J1'' is a preventative routine examination in Germany recommended for adolescents at the age of 12-14 years. In contrast to the well-established U1-U9 examinations for younger children, with participation rates above 90%, the attendance of the J1 examination is approximately only 40%. The most frequent reason for not attending J1 is the unawareness of this examination. ''Ticket to J1'' is an intervention including an information leaflet introduced in Bavaria in 2017 to inform adolescents about J1. The aims of the present analysis are to investigate (1) if the regional policy was effective in increasing the attendance in J1, (2) if the effects vary by family socioeconomic status (SES), and (3) which meso-level characteristics of the healthcare system correlate with attendance rates in J1.

Methods:
We used anonymised data of a large statutory health insurance in Germany for the timeframe of 2016-2018. To investigate the effect of the policy, a difference-in-differences design at the individual level was used. Assuming a parallel trend at the level of federal states, the likelihood of attendance in J1 of 13-and 14-year-olds was compared between Bavaria and other federal German states before and after policy introduction. All analyses were additionally stratified by SES.

Results:
The introduction of ''Ticket to J1'' increased participation in J1 by 1% after controlling for all confounders. Furthermore, the effect was stronger for children from families with lower SES (an increase of 5%). Density of pediatricians was positively significantly correlated with participation in J1. Discussion: Regional health policy intervention had a significant positive impact on attendance of J1 and appears to have the potential to reduce socioeconomic inequalities in healthcare utilization. Informing adolescents about J1 seems to increase the attendance, in particular for children from families with lower SES.

9.J. Round table: Experiences on infodemic management in public health authorities in Europe and internationally
Abstract citation ID: ckac129.585 The COVID-19 pandemic and current recovery efforts have been complicated by a parallel infodemic, an overwhelming amount of information, including mis-and disinformation, accompanying emergencies as individuals and communities struggle to separate scientific facts and guidance from manipulative, emotionally charged or inaccurate content. The infodemic has manifested itself in the rapid spread of questions, concerns and misinformation that can affect population attitudes and behavior harmful to health-from promoting stigma and discrediting science, to promoting alternative, non-recommended treatment and cures to politicizing public health programs and eroding trust in healthcare personnel and health system. Since the beginning of the COVID-19 pandemic, major advances in the nascent field of infodemiology and the practice of infodemic management have been made, with over 80% of WHO Member States reporting in a pulse survey that they are tracking COVID-19 misinformation and doing infodemic management work. Infodemic management, analogous to epidemic management, is an evidence-based practice in detecting, characterising, responding and managing the infodemic and its harmful effects. It is a leading area of concern for Ministries of Health, who have established infodemic management teams and insights units to help inform programmatic and communications shifts in face of a constantly evolving infodemic. During the COVID-19 crisis and ensuing recovery efforts in face of competing health priorities, public health authorities have been challenged in the way they engage with the public. Advances in social media and media consumption that have