共查询到20条相似文献，搜索用时 359 毫秒
1.
Dawei Zhu Na Guo Jian Wang Stephen Nicholas 《International journal for equity in health》2017,16(1):210
Background
China’s health system has shown remarkable progress in health provision and health outcomes in recent decades, however inequality in health care utilization persists and poses a serious social problem. While government pro-poor health policies addressed affordability as the major obstacle to equality in health care access, this policy direction deserves further examination. Our study examines the issue of health care inequalities in China, analyzing both regional and individual socioeconomic factors associated with the inequality, and provides evidence to improve governmental health policies.Methods
The China Health and Nutrition Survey (CHNS) 1991–2011 data were used to analyze the inequality of health care utilization. The random effects logistic regression technique was used to model health care utilization as the dependent variable, and income and regional location as the independent variables, controlling for individuals’ age, gender, marital status, education, health insurance, body mass index (BMI), and period variations. The dynamic trend of 1991–2011 regional disparities was estimated using an interaction term between the regional group dummy and the wave dummy.Results
The probability of using outpatient service and inpatient services during the previous 4 weeks was 8.6 and 1.1% respectively. Compared to urban residents, suburban (OR: 0.802, 95% CI: 0.720–0.893), town (OR: 0.722, 95% CI: 0.648–0.804), rich (OR: 0.728, 95% CI: 0.656–0.807) and poor village (OR: 0.778, 95% CI: 0.698–0.868) residents were less likely to use outpatient service; and rich (OR: 0.609, 95% CI: 0.472–0.785) and poor village (OR: 0.752, 95% CI: 0. 576–0.983) residents were less likely to use inpatient health care. But the differences between income groups were not significant, except the differences between top and bottom income group in outpatient service use.Conclusion
Regional location was a more important factor than individual characteristics in determining access to health care. Besides demand-side subsidies, Chinese policy makers should pay enhanced attention to health care resource allocation to address inequity in health care access.2.
Background
In January 2006, the Korean government implemented a copayment waiver policy for hospitalized children under the age of 6 years to reduce the economic burden on patients. This policy was implemented from 2006 to 2007 in Korea and involved hospitalized children under the age of 6 years. The goal of this study is to evaluate the effect of the copayment waiver policy on health insurance beneficiaries.Methods
The change in medical service utilization before and after the policy implementation was analyzed using data from the national health insurance corporation (NHIC) and compared with medical aid beneficiaries who were already exempt from copayment. The “difference in difference” method was applied to determine the net effect of the copayment waiver policy.Results
The net effect of policy implementation on NHIC beneficiaries was unclear by the “difference in difference” method because the number of inpatient days and hospital expenditure after policy implementation showed opposite results. The copayment waiver policy did not decrease the intensity of health care utilization when compared with the medical aid beneficiaries group. Among the NHIC beneficiaries, patients who utilized medical services for fatal disease and those with the low premiums group were more affected by the policy.Conclusions
The net effect of copayment waiver policy remains unclear. Therefore, further studies are needed to determine the effects of policies implemented to reduce the economic burden on patients, such as the herein-described copayment waiver policy.3.
Background
Hospitalisation of acutely ill nursing home residents is associated with health risks such as infections, complications, or falls, and results in high costs for the health care system. Taking the case of pneumonia, nursing homes generally can ensure care according to guidelines.Aim
Extrapolation of overall expenditures for the German statutory health insurance system from the hospitalisation of nursing home residents with respiratory infection/pneumonia; developing alternative cost scenarios to compare nursing home care with hospital care in consideration of patients’ condition.Methods
Data provided by health insurance funds were extrapolated to the German statutory health insurance system and weighted via German-DRG case values. Care processes (hospital vs. nursing home) were modelled, and treatment steps were divided into cost categories. The patient’s condition was standardised via the Barthel Index.Results
Total expenditures of € 163.3 million were incurred for inpatient care of nursing home residents transferred to hospitals for respiratory infection/pneumonia in 2013 in Germany. Process modelling reveals lower direct costs for nursing home care as well as better development of patients’ condition. Looking at operators of nursing homes, both care scenarios necessitate additional services without reimbursement.Conclusion
Expenditure projections for the hospital care of nursing home residents with pneumonia reveal high saving potential. Avoidance of hospital admission serves to considerably reduce the insurers’ expenditures but also the duration and severity of illness. The study illustrates economic incentive structures for health care providers and indicates courses of action for health policy and nursing homes operators.4.
Health status in a transitional society: urban-rural disparities from a dynamic perspective in China
Background
The phenomenon of urban-rural segmentation has emerged and is remarkable, and the health disparities between rural and urban China should be stressed.Methods
Based on data from the Chinese General Social Survey from 2005 to 2013, this study not only explored the net age, period, and cohort effects of self-rated health, but compared these effects between rural and urban China from a dynamic perspective through hierarchical age-period-cohort-cross-classified random effects model.Results
Urban-rural disparities, as well as work status and gender disparities in health increased with age, in line with the cumulative advantage/disadvantage effects theory, while marital status disparities in health declining with age was in line with the age-as-leveler effects theory. The war cohort, famine cohort, later cultural revolution cohort, and early reform cohort had poorer health than did those in the early China cohort, economic recovery cohort, and later reform cohort. The economic crisis period, war cohort, baby boomer, and early cultural revolution cohort encountered larger urban-rural health disparities, while the early China cohort and early reform cohort experienced smaller urban-rural disparities in health.Conclusions
Population health is closely related to social context and health care development. It is necessary to keep economic development stable and boost medical technology improvements and the construction of the health care system.5.
Background
Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing.Objective
The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system.Methods
Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index.Results
Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes).Conclusion
Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to help shape health financing strategies for the nation.6.
Background
Nursing care insurance funds are supposed to deliver preventive services in nursing homes. The strengthening of cognitive resources is considered as one field of action.Aim
The preventive effectiveness of physical activity on cognitive performance in nursing home residents shall be evaluated.Methods
A systematic search was carried out in the databases MEDLINE, the Cochrane Library, EMBASE, CINAHL, PsycINFO and PEDro. Results were combined in random-effects meta-analyses.Results
Taking into account 13 primary studies, it was shown that those participating in physical activity showed statistically significant greater cognitive performance compared to controls (SMD = 0.43, 95% CI 0.20–0.66, p = 00002). Subgroup analyses suggest that nursing home residents with different cognitive impairments might benefit from long-lasting physical activity interventions. Due to the high risk of bias in included studies, the results must be interpreted with caution.Conclusion
Physical activity might be effective in the inpatient care setting. Further studies with longer intervention periods are required.7.
Objective
In recent years, the co-existence in Germany of two parallel comprehensive insurance systems—statutory health insurance (SHI) and private health insurance (PHI)—has been posited as a possible cause of a persistent unequal regional distribution of physicians. The present study investigates the effect of the proportion of privately insured patients on the density of SHI-licensed physicians, while controlling for regional variations in the average income from SHI patients.Methods
The proportion of residents in a district with private health insurance is estimated using complete administrative data from the SHI system and the German population census. Missing values are estimated using multiple imputation techniques. All models control for the estimated average income ambulatory physicians generate from treating SHI insured patients and a well-defined set of covariates on the level of districts in Germany in 2010.Results
Our results show that every percentage change in the proportion of residents with private health insurance is associated with increases of 2.1 and 1.3 % in the density of specialists and GPs respectively. Higher SHI income in rural areas does not compensate for this effect.Conclusion
From a financial perspective, it is rational for a physician to locate a new practice in a district with a high proportion of privately insured patients. From the perspective of patients in the SHI system, the incentive effects of PHI presumably contribute to a concentration of health care services in wealthy and urban areas. To date, the needs-based planning mechanism has been unable to address this imbalance.8.
Anders Wimo L. Fratiglioni B. -M. Sjölund A. Sköldunger C. Fagerström J. Berglund M. Lagergren 《The journal of nutrition, health & aging》2017,21(1):17-24
Objectives
Study formal and informal care of community-living older people in the Swedish National study of Aging and Care (SNAC).Design
Cross-sectional, population based cohort.Setting
Three areas in Sweden: Municipality of Nordanstig, Stockholm and Skåne County.Participants
3,338 persons ≥72 years.Measurements
Patterns and amounts of informal and formal care by cognition and area of residence.Results
73% received no care; 14% formal care; and 17% informal care (7% received both). In the whole study population, including those who used no care, individuals in small municipalities received 9.6 hours of informal care/month; in mid-size municipalities, 6.6; and in urban areas, 5.6. Users of informal care received 33.1 hours of informal care/month in small municipalities, 54.6 in mid-size municipalities and 36.1 in urban areas. Individuals with cognitive impairment received 14.1 hours of informal care/month, 2.7 times more than people with no/slight impairment. In the whole study population, individuals in small municipalities received an average of 3.2 hours of formal care/month; in mid-size municipalities 1.4; and in urban areas, 2.6. Corresponding figures for formal care users were 29.4 hours in small municipalities, 13.6 in mid-size municipalities and 16.7 in urban areas. Formal care users received 7.1 hours, and informal care users, 5.9 hours for each hour/month received by people in the study population as a whole.Conclusions
More informal than formal care was provided. Informal care is more frequent in small municipalities than urban areas and for those with than without cognitive impairment. The relationship between data on the whole population and the data on users or care indicates that population-based data are needed to avoid overestimates of care.9.
Shivendra Sangar Varun Dutt Ramna Thakur 《Zeitschrift fur Gesundheitswissenschaften》2018,26(5):485-494
Aim
This article aimed to study the burden, impact and coping mechanisms associated with out-of-pocket (OOP) health expenditure in rural and urban areas in India.Methods
National Sample Survey Organisation (NSSO) data on ‘Health and Morbidity’ gathered in 2004 and 2014 were employed to measure the catastrophic burden, impoverishment impact and various coping strategies associated with out-of-pocket health in India.Results
Results revealed that over the study period, considerable rural-urban differentials existed in the economic burden and impact of out-of-pocket health expenditure. As a coping strategy, borrowing and other distress sources were used in higher proportions by the rural population than their urban counterparts. Overall, our results demonstrated an alarming situation regarding health care financing in India.Conclusion
Substantial investment in public health is needed, especially in rural areas as it is here that people are facing the real brunt of catastrophic OOP health expenditures in the form of impoverishment with more dependence on distress sources including borrowing and sale of assets as coping mechanisms.10.
Ellen Van de Poel Ahmad Reza Hosseinpoor Caroline Jehu-Appiah Jeanette Vega Niko Speybroeck 《International journal for equity in health》2007,6(1):21
Background
Malnutrition is a major public health and development concern in the developing world and in poor communities within these regions. Understanding the nature and determinants of socioeconomic inequality in malnutrition is essential in contemplating the health of populations in developing countries and in targeting resources appropriately to raise the health of the poor and most vulnerable groups.Methods
This paper uses a concentration index to summarize inequality in children's height-for-age z-scores in Ghana across the entire socioeconomic distribution and decomposes this inequality into different contributing factors. Data is used from the Ghana 2003 Demographic and Health Survey.Results
The results show that malnutrition is related to poverty, maternal education, health care and family planning and regional characteristics. Socioeconomic inequality in malnutrition is mainly associated with poverty, health care use and regional disparities. Although average malnutrition is higher using the new growth standards recently released by the World Health Organization, socioeconomic inequality and the associated factors are robust to the change of reference population.Conclusion
Child malnutrition in Ghana is a multisectoral problem. The factors associated with average malnutrition rates are not necessarily the same as those associated with socioeconomic inequality in malnutrition.11.
Background
Private health expenditure in systems of national health insurance has raised concern in many countries. The concern is mainly about the accessibility of care to the poor and the sick, and inequality in use and in health. The concern thus refers specifically to the care financed privately rather than to private health expenditure as defined in the national health accounts.Objectives
To estimate the share of private finance in total use of services covered by the national package of benefits. and to relate the private finance of use to the income and health of the users.Methods
The Central Bureau of Statistics linked the 2009 Health Survey and the 2010 Incomes Survey. Twenty-four thousand five hundred ninety-five individuals in 7175 households were included in the data. Lacking data on the share of private finance in total cost of care delivered, we calculated instead the share of uses having any private finance—beyond copayments—in total uses, in primary, secondary, paramedical and total care. The probability of any private finance in each type of care is then related, using random effect logistic regression, to income and health state.Results
Fifteen percent of all uses of care covered by the national package of benefits had any private finance. This rate ranges from 10 % in primary care, 16 % in secondary care and 31 % in paramedical care. Twelve percent of all uses of physicians’ services had any private finance, ranging from 10 % in family physicians to 20 % in pulmonologists, psychiatrists, neurologists and urologists. Controlling for health state, richer individuals are more likely to have any private finance in all types of care. Controlling for income, sick individuals (1+ chronic conditions) are 30 % in total care and 60 % in primary care more likely to have any private finance compared to healthy individuals (with no chronic conditions).Conclusions
The national accounts’ “private health spending” (39 % of total spending in 2010) is not of much use regarding equity of and accessibility to medical care by the population. The mean share of uses financed privately in 2010, a more relevant measure, is 15 % with large variation between types of care and physicians. While, as under national health insurance, richer persons contribute more into the finance of (private) medical care , and sicker persons are more likely to use it, the solidarity principle—cross subsidization from the rich to the sick, which is a fundamental principle of national health insurance systems, is clearly violated.12.
Aim
The objective of this study was to assess and compare the prevalence of self-reported unmet healthcare needs (UHN) among Canadian indigenous groups using the 2006 and 2012 Aboriginal Peoples Surveys (APS).Subject and methods
Frequency distributions and cross tabulations were produced to estimate the proportion of indigenous people who reported UHN in 2006 and 2012 and for sub-populations, based on indigenous identity, gender, age, geographic region and urban/rural area. Additionally, frequency distributions were produced for reasons for UHN and types of care needed. Standard errors and confidence intervals were calculated and took into account bootstrap weights.Results
In 2006, 11.65% (CI: 11.04, 12.26) of indigenous people reported UHN, and this proportion significantly increased to 13.74% (CI: 12.88, 14.60) in 2012. UHN varied among indigenous identities; however, only Inuit had a significant difference in UHN between 2006 (10.19%, CI: 9.05, 11.33) and 2012 (14.58%, CI: 12.57, 16.59). Individuals aged 18–34 years, females, and those in the Prairies and Territories and in urban areas had significant differences in UHN. The most common reasons for UHN were related to availability, and the majority of respondents reported needing care for physical health problems.Conclusions
Further research is warranted that examines the association between general factors related to UHN and indigenous-specific factors. Additionally, assessing how chronic disease impacts UHN will provide information on reasons for UHN (e.g., healthcare system-related versus personal circumstances).13.
Kazutoshi Nakamura Kaori Kitamura Yumi Watanabe Hiroko Shinoda Hisami Sato Toshiyuki Someya 《Environmental health and preventive medicine》2016,21(6):422-429
Background
This study aimed to examine rural–urban differences in the prevalence of cognitive impairment in Japan.Methods
We targeted 592 residents aged 65 years and older who did not use long-term care insurance services in one rural and two urban areas in Ojiya City, Japan. Of these, 537 (90.7 %) participated in the study. The revised Hasegawa’s dementia scale (HDS-R) was used to assess cognitive function, and cognitive impairment was defined as a HDS-R score ≤20. Lifestyle information was obtained through interviews. The prevalence of cognitive impairment was compared according to the levels of predictor variables by odds ratios (ORs) calculated by a logistic regression analysis.Results
Mean age of participants was 75.7 years (SD 7.0). The prevalence of cognitive impairment was 20/239 (8.4 %) in the rural area and 6/298 (2.0 %) in the urban areas, for a total of 26/537 (4.8 %) overall. Men tended to have a higher prevalence of cognitive impairment (P = 0.0628), and age was associated with cognitive impairment (P for trend <0.0001). The rural area had a significantly higher prevalence of cognitive impairment (age- and sex-adjusted OR = 4.04, 95 % CI: 1.54–10.62) than urban areas. This difference was significant after adjusting for other lifestyle factors.Conclusions
The prevalence of cognitive impairment was higher in the rural area relative to urban areas in Ojiya city. This regional difference suggests the existence of potentially modifiable factors other than lifestyle in relation to cognitive impairment.14.
Background
This study examines variations in breast cancer screening among primary care clinicians by geographic location of clinical practice.Methods
A cross-sectional survey design was used to examine approaches to breast cancer screening among physicians, nurse practitioners, and physician assistants involved in primary care practice. A summary index of beliefs about breast cancer screening was created by summing the total number of responses in agreement with each of four survey items; values for this summary variable ranged between zero and four. Respondents were classified into urban, rural and suburban categories based upon practise location.Results
Among the 428 respondents, agreement with "correct" responses ranged from 50% to 71% for the individual survey items; overall, half agreed with three or more of the four breast cancer screening items. While no significant differences were noted by practice location, variation in responses were evident. Reported use of written breast cancer guidelines was less in both suburban (OR = 0.51) and urban areas (OR = 0.56) when compared to clinicians in rural areas.Conclusion
Development of an evidence-based consensus statement regarding breast cancer screening would support a single set of unambiguous guidelines for implementation in all primary care settings, thus decreasing variations in how breast cancer screening is approached across varied clinical settings.15.
Silke Neusser Janine Biermann Gerald Lux Jürgen Wasem Volker Reissner Anja Neumann 《Zeitschrift fur Gesundheitswissenschaften》2018,26(3):271-278
Aim
This study aims to calculate the cost of illness concerning multiple sclerosis (MS) from the perspective of the German social insurance system.Subjects and methods
Expenditures for MS (ICD-10 GM: G35) were evaluated retrospectively for the year 2012 from the perspective of the social insurance system. Expenditures from the German statutory health insurance, the Federal statutory pension fund, and statutory long-term care insurances were calculated based on administrative claims of a large nationwide health insurance and statistics from the Federal statutory pension fund. Additionally, expenditures of the long-term care insurances were requested by standardized questionnaire. Costs were extrapolated for all health and statutory long-term care insurances.Results
In the base case, extrapolated expenditures for German statutory health insurance amount to 1.062 billion €. German statutory pension funds expenses for MS were around 258.700 million € on medical rehabilitation and early retirement. Extrapolated for the whole population insured expenditures of the statutory long-term care insurances on persons with MS were approximately 372.200 million €.Conclusion
This study delivered important information regarding the economic burden of MS for the social insurance system in Germany. The top-down process of data collection yielded population-based results on the cost of illness.16.
M. Helbich V. Blüml T. de Jong P. L. Plener M.-P. Kwan N. D. Kapusta 《International journal of health geographics》2017,16(1):39
Background
Urban–rural disparities in suicide mortality have received considerable attention. Varying conceptualizations of urbanity may contribute to the conflicting findings. This ecological study on Germany assessed how and to what extent urban–rural suicide associations are affected by 14 different urban–rural indicators.Methods
Indicators were based on continuous or k-means classified population data, land-use data, planning typologies, or represented population-based accessibility indicators. Agreements between indicators were tested with correlation analyses. Spatial Bayesian Poisson regressions were estimated to examine urban–rural suicide associations while adjusting for risk and protective factors.Results
Urban–rural differences in suicide rates per 100,000 persons were found irrespective of the indicator. Strong and significant correlation was observed between different urban–rural indicators. Although the effect sign consistently referred to a reduced risk in urban areas, statistical significance was not universally confirmed by all regressions. Goodness-of-fit statistics suggested that the population potential score performs best, and that population density is the second best indicator of urbanicity. Numerical indicators are favored over classified ones. Regional planning typologies are not supported.Conclusions
The strength of suicide urban–rural associations varies with respect to the applied indicator of urbanicity. Future studies that put urban–rural inequalities central are recommended to apply either unclassified population potentials or population density indicators, but sensitivity analyses are advised.17.
Background
Knowledge of caregiver perspectives of their psychosocial resources and needs during the post inpatient psychiatric hospitalization is limited. Examining caregivers’ perspectives of the transition period may be a critical step in improving the transition success of children with emotional and behavioral disorders. Using quantitative and qualitative methods, we investigated the psychosocial resources and needs of caregivers after a child inpatient hospitalization.Objective
This study sought to examine the psychosocial resources of caregivers of children leaving intensive psychiatric care and participating in a post-inpatient transition program, and to describe their reported needs at home and school.Methods
Forty-four caregivers were recruited from the child and adolescent psychiatric inpatient units of two hospitals (one urban, one suburban). We utilized a partially mixed concurrent equal status design for mixed-methods analysis. Qualitative data were analyzed using consensual qualitative research methodology.Results
Caregivers reported high levels of strain, child symptomatology, and low levels of empowerment and social support. Their satisfaction with school and mental health services were mixed. Caregivers identified a need for increased knowledge of behavior management strategies, improved caregiver/child relationship, more emotional support, and increased access to services for their children. Areas of concern in the school setting included social–emotional functioning, learning, access to school services, and advocacy.Conclusion
These findings expand our knowledge of caregivers’ psychosocial resources and needs during their children’s inpatient psychiatric hospitalization and subsequent transition to home and school. As research in this area develops, we suggest that incorporating caregivers’ needs into transition planning may result in more effective and acceptable interventions for families.18.
Beate Blättner Katharina Ponomarew Katharina Kraemer Sabrina Griesel Stefanie Roß-Stabernack Kerstin Krüger 《Pr?vention und Gesundheitsf?rderung》2018,13(2):146-150
Background
Nursing care insurance should stimulate healthy organizational development processes in order to strengthen the health resources of people who are in need of in-patient care. The perceptions of decision-makers in the nursing homes were of interest.Methods
Between July and September 2016, 17 business directors and 4 nursing managers of different sponsorships and size were interviewed.Results
Decision-makers hoped for an improvement of the financial situation in the homes. They view the possibility of universal prevention and the participation of inhabitants as unrealistic. They also see the presentation of such a process administrated through nursing care insurance rather skeptically.Discussion
More optimistic perceptions of committed decision-makers of other nursing homes can be possible and changes are likely. However, arguments of why managers of nursing facilities should support such a process are still lacking. This could become easier with the thorough inclusion of workplace health promotion.19.
Shireen Assaf Stefano Campostrini Cinzia Di Novi Fang Xu Carol Gotway Crawford 《The European journal of health economics》2017,18(3):387-398
Objective
To explore the changing disparities in access to health care insurance in the United States using time-varying coefficient models.Data
Secondary data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1993 to 2009 was used.Study design
A time-varying coefficient model was constructed using a binary outcome of no enrollment in health insurance plan versus enrolled. The independent variables included age, sex, education, income, work status, race, and number of health conditions. Smooth functions of odds ratios and time were used to produce odds ratio plots.Results
Significant time-varying coefficients were found for all the independent variables with the odds ratio plots showing changing trends except for a constant line for the categories of male, student, and having three health conditions. Some categories showed decreasing disparities, such as the income categories. However, some categories had increasing disparities in health insurance enrollment such as the education and race categories.Conclusions
As the Affordable Care Act is being gradually implemented, studies are needed to provide baseline information about disparities in access to health insurance, in order to gauge any changes in health insurance access. The use of time-varying coefficient models with BRFSS data can be useful in accomplishing this task.20.