Hospitalisation among the elderly in urban China

OBJECTIVES: The aim of this study was to examine the trend of hospitalisation amongst the elderly in urban China and analyse the main socio-economic factors which are affecting the use of inpatient care. METHODS: Data from the Chinese national household health interview surveys conducted in 1993, 1998 and 2003 were analysed. The following variables were selected: gender, health insurance coverage and household income. RESULTS: Elderly people with insurance are more likely to use inpatient services than those who were not insured. Elderly people in the low income group are less likely than ones in the high income group to use inpatient services. Non-hospitalisation is more common amongst elderly women than elderly men and amongst the non-insured. The likelihood of elderly people in the low income groups not using inpatient services has increased dramatically from 12% in 1993 to 134% in 2003. Financial difficulty appeared to be the most common reason for not accessing inpatient care, particularly for elderly people without health insurance. CONCLUSIONS: Elderly people with low income, without health insurance, and women appear to be more vulnerable in their access to inpatient care. Appropriate policies could be developed to protect these groups of people from high health care expenses.     

Hospitalisation among the elderly in urban China

ObjectivesThe aim of this study was to examine the trend of hospitalisation amongst the elderly in urban China and analyse the main socio-economic factors which are affecting the use of inpatient care.MethodsData from the Chinese national household health interview surveys conducted in 1993, 1998 and 2003 were analysed. The following variables were selected: gender, health insurance coverage and household income.ResultsElderly people with insurance are more likely to use inpatient services than those who were not insured. Elderly people in the low income group are less likely than ones in the high income group to use inpatient services. Non-hospitalisation is more common amongst elderly women than elderly men and amongst the non-insured. The likelihood of elderly people in the low income groups not using inpatient services has increased dramatically from 12% in 1993 to 134% in 2003. Financial difficulty appeared to be the most common reason for not accessing inpatient care, particularly for elderly people without health insurance.ConclusionsElderly people with low income, without health insurance, and women appear to be more vulnerable in their access to inpatient care. Appropriate policies could be developed to protect these groups of people from high health care expenses.     

The poor pay more: Health-related inequality in Thailand

This paper examines the equality of utilization for equal need and equity of out-of-pocket expenditure for health services in a large urban area in Thailand. Data from a household health interview survey were used to explore patterns of perceived morbidity, utilization of various treatment sources, and out-of-pocket payment. Financial access to health care, as reflected in medical benefit/insurance cover, appeared to influence reported illness and hospitalization rates. Gross lack of access to health care amongst lower socio-economic groups was not the main problem in this densely populated urban area because people could choose and use alternative health services according to their ability and willingness to pay. The corollary, however, was an inequitable pattern of out-of-pocket health expenditure by income quintile and per capita. The underprivileged were more likely to pay out of their own pocket for their health problems, and to pay out of proportion to their household income when compared with more privileged groups. Furthermore, the underprivileged were least likely to be covered by government health benefit schemes, in contrast in particular to civil servants, who paid less out of pocket and did not contribute to their medical benefit fund. The private health sector (private clinics and private hospitals) was the major provider of health care to urban dwellers for both outpatient and inpatient services. Policy options for the short and long term to improve the equity of payment systems for health care are discussed.     

我国大城市15岁及以上居民门诊费用及其影响因素分析

目的 分析我国大城市１５岁及以上居民就诊费用及其变化趋势,探讨影响居民门诊费用的因素,为卫生改革和控制医药费用进一步上涨提供参考依据。方法 利用１９９３年和１９９８年二次国家卫生服务调查１５岁及以上患者两周就诊情况的资料,采用描述性分析和建立对数线性回归模型的方法。结果 地区、年龄、性别、文化程度、收入水平、医疗保障制度、疾病别的次均就诊费用存在差异。结论 性别、疾病种类、医疗保健制度、收入、恩格     

Do health care reforms in Turkey have a significant effect in equal access to maternal and child health services in Turkey: An evidence from 20 years

This study aimed to investigate whether there was an improvement in the equitable access to maternal and child health care services by examining the effects of socioeconomic and individual factors in Turkey from 1993 to 2013 and determine the effectiveness of health care reforms implemented mainly under the Health Transformation Program since 2003 on equitable access t;o maternal and child health care services in terms of years. The study used nationally representative 5 Turkey Demographic and Health Surveys (1993, 1998, 2003, 2008, and 2013). Prenatal care utilization rate increased from 67.0% in 1993 to 96.2% in 2013 while the rate of women giving birth at health care facilities increased from 63.8% to 98.1% in 2013. Prenatal care utilization and giving birth at health care facilities were higher among women who were under health insurance coverage, first time mothers, those staying in the western region and urban areas, and those with the highest level of wealth. The findings suggest that the issue of equity in the utilization of maternal and child health care services exists in Turkey, and the latest health care reforms under HTP are not effective in diminishing the effect of wealth.     

The impact of social security system reform on health services equity in Colombia

To evaluate the impact on access to, and use of, health services in Colombia's new national health insurance system, the authors compared two cross sections of the population: before (1993) and after (1997), with the approval of Act 100, creating the General System for Social Security in Health (SGSSS). Two equity indicators were assessed: concentration curves (CC) and concentration indices (CI), summarizing the distribution of access to health care and utilization of health care services provided by the SGSSS according to income deciles. Between 1993 and 1997, the CI for access to insurance halved from 0.34 to 0.17; simultaneously, coverage increased from 23% to 57%, especially among the poorest segments of the population, where it increased from 3.7% to 43.7% as a result of subsidies provided by local governments. The CI for utilization of health care services did not vary significantly. Increased disease prevalence and utilization of services among the insured, due to biased selection of risks and moral hazards, were also documented. These findings suggest a positive impact by the Reform on inequalities in access to health care insurance; however, a similar effect on inequities in utilization of health services is not clear.     

Health insurance and health services utilization in Ireland

The numbers buying private health insurance in Ireland have continued to grow, despite a broadening in entitlement to public care. About 40% of the population now have insurance, although everyone has entitlement to public hospital care. In this paper, we examine in detail the growth in insurance coverage and the factors underlying the demand for insurance. Attitudinal responses reveal the importance of perceptions about waiting times for public care, as well as some concerns about the quality of that care. Individual characteristics, such as education, age, gender, marital status, family composition and income all influence the probability of purchasing private insurance. We also examine the relationship between insurance and utilization of hospital in-patient services. The positive effect of private insurance appears less than that of entitlement to full free health care from the state, although the latter is means-tested, and may partly represent health status.     

The impact of public voluntary health insurance on private health expenditures in Vietnam

As a financing mechanism with the potential to raise additional funds for health services, whilst improving access to services amongst the poor, non-profit health insurance has become increasingly attractive to health policy-makers. Using data from a household survey in Vietnam, out of pocket health expenditure are compared between members and eligible non-members of the government-implemented voluntary health insurance scheme. Expenditures are analysed for individuals who sought care during their most recent illness. Using an endogenous dummy variable model to control for bias resulting from self-selection into the scheme, we find that health insurance reduces average out-of-pocket expenditures by approximately 200%. Whilst income inelastic, health expenditures are found to be significantly influenced by an individuals level of income, irrespective of insurance status. Despite this, insurance reduces expenditures significantly more for the poor than for the rich.     

The effects of accessibility on general practitioner consultations,out-patient attendances and in-patient admissions in Norfolk,England

A social survey was conducted to investigate the effects of accessibility on contacts with general practitioners and hospitals under the National Health Service in the predominantly rural county of Norfolk. Random samples of adults were taken close to hospital and general practitioner services in the city of Norwich, in villages close to Norwich with and without a general practitioner surgery and in villages relatively remote from the city with and without a surgery. General practitioner consultation rates, out-patient attendance rates and in-patient admissions were all found to decline with decreasing accessibility. For people with a long-standing illness, the main difference in rates was between urban and rural areas. The groups most affected in the rural areas were those with the highest relative need for health care. Their counterparts in the city used the health services much more. For the larger section of the sample, those with no long-standing illness, the most significant differences were between the various rural locations. Here, both distance to a surgery and distance to the city hospitals were associated with decreasing consultation, out-patient and in-patient rates. The main trend was of young mobile people with high expectations in places with readily accessible health services using those services more than would be expected from their usage rates elsewhere. There was also evidence among the people with no long-standing illness of less prosperous sub-groups being affected by remoteness at the out-patient stage.     

Modeling risk-adjusted capitation rates for Umbria,Italy

We studied the potential effect of refining per capita financing in Italy by risk adjustment using severity of illness as well as age and gender. Data were drawn from hospital, pharmaceutical, and demographic files for the entire population of the Umbrian region of Italy in 1997 and 1998. Hospitalization data from 1997 were used to classify patients into severity of illness categories which were hypothesized to be at risk for higher health services costs in 1998. Data on costs in 1998 were developed from hospital and pharmaceutical administrative data. Coefficients from 1997 models were used to develop predicted 1998 costs. Predicted costs in 1998 were compared to observed costs. Disease Staging models identified 155 unique clinical risk adjustment categories. These categories included 5.3% of the Umbrian population in 1997, who accounted for 21.6% of costs in the next year. In prediction models of future year costs using Umbrian data, R² values for Disease Staging models were 0.16, compared to values of 0.07 for a risk adjustment model used by Medicare. By identifying groups within the overall population who were more severely ill and who used more resources, these models can be used to assist health care planners estimate health care resources such as facilities, manpower, and programs.     

Does non‐profit health insurance reduce financial burden? Evidence from the Vietnam living standards survey panel

Many low-income countries are implementing non-profit medical insurance to increase access to health services, especially among low-income households, and to raise additional revenue for financing public health services. This paper estimates the effect of insurance on out-of-pocket health expenditures using the Vietnam Living Standards Surveys for 1993 and 1998 and appropriate models for panel data. Our findings suggest that health insurance reduces health expenditure when unobserved heterogeneity is accounted for. Failure to capture unobserved heterogeneity produces contrary results that are consistent with previous cross-sectional studies in the literature. Health insurance is found to reduce out-of-pocket expenditure between 16 and 18% and the reduction in expenditure is more pronounced for individuals with lower incomes. At mean income, the effect of health insurance is to reduce health expenditures between 28 and 35%.     

Health problems and use of services at two urban American Indian clinics

The use of primary health care services by urban American Indians and their health problems were compared with national and regional data compiled by the Indian Health Service, Bureau of the Census, Office of Technology Assessment, and the National Center for Health Statistics. A survey of medical records was conducted at urban Indian health clinics, one located in Oklahoma City, OK, and the other in Wichita, KS. Health records of 500 patients from each clinic were reviewed. Information was gathered concerning reasons for visit, diagnoses, and number of physician visits. In addition, predisposing variables and enabling variables from each patient's registration form were reviewed. According to the data collected in the survey, the clientele of these urban Indian clinics have annual incomes well below the average income of the general population and the overall American Indian population in these cities. Their lack of health insurance and low education levels were also evident. Use of primary health services was below that of the general population, and lower, but relatively close, to use levels of American Indians residing in rural Oklahoma and Kansas. Information on health problems indicated high levels of diabetes mellitus and hypertension among the middle-age groups, and high levels of use by young women for prenatal care and contraception. The absence of systematically collected and comprehensive health and health care use information about urban American Indians, who now comprise more than half the U.S. American Indian population, and the limitations in the available information leave important questions unanswered.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mental Illness as a Risk Factor for Uninsurance Among Mothers of Infants

The objective of this study was to assess the extent to which maternal prenatal mental illness is associated with mothers’ health insurance status 12–18 months after giving birth. The sample consisted of 2,956 urban, mostly unwed, mothers who gave birth in 20 large U.S. cities between 1998 and 2000 and participated in the Fragile Families and Child Wellbeing birth cohort study. Multinomial logistic regression models were used to assess associations between maternal prenatal mental illness and whether the mother had private, public, or no insurance one year after the birth. Covariates included the mother’s and child’s physical health status, the father’s physical and mental health status, and numerous other maternal, paternal, and family characteristics. Potential mediating factors were explored. The results showed that mothers with prenatal diagnosed mental illness were almost half as likely as those without mental illness diagnoses to have private insurance (vs. no insurance) one year after the birth. Among mothers who did not have a subsequent pregnancy, those with prenatal mental illness were less likely than those without mental illness diagnoses to have public insurance than to be uninsured. Screening positive for depression or anxiety at one year decreased the likelihood that the mother had either type of insurance. Policies to improve private mental health care coverage and public mental health services among mothers with young children may yield both private and social benefits. Encounters with the health care and social service systems experienced by pregnant and postpartum women present opportunities for connecting mothers to needed mental health services and facilitating their maintenance of health insurance.     

Health care services utilization and access inequalities in the Sao Paulo Metropolitan Region

This paper presents case study findings in five municipalities in the S?o Paulo Metropolitan Region. Inequalities in access to health care services and their utilization were described through advanced tabulation data from the 1998 SEADE Life Conditions Survey. The variables analyzed were: owning or not owning private health care insurance, income and age brackets. The health care service attributes studied were: health care services coverage by a health insurance plan, health services demands and average waiting time to receive health care. Compared with other studies, using the 1998 IBGE PNAD, the results allowed us to confirm interregional imbalances which can only be detected in shorter special scale studies: the municipalities. Despite showing the high private health insurances coverage the S?o Paulo Metropolitan Region has a great inner heterogeneity. The inequalities in private health care insurance, access, waiting time, and type of insurance coverage were observed through income quintiles and age classes analyses. Findings suggest that an expansion of the State's regulation capacity is necessary in order to empower the Brazilian Health Care System principles of universality and equity to be qualified to offer Brazilians the right to access health care services.     

Access to and Use of Eye Care Services in Rural Arkansas

Context: Rural residents are more likely to be uninsured and have low income.
Purpose: To determine if rural residents in Arkansas have decreased access to eye care services and use them less frequently than urban residents.
Methods: Data from the 2006 Visual Impairment and Access to Eye Care Module from the Arkansas Behavioral Risk Factor Surveillance System (BRFSS) were used in the analysis. Adults age 40 years and older were included (n = 4,289). Results were weighted to reflect the age, race, and gender distribution of the population of Arkansas. Multiple logistic regression was used to adjust for demographic differences between rural and urban populations.
Findings: Significantly fewer rural residents (45%) reported having insurance coverage for eye care services compared with residents living in urban areas (55%). Rural residents were less likely (45%) than urban residents (49%) to have had a dilated eye exam within the past year. Among residents aged 40-64, those from rural areas were more likely than their urban counterparts to report cost/lack of insurance as the main reason for not having a recent eye care visit.
Conclusions: In 2006, rates of eye care insurance coverage were significantly lower for rural residents while use of eye care services differed slightly between rural and urban residents. Rural residents in Arkansas age 40-64 would benefit from having increased access to eye care insurance and/or low cost eye care services.     

Health needs and health status of the elderly in rural Bangladesh

This study was undertaken to understand the health status of elderly people and to gather some information about their perceived health needs. This study was conducted in the north-western part of Dhaka district in the year 1999-2000. People aged over 60 years constituted about 3.5% of the total population with more than half (55.6%) belonging to the middle class and another one third to the lower class. Elderly people made up 5.7% of all out-patient consultations and 6.9% of all in-patient admissions. Hypertension, peptic ulcer, chronic obstructive pulmonary diseases, pneumonia, skin diseases and anaemia were common among these people. Only 14% of the elderly people in this rural area were insured, but these insured people constituted about half (48%) of the in-patient and 90% of the out-patient elderly patients. Thus insurance has significantly increased their health care access (p<0.05). Provision of free health care, drugs at a cheaper price, services at their doorsteps, free ambulance service and allocation of old age allowance were some of their notable demands. A cheaper, accessible and effective geriatric health care service with an emphasis on health promotion, income generating activities and rehabilitation programme should be developed to protect the health and well being of the elderly people.     

The Impacts of China's Urban Employee Basic Medical Insurance on Healthcare Expenditures and Health Outcomes

At the end of 1998, China launched a government‐run mandatory insurance program, the urban employee basic medical insurance (UEBMI), to replace the previous medical insurance system. Using the UEBMI reform in China as a natural experiment, this study identifies variations in patient cost sharing that were imposed by the UEBMI reform and examines their effects on the demand for healthcare services. Using data from the 1991–2006 waves of the China Health and Nutrition Survey, we find that increased cost sharing is associated with decreased outpatient medical care utilization and expenditures but not with decreased inpatient care utilization and expenditures. Patients from low‐income and middle‐income households or with less severe medical conditions are more sensitive to prices. We observe little impact on patient's health, as measured by self‐reported health status. Copyright © 2015 John Wiley & Sons, Ltd.     

Insurance coverage and access: implications for health policy.

Data are presented from a recent survey of the United States population comparing the characteristics and levels of access to medical care of persons under 65 years who have group or individual private health insurance, public health insurance, or no third-party coverage. The uninsured group appeared to fall between the privately insured and publicly insured groups on measures of social and economic status. Persons with publicly subsidized forms of insurance coverage utilized services at the highest rates, and uninsured persons used them at the lowest rates. Neither of these groups was as satisfied with the convenience or the quality of the care it obtained as the privately insured group. Implications of these findings for national health insurance and other health policy initiatives are discussed.     

Access to health care in relation to socioeconomic status in the Amazonian area of Peru

Background  

Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drugs in relation to household socioeconomic status for children in two small Amazonian urban communities of Peru; Yurimaguas, Department of Loreto and Moyobamba, Department of San Martin, Peru.