The effect of health care expenditures on self-rated health status and the Health Utility Index: Evidence from Canada

Studies of the effect of health care expenditures on health status suggest conflicting evidence of a relationship using data from numerous countries. We use data from the Canadian National Population Health Survey and the Canadian Institute for Health Information to estimate the relationship between per capita provincial health care expenditures and both self-assessed health status and the Health Utility Index. Our sample includes all individuals who were 18 years old or over at the beginning of the survey in 1994. We use random effects ordered probits for self-assessed health status and quantile regressions for the Health Utility Index (HUI). Our results show that provincial health care expenditures have a limited effect on self-rated health status and the HUI. It may be that self-rated health status and the HUI are noisy measures of heath status and as such, combined with the small variation observed in health care expenditure trends over the period, make the magnitude of the relationship between health care expenditures and health difficult to estimate.     

Primary care experience and racial disparities in self-reported health status

CONTEXT: Access to high quality primary care was identified by Healthy People 2010 as one of the mechanisms through which racial and ethnic disparities in health might be reduced. Despite the well-established connections between good primary care and health, the scientific evidence on whether good primary care can reduce racial disparities in health is sparse. OBJECTIVE: To examine whether better primary care experience can attenuate racial and ethnic disparities in self-reported health status. DATA SOURCES: The 1996 to 1997 and 1998 to 1999 data from the Community Tracking Study (CTS) sponsored by the Robert Wood Johnson Foundation. STUDY DESIGN: Cross-sectional, bivariate, and multivariate analyses of inter-relationships between self-rated general and mental health status, access to and interpersonal relationship with primary care provider, and vulnerability measured by race and poverty status. RESULTS: We found that higher quality primary care levels are associated with reduced racial and ethnic disparities in health status, as measured by self-rated general and mental health. This relationship is particularly pronounced for the racial and ethnic minorities living at or below poverty level. Based on the data from 1996 to 1999, the study also confirmed the presence of significant and persistent health differences across racial and ethnic groups. CONCLUSION: Promoting primary care may be a viable approach toward reducing racial and ethnic disparities in self-reported health status.     

Vertical and horizontal aspects of socio-economic inequity in general practitioner contacts in Scotland

Health status varies across socio-economic groups and health status is generally assumed to predict health care needs. Therefore the need for health care varies across socio-economic groups, and studies of equity in the distribution of health care between socio-economic groups must compare levels of utilisation with levels of need. Economic studies of equity in health care generally assume that health care needs can be derived from the current health-health care relationship. They therefore do not consider whether the current health-health care relationship is (vertically) equitable and the focus is restricted to horizontal inequity. This paper proposes a framework for incorporating the implications of vertical inequity for the socio-economic distribution of health care. An alternative to the current health-health care relationship is proposed using a restriction on the health-elasticity of health care. The health-elasticity of general practitioner contacts in Scotland is found to be generally negative, but positive at low levels of health status. Pro-rich estimates of horizontal inequity and vertical inequity are obtained but neither is statistically significant. Further analysis demonstrates that the magnitude of vertical inequity in health care may be larger than horizontal inequity.     

Health status and medical expenditures: is there a link?

Until now, cross-national studies have not demonstrated a positive relationship between health care expenditures and improved health status, as measured by such indicators as age-adjusted mortality rates. It has therefore been argued that cutting expenditures will not have a negative effect upon health status. Using health and life-style data from the OECD for Germany, the United Kingdom, The Netherlands, France, Sweden and the United States, this study finds that when one holds constant those changes in life style that have an impact upon health (e.g. smoking, drinking, traffic accidents, dangers on the job) and adjusts for inflation and population size, health care expenditures do bear a positive relationship to health status. This suggests that reductions in health care expenditures may well have some cost in terms of overall health.     

Women and poverty: the effects on reproductive status

National surveys, over the years, have provided evidence of relationship between poverty and health. In the United States, access to health care is generally dependent on the ability to pay for it. As a consequence, poor women are dependent upon government-funded social-welfare programs to attain access to health care. This paper examines the relationship between poverty and several indicators of reproductive status, and concludes that there is a relationship between poverty and poor reproductive status. The health gap between poor and nonpoor women is related to the absence of financial and other resources that dictate lifestyle.     

Access to Health Care: Urban-Rural Comparisons from a Midwestern Agricultural State

Lack of access to quality health care for a large number of Americans, particularly those living in rural areas, is a major health care problem. Differences in access between rural and urban areas are caused by obstacles to providing adequate care, such as hospital closures and physician shortages, and low income and/or employment that does not provide health insurance as an employee benefit. This study, based on a random sample of 6,000 households in Nebraska, finds that access to health care is better for residents of rural than urban areas. The relationship holds with controls for health status and health insurance. The pattern in Nebraska reflects an absence of differences in income, health insurance, and health status that produce differences in access between rural and urban areas nationwide. The findings suggest that any serious proposal to reform health care delivery should involve the states and use established patterns of seeking care among state residents.     

Maternal Mental Health and Pediatric Health Care Use Among a National Sample of Medicaid- and SCHIP-Insured Children

While the literature has shown that health care use is associated with mental health status, little is known about the relationship between a mother’s mental health status and her children’s health care use. This study examined the association of maternal mental health status and pediatric health care for their children in a nationally representative sample of 17,830 women parenting children ages 0–17 insured through Medicaid or a State Children’s Health Insurance Program (SCHIP). Mothers with a mental health problem were significantly more likely to be poorer, single parents, with lower levels of education, fewer parenting supports, and greater difficulty coping with parenting than mothers without a mental health problem; however, they reported comparable receipt of pediatric health care for their children, indicating their resilience as caretakers. The findings also suggest that all Medicaid- or SCHIP-eligible families could benefit from targeted engagement strategies linking them with consistent and appropriate sources of pediatric health care.     

Women's health issues across the lifespan.

This study examines differences and similarities in women's health status, health care needs, and access to care across age groups. Data are from the Commonwealth Fund 1998 Survey of Women's Health. Several age-group specific issues stand out, such as more limited access to health insurance and a usual source of care among younger women, the emergence of chronic health care problems among women in the 45-64 age group, and the presence of multiple health problems among elderly women. The analyses reveal several themes that cut across age groups, such as the relationship between poverty and health status, the importance of health insurance, and the generally limited receipt of physician information about health-related behaviors.     

Marital status and health care expenditures among the elderly in a managed care organization

The purpose of this study was to determine the relationship of marital status in and health care expenditures among the elderly in a managed care organization. The study population consisted of 277 functionally impaired elderly people who were 75 years and older enrolled in a managed care organization. In separate analyses, the relationship between marital status and total expenditure per enrollee, the number of outpatient visits, hospital admissions, and emergency department (ED) visits during the two-year study period was examined. The results indicate that married individuals had significantly higher health care expenditures than the unmarried. However, there were no significant differences in number of hospital admissions, number of outpatient visits, and number of ED visits. It would behoove health care administrators and policy makers to take into consideration marital status when planning, designing, and implementing health care policies for the elderly.     

2010年青岛市预防保健与社区卫生服务机构间分工合作情况调查分析

[目的]找出制约预防保健机构与社区卫生服务机构之间建立分工协作关系的症结,提出建设性意见。[方法]2010年,用6种调查问卷,对全市疾病预防控制、妇幼保健和12个社区卫生服务机构的负责人和工作人员进行调查,了解其合作关系状况、服务情况和效果等。[结果]72.22%的疾控人员、68.06%妇幼人员认为预防保健机构的技术指导滞后,90.28%的疾控人员、91.67%妇幼人员认为信息沟通不畅,65.28%的疾控人员、68.06%妇幼人员认为合作关系未理顺;不同机构对存在问题的态度存在显著性差异。[结论]应明确预防保健机构的职能定位,理顺其与社区卫生服务机构的合作关系,完善技术指导和信息报告制度,以促进基本公共卫生服务工作的顺利开展。     

Modelling socioeconomic and health determinants of health-care use: a semiparametric approach

This paper suggests bivariate semiparametric index models as a tool for modelling the interplay of socioeconomic and health characteristics in determining health-care utilisation. These models allow for a fully nonparametric relationship between socioeconomic status, health-care need and care utilisation. The only parametric restriction imposed is that multiple socioeconomic and health indicators can be aggregated into two distinct indices that measure the broader concepts of socioeconomic status and health-care need, respectively. We demonstrate the usefulness of this class of models based on an illustrative empirical example. The estimations highlight complex interactions of socioeconomic status and health-care need in determining care use, which may be difficult to grasp via standard parametric modelling approaches.     

Epidemiology and the Italian national health service.

The Italian national health services is under criticism. Although recent legislative changes are intended to introduce managed competition, there is no clear epidemiological view of the health care needs and priorities. Several inconsistencies and inequalities (particularly between the northern and the southern regions) are obvious, both in the health status of the population and in the provision of health care. Problems that should be addressed by future governments are: the uneven distribution of medical technology; the persistence of large inequalities, documented by outcomes such as rheumatic fever, between northern and southern regions; the large variability in clinical practices; the lack of an explicit policy as far as the diffusion of advanced technology is concerned; the ensuing "hidden" rationing; and the peculiar relationship between public and private health structures. Both the current ideological shift towards a market economy for health care and the traditional lack of epidemiological input in health care planning could threaten a rational approach to these problems.     

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.     

Quality of care and its impact on population health: a cross-sectional study from Macedonia

Research has revealed significant variation in both the quality of clinical care and the health status of populations. We conducted a study to determine if variations in the quality of clinical care can be quantitatively linked to variations in health status, at the patient and the population level. This study, conducted at health facilities in four municipalities in Macedonia, collected cross-sectional data on (1) structural measures (such as infrastructure, facilities, equipment and costs) and the quality of clinical care provided by physicians (as measured by clinical vignettes); (2) detailed health and socioeconomic status information on patients using the facilities; and (3) nearly the same information on a random sample of adults in each municipality. Data were collected from a total of 57 facilities, 273 physicians, 1451 patients, and 1627 adults from the general population. The main outcome measure was health status, based on self-reported health surveys. Objective health measures were obtained to control for preexisting conditions. The main explanatory variable was quality of clinical care, based on physicians' clinical vignette scores. Structural measures were included in our model but had a more distal relationship to health status. We found that quality of care strongly predicted self-reported health status of patients using the facilities even after controlling for other factors (p < .05). Quality of care was also associated with higher health status for the population living in the surrounding community, regardless of utilization (p < .05). This linkage between quality of clinical care and health suggests that policies that improve clinical practice have the potential to improve population health more rapidly than other interventions.     

Gesundheit und Gerechtigkeit

The paper discusses issues of justice related to health and illness. The special normative status of health is justified based on Norman Daniels' theory of just health. As the health status of individuals is not only determined by access to health care services, the relationship between social inequalities and health status is described empirically and evaluated from an ethical perspective. There are good ethical and conomical reasons against a purely market driven organization of the health care system. As a result we have to answer the question how we can deal with the increasing scarcity of health care resources. Three strategies are presented and ethically evaluated: (1) Increase efficiency ("rationalization"), (2) increase available resources and (3) limit access to services ("rationing"). Especially the pros and cons of implicit vs. explicit ways to limit services are discussed. Finally, the procedural and material ethical criteria for the just distribution of scarce health care resources are presented.     

Children''s Health Insurance Status, Access to and Utilization of Health Services, and Unmet Health Needs in a Rural Alabama School System

PURPOSE: This study examines the relationship between children's health insurance status and utilization of health services, establishment of a medical home, and unmet health needs over a 3-year period (1996-1998) in a rural Alabama K-12 school system. METHODS: As part of a children's health insurance outreach program, questionnaires were administered to parents of 754 children regarding health and health care access. In addition, noninvasive head-to-toe physical assessments of children were conducted on-site at 4 schools. FINDINGS: A relationship between health care utilization and insurance status was observed. Results found that insured children had 1.183 (P < .0115) times the number of medical visits as uninsured children. Among uninsured children, the time since last dental visit was 1.6 (P < .001) times longer than that of insured children. Also, insured children were 5.21 times more likely than uninsured (P < .0001) to report having a medical home. No significant differences between insured and uninsured children were found regarding unmet health needs as measured by referrals made after the children's physical assessments. CONCLUSIONS: Child health coverage is an important determining factor in the ability of families to access and utilize health care services. These findings have implications for populations in similar rural communities across the nation.     

Health insurance and subjective health status: data from the 1987 National Medical Expenditure survey.

OBJECTIVES. The relationship between health insurance and subjective health status was investigated. It was hypothesized that persons without health insurance would have lower levels of subjective health status than those with health insurance and that this relationship would hold for both poor and nonpoor persons. METHODS. Data from the 1987 National Medical Expenditure Survey were analyzed to examine the relationship between health insurance and self-reported health status. The analysis controlled for sociodemographic and attitudinal variables and medical conditions. RESULTS. Persons without health insurance had significantly lower levels of subjective health status than did persons with insurance. This adverse effect persisted after adjustments were made for the effects of age, sex, race, income, attitude toward the value of medical care and health insurance, and medical conditions. The detrimental effect of lacking health insurance on subjective health status was present for persons at all income levels and was greater than the effect on subjective health status found for 2 of the 11 reported medical conditions. CONCLUSIONS. Lacking health insurance is associated with clinically significant lower levels of subjective health status in both poor and non-poor persons.     

‘Falling off the radar’ of public health: The case of uninsured Chinese patients in Vienna,Austria

In public health policy debates, the 2015–2016 refugee crisis made visible that even in European welfare states with (close to) universal health coverage there are specific vulnerable groups with highly limited access to health care. Among them is a population of so-called ‘undocumented’ or ‘irregular’ migrants who have no regular status of residence and falls off the radar of publicly funded health care services and thus from the public health surveillance systems. The aim of our study is to provide the first-of-its-kind evidence on the characteristics, health problems and health care needs of one such vulnerable group in Austria – Chinese migrants residing in Vienna without a regular status. Medical records of 74 uninsured assumingly undocumented Chinese patients were analysed. The data was provided by a Non-governmental organisation (NGO) which delivers primary care to uninsured people in Vienna. The most frequently diagnosed health problems clustered around cardiovascular and metabolic-related diseases (hypertension and diabetics) and there was a high burden of multiple chorionic non-communicable diseases. Further efforts and resources are needed for collecting more data in a systematic way. A trusting relationship between science and practice and a cooperative relationship between and among the government agencies and NGOs are essential for evidence-based public health policy making.