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1.
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.2.
Objectives
To identify the relationship between diet-related indicators and overweight and obesity in older adults in rural Japan.Design
Cross-sectional survey.Setting
Obira, Hokkaido, Japan.Participants
Local residents aged between 65 and 74 years, except for those with poor health, were included.Intervention
A health- and diet-related questionnaire was applied to participants house-to-house by trained health professionals.Measurements
The following indicators were examined: number of meals, number of balanced meals, food diversity, food group diversity, chewing ability, alcohol intake habit, smoking habit, instrumental activities of daily living scores, age, and residing alone or with family.Results
Of 550 residents, 317 residents completely responded to the questionnaire. Of these, 41 were had low body mass index (BMI≤20) and were excluded. This resulted in a sample of 307 subjects comprising 117 men and 190 women; 37.6% and 46.8% of men and women were classified as obese (BMI≥25), respectively. Women with a normal BMI (20<BMI<25) had significantly higher food diversity in diet-related indicators compared with women with high BMI. The mean number of meals per day of normal men was significantly higher than of obese men. Using logistic regression analysis (stepwise), it was found that the number of meals per day was associated with obesity in men (OR=3.02; 95% CI 0.91–9.98; P=0.071), and food diversity was significantly associated with obesity in women (OR=1.95; 95% CI 1.12–3.38; P=0.018).Conclusions
The associations between dietary indicators and obesity differed by sex. Food diversity may be a potential indicator to measure nutritional status in women.3.
Bach Xuan Tran Victoria L. Boggiano Cuong Tat Nguyen Long Hoang Nguyen Anh Tuan Le Nguyen Carl A. Latkin 《Substance abuse treatment, prevention, and policy》2017,12(1):35
Background
Methadone maintenance treatment (MMT) patients face unique costs associated with their healthcare expenditures. As such, it is important that these patients have access to health insurance (HI) to help them pay for both routine and unforeseen health services. In this study, we explored factors related to health insurance enrollment and utilization among MMT patients, to move Vietnam closer to universal coverage among this patient population.Methods
A cross-sectional study was conducted with 1003 patients enrolled in MMT in five clinics in Hanoi and Nam Dinh provinces. Patients were asked a range of questions about their health, health expenditures, and health insurance access and utilization. We used multivariate logistic regressions to determine factors associated with health insurance access among participants.Results
The majority of participants (nearly 80%) were not currently enrolled in health insurance at the time of the study. Participants from rural regions were significantly more likely than urban participants to report difficulty using HI. Family members of participants from rural regions were more likely to have overall poor service quality through health insurance compared with family members of participants from urban regions. Overall, 37% of participants endorsed a lack of information about HI, nearly 22% of participants reported difficulty accessing HI, 22% reported difficulty using HI, and more than 20% stated they had trouble paying for HI. Older, more highly educated, and employed participants were more likely to have an easier time accessing HI than their younger, less well educated, and unemployed counterparts. HIV-positive participants were more likely to have sufficient information about health insurance options.Conclusions
Our study highlights the dearth of health insurance utilization among MMT patients in northern Vietnam. It also sheds light on factors associated with increased access to and utilization of health insurance among this underserved population. These results can help improve health insurance enrollment among MMT patients, a population that is at increased need of financial assistance in accessing health services.4.
Midori Ishikawa T. Yokoyama Y. Takemi Y. Fukuda T. Nakaya K. Kusama N. Yoshiike M. Nozue K. Yoshiba N. Murayama 《The journal of nutrition, health & aging》2017,21(5):514-520
Objective
This study aimed to examine perceptions of shopping difficulty, and the relationships with satisfaction with state of health and meals, physical condition, food diversity and health behavior in older people living alone in Japan.Design
A cross-sectional, multilevel survey was designed. The questionnaire was distributed by mail and self-completed by participants.Setting
The sample was drawn from seven towns and cities across Japan.Participants
A geographic information system was used to select the sample of older people living alone, by proximity to a supermarket. In total, 2,346 older people (827 men and 1,519 women) completed the questionnaire.Measurements
The dependent variable was whether shopping was easy or difficult. A logistic regression analysis was performed, adjusting for age, socioeconomic status and proximity of residence to a supermarket using stepwise variable analyses.Results
The response rate was 67.8%. Overall, 14.5% of men and 21.7% of women considered shopping difficult. The stepwise logistic analysis showed that the factors most strongly related to shopping difficulty were a subjective feeling of poor health (men: OR = 3.01, women: OR = 2.16) and lack of satisfaction with meals (men: OR = 2.82, women: OR = 3.69). Other related physical condition and dietary factors were requiring nursing care (men: OR = 3.69, women: OR = 1.54), a high level of frailty, measured using the frailty index score (women: OR = 0.36) and low food diversity score (men: OR = 1.84, women: OR = 1.36).Conclusion
The study found that older people’s assessment of their shopping difficulty was related to satisfaction aspects, including a subjective feeling of poor health, and lack of satisfaction with meals, as well as physical condition. These have a greater influence on shopping difficulty than income in both sexes, and proximity to a supermarket in women.5.
Peter Paulus Heinz Hundeloh Kevin Dadaczynski 《Pr?vention und Gesundheitsf?rderung》2016,11(4):237-242
Background
Social insurance agencies are important stakeholders in the field of school health promotion and prevention in Germany. Since 1989 the prevention regulations have given them various guidelines to support schools.Objectives
Opportunities created by the new prevention law and the need for action to strengthen school health promotion and prevention are presented. The different positions of social insurance agencies will be elaborated based on the current situation of school health promotion and prevention in Germany.Results
Schools are described as “social systems of learning”. Interventions on school health promotion and prevention that follow a comprehensive school approach are closely linked to educational school development. This position is also shared by the Standing Conference of the Ministers of Education and Cultural Affairs of the Laender in the Federal Republic of Germany. The social insurance agencies are required to cooperate and jointly establish goals. As a result, structured and systematic interventions on school health promotion and prevention have the potential to overcome a low level of cooperation, a lack of transparency and an often unclear level of intervention effectiveness.Conclusion
It is expected that the new prevention law will give important impetus for further development of school health promotion and prevention (especially with regard to vulnerable groups) in terms of intervention quality and sustainability.6.
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.7.
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.8.
S. Lee A. R. Teschemaker M. Daniel M. K. Maneno A. A. Johnson A. K. Wutoh Euni Lee 《The journal of nutrition, health & aging》2016,20(3):300-305
Objective
This study was conducted to describe a 10-year trend of the supplement from 2000 to 2009 and to evaluate age, gender and racial disparities using a national level health data.Design
Cross-sectional observational study.Setting and Participants
Data collected from patient visit records to stand-alone US ambulatory care clinics. Visits made by men and women who were 40 years of age and older were included (n=175,830).Measurements
Overall prevalence of recorded calcium and vitamin D use for osteoporosis prevention and treatment, and annual visit rates were estimated by age, gender, race, insurance types, physician specialties, geographical regions, and metropolitan status using chi square test. Multivariate logistic regression was conducted to determine potential predictive factors for calcium and vitamin D supplements.Results
An increase in yearly trend of calcium and vitamin D supplements was observed. The increase was proportional to patients’ age (p<0.05) and female gender was a strong predictor of calcium and vitamin D supplement (p<0.0001).Visits made by blacks were significantly less likely to be associated with the supplement (p<0.05). Visits associated with self-pay and Medicaid was less likely to be recorded with vitamin D (p<0.05) but not calcium supplements. Osteoporosis diagnosis was an independent predictor of calcium and vitamin D records (p<0.0001).Conclusions
In spite of the observed increases in the trend of visits associated with calcium and vitamin D supplements, variability in the access to the medications was observed. More focused strategies targeting elderly, men, or black population are needed to maintain and improve adequate calcium and vitamin D supplements.9.
Background
The new Prevention Law includes important starting points to strengthen and to further develop occupational health promotion and prevention practices in Germany. A major impetus lies in the encouragement of specific and better collaboration of social insurance and other health policy players, in establishing corresponding structures and in the rearrangement of the financial basis.Aims
The Prevention Law strengthens the development of health insurance services with respect to content and systematic orientation and evaluation.Results
Opportunties for systematic development of different approaches and services in health promotion and prevention are fostered through the Prevention Law. It covers rules for intersectoral cooperation with the occupational safety and health system, which have been long overdue; finally, it aims at reducing gender inequality with regard to health promotion and prevention.10.
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.11.
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.12.
Objectives
Recent research has shown that ethnic minorities still have less access to medical care and are less satisfied with the treatment they receive and the outcomes of the health care process. This article assesses how migrants in Europe experience access, treatment and outcomes in the European health care systems.Methods
Data were obtained from the QUALICOPC study (Quality and Costs of Primary Care in Europe). Regression analyses were used to estimate the access, treatment and outcomes of care for ethnic minorities.Results
In several countries, migrants experience that the opening hours of their GP practice were too limited and indicate that the practice was too far away from their work or home (lower access). They are more likely to report negative patient–doctor communication and less continuity of care than native patients (worse treatment). In addition, they are less satisfied with the care they received and are more likely to postpone care (worse outcomes).Conclusions
In general, migrants are still disadvantaged during the health care process. However, our results also indicate that satisfaction with the health care process improves for second-generation migrants in comparison with first-generation migrants.13.
Arezoo Yari Saharnaz Nedjat Mohsen Asadi-Lari Reza Majdzadeh 《BMC international health and human rights》2017,17(1):24
Background
Evidence shows ethnic-inequality is a very effective variable in the Community and individual health associated outcomes. This study focused on gaining a deeper understanding of people’s perception on inequality of health in Iranian-Kurds and its determinants.Methods
The study was conducted in the three cities of Marivan, Sanandaj (capital of Kurdistan province in Iran) and Tehran (capital of the country). The study was conducted through 34 in-depth interviews and ten focus group discussions with health services users, academic graduates and health delivery service personnel.Results
Consensus on social, mental and physical health inequality did not exist within the study participants. However, there were concerns about differences in healthcare access and utilization. Several participants believed that access to health services and socio-cultural differences of Kurds affected the healthcare utilization.Conclusions
Since, people perceived ethnic-inequality in healthcare access and utilization, ethnicity must be considered as a mandatory stratifier in monitoring health status and a concern during planning health interventions. People’s awareness, resources management and allocation are factors requiring more consideration when choosing policy options.14.
Background
Schizophrenia remains a priority condition in mental health policy and service development because of its early onset, severity and consequences for affected individuals and households.Aims and methods
This paper reports on an ‘extended’ cost-effectiveness analysis (ECEA) for schizophrenia treatment in India, which seeks to evaluate through a modeling approach not only the costs and health effects of intervention but also the consequences of a policy of universal public finance (UPF) on health and financial outcomes across income quintiles.Results
Using plausible values for input parameters, we conclude that health gains from UPF are concentrated among the poorest, whereas the non-health gains in the form of out-of-pocket private expenditures averted due to UPF are concentrated among the richest income quintiles. Value of insurance is the highest for the poorest quintile and declines with income.Conclusions
Universal public finance can play a crucial role in ameliorating the adverse economic and social consequences of schizophrenia and its treatment in resource-constrained settings where health insurance coverage is generally poor. This paper shows the potential distributional and financial risk protection effects of treating schizophrenia.15.
Jens-Oliver Bock Dirk Heider Herbert Matschinger Hermann Brenner Kai-Uwe Saum Walter E. Haefeli Hans-Helmut König 《The European journal of health economics》2016,17(2):149-158
Introduction
All elderly Germans are legally obliged to have health insurance. About 90 % of this population are members of social health insurances (SHI) whose premiums are generally income-related and independent of health status. For most of these members, holding social health insurance is mandatory. As a consequence, genuine information about preferences for health insurance is not available. The aim of this study was therefore to determine and analyze the willingness to pay (WTP) for health insurance among elderly Germans.Methods
Data from a population-based 8-year follow-up of a large cohort study conducted in the Saarland, Germany was used. Participants aged 57–84 years passed a geriatric assessment and responded to a health economic questionnaire. Individuals’ WTP was elicited based on a contingent valuation method with a payment card.Results
Mean monthly WTP per capita for health insurance amounted to €260. This corresponded to about 20 % of individual disposable income. Regression analyses showed that WTP increased significantly with higher income, male gender, higher educational level, and privately insured status. In contrast, neither increasing morbidity level nor higher individual health care costs influenced WTP significantly.Discussion
The relatively large extent of average WTP for health insurance indicates that the elderly would probably accept higher contributions to SHI rather than policy efforts to reduce contributions. The identified determinants of WTP might indicate that elderly generally approve the principle of solidarity of the SHI with contributions depending on income rather than morbidity.16.
Mirjam Philippi Petra Melchert Dagmar Renaud 《Pr?vention und Gesundheitsf?rderung》2018,13(3):203-210
Background
The inclusion of refugees into the German health system is fraught with challenges. Besides need-based health services, refugees need information that enables them to appropriately use the German health care system and to increase their health literacy.Objectives
The aim of the study was to analyze the demands and needs for further health information for refugees from the views of medical experts and refugees.Materials and methods
In a mixed-methods design, 10 experts (medical staff) were interviewed. Based on the results of this qualitative research, a standardized questionnaire was developed. A total of 100 refugees (76.3% men; mean age 30.5 years; 84.7% came from Syria) answered the questionnaire.Results
The medical experts identified information needs for refugees about structures, access, and characteristics of the German health system. Concerning health knowledge, the experts miss appropriate information about prevention, health behavior, medication management as well as psyche and somatization. For the refugees, information about expenses, contact points in case of emergency and diagnostic screening seemed to be remarkably relevant.Conclusions
The results of this study illustrate health-related information needs of refugees. The results serve as a basis for target health information and health promotion. They can alert health care staff to the health information needs of refugees. Important topics for more understandable information seem to be the access to health system and additional costs for health services.17.
Raimund Geene Antje Richter-Kornweitz Petra Strehmel Susanne Borkowski 《Pr?vention und Gesundheitsf?rderung》2016,11(4):230-236
Background
The German law to strengthen health promotion and prevention (Prevention Law, PraevG 2015) along with the Federal Recommendations Framework recognize daycare centers for children as a central setting for health promotion. However, concrete regulations and strategies to support implementation are currently lacking.Objective
The objective of this article is to discuss how day-care centers for children can be established as a central setting for health promotion in practice.Methods
The new legal regulations for the setting approach and the agreements with daycare centers of the national prevention conference are presented, the field-specific challenges for health care promotion in daycare enters are compared, the current situation is analyzed, and the needs for action are identified based on the evaluation of the health objective and the federal health report.Results
The Prevention Law (PraevG 2015) has substantially improved the situation to initiate health promotion activities in daycare centers for children. Educational frameworks offer a number of points for further contact regarding health promotion activities. While a large number of health promotion activities already exist, they mainly tend to be isolated projects offered by various health insurance funds rather than a coordinated approach.Conclusion
New opportunities should be used to focus on quality development and coordination of the existing programs with due consideration of field-specific requirements. A comprehensive strategy to promote and guide coordinated efforts for activities is needed to replace the current trend of isolated programs.18.
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