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Pulido J, Barrio G, Donat M, Politi J, Moreno A, Cea-Soriano L, Guerras JM, Huertas L, Mateo-Urdiales A, Ronda E, Martínez D, Lostao L, Belza MJ, Regidor E. Excess Mortality During 2020 in Spain: The Most Affected Population, Age, and Educational Group by the COVID-19 Pandemic. Disaster Med Public Health Prep 2024; 18:e27. [PMID: 38372080 DOI: 10.1017/dmp.2024.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
OBJECTIVE The objective of this work was to study mortality increase in Spain during the first and second academic semesters of 2020, coinciding with the first 2 waves of the Covid-19 pandemic; by sex, age, and education. METHODS An observational study was carried out, using linked populations and deaths' data from 2017 to 2020. The mortality rates from all causes and leading causes other than Covid-19 during each semester of 2020, compared to the 2017-2019 averages for the same semester, was also estimated. Mortality rate ratios (MRR) and differences were used for comparison. RESULTS All-cause mortality rates increased in 2020 compared to pre-covid, except among working-age, (25-64 years) highly-educated women. Such increases were larger in lower-educated people between the working age range, in both 2020 semesters, but not at other ages. In the elderly, the MMR in the first semester in women and men were respectively, 1.14, and 1.25 among lower-educated people, and 1.28 and 1.23 among highly-educated people. In the second semester, the MMR were 1.12 in both sexes among lower-educated people and 1.13 in women and 1.16 in men among highly-educated people. CONCLUSION Lower-educated people within working age and highly-educated people at older ages showed the greatest increase in all-cause mortality in 2020, compared to the pre-pandemic period.
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Affiliation(s)
- José Pulido
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Gregorio Barrio
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Donat
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Julieta Politi
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Almudena Moreno
- Department of Sociology, Universidad Pública de Navarra, Spain
| | - Lucía Cea-Soriano
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Juan Miguel Guerras
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Lidia Huertas
- Instituto Valenciano de Estadística, Valencia, Spain
- National Epidemiology Center, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Elena Ronda
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Preventive Medicine and Public Health Area, Universidad de Alicante, Alicante, Spain
| | - David Martínez
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Lourdes Lostao
- Department of Sociology, Universidad Pública de Navarra, Spain
| | - María José Belza
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- National School of Public Health, Instituto de Salud Carlos III, Madrid, Spain
| | - Enrique Regidor
- Department of Public Health and Maternal & Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Yuan L, Cao J, Wang D, Yu D, Liu G, Qian Z. Regional disparities and influencing factors of high quality medical resources distribution in China. Int J Equity Health 2023; 22:8. [PMID: 36627636 PMCID: PMC9832614 DOI: 10.1186/s12939-023-01825-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND With the gradual increase of residents' income and the continuous improvement of medical security system, people's demand for pursuing higher quality and better medical and health services has been released. However, so far little research has been published on China's high quality medical resources (HQMR). This study aims to understand the spatiotemporal variation trend of HQMR from 2006 to 2020, analyze regional disparity of HQMR in 2020, and further explore the main factors influencing the distribution of HQMR in China. METHODS The study selected Class III level A hospitals (the highest level medical institutions in China) to represent HQMR. Descriptive statistical methods were used to address the changes in the distribution of HQMR from 2006 to 2020. Lorentz curve, Gini coefficient (G), Theil index (T) and High-quality health resource density index (HHRDI) were used to calculate the degree of inequity. The geographical detector method was used to reveal the key factors influencing the distribution of HQMR. RESULTS The total amount of HQMR in China had increased year by year, from 647 Class III level A hospitals in 2006 to 1580 in 2020. In 2020, G for HQMR by population was 0.166, while by geographic area was 0.614. T was consistent with the results for G, and intra-regional contribution rates were higher than inter-regional contribution rates. HHRDI showed that Beijing, Shanghai, and Tianjin had the highest allocated amounts of HQMR. The results of the geographical detector showed that total health costs, government health expenditure, size of resident populations, GDP, number of medical colleges had a significant impact on the spatial distribution of HQMR and the q values were 0.813, 0.781, 0.719, 0.661, 0.492 respectively. There was an interaction between the influencing factors. CONCLUSIONS China's total HQMR is growing rapidly but is relatively inadequate. The distribution of HQMR by population is better than by geography, and the distribution by geography is less equitable. Population size and geographical area both need to be taken into account when formulating policies, rather than simply increasing the number of HQMR.
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Affiliation(s)
- Lei Yuan
- grid.452223.00000 0004 1757 7615Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan China
| | - Jing Cao
- grid.431010.7Department of Cardiovascular Medicine, Third Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Dong Wang
- grid.452223.00000 0004 1757 7615Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Dan Yu
- grid.452223.00000 0004 1757 7615Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan China
| | - Ge Liu
- grid.452223.00000 0004 1757 7615Xiangya Hospital, Central South University, Changsha, Hunan China
| | - Zhaoxin Qian
- grid.452223.00000 0004 1757 7615Xiangya Hospital, Central South University, Changsha, Hunan China ,grid.452223.00000 0004 1757 7615National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan China
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Grau-Pérez M, Borrego L, Carretero G, Almeida P, Cano J. Assessing the effect of environmental and socio-economic factors on skin melanoma incidence: an island-wide spatial study in Gran Canaria (Spain), 2007-2018. Cancer Causes Control 2022; 33:1261-1272. [PMID: 35925499 PMCID: PMC9427872 DOI: 10.1007/s10552-022-01614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/12/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Skin melanoma incidence has risen in the last decades becoming a major public health problem in many regions of the world. Geographic variation of rates is not well understood. PURPOSE To assess the spatial distribution of skin melanoma in Gran Canaria Island (Canary Islands, Spain) and to evaluate the role of environmental, socio-economic, and demographic factors in this distribution. METHODS We performed a small-area study with disease mapping at the census-tract level (CT) in Gran Canaria between 2007 and 2018. After testing for spatial autocorrelation, we integrated individual-level health data with census-based demographic and socio-economic indicators, and satellite-based environmental data. Finally, we assessed the role of demographic, socio-economic and environmental factors on skin melanoma incidence using a Bayesian analytical framework, with options for non-spatial and spatial random effects. RESULTS 1058 patients were diagnosed with invasive skin melanoma in the study period and geolocated to a CT (number of CT in Gran Canaria = 565). We found evidence of global spatial autocorrelation in skin melanoma incidence (Moran's I = 0.09, pseudo p-value = 0.001). A few hotspots were detected, fundamentally in urban northern tracts. A radial pattern of high values was also observed in selected ravines with historical isolation. Multivariable conditional autoregressive models identified urbanicity, percent of females, and a high socio-economic status as risk factors for disease. Solar radiation did not show a significant role. CONCLUSION Urbanicity and a high socio-economic status were identified as the main risk factors for skin melanoma. These associations might reflect differential melanoma susceptibilities or be explained by health inequalities in detection. This study also uncovered high-risk areas in particular ravines. Future targeted research in these regions might help better understand the role of genetic and toxic factors in melanoma pathogenesis.
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Affiliation(s)
- Mercè Grau-Pérez
- grid.4521.20000 0004 1769 9380Universidad de Las Palmas de Gran Canaria (ULPGC), Calle Juan de Quesada 30, 35001 Las Palmas de Gran Canaria, Spain ,grid.73221.350000 0004 1767 8416Dermatology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Leopoldo Borrego
- grid.4521.20000 0004 1769 9380Universidad de Las Palmas de Gran Canaria (ULPGC), Calle Juan de Quesada 30, 35001 Las Palmas de Gran Canaria, Spain
| | - Gregorio Carretero
- grid.411250.30000 0004 0399 7109Dermatology Department, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain
| | - Pablo Almeida
- grid.411322.70000 0004 1771 2848Dermatology Department, Complejo Hospitalario Universitario Insular-Materno Infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Jorge Cano
- Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN), World Health Organization’s Regional Office for Africa, Brazzaville, Republic of the Congo
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Nurminen M, Blomgren J. Associations of Medical Visits with Dentist Visits: A Register-Linkage Study of a Working-Age Population in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:13337. [PMID: 34948946 PMCID: PMC8703975 DOI: 10.3390/ijerph182413337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/30/2022]
Abstract
Studies have usually addressed the utilization of either medical or dental services, and less is known about how medical and dentist visits are associated. As oral health is linked to systemic health, knowledge on care coordination between dental and medical services is important to gain understanding of the overall functioning of health care. Register data on 25-64-year-old residents of the city of Oulu, Finland, were used for the years 2017-2018 (N = 91,060). Logit models were estimated to analyze the probability of dentist visits, according to the number of medical visits in total and by three separate health care sectors. The majority, 61%, had visited both a medical professional and a dentist. All sectors combined, as few as one to two visits increased the odds of dentist visits (OR: 1.43, CI: 1.33, 1.53). When separated by medical professionals' health care sectors, for one to two visits, the strongest association was found with public (OR: 1.17, CI: 1.12, 1.22) and private sector (OR: 1.35, CI: 1.30, 1.41). For occupational health service visits, the odds increased only after six or more visits. The results support the idea of integrated medical and dental care. However, the result may also arise from individual health behavior where health-conscious persons seek both medical and dental care independently.
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Affiliation(s)
- Mikko Nurminen
- Research Unit, The Social Insurance Institution of Finland, P.O. Box 450, 00056 Helsinki, Finland;
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Tang S, Yao L, Ye C, Li Z, Yuan J, Tang K, Qian D. Can health service equity alleviate the health expenditure poverty of Chinese patients? Evidence from the CFPS and China health statistics yearbook. BMC Health Serv Res 2021; 21:718. [PMID: 34289849 PMCID: PMC8293547 DOI: 10.1186/s12913-021-06675-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/17/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives To comprehend the relationship between various indicators of health service equity and patients’ health expenditure poverty in different regions of China, identify areas where equity in health service is lacking and provide ideas for improving patients’ health expenditure poverty. Method Data from China Family Panel Studies (CFPS) in 2018 and the HFGT index formula were used to calculate the health expenditure poverty index of each province. Moreover, Global Moran’s I and Local Moran’s I test are applied to measure whether there is spatial aggregation of health expenditure poverty. Finally, an elastic net regression model is established to analyze the impact of health service equity on health expenditure poverty, with the breadth of health expenditure poverty as the dependent variable and health service equity as the independent variable. Results In the developed eastern provinces of China, the breadth of health expenditure poverty is relatively low. There is a significant positive spatial agglomeration. “Primary medical and health institutions per 1,000 population”, “rural doctors and health workers per 1,000 population”, “beds in primary medical institutions per 1,000 population”, “proportion of government health expenditure” and “number of times to participate in medical insurance (be aided) per 1,000 population” have a positive impact on health expenditure poverty. “Number of health examinations per capita” and “total health expenditure per capita” have a negative impact on health expenditure poverty. Both effects passed the significance test. Conclusion To enhance the fairness of health resource allocation in China and to alleviate health expenditure poverty, China should rationally plan the allocation of health resources at the grassroots level, strengthen the implementation of hierarchical diagnosis and treatment and encourage the investment in business medical insurance industry. Meanwhile, it is necessary to increase the intensity of medical assistance and enrich financing methods. All medical expenses of the poorest should be covered by the government. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06675-y.
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Affiliation(s)
- Shaoliang Tang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China.
| | - Ling Yao
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Chaoyu Ye
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhengjun Li
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jing Yuan
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Kean Tang
- Faculty of Science, Skane, Lund University, Lund, Sweden
| | - David Qian
- Swinburne Business School, Swinburne University of Technology, Melbourne, Australia
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Perhoniemi R, Blomgren J. Frequent attenders of three outpatient health care schemes in Finland: characteristics and association with long-term sickness absences, 2016-2018. BMC Public Health 2021; 21:870. [PMID: 33957897 PMCID: PMC8101095 DOI: 10.1186/s12889-021-10866-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/12/2021] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES Frequent attenders (FAs) impose a significant burden on service capacity and public health funding. Although the characteristics of the group and their risk for sickness absences (SA) have been studied, an understanding of FAs in different health care schemes is lacking. The aim of the study was to investigate FAs and their SA risk in the working-age population in public care, occupational health services (OHS) and private care schemes. The average number of SA days was also examined by diagnostic group. SETTING AND PARTICIPANTS Register data on the use of outpatient health care, sickness allowance spells and background characteristics (2015-2018) for 25-64 year old residents of the city of Oulu, Finland, (n = 91,737) were used. Subjects were categorized into non-attenders, non-frequent attenders and FAs (top decile of attenders) both for all outpatient health care and specifically for each care scheme in 2016. The number of sickness absence days was measured yearly in 2016, 2017 and 2018. The data were analyzed with descriptive methods and negative binomial regression models. RESULTS FAs consumed 31 to 44% of all visits depending on scheme in 2016. Frequent attendance was common among low socioeconomic groups in the public scheme, among lower non-manual employees and manual workers in OHS, and among entrepreneurs in the private scheme. FAs had a higher average number of SA days than others in each scheme, although group differences decreased from 2016 to 2017 and 2018. In public care, the adjusted effect of frequent attendance was strong especially for SA due to mental disorders (adjusted incidence rate ratio [IRR] for FAs 13.40), and in OHS for SA due to musculoskeletal disorders (adjusted IRR for FAs 8.68). CONCLUSION In each outpatient health care scheme, frequent attenders pose a great challenge both by consuming services and through their increased risk of disability. FAs in different schemes have partially different characteristics and risks. Common patient registers covering various service schemes would enable an identification of FAs visiting multiple schemes and services. Better coordinated services are needed for public care FAs in particular.
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Affiliation(s)
- Riku Perhoniemi
- The Social Insurance Institution of Finland, P.O. Box 450, 00056 KELA, Helsinki, Finland
| | - Jenni Blomgren
- The Social Insurance Institution of Finland, P.O. Box 450, 00056 KELA, Helsinki, Finland
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Carmona R, Cook BL, Baca-García E, Chavez L, Alvarez K, Iza M, Alegría M. Comparison of Mental Health Treatment Adequacy and Costs in Public Hospitals in Boston and Madrid. J Behav Health Serv Res 2020. [PMID: 29516339 DOI: 10.1007/s11414-018-9596-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Analyses of healthcare expenditures and adequacy are needed to identify cost-effective policies and practices that improve mental healthcare quality. Data are from 2010 to 2012 electronic health records from three hospital psychiatry departments in Madrid (n = 29,944 person-years) and three in Boston (n = 14,109 person-years). Two-part multivariate generalized linear regression and logistic regression models were estimated to identify site differences in mental healthcare expenditures and quality of care. Annual total average treatment expenditures were $4442.14 in Boston and $2277.48 in Madrid. Boston patients used inpatient services more frequently and had higher 30-day re-admission rates (23.7 vs. 8.7%) despite higher rates of minimally adequate care (49.5 vs. 34.8%). Patients in Madrid were more likely to receive psychotropic medication, had fewer inpatient stays and readmissions, and had lower expenditures, but had lower rates of minimally adequate care. Differences in insurance and healthcare system policies and mental health professional roles may explain these dissimilarities.
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Affiliation(s)
- Rodrigo Carmona
- Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance and Harvard Medical School, Cambridge, MA, 01241, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Enrique Baca-García
- Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain.,Psychiatry Department, Autonoma University of Madrid, Madrid, Spain.,Department of Psychiatry, University Hospital Rey Juan Carlos, Madrid, Spain.,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain.,Department of Psychiatry, University Hospital Infanta Elena, Madrid, Spain.,CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain.,Universidad Católica del Maule, Curico, Chile
| | - Ligia Chavez
- Behavioral Sciences Research Institute, University of Puerto Rico Medical Sciences Campus, Rio Piedras, 00935, Puerto Rico
| | - Kiara Alvarez
- Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA
| | - Miren Iza
- Fundación Jiménez Díaz, Avda. Reyes Católicos, 2, 28040, Madrid, Spain
| | - Margarita Alegría
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA. .,Disparities Research Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, 50 Staniford Street, Suite 830, Boston, MA, 02114, USA.
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Abuduxike G, Aşut Ö, Vaizoğlu SA, Cali S. Health-Seeking Behaviors and its Determinants: A Facility-Based Cross-Sectional Study in the Turkish Republic of Northern Cyprus. Int J Health Policy Manag 2020; 9:240-249. [PMID: 32613792 PMCID: PMC7382910 DOI: 10.15171/ijhpm.2019.106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 10/26/2019] [Indexed: 12/16/2022] Open
Abstract
Background: Understanding health-seeking behaviors and determining factors help governments to adequately allocate and manage existing health resources. The aim of the study was to examine the health-seeking behaviors of people in using public and private health facilities and to assess the factors that influence healthcare utilization in Northern Cyprus. Methods: A cross-sectional study was conducted in 2 polyclinics among 507 people using a structured intervieweradministered questionnaire. Health-seeking behaviors were measured using four indicators including routine medical check-ups, preferences of healthcare facilities, admission while having health problems, and refusal of health services while ill. Descriptive statistics and multivariable logistic regression analyses were done to explore factors influencing the use of health services. Results: About 77.3% of the participants reported to have visited health centers while they had any health problems. More than half (51.7%) of them had a routine medical check-up during the previous year, while 12.2% of them had refused to seek healthcare when they felt ill during the last five years. Of all, 39.1% of them reported preferring private health services. Current smokers (adjusted odds ratio [AOR]=1.92, 95% CI: 1.17-3.14), having chronic diseases (AOR=2.05, 95% CI: 1.95-2.16), having poor perceptions on health (AOR=2.33; 95% CI: 1.563.48), and spending less on health during the last three months (AOR=2.08, 95% CI: 1.43- 3.01) had about twice the odds of having routine checkups. Higher education (AOR=1.87, 95% CI: 1.38-2.55) was shown to be a positive predictor for the health-seeking behaviors, whereas having self-care problems (AOR=0.18, 95% CI: 0.08-0.40) and having a moderate-income (AOR=0.68, 95% CI: 0.57-0.81) were inversely associated with seeking healthcare. Conclusion: The utilization of public and private health sectors revealed evident disparities in the socio-economic characteristics of participants. The health-seeking behaviors were determined by need factors including chronic disease status and having poor health perception and also by enabling factors such as education, income, insurance status and ability to pay by oneself. These findings highlight the need for further nationwide studies and provide evidence for specific strategies to reduce the socioeconomic inequalities in the use of healthcare services.
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Affiliation(s)
| | - Özen Aşut
- Medical Faculty, Near East University, Nicosia,TRNC, Turkey
| | | | - Sanda Cali
- Medical Faculty, Near East University, Nicosia,TRNC, Turkey
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Pianori D, Maietti E, Lenzi J, Quargnolo M, Guicciardi S, Adja KYC, Fantini MP, Toth F. Sociodemographic and health service organizational factors associated with the choice of the private versus public sector for specialty visits: Evidence from a national survey in Italy. PLoS One 2020; 15:e0232827. [PMID: 32379839 PMCID: PMC7205245 DOI: 10.1371/journal.pone.0232827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/22/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Although Italy's NHS is funded through general taxation, the private sector plays an important role in health service provision and financing. The aim of this paper was to identify the sociodemographic and health service organizational factors associated with the propensity to seek specialist care in the private sector. MATERIALS AND METHODS Data were retrieved from the national Istat survey "Health conditions and use of health services" carried out in 2012-2013. We selected adults with a specialty visit in the previous 12 months in the four most frequent medical specialties: ophthalmology, cardiology, obstetrics/gynecology and orthopedics. The study outcome was the choice to use a private service. In order to investigate the determinants of private use, we adopted the socio-behavioral model by Andersen and Newman, making a distinction between sociodemographic and healthcare organizational factors. The associations with the outcome were analyzed using chi-squared test, t-test and multivariable logistic regression analysis. RESULTS AND DISCUSSION Use of private care varied widely, from 26.3% for cardiology to 53.6% for obstetrics/gynecology. Females, patients with higher educational levels and patients with higher self-reported economic resources sought more frequently private healthcare for all specialties; younger patients and employed patients were more likely to seek private care for ophthalmic conditions. Exemption from copayment for public services reduced more than half the propensity to seek private care. Trust in this healthcare service was the main reason for private users (52.5%) followed by waiting time (26.7%) and physician choice (20.1%). CONCLUSION The attitude of the population to use private services for specialist visits is linked both to sociodemographic and health services organizational factors: the former are unmodifiable while the latter are susceptible to managerial and health policy actions. In a public-financed, universal coverage system, policy makers may act upon the organizational factors that make private health facilities more attractive in order to reduce private care use.
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Affiliation(s)
- Davide Pianori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- * E-mail:
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Mattia Quargnolo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Stefano Guicciardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | | | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Federico Toth
- Department of Political and Social Sciences, University of Bologna, Bologna, Italy
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10
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Blomgren J, Virta LJ. Socioeconomic differences in use of public, occupational and private health care: A register-linkage study of a working-age population in Finland. PLoS One 2020; 15:e0231792. [PMID: 32298356 PMCID: PMC7162494 DOI: 10.1371/journal.pone.0231792] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/31/2020] [Indexed: 11/18/2022] Open
Abstract
There is little knowledge on socioeconomic differences in use of health care organized by different care schemes and on exclusive and concurrent use of health care at different schemes in different socioeconomic groups. In Finland, public, occupational and private schemes offer parallel outpatient primary health care services. Each scheme mainly reaches different population groups because of differences in availability, costs and gatekeeping. This study aimed to analyse how the probability of using health care organized by the three schemes differed by socioeconomic status in a working-age population. Individual-level register-based data on use of public, occupational and private outpatient primary health care during 2013 as well as data on sociodemographic covariates were linked for the total population aged 25-64 of the city of Oulu, Finland. Data were analysed with descriptive methods and multinomial logistic regression models. Those in the study population most often used only occupational care or only public care, or did not use any of the studied health care schemes at all. The lower the socioeconomic status, the higher was the probability of not using care or using only public care. The higher the socioeconomic status, the higher was the probability of using occupational care-either only occupational care or occupational care in combination with private care. Education, occupational class and income were all associated with care use also when adjusted for sociodemographic covariates and chronic disease, but income proved to be the strongest predictor of the three. The results reflect the design of the Finnish health care system, with a strong occupational health care scheme for the employed population contributing to inequality in use of health care and potentially to health inequality between socioeconomic groups.
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Affiliation(s)
- Jenni Blomgren
- Research Unit, The Social Insurance Institution of Finland (Kela), Helsinki, Finland
| | - Lauri J. Virta
- Research Unit, The Social Insurance Institution of Finland (Kela), Turku, Finland
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Zhang T, Liu C, Liu L, Gan Y, Lu W, Tao H. General practice for the poor and specialist services for the rich: inequality evidence from a cross-sectional survey on Hangzhou residents, China. Int J Equity Health 2019; 18:69. [PMID: 31088453 PMCID: PMC6518799 DOI: 10.1186/s12939-019-0966-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 04/22/2019] [Indexed: 12/03/2022] Open
Abstract
Background Inequalities in health care services are becoming an increasing concern in the world including in China. This study measured the income-related inequalities of residents in Hangzhou of China in access to general practice and specialist care and identified socioeconomic factors associated with such inequalities. Methods A cross-sectional questionnaire survey was conducted on 1048 residents in ten urban communities in Hangzhou, China. The percentage and frequency of respondents visiting general practice (GP) and hospital specialist clinics over the past four weeks prior to the survey were estimated. Income-related inequalities in access to these services were measured by the concentration index. Logistic regression and Poisson regression models were established to decompose the contributions of socioeconomic factors (residency, income, education, marital status, and social health insurance) to the inequalities in the probability and frequency of accessing these services, respectively, after adjustment for the needs factors (age, sex and illness conditions). Results The GP services were in favor of the poor, with a concentration index of − 0.0464 and − 0.1346 for the probability and frequency of GP visits, respectively. In contrast, the specialist services were in favor of the rich, with a concentration index of 0.1258 and 0.1279 for the probability and frequency of specialist visits, respectively. Income is the biggest contributor to the inequalities, except for the frequency of visits to specialists in which education played the greatest role. Conclusions Income-related inequalities in GP and specialist care are evident in China. Policy interventions should pay increasing attention to the emergence of a two-tier system, potentially enlarging socioeconomic disparities in health care services. Electronic supplementary material The online version of this article (10.1186/s12939-019-0966-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tao Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13, Aviation Road, Qiaokou District, Wuhan, Hubei, China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Lingrui Liu
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA.,Global Health Leadership Initiative, Yale University, New Haven, CT, USA
| | - Yong Gan
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - Wei Lu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13, Aviation Road, Qiaokou District, Wuhan, Hubei, China
| | - Hongbing Tao
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No.13, Aviation Road, Qiaokou District, Wuhan, Hubei, China.
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12
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San Sebastián M, Mosquera PA, Ng N, Gustafsson PE. Health care on equal terms? Assessing horizontal equity in health care use in Northern Sweden. Eur J Public Health 2018; 27:637-643. [PMID: 28340208 DOI: 10.1093/eurpub/ckx031] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background The Swedish health care system has successively moved toward increased market-orientation, which has raised concerns as to whether Sweden still offers health on equal terms. To explore this issue, this study aimed (i) to assess if the principles of horizontal equity (equal access for equal need regardless of socio-economic factors) are met in Northern Sweden 2006-14; and (ii) to explore the contribution of different factors to the inequalities in access along the same period. Methods Data came from cross sectional surveys known in 2006, 2010 and 2014 targeting 16-84-year-old residents in the four northern-most counties in Sweden. The horizontal inequity index was calculated based on variables representing (i) the individual socioeconomic status, (ii) the health care needs, (iii) non-need factors as well as (iv) health care utilization: general practitioner (GP), specialist doctors, hospitalization. Decomposition analysis of the concentration index for need-standardized health care utilization was applied. Results Adjusting for needs, there was a higher use of GP services by rich people during the two last surveys, a roughly equal use of specialists, and hospitalization concentrated among the poor but with a clear time trend toward equality. The pro-rich inequalities in GP use were to a large part explained by the income gap. Conclusion While health care utilization can be considered equitable regarding specialist and hospital use, the increasing pro-rich trend in the use of GP is a concern. Further studies are required to investigate the reasons and a constant monitoring of socioeconomic differences in health care access is recommended.
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Affiliation(s)
- Miguel San Sebastián
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Nursing I, University of Basque Country, Bilbao, Spain
| | - Paola A Mosquera
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Nawi Ng
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Per E Gustafsson
- Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Tornero Patricio S, Charris-Castro L, Granero Asencio M, Daponte Codina A. Influence of postcode on paediatric admissions in Seville. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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14
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Chamla D, Asadu C, Adejuyigbe E, Davies A, Ugochukwu E, Umar L, Oluwafunke I, Hassan-Hanga F, Onubogu C, Tunde-Oremodu I, Madubuike C, Umeadi E, Epundu O, Omosun A, Anigilaje E, Adeyinka D. Caregiver satisfaction with paediatric HIV treatment and care in Nigeria and equity implications for children living with HIV. AIDS Care 2017; 28 Suppl 2:153-60. [PMID: 27392010 PMCID: PMC4991217 DOI: 10.1080/09540121.2016.1176682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Caregiver satisfaction has the potential to promote equity for children living with HIV, by influencing health-seeking behaviour. We measured dimensions of caregiver satisfaction with paediatric HIV treatment in Nigeria, and discuss its implications for equity by conducting facility-based exit interviews for caregivers of children receiving antiretroviral therapy in 20 purposively selected facilities within 5 geopolitical zones. Descriptive analysis and factor analysis were performed. Due to the hierarchical nature of the data, multilevel regression modelling was performed to investigate relationships between satisfaction factors and socio-demographic variables. Of 1550 caregivers interviewed, 63% (95% CI: 60.6–65.4) reported being very satisfied overall; however, satisfaction varied in some dimensions: only 55.6% (53.1–58.1) of caregivers could talk privately with health workers, 56.9% (54.4–59.3) reported that queues to see health workers were too long, and 89.9% (88.4–91.4) said that some health workers did not treat patients living with HIV with sufficient respect. Based on factor analysis, two underlying factors, labelled Availability and Attitude, were identified. In multilevel regression, the satisfaction with availability of services correlated with formal employment status (p < .01), whereas caregivers receiving care in private facilities were less likely satisfied with both availability (p < .01) and attitude of health workers (p < .05). State and facility levels influenced attitudes of the health workers (p < .01), but not availability of services. We conclude that high levels of overall satisfaction among caregivers masked dissatisfaction with some aspects of services. The two underlying satisfaction factors are part of access typology critical for closing equity gaps in access to HIV treatment between adults and children, and across socio-economic groups.
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Affiliation(s)
- Dick Chamla
- a Health Section , UNICEF , New York , NY , USA
| | | | - Ebun Adejuyigbe
- c Faculty of Clinical Sciences , Obafemi Awolowo University , Ile-Ife , Nigeria
| | | | - Ebele Ugochukwu
- e Department of Paediatrics , Nnamdi Azikiwe University Teaching Hospital , Nnewi Anambra State , Nigeria
| | - Lawal Umar
- f Department of Paediatrics , ABU Teaching Hospital Zaria , Kaduna State , Nigeria
| | | | - Fatimah Hassan-Hanga
- h Paediatrics Department , Aminu Kano Teaching Hospital/Bayero University , Kano State , Nigeria
| | - Chinyere Onubogu
- e Department of Paediatrics , Nnamdi Azikiwe University Teaching Hospital , Nnewi Anambra State , Nigeria
| | - Immaculata Tunde-Oremodu
- i Paediatric HIV and Infectious Disease Unit , Federal Medical Centre , Yenagoa Bayelsa State , Nigeria
| | - Chinelo Madubuike
- e Department of Paediatrics , Nnamdi Azikiwe University Teaching Hospital , Nnewi Anambra State , Nigeria
| | - Esther Umeadi
- e Department of Paediatrics , Nnamdi Azikiwe University Teaching Hospital , Nnewi Anambra State , Nigeria
| | - Obed Epundu
- e Department of Paediatrics , Nnamdi Azikiwe University Teaching Hospital , Nnewi Anambra State , Nigeria
| | | | - Emmanuel Anigilaje
- f Department of Paediatrics , ABU Teaching Hospital Zaria , Kaduna State , Nigeria
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15
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Pallegedara A, Grimm M. Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka. Health Policy Plan 2017; 32:1267-1284. [DOI: 10.1093/heapol/czx085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 11/13/2022] Open
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16
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Zhang T, Xu Y, Ren J, Sun L, Liu C. Inequality in the distribution of health resources and health services in China: hospitals versus primary care institutions. Int J Equity Health 2017; 16:42. [PMID: 28253876 PMCID: PMC5335774 DOI: 10.1186/s12939-017-0543-9] [Citation(s) in RCA: 159] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 02/24/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Equity is one of the major goals of China's recent health system reform. This study aimed to evaluate the equality of the distribution of health resources and health services between hospitals and primary care institutions. METHODS Data of this study were drawn from the China Health Statistical Year Books. We calculated Gini coefficients based on population size and geographic size, respectively, for the indicators: number of institutions, number of health workers and number of beds; and the concentration index (CI) for the indicators: per capita outpatient visits and annual hospitalization rates. RESULTS The Gini coefficients against population size ranged between 0.17 and 0.44 in the hospital sector, indicating a relatively good equality. The primary care sector showed a slightly higher level of Gini coefficients (around 0.45) in the number of health workers. However, inequality was evident in the geographic distribution of health resources. The Gini coefficients exceeded 0.7 in the geographic distribution of institutions, health workers and beds in both the hospital and the primary care sectors, indicating high levels of inequality. The CI values of hospital inpatient care and outpatient visits to primary care institutions were small (ranging from -0.02 to 0.02), indicating good wealth-related equality. The CI values of outpatient visits to hospitals ranged from 0.16 to 0.21, indicating a concentration of services towards the richer populations. By contrast, the CI values of inpatient care in primary care institutions ranged from -0.24 to -0.22, indicating a concentration of services towards the poorer populations. The eastern developed region also had a high internal inequality compared with the other less developed regions. CONCLUSION Significant inequality in the geographic distribution of health resources is evident, despite a more equitable per capita distribution of resources. Richer people are more likely to use well-resourced hospitals for outpatient care. By contrast, poorer people are more likely to use poorly-resourced primary care institutions for inpatient care. There is a risk of the emergence of a two-tiered health care delivery system.
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Affiliation(s)
- Tao Zhang
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang 310036 China
| | - Yongjian Xu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi 710000 China
| | - Jianping Ren
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang 310036 China
| | - Liqi Sun
- School of Medicine, Hangzhou Normal University, Hangzhou, Zhejiang 310036 China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, 3086 Australia
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17
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Tornero Patricio S, Charris-Castro L, Granero Asencio M, Daponte Codina A. [Influence of postcode on paediatric admissions in Seville]. An Pediatr (Barc) 2017; 87:320-329. [PMID: 28063821 DOI: 10.1016/j.anpedi.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/23/2016] [Accepted: 12/01/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The postcode (where the home is situated) is an indicator of socioeconomic status and is associated with morbidity, mortality, and the use of health services. The aim of this study was to analyse its effects on paediatric admissions and to determine the rates of the most common causes of paediatric admissions in Seville. MATHERIAL AND METHODS An observational cross-sectional study with two analysis units: under 15 year-old "admissions" in public hospitals in Seville (n=2,660) and "city districts" of Seville (n=11). The independent variable analysed was whether the postcode of the admitted patients was within a Regional Government designated "area with social transformation needs". The analysis of the admissions was performed using X2-test, Fisher test and Student-t test, with the description of rates using the calculation of crude and specific rates, and by rate ratio. RESULTS Children living in districts with a lower socioeconomic status were on average 7 months younger (P<.001), and they were significantly more likely to be admitted via the emergency department (P<.001). There was no statistical difference detected in either the length of hospital stay or mortality. The crude admission rate ratio was higher in districts with a lower socioeconomic status (1.8), with a higher specific rate ratio detected in admissions due to asthma, respiratory infections, inguinal hernia, and epilepsy/convulsions. CONCLUSIONS Paediatric hospital admission rates of the main diagnoses were higher in districts with a lower socioeconomic status. Children living in these districts were more likely to be admitted younger and via the emergency department.
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Affiliation(s)
- Sebastián Tornero Patricio
- Pediatría Atención Primaria, Distrito Sevilla de Atención Primaria, Servicio Andaluz de Salud, Sevilla, España.
| | - Liliana Charris-Castro
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen del Rocío, Servicio Andaluz de Salud, Sevilla, España
| | - Mercedes Granero Asencio
- Unidad de Neonatología, Hospital Universitario Virgen Macarena, Servicio Andaluz de Salud, Sevilla, España
| | - Antonio Daponte Codina
- Ciber de Epidemiología y Salud Pública (CIBERESP), Observatorio de Salud y Medio Ambiente de Andalucía (OSMAN), Escuela Andaluza de Salud Pública, Campus Universitario de la Cartuja, Granada, España
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Grigorakis N, Floros C, Tsangari H, Tsoukatos E. Combined social and private health insurance versus catastrophic out of pocket payments for private hospital care in Greece. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2017; 17:10.1007/s10754-016-9203-7. [PMID: 28050680 DOI: 10.1007/s10754-016-9203-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/03/2016] [Indexed: 02/28/2024]
Abstract
The high level of out of pocket (OOP) payments constitutes a major concern for Greece and several other European and OECD countries as a result of the significant down turning of their public health finances due to the 2008 financial crisis. The basic objective of this study is to provide empirical evidence on the effect of combining social health insurance (SHI) and private health insurance (PHI) on OOP payments. Further, this study examines the catastrophic impact of OOP payments on insured's welfare using the incidence and intensity methodological approach of measuring catastrophic health care expenditures. Conducting a cross-sectional survey in Greece in 2013, we find that the combination of SHI-PHI has a strong negative influence on insured OOP payments for inpatient health care in private hospitals. Furthermore, our results indicate that SHI coverage is not sufficient by itself to manage with this issue. Moreover, we find that poor people present a greater tendency to incur catastrophic OOP expenditures for hospital health care in private providers. Drawing evidence from Greece, a country with huge fiscal problems that has suffered the consequences of the economic crisis more than any other, could be a starting point for policymakers to consider the perspective of SHI-PHI co-operation against OOP payments more seriously.
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Affiliation(s)
| | - Christos Floros
- School of Management and Economics, T.E.I of Crete, Heraklion, Greece.
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Insurance coverage and socioeconomic differences in patient choice between private and public health care providers in China. Soc Sci Med 2016; 170:124-132. [DOI: 10.1016/j.socscimed.2016.10.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 09/25/2016] [Accepted: 10/17/2016] [Indexed: 01/09/2023]
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20
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Blomgren J. Transition to Retirement and Use of Private Health Care. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 47:312-332. [PMID: 26979274 DOI: 10.1177/0020731416637828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Associations between retirement and changes in health care use have not been shown in a longitudinal setting. In the Finnish universal health care system, transition into retirement from employment entails loss of access to occupational health care that provides easily accessible primary health care services, which may cause changes in utilization of other health care sectors. The aim of this study was to find out whether transition into old-age retirement is associated with change in utilization of private health care. The panel data consist of a 30% random sample of the Finnish population aged 62-75 in 2006-2011. Register data on National Health Insurance compensation were linked to socio-demographic covariates. Fixed-effects logistic and Poisson regression models were used. Adjusted for changes in covariates, retirement from employment was associated especially with private general practitioner visits but also with specialist visits among both women and men. Interaction analyses showed that retirement was associated with an increase in private care use only among those with higher-than-median income. The results may indicate preferences for quick access to care, mistrust toward the universal system, and problems of the public system in delivering needed services.
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Affiliation(s)
- Jenni Blomgren
- 1 The Social Insurance Institution of Finland, Helsinki, Finland
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Tamayo-Fonseca N, Nolasco A, Quesada JA, Pereyra-Zamora P, Melchor I, Moncho J, Calabuig J, Barona C. Self-rated health and hospital services use in the Spanish National Health System: a longitudinal study. BMC Health Serv Res 2015; 15:492. [PMID: 26537822 PMCID: PMC4634188 DOI: 10.1186/s12913-015-1158-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 10/30/2015] [Indexed: 11/20/2022] Open
Abstract
Background Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. Methods Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. Results By the end of a 4-year follow-up period, 1,184 participants (22.4 %) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. Conclusions Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.
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Affiliation(s)
- Nayara Tamayo-Fonseca
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain.
| | - Andreu Nolasco
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain.
| | - Jose A Quesada
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain.
| | - Pamela Pereyra-Zamora
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain.
| | - Inmaculada Melchor
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain. .,Registro de Mortalidad de la Comunidad Valenciana, Servicio de Estudios Epidemiológicos y Estadísticas Sanitarias. Subdirección General de Epidemiología y Vigilancia de la Salud. Conselleria de Sanitat, Plaza de España 6, 03010, Alicante, Spain.
| | - Joaquin Moncho
- Department of Community Nursing, Research Unit for the Analysis of Mortality and Health Statistics, Preventive Medicine, Public Health and History of Science. University of Alicante. Campus de San Vicente del Raspeig s/n, Apartado 99, 03080, Alicante, Spain.
| | - Julia Calabuig
- Servicio de Análisis de Sistemas de Información Sanitaria, Conselleria de Sanitat, Generalitat Valenciana. C/Micer Mascó, 31-33, 46010, Valencia, Spain.
| | - Carmen Barona
- Servicio del Plan de Salud, Dirección General de Salud Pública. Conselleria de Sanitat, Generalitat Valenciana. Avda. Cataluña, 21, 46020, Valencia, Spain.
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Pullicino G, Sciortino P, Calleja N, Schäfer W, Boerma W, Groenewegen P. Comparison of patients' experiences in public and private primary care clinics in Malta. Eur J Public Health 2014; 25:399-401. [PMID: 25395398 DOI: 10.1093/eurpub/cku188] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Demographic changes, technological developments and rising expectations require the analysis of public-private primary care (PC) service provision to inform policy makers. We conducted a descriptive, cross-sectional study using the dataset of the Maltese arm of the QUALICOPC Project to compare the PC patients' experiences provided by public-funded and private (independent) general practitioners in Malta. Seven hundred patients from 70 clinics completed a self-administered questionnaire. Direct logistic regression showed that patients visiting the private sector experienced better continuity of care with more difficulty in accessing out-of-hours care. Such findings help to improve (primary) healthcare service provision and resource allocation.
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Affiliation(s)
- Glorianne Pullicino
- 1 Department of Family Medicine, University of Malta, Msida, Malta 2 Primary Health Care Department, Floriana, Malta
| | - Philip Sciortino
- 1 Department of Family Medicine, University of Malta, Msida, Malta
| | - Neville Calleja
- 3 Department of Public Health, University of Malta, Msida, Malta
| | - Willemijn Schäfer
- 4 Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Wienke Boerma
- 4 Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Peter Groenewegen
- 4 Netherlands Institute for Health Services Research, Utrecht, Netherlands
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Private health care expenditure and quality in Beveridge systems: cross-regional differences in the Italian NHS. Health Policy 2014; 119:356-66. [PMID: 25467792 DOI: 10.1016/j.healthpol.2014.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 09/18/2014] [Accepted: 10/22/2014] [Indexed: 11/20/2022]
Abstract
Private health care expenditure ranges from 15% to 30% of total healthcare spending in OECD countries. The literature suggests that there should be an inverse correlation between quality of public services and private expenditures. The main objective of this study is to explore the association between quality of public healthcare and private expenditures in the Italian Regional Healthcare Systems (RHSs). The institutional framework offered by the Italian NHS allows to investigate on the differences among the regions while controlling for institutional factors. The study uses micro-data from the ISTAT Household Consumption Survey (HCS) and a rich set of regional quality indicators. The results indicate that there is a positive and significant correlation between quality and private spending per capita across regions. The study also points out the strong association between the distribution of private consumption and income. In order to account for the influence of income, the study segmented data in three socio-economic classes and computed cross-regional correlations of RHSs quality and household healthcare expenditure per capita, within each class. No correlation was found between the two variables. These findings are quite surprising and call into question the theory that better quality of public services crowds out private spending, or, at the very least, it undermines the simplistic notions that higher levels of private spending are a direct consequence of poor quality in the public sector. This suggests that policies should avoid to simplistically link private spending with judgements or assessments about the functioning or efficacy of the public system and its organizations.
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