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Con Wright G, Gedik TE. Sociopolitical values, sociodemographic factors, and willingness to pay higher taxes to improve public healthcare in Turkey. Public Health 2023; 217:133-137. [PMID: 36889051 DOI: 10.1016/j.puhe.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 10/05/2022] [Accepted: 12/09/2022] [Indexed: 03/07/2023]
Abstract
OBJECTIVES Healthcare systems' reliance on taxes varies across countries with corresponding heterogeneity in public's willingness to pay taxes (WTP) for national healthcare provision. Turkey, a developing country that witnessed a major healthcare transformation, provides a unique context to understand what motivates WTP in a non-Western context. STUDY DESIGN This is a cross-sectional study. METHODS We used the data from the International Social Survey Programme module on health and healthcare in Turkey. The data were collected from a nationally representative sample of adults aged >18 years (n = 1559). Using logistic regression models, we examine the association of sociopolitical values and sociodemographic factors with individuals' WTP to improve public healthcare. RESULTS We find that sociopolitical values are more closely associated to the WTP in Turkey compared with sociodemographic factors. However, egalitarianism and humanitarianism were differentially linked to the WTP. Humanitarianism was positively associated, whereas egalitarianism was negatively associated with WTP. CONCLUSIONS This study shows the prevalence of value-based approach to healthcare provision support in a developing country in the height of healthcare reforms.
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Affiliation(s)
- Gülçin Con Wright
- TED University, Faculty of Arts & Sciences, Sociology Department, Ziya Gökalp Caddesi No. 48 06420, Kolej Çankaya, Ankara, Turkey.
| | - Tahir Enes Gedik
- İzmir Kâtip Çelebi University, Faculty of Health Sciences, Department of Social Work, Havaalanı Şosesi, No: 33/2, Balatçık, Çiğli 35620, İzmir, Turkey.
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van Hulsen MAJ, Rohde KIM, van Exel J. Preferences for investment in and allocation of additional healthcare capacity. Soc Sci Med 2023; 320:115717. [PMID: 36716698 DOI: 10.1016/j.socscimed.2023.115717] [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] [Received: 07/28/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023]
Abstract
Policy makers need to make decisions regarding the allocation of scarce healthcare resources. We study preferences for investment in additional healthcare capacity and allocation between two regions, focusing on reducing waiting time for elective surgery for a physical health problem. We elicit preferences from a societal and an individual perspective, with unequal initial waiting times between the two regions. In an online survey, 1039 respondents were randomly assigned to one of three versions of the experiment: (1) a social planner perspective, placing respondents in the role of a policy maker; (2) an individual perspective where the respondent's own region was better off regarding initial waiting times; (3) an individual perspective where the individual's own region was worse off regarding initial waiting times. Respondents were asked to rank the status quo and five scenarios where the investment in additional capacity led to different distributions of shorter waiting times between regions. For all allocations we presented both the reduction in waiting time and the resulting final waiting time for both regions. We find that in version 1 of the experiment, preferences were in line with inequality aversion and Rawlsian preferences regarding final waiting time. In version 3, similar preferences were found, although here they also align with individualistic preferences. In version 2, preferences were more heterogeneous, with both individualistic and egalitarian preferences present. Concluding, individualistic and egalitarian preferences mostly concerned final waiting time. We therefore recommend policy makers to focus on the effect on final waiting time instead of the reduction of waiting time.
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Affiliation(s)
- Merel A J van Hulsen
- Erasmus School of Economics (ESE), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Research Institute of Management (ERIM), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Kirsten I M Rohde
- Erasmus School of Economics (ESE), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Research Institute of Management (ERIM), Erasmus University Rotterdam, Rotterdam, the Netherlands; Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Job van Exel
- Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Rotterdam, the Netherlands.
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Steigenberger C, Flatscher-Thoeni M, Siebert U, Leiter AM. Determinants of willingness to pay for health services: a systematic review of contingent valuation studies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:1455-1482. [PMID: 35166973 PMCID: PMC8853086 DOI: 10.1007/s10198-022-01437-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/12/2022] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Stated preference studies are a valuable tool to elicit respondents' willingness to pay (WTP) for goods or services, especially in situations where no market valuation exists. Contingent valuation (CV) is a widely used approach among stated-preference techniques for eliciting WTP if prices do not exist or do not reflect actual costs, for example, when services are covered by insurance. This review aimed to provide an overview of relevant factors determining WTP for health services to support variable selection. METHODS A comprehensive systematic literature search and review of CV studies assessing determinants of WTP for health services was conducted, including 11 electronic databases. Two of the authors made independent decisions on the eligibility of studies. We extracted all determinants used and related p values for the effect sizes (e.g. reported in regression models with WTP for a health service as outcome variable). Determinants were summarised in systematic evidence tables and structured by thematic domains. RESULTS We identified 2082 publications, of which 202 full texts were checked for eligibility. We included 62 publications on 61 studies in the review. Across all studies, we identified 22 WTP determinants and other factors from 5 thematic domains: sociodemographic characteristics, perceived threat, perceived benefit, perceived barriers, and other information. CONCLUSION Our review provides evidence on 22 relevant determinants of WTP for health services, which may be used for variable selection and as guidance for planning CV surveys. Endogeneity should be carefully considered before interpreting these determinants as causal factors and potential intervention targets.
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Affiliation(s)
- Caroline Steigenberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
| | - Magdalena Flatscher-Thoeni
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment, ONCOTYROL, Center for Personalized Cancer Medicine, Innsbruck, Austria
- Institute for Technology Assessment, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Center for Health Decision Science, Departments of Epidemiology and Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrea M Leiter
- Department of Economics, Faculty of Economics and Statistics, University of Innsbruck, Innsbruck, Austria
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Teshome Bekele W. Predictors of Community-Based Health Insurance in Ethiopia via Multilevel Mixed-Effects Modelling: Evidence from the 2019 Ethiopia Mini Demography and Health Survey. Clinicoecon Outcomes Res 2022; 14:547-562. [PMID: 35996638 PMCID: PMC9391937 DOI: 10.2147/ceor.s368925] [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: 04/14/2022] [Accepted: 08/06/2022] [Indexed: 11/29/2022]
Abstract
Background The World Health Organization has endorsed a community-based health insurance scheme (CBHIS) as a shared financing plan to improve access to health services and ensure universal coverage of the healthcare delivery system. Such a contributory scheme is the most likely option to provide health insurance coverage when governments cannot offer direct health care support. Despite improvements in access to current healthcare services, Ethiopia’s healthcare delivery remained low, owing to the country’s underdeveloped healthcare finance system. As a result, the present study assessed CBHIS coverage and its predictors in Ethiopia at the individual and community level. Methods The availability of CBHIS was checked via a criterion: at least one of the cluster respondents had to be enrolled in CBHIS. This study was based on secondary data from the Ethiopia Mini Demography and Health Survey (EMDHS) 2019 and included 7724 respondents. The study population was described using percentage and frequency. Four multilevel mixed-effects logistic regression modelling stages were performed to control for variations due to heterogeneity across clusters, and determinant predictors of CBHIS enrollment were outplayed. Results The prevalence of CBHIS enrollment in Ethiopia was 33.13%. Rural residents were 3.218 times (AOR = 3.218; 95% CI: 1.521, 6.809), male household heads were 1.574 times (AOR = 1.574, 95% CI: 1.105, 2.241), getting funds from the safety net program were times 2.062 (AOR = 2.062, 95% CI: 1.297, 3.279), attending the primary educational level was 1.686 times (AOR = 1.686, 95% CI: 1.007, 2.821), bank accounts were 1.373 times (AOR = 1.373, 95% CI: 1.052, 1.792), and wealth index was 1.356 times (AOR = 1.356, 95% CI: 1.001, 1.838) more likely associated with CBHIS coverage, whereas the regions, the other religions, and women aged 20–24 had lower odds of CBHIS coverage. Conclusion In Ethiopia, regional healthcare expenditure per capital, religious affiliation, women age range, residents, sex of household head, funds from the safety net program, formal educational level, and having bank accounts were associated with community-based health insurance scheme coverage.
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Pollerhoff L, Stietz J, Depow GJ, Inzlicht M, Kanske P, Li SC, Reiter AMF. Investigating adult age differences in real-life empathy, prosociality, and well-being using experience sampling. Sci Rep 2022; 12:3450. [PMID: 35236872 PMCID: PMC8891267 DOI: 10.1038/s41598-022-06620-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 02/02/2022] [Indexed: 12/11/2022] Open
Abstract
While the importance of social affect and cognition is indisputable throughout the adult lifespan, findings of how empathy and prosociality develop and interact across adulthood are mixed and real-life data are scarce. Research using ecological momentary assessment recently demonstrated that adults commonly experience empathy in daily life. Furthermore, experiencing empathy was linked to higher prosocial behavior and subjective well-being. However, to date, it is not clear whether there are adult age differences in daily empathy and daily prosociality and whether age moderates the relationship between empathy and prosociality across adulthood. Here we analyzed experience-sampling data collected from participants across the adult lifespan to study age effects on empathy, prosocial behavior, and well-being under real-life circumstances. Linear and quadratic age effects were found for the experience of empathy, with increased empathy across the three younger age groups (18 to 45 years) and a slight decrease in the oldest group (55 years and older). Neither prosocial behavior nor well-being showed significant age-related differences. We discuss these findings with respect to (partially discrepant) results derived from lab-based and traditional survey studies. We conclude that studies linking in-lab experiments with real-life experience-sampling may be a promising venue for future lifespan studies.
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Affiliation(s)
- Lena Pollerhoff
- Lifespan Developmental Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany.
| | - Julia Stietz
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | | | - Michael Inzlicht
- Department of Psychology, University of Toronto, Toronto, ON, Canada
- Rotman School of Management, University of Toronto, Toronto, ON, Canada
| | - Philipp Kanske
- Clinical Psychology and Behavioral Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Shu-Chen Li
- Lifespan Developmental Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
- Centre for Tactile Internet with Human-in-the-Loop, Technische Universität Dresden, Dresden, Germany
| | - Andrea M F Reiter
- Lifespan Developmental Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany
- German Centre of Prevention Research On Mental Health, Julius-Maximilians-Universität Würzburg, Würzburg, Germany
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Cheno RW, Tchabo W, Tchamy J. Willingness to join and pay for community-based health insurance and associated determinants among urban households of Cameroon: case of Douala and Yaounde. Heliyon 2021; 7:e06507. [PMID: 33817375 PMCID: PMC8010406 DOI: 10.1016/j.heliyon.2021.e06507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/20/2021] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background The risks associated with direct health spending are high in Cameroon, where almost all household income is spent on health care. Moreover, there is no real social security in Cameroon because of the lack of a universal social protection system. Objectives This study aimed to assess the willingness of Cameroonian urban dwellers to subscribe and the amount to pay for voluntary (VCHI) or compulsory community-based health insurance (CCHI). Methods A cross-sectional study based on a three-stage stratified cluster random sampling design using a bidding game style based on the contingent valuation approach was performed to in the two largest urban areas of Cameroon (Douala and Yaoundé) evaluate the willingness to pay for the VCHI and CCHI. Results The results shown that 46% of respondent were willing to join the CCHI and 41% for VCHI. Furthermore, household income, working sector, chronic disease, health priority, and family size were factors mostly associated (p < 0.001) with the willingness to join CCHI or VCHI. Increase in household income has a positive effect on household's desire for both CCHI and VCHI. While for VCHI, increase of children number resulted in an increment of the premium, contrary to the occurrence of chronic ailment which led in the decrease of the bid. Conclusions From the results, it is clear that city dwellers in Cameroon are ready to join and pay for community health insurance. This willingness was related to their financial power which resulted in an average insurance premium of 9.03 USD and 8.17 USD, respectively for CCHI and VCHI. That bid was found to be enough for an implementation of these types of health insurance in Cameroon.
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Affiliation(s)
- Rosine Wafo Cheno
- Department of Health Policy and Management, Jiangsu University, 301 Xuefu Road, Zhenjiang 212013, China.,Ministry of Public Health of Cameroon, Road 3038, Quartier du Lac, Yaounde, Cameroon
| | - William Tchabo
- University of Ngaoundere, PO Box 455, Ngaoundere, Cameroon
| | - Jonathan Tchamy
- University of Ngaoundere, PO Box 455, Ngaoundere, Cameroon.,Jonathan Tchamy, School of Management and Economics, Kunming University of Science and Technology, Kunming 650093, China
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Reis AM, Pinto Borges A, Araújo N. Managing NHS money in Portugal: who decides? INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2020. [DOI: 10.1108/ijhg-08-2020-0087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe need to reduce health expenditures raises the discussion on rationing possibilities and there is a growing interest in considering society's perspectives. The aim of this paper was to evaluate Portuguese citizens' opinion regarding the imposition of limits on National Health Service (NHS) spending. We also asked who decides how NHS money is spent, in order to obtain the respondents' views on public involvement.Design/methodology/approachAn online questionnaire was used to collect data. Descriptive and inferential statistics, factorial analysis and a logit model were applied.FindingsOur results showed that most of the respondents believe citizens have low participation on NHS' financial decisions, confirming the lack of public involvement. Health professionals are more likely to agree with limits on NHS spending, which could indicate potential inefficiencies.Practical implicationsFrom a health policy perspective, we have concluded that different stakeholders should be involved before deciding how public spending limits should be implemented. Health professionals' perspectives should be considered, taking advantage of their experience.Originality/valueThe main novelty of this paper is the evaluation of whether there should be limits on NHS spending, comparing health professionals and non-health professionals.
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Zemene A, Kebede A, Atnafu A, Gebremedhin T. Acceptance of the proposed social health insurance among government-owned company employees in Northwest Ethiopia: implications for starting social health insurance implementation. Arch Public Health 2020; 78:104. [PMID: 33093953 PMCID: PMC7576701 DOI: 10.1186/s13690-020-00488-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 10/14/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Ethiopia is currently planning to introduce Social Health Insurance (SHI) that will lead to universal health coverage and assist a country to achieve its health system's objectives and to prevent the catastrophic health expenditure. But there is no evidence until now about the level of acceptance of the proposed SHI among government-owned companies' employees. Therefore, this study was intended to assess the acceptance of SHI and associated factors among government-owned companies' employees in northwest Ethiopia. METHODS An institution-based cross-sectional study was conducted from February 1 to April 30, 2019. A randomly selected 541 government-owned companies' employees were participated in the study. A pretested self-administered structured questionnaire was used that consisted sociodemographic and economic, health status-related factors, attitude (measured by 12 items), organizational related factors and knowledge about SHI (measured by 11 items). Finally, binary logistic regression analysis was performed and in the multivariable logistic regression analysis, a significant level at a p-value of < 0.05 and Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) were used to identify factors statistically associated with SHI acceptance. RESULTS Overall, 32% (95% CI: 27.7-36.2) of the government-owned companies' employees accepted the proposed Ethiopian SHI scheme. Self-perceived health status (AOR: 8.55, 95% CI: 2.69-27.13), heard about SHI (AOR: 1.69, 95% CI: 1.12-2.54), coverage of medical healthcare cost (AOR: 0.60, 95% CI: 0.39-0.92), work experience (AOR: 0.49, 95% CI: 0.26-0.89) and quality of healthcare service at the facilities (AOR: 0.17, 95% CI: 0.04-0.71) were significantly associated with acceptance of SHI among government-owned companies' employees. CONCLUSIONS One-third of the study participants accepted the proposed Ethiopian SHI scheme. Self-perceived health status, quality of healthcare service at health facilities, coverage of the medical cost by their organization, heard about SHI and work experience were the factors that affect acceptance of the proposed SHI among the government-owned company employees. Therefore, policymakers should devise a plan to promote the benefit packages of SHI for the formal sector employees to start the implementation.
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Affiliation(s)
- Abuneh Zemene
- University of Gondar Student Clinic, University of Gondar, Gondar, Ethiopia
| | - Adane Kebede
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Gondar, Ethiopia
| | - Tsegaye Gebremedhin
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P. O. Box: 196, Gondar, Ethiopia
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Nembrini S, Ceretti E, Gelatti U, Castaldi S, Schulz P, Levaggi R, Auxilia F, Covolo L. Willingness to pay for risky lifestyles: results from the Pay for Others (PAY4O) study, Italy. Public Health 2020; 182:179-184. [DOI: 10.1016/j.puhe.2020.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/03/2020] [Accepted: 01/09/2020] [Indexed: 10/24/2022]
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Martínez-García M, Vargas-Barrón J, Bañuelos-Téllez F, González-Pacheco H, Fresno C, Hernández-Lemus E, Martínez-Ríos MA, Vallejo M. Public insurance program impact on catastrophic health expenditure on acute myocardial infarction. Public Health 2018; 158:47-54. [PMID: 29547759 DOI: 10.1016/j.puhe.2018.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/07/2017] [Accepted: 01/23/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE ST-segment elevation myocardial infarction (STEMI) has an important economic burden that poised the urgent need to evaluate its catastrophic medical expense. This study evaluates the first 5 years of the national health initiative called Popular Insurance (PI) at the National Institute of Cardiology in Mexico. STUDY DESIGN Retrospective data analysis. METHODS STEMI patients with (n=317) and without (n=260) PI were selected. Analysed variables included socio-economical context, management care, cost evaluation and three outcomes (mortality, hospital readmission and therapeutic adherence). Descriptive statistical analyses, Kaplan-Meier survival and Support Vector Machine models were used accordingly. RESULTS Treatment costs were higher for PI-covered individuals (P=0.022) and only 1.89% of them remained in debt, in contrast to 16.15% of those without PI. Statistically significant differences were found in relation to days in hospital wards (P<0.001), imaging studies (P<0.001) and surgical materials (P=0.04). Survival analysis (P=0.44) and therapeutic adherence (P=0.38) showed no differences. Hospital readmission was predicted with an 81.97% accuracy. The most important predictive variables included were stent type, number of days at the coronary care unit and hospital wards. CONCLUSIONS The PI has proven to be a successful program where no differences were found in terms of health care and survival, whereas it provides timely financial support for families facing catastrophic health challenging events.
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Affiliation(s)
- M Martínez-García
- Sociomedical Research Department, National Institute of Cardiology, Mexico City, Mexico; Ph.D. Programme in Collective Health, Practices and Policies in Healthcare, Metropolitan Autonomous University, Xochimilco, Mexico City, Mexico
| | | | - F Bañuelos-Téllez
- Planning Division, National Institute of Cardiology, Mexico City, Mexico
| | - H González-Pacheco
- Coronary Care Unit, National Institute of Cardiology, Mexico City, Mexico
| | - C Fresno
- Computational Genomics Division, National Institute of Genomic Medicine, Mexico City, Mexico
| | - E Hernández-Lemus
- Computational Genomics Division, National Institute of Genomic Medicine, Mexico City, Mexico
| | | | - M Vallejo
- Sociomedical Research Department, National Institute of Cardiology, Mexico City, Mexico.
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