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Agyemang-Duah W, Braimah JA, Asante D, Appiah JO, Peprah P, Awuviry-Newton K, Mensah AA, Ofori-Amoah J, Opoku K. Family Support, Perceived Physical Activeness and Chronic Non-Communicable Diseases as Determinants of Formal Healthcare Utilization Among Older Adults with Low Income and Health Insurance Subscription in Ghana. J Aging Soc Policy 2024; 36:658-674. [PMID: 37724601 DOI: 10.1080/08959420.2023.2255488] [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: 08/12/2022] [Accepted: 06/08/2023] [Indexed: 09/21/2023]
Abstract
Evidence suggests that enrollment in a health insurance scheme is associated with higher levels of formal healthcare utilization among older adults, especially those with low income in sub-Saharan Africa (SSA), including Ghana. This study examines the prevalence of formal healthcare utilization and associated factors among older adults with low income and health insurance subscription enrolled in a social intervention program (known as the Livelihood Empowerment Against Poverty [LEAP] program) in Ghana. Cross-sectional data were obtained from an Aging, Health, Lifestyle and Health Services Survey conducted in 2018 among 200 older adults aged 65 years and above enrolled in the LEAP program. The results showed that almost 9 in 10 (87%) older adults utilized formal healthcare services for their health problems. Older adults who received family support, rated themselves to be physically active and had non-communicable diseases (NCDs) were more significantly likely to utilise formal health care services than their counter parts. We recommend that health policies and programs for older adults with low income and health insurance subscription under the LEAP program should consider the roles of family support, physical activeness and NCDs in influencing their use of formal healthcare services.
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Affiliation(s)
| | | | - Dennis Asante
- College of Medicine & Public Health, Rural and Remote Health, Flinders University, Renmark, South Australia
| | - Joseph Oduro Appiah
- School of Environmental Planning, University of Northern British Columbia, Prince George, BC, Canada
| | - Prince Peprah
- Social Policy Research Centre, Centre for Primary Health Care and Equity, The University of New South Wales, Sydney, Australia
| | - Kofi Awuviry-Newton
- Priority Research Centre for Generational Health and Ageing, School of Medicine and Health, University of Newcastle, Callaghan, Australia
| | - Anthony Acquah Mensah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Kwabena Opoku
- Social Science Department, Okomfo Anokye Senior High School, Wiamoase-Ashanti Region, Ghana
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Radhamony R, Cross WM, Townsin L, Banik B. Culturally and Linguistically Diverse Community Access and Utilisation of the Mental Health Service: An Explanation Using Andersen's Behavioural Model. Issues Ment Health Nurs 2024:1-8. [PMID: 38954511 DOI: 10.1080/01612840.2024.2359602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
Andersen's Behavioural Model of Health Service Use (ABMHSU) is a multilevel model that helps understand the factors influencing health service access and utilisation. This framework is a widely used model for health service use in general, as well as in immigrant populations and vulnerable populations. ABMHSU, in this project, provided a framework to explain how the mental health nurses' cultural competence can influence the Victorian CALD community members' mental health care access and utilisation. A unique model of ABMHSU in the current multiple-method project provided a theoretical framework for examining the factors associated with people from the CALD community accessing mental health services in an Australian context to answer the research questions. The key findings of the research were discussed with reference to the extant literature and with triangulation of research results with the ABMHSU in the context of Victoria. The researchers argue that even though predisposing, enabling, and need factors are necessary to determine whether a person is selected for expert care for mental health issues, these factors alone are insufficient. Ongoing research is essential to ascertain the potential of mental health nurses' cultural competence education and cultural responsiveness in addressing the mental health service access and utilisation of the heterogeneous CALD communities. Additional research is advocated to identify the supplementary factors, as there is a dearth of research exploring the potential of ABMHSU worldwide.
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Affiliation(s)
- Reshmy Radhamony
- Institute of Health and Wellbeing, Federation University, Berwick, Victoria, Australia
| | - Wendy M Cross
- School of Health, Federation University, Ballarat, Australia
| | - Louise Townsin
- School of Health, Federation University, Ballarat, Australia
- Research Office, Torrens University, Adelaide, South Australia, Australia
| | - Biswajit Banik
- Institute of Health and Wellbeing, Federation University, Berwick, Victoria, Australia
- Manna Institute, Regional Australia Mental Health Research and Training Institute, University of New England, Armidale, New South Wales, Australia
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Rahaman M, Roy A, Chouhan P, Kapasia N, Muhammad T. Factors associated with public and private healthcare utilization for outpatient care among older adults in India: A Wagstaff's decomposition of Anderson's behavioural model. Int J Health Plann Manage 2024; 39:1056-1080. [PMID: 38269594 DOI: 10.1002/hpm.3771] [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: 07/13/2022] [Revised: 12/22/2022] [Accepted: 01/12/2024] [Indexed: 01/26/2024] Open
Abstract
In India, an expanding ageing population will become a public health alarm, putting additional pressure on the healthcare system. Therefore, the current study aimed to examine the factors associated with outpatient healthcare choices among older Indian adults. We used data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-2018). A total of 34,588 individuals (age 45 years and over) who accessed outpatient healthcare services in the last 12 months during the survey were included in this research. A bivariate chi-square test was used to present the percentage distribution of types of outpatient healthcare utilisation by background characteristics. Multinomial logistic regression and Wagstaff's decomposition analyses were employed to explore the interplay of outpatient healthcare utilisation and allied predisposing, enabling, and need factors and examine these factors' contributions to the wealth-based inequalities in public, private, and other healthcare utilisation. Outpatient healthcare utilisation varied significantly according to socioeconomic and demographic factors. The findings suggest that consumption quintiles, place of residence, education, and health insurance were significant determinants of private and public healthcare utilisation and contributed to wealth-based inequalities in healthcare choices. The current study emphasises the need to strengthen and promote public healthcare services.
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Affiliation(s)
- Margubur Rahaman
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, India
| | - Avijit Roy
- Department of Geography, Malda College, Malda, West Bengal, India
| | - Pradip Chouhan
- Department of Geography, University of Gour Banga, Malda, West Bengal, India
| | | | - T Muhammad
- Center for Healthy Aging, The Pennsylvania State University, Pennsylvania, USA
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Tuoyire DA, Baatiema L, Dwomoh D, Bosomprah S. Healthcare utilization in Ghana: Insights from the 2017 Ghana Living Standard Survey. PLoS One 2024; 19:e0306032. [PMID: 38917162 PMCID: PMC11198759 DOI: 10.1371/journal.pone.0306032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 06/10/2024] [Indexed: 06/27/2024] Open
Abstract
INTRODUCTION The persistence of healthcare utilization disparities in Ghana despite several policy efforts highlights the urgency of understanding its determinants to enhance equitable health access. We sought to examine the determinants of healthcare utilization in Ghana. METHODS We used the 2017 Ghana Living Standard Survey (GLSS) data. This was a cross-sectional design, which employed a stratified two-stage random sampling technique. We analyzed data involving 8,298 respondents with information on visits to healthcare facilities for services on account of illness or injury two weeks prior to the survey. Pearson's chi-squared test was used to assess the distribution of healthcare utilization across background characteristics. Further, we used multivariable Poisson regression model with robust standard error to identify factors independently associated with healthcare utilization. RESULTS Among the 8,298, the median age was 24 years (interquartile range = 7-47), 45% were males, and 45% had no education. About 42% of respondents utilized health services during an episode of illness or injury. Age, sex, educational level, marital status, wealth quintile, health insurance and severity of illness/injury were independently associated with healthcare utilization. Healthcare utilization increased significantly with wealth quintiles-those in the highest wealth quintiles had about 22% increased utilization compared to those in the lowest wealth quintiles (aPR = 1.22; 95%CI = 1.13-1.32) while it was about 77% higher among those who had valid health insurance compared to those without (aPR = 1.77; 95% CI = 1.68-1.86). Regarding severity of illness or injury, those with severe conditions were about 65% more likely to utilize healthcare services compared to those with acute conditions (aPR = 1.65; 95% CI = 1.53-1.78). CONCLUSION Our study underscores the importance of socio-economic factors and health insurance in healthcare utilization in Ghana. Addressing these can pave the way for more equitable access to healthcare services across all segments of the population.
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Affiliation(s)
- Derek Anamaale Tuoyire
- Department of Community Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Leonard Baatiema
- Department of Health Policy Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | - Duah Dwomoh
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Ghana
| | - Samuel Bosomprah
- Department of Biostatistics, School of Public Health, University of Ghana, Legon, Ghana
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Frempong EA, Van Staden DW. Accessibility of and barriers to the use of eye health services in Kumasi Metropolis, Ghana. Afr J Prim Health Care Fam Med 2024; 16:e1-e8. [PMID: 38949439 DOI: 10.4102/phcfm.v16i1.4270] [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: 08/18/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 07/02/2024] Open
Abstract
BACKGROUND There is a high prevalence of vision impairment and blindness in Africa. The poor access to eye health services, among other barriers, has been found to have a considerable effect on the burden of avoidable vision loss and blindness, particularly in low- and middle-income countries. AIM To determine the accessibility of and barriers to the utilisation of eye health services in the Kumasi Metropolis of Ghana. SETTING A descriptive cross-sectional survey was conducted in the Kumasi Metropolis of the Ashanti Region in Ghana to identify barriers affecting the utilisation of eye health services. METHODS Convenience sampling was used to recruit participants visiting the eye clinics at five selected District Municipal Hospitals for the first time. Data were collected by means of questionnaires and analysed using Statistical Package for Social Sciences (SPSS). RESULTS Barriers faced by participants when accessing eye health services included distance to the clinic, cost of services, time spent away from work and/or school, self-medication and long waiting periods. CONCLUSION The study found that eye care services in the Kumasi Metropolis, Ghana are largely accessible, but underutilised. Improvement of public health education initiatives through engagement with community groups will also enhance uptake at health care facilities.Contribution: Underutilisation of health services in the Metropolis has been identified in the study and must be addressed by health managers in various sectors. Accessibility is relatively good but can further be improved especially for the elderly to be able to utilise health care services with ease.
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Affiliation(s)
- Eunice A Frempong
- Department of Optometry, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa; and Department of Optometry, Faculty of Science, Kwame Nkrumah University of Science and Technology, Kumasi.
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Amoak D, Antabe R, Braimah JA, Agyemang-Duah W, Sano Y, Luginaah I. Exploring the association of self-rated oral health with self-rated general and mental health among older adults in a resource-poor context: Insights for advancing Sustainable Development Goal 3. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38863160 DOI: 10.1111/scd.13033] [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: 11/03/2023] [Revised: 04/27/2024] [Accepted: 06/02/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Older adults in Ghana have been disproportionately affected by oral health issues such as caries and periodontitis. This situation calls for comprehensive attention within health and healthcare policies, due to the established connections between oral health and other aspects of health and well-being in high-income countries, including physical and mental health. However, there is a significant gap in the literature when it comes to exploring the association of oral health with physical and mental health in resource-constrained settings like Ghana. METHODS To address this void, we collected a cross-sectional sample comprising older adults aged 60 and above (n = 1073) and analyzed self-rated health measures to investigate the relationship between oral health and general and mental health in Ghana. RESULTS The results of our logistic regression analysis revealed a significant association: older adults who reported poor oral health were more likely to rate their general (OR = 5.10; p < .001) and mental health (OR = 4.78, p < .001) as poor, compared to those with good oral health, even after accounting for demographic and socioeconomic variables. CONCLUSIONS Based on these findings, we discuss the policy implications of our findings, especially in the context of advancing Sustainable Development Goal 3 in Ghana and other resource-constrained settings.
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Affiliation(s)
- Daniel Amoak
- Department of Geography and Environment, Western University, London, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Scarborough, Canada
| | | | | | - Yujiro Sano
- Department of Sociology and Anthropology, Nipissing University, North Bay, Canada
| | - Isaac Luginaah
- Department of Geography and Environment, Western University, London, Canada
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Agyemang-Duah W, Abdullah A, Rosenberg MW. Caregiver burden and health-related quality of life: A study of informal caregivers of older adults in Ghana. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:31. [PMID: 38383532 PMCID: PMC10882722 DOI: 10.1186/s41043-024-00509-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Similar to many developing countries, caregiver burden remains high in Ghana which may affect informal caregivers of older adults' health-related quality of life (HRQoL). However, no study has examined the association between caregiver burden and HRQoL among informal caregivers of older adults in Ghana to date. Understanding this association may well help to inform health and social policy measures to improve HRQoL among informal caregivers of older adults in Ghana. Situated within a conceptual model of HRQoL, the purpose of this study was to examine the relationship between caregiver burden and HRQoL among informal caregivers of older adults in Ghana. METHODS We obtained cross-sectional data from informal caregiving, health, and healthcare (N = 1853) survey conducted between July and September 2022 among caregivers (≥ 18 years) of older adults (≥ 50 years) in the Ashanti Region of Ghana. The World Health Organization Impact of Caregiving Scale was used to measure caregiver burden. An 8-item short form Health Survey scale developed by the RAND Corporation and the Medical Outcomes Study was used to measure HRQoL. Generalized Linear Models were employed to estimate the association between caregiver burden and HRQoL. Beta values and standard errors were reported with a significance level of 0.05 or less. RESULTS The mean age of the informal caregivers was 39.15 years and that of the care recipients was 75.08 years. In our final model, the results showed that caregiver burden was negatively associated with HRQoL (β = - .286, SE = .0123, p value = 0.001). In line with the conceptual model of HRQoL, we also found that socio-economic, cultural, demographic and healthcare factors were significantly associated with HRQoL. For instance, participants with no formal education (β = -1.204, SE= .4085, p value = 0.01), those with primary level of education (β = -2.390, SE= .5099, p value = 0.001) or junior high school education (β = -1.113, SE= .3903, p value= 0.01) had a significantly decreased HRQoL compared to those with tertiary level of education. Participants who were between the ages of 18-24 (β = 2.960, SE= .6306, p value=0.001), 25-34 (β = 1.728, SE= .5794, p value = 0.01) or 35-44 (β = 1.604, SE= .5764, p value= 0.01) years significantly had increased HRQoL compared to those who were 65 years or above. Also, participants who did not utilize healthcare services in the past year before the survey significantly had increased HRQoL compared to those who utilized healthcare services five or more times in the past year (β = 4.786, SE=. 4610, p value= 0.001). CONCLUSION Consistent with our hypothesis, this study reported a significant negative association between caregiver burden and HRQoL. Our findings partially support the conceptual model of HRQoL used in this study. We recommend that health and social policy measures to improve HRQoL among informal caregivers of older adults should consider caregiver burden as well as other significant socio-economic, cultural, demographic, and healthcare factors.
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Affiliation(s)
- Williams Agyemang-Duah
- Department of Geography and Planning, Queen's University, Kingston, ON, K7L 3N6, Canada.
| | - Alhassan Abdullah
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Mark W Rosenberg
- Department of Geography and Planning, Queen's University, Kingston, ON, K7L 3N6, Canada
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Lakin K, Ha DT, Mirzoev T, Ha BTT, Agyepong IA, Kane S. "We can't expect much": Childbearing women's 'horizon of expectations' of the health system in rural Vietnam. Health Place 2024; 85:103166. [PMID: 38101200 DOI: 10.1016/j.healthplace.2023.103166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023]
Affiliation(s)
- Kimberly Lakin
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - Dinh Thu Ha
- Hanoi University of Public Health, Hanoi, Viet Nam
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
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Agyemang-Duah W, Rosenberg MW. Healthcare utilization among informal caregivers of older adults in the Ashanti region of Ghana: a study based on the health belief model. Arch Public Health 2023; 81:187. [PMID: 37872631 PMCID: PMC10591341 DOI: 10.1186/s13690-023-01200-5] [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: 06/05/2023] [Accepted: 10/09/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Existing global evidence suggests that informal caregivers prioritize the health (care) of their care recipients (older adults) over their own health (care) resulting in sub-optimal health outcomes among this population group. However, data on what factors are associated with healthcare utilization among informal caregivers of older adults are not known in a sub-Saharan African context. Guided by the Health Belief Model (HBM), the principal objective of this study was to examine the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. METHODS Data were extracted from a large cross-sectional study of informal caregiving, health, and healthcare survey among caregivers of older adults aged 50 years or above (N = 1,853; mean age of caregivers = 39.15 years; and mean age of care recipients = 75.08 years) in the Ashanti Region of Ghana. Poisson regression models were used to estimate the association between the dimensions of the HBM and healthcare utilization among informal caregivers of older adults. Statistical significance of the test was set at a probability level of 0.05 or less. RESULTS The results showed that 72.9% (n = 1351) of the participants were females, 56.7% (n = 1051) were urban informal caregivers and 28.6% (n = 530) had no formal education. The results further showed that 49.4% (n = 916) of the participants utilized healthcare for their health problems at least once in the past year before the survey. The final analysis showed a positive and statistically significant association between perceived susceptibility to a health problem (β = 0.054, IRR = 1.056, 95% CI = [1.041-1.071]), cues to action (β = 0.076, IRR = 1.079, 95% CI = [1.044-1.114]), self-efficacy (β = 0.042, IRR = 1.043, 95% CI = [1.013-1.074]) and healthcare utilization among informal caregivers of older adults. The study further revealed a negative and statistically significant association between perceived severity of a health problem and healthcare utilization (β= - 0.040, IRR = 0.961, 95% CI= [0.947-0.975]) among informal caregivers of older adults. The results again showed that non-enrollment in a health insurance scheme (β= - 0.174, IRR = 0.841, 95% CI= [0.774-0.913]) and being unemployed (β= - 0.088, IRR = 0.916, 95% CI= [0.850-0.986]) were statistically significantly associated with a lower log count of healthcare utilization among informal caregivers of older adults. CONCLUSION The findings of this study to a large extent support the dimensions of the HBM in explaining healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana. Although all the dimensions of the HBM were significantly associated with healthcare utilization in Model 1, perceived barriers to care-seeking and perceived benefits of care-seeking were no longer statistically significant after controlling for demographic, socio-economic and health-related variables in the final model. The findings further suggest that the dimensions of the HBM as well as demographic, socio-economic and health-related factors contribute to unequal healthcare utilization among informal caregivers of older adults in the Ashanti Region of Ghana.
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Affiliation(s)
- Williams Agyemang-Duah
- Department of Geography and Planning, Queen's University, Kingston, ON, K7L 3N6, Canada.
| | - Mark W Rosenberg
- Department of Geography and Planning, Queen's University, Kingston, ON, K7L 3N6, Canada
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Ekadinata N, Hsu HC, Chen YM, Chuang KY. Effects of social capital on healthcare utilization among older adults in Indonesia. Health Promot Int 2023; 38:daad104. [PMID: 37715938 DOI: 10.1093/heapro/daad104] [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: 09/18/2023] Open
Abstract
Social capital potentially affects older adults' access to healthcare services. However, the effects of social capital on the use of various types of healthcare services using longitudinal data have yet to be explored. This study aimed to examine the effects of structural and cognitive social capital on different types of healthcare utilization by older adults in Indonesia. Data were from the Indonesian Family Life Survey (waves 4 and 5) in 2007 and 2014. The sample consisted of participants aged 60 years and older who completed both waves (n = 1374). Healthcare utilization by older adults assessed health posts (posyandu), health checkups, outpatient care and hospital admissions. Social capital consisted of neighborhood trust and community participation. Generalized estimating equation models were used for the analysis. Older adults with high community participation had a higher likelihood of using preventive care in posyandu (OR = 5.848, 95% CI = 2.585-13.232) and health checkup visits (OR = 1.621, 95% CI = 1.116-2.356). Meanwhile, neighborhood trust was related to a higher probability of hospital admissions (OR = 1.255, 95% CI = 1.046-1.505). Social capital significantly affects older adults' preventive and treatment healthcare utilization. Maximizing the availability of social participation and removing barriers to access to preventive and medical care in an age-friendly environment are suggested.
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Affiliation(s)
- Nopryan Ekadinata
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei, Taiwan
- School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta, Indonesia
| | - Hui-Chuan Hsu
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei, Taiwan
- Research Center of Health Equity, College of Public Health, Taipei Medical University, New Taipei, Taiwan
| | - Ya-Mei Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kun-Yang Chuang
- School of Public Health, College of Public Health, Taipei Medical University, New Taipei, Taiwan
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Fatma N, Ramamohan V. Healthcare seeking behavior among patients visiting public primary and secondary healthcare facilities in an urban Indian district: A cross-sectional quantitative analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001101. [PMID: 37669247 PMCID: PMC10479939 DOI: 10.1371/journal.pgph.0001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 07/17/2023] [Indexed: 09/07/2023]
Abstract
In this work, we examined healthcare seeking behavior (HSB) of patients visiting public healthcare facilities in an urban context. We conducted a cross-sectional survey across twenty-two primary and secondary public healthcare facilities in the South-west Delhi district in India. The quantitative survey was designed to ascertain from patients at these facilities their HSB-i.e., on what basis patients decide the type of healthcare facility to visit, or which type of medical practitioner to consult. Based on responses from four hundred and forty-nine participants, we observed that factors such as wait time, prior experience with care providers, distance from the facility, and also socioeconomic and demographic factors such as annual income, educational qualification, and gender significantly influenced preferences of patients in choosing healthcare facilities. We used binomial and multinomial logistic regression to determine associations between HSB and socioeconomic and demographic attributes of patients at a 0.05 level of significance. Our statistical analyses revealed that patients in the lower income group preferred to seek treatment from public healthcare facilities (OR = 3.51, 95% CI = (1.65, 7.46)) irrespective of the perceived severity of their illness, while patients in the higher income group favored directly consulting specialized doctors (OR = 2.71, 95% CI = (1.34, 5.51)). Other factors such as having more than two children increased the probability of seeking care from public facilities. This work contributes to the literature by: (a) providing quantitative evidence regarding overall patient HSB, especially at primary and secondary public healthcare facilities, regardless of their presenting illness, (b) eliciting information regarding the pathways followed by patients visiting these facilities while seeking care, and (c) providing operational information regarding the surveyed facilities to facilitate characterizing their utilization. This work can inform policy designed to improve the utilization and quality of care at public primary and secondary healthcare facilities in India.
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Affiliation(s)
- Najiya Fatma
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Varun Ramamohan
- Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India
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Turyamureba M, Yawe BL, Oryema JB. Factors influencing public and private healthcare utilisation in Uganda. Afr Health Sci 2023; 23:724-731. [PMID: 38357188 PMCID: PMC10862578 DOI: 10.4314/ahs.v23i3.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background In Uganda, health care utilisation remains very low despite a number of government reforms that have been implemented in the health sector since the 1990's such as decentralization and removal of user fees in public health facilities among others. Objective To examine the factors influencing public and private health care utilisation in Uganda. Methods The study used cross sectional data from the Uganda National Household Survey collected between July 2016 and June 2017. Anderson's conceptual framework was used to identify explanatory variables associated with choice of health care providers and a multinomial logistic regression model was estimated. Results Out of the 17,912 individuals who sought care, 36% used a government facility, 60% used private facility while 4% had self- care/treatment. The results show that out of pocket health expenditure, age, level of education, marital status, residence, and type of illness significantly influenced choice of public healthcare providers. Similarly, utilisation of private healthcare providers was associated with household welfare, level of education, residence, marital status, illness days, and type of illness. Conclusion The findings highlight the need for a national health insurance scheme to reduce out of pocket payments for health care and enable the poor and vulnerable patients visit the modern health facilities.
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Affiliation(s)
| | - Bruno L Yawe
- Makerere University, College of Business and Management Sciences
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Hasan MS, Ghosal S. Gender differentials in the choice of in-patient healthcare services among the older adults in India: A cross-sectional study. Int J Health Plann Manage 2023; 38:1464-1482. [PMID: 37340537 DOI: 10.1002/hpm.3673] [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: 09/12/2022] [Revised: 05/14/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
India is presently undergoing a rapid demographic transition and experiencing a gradual increase in an ageing population. As a result, the households were continuously exposed to catastrophic economic impacts, ultimately influencing the healthcare utilisation of older people. The study examined the gender differentials in the choice of in-patient private and public hospitalisation among Indian elderly using Andersen's Health Behaviour Model. The database was acquired from the nationally representative cross-sectional survey (NSSO, 2017-18). Bivariate chi-square and binomial logistic regression techniques were used to fulfill the objective. In addition, the poor-rich ratio and concentration index was used to understand the inherent socioeconomic inequalities in healthcare preferences. The findings suggest that aged men were 27 percent more prone to avail private healthcare facilities than aged women. Further, older adults, who are married, belong to the upper caste, have higher education and gone through surgery, and primarily reside in an affluent society were more likely to prefer private in-patient hospitalisation. It represents negligence of older women in access to better healthcare who had financial strain and economically dependent. The study can be used to reframe existing public health policies and programs, particularly focusing on the older women, to avail cost-effective treatment.
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Affiliation(s)
- Md Sayed Hasan
- Centre for Rural Development and Innovative Sustainable Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
| | - Somnath Ghosal
- Centre for Rural Development and Innovative Sustainable Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
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Braimah JA, Agyemang-Duah W, Amoak D, Sano Y, Antabe R, Dassah E. Healthcare seeking behaviour during illness among older adults in Ghana: does food security status matter? BMC Geriatr 2023; 23:327. [PMID: 37231374 DOI: 10.1186/s12877-023-04023-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 05/06/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Ghana's growing older adult population raises critical questions regarding healthcare for these older adults. At the same time, food insecurity is high among older adults in Ghana. This underscores the need to investigate the issues of food security and healthcare seeking behaviour among older adults. However, research on the association between food security status and healthcare seeking behaviour among older adults is scant in the Ghanaian context. In this study, we advance the social gerontology literature by examining the association between food security status and healthcare seeking behaviors among older adults. METHODS Using a multi-stage sampling framework, we collected data from a representative sample of older adults across three regions in Ghana. Data were analyzed using logistic regression technique. We determined the significance of the test at a probability value of 0.05 or less. RESULTS Over two-thirds (69%) of respondents did not seek care during their last illness. Additionally, 36% of respondents were severely food insecure, 21% were moderately food insecure, 7% were mildly food insecure, and 36% were food secure. After controlling for theoretically relevant variables, our multivariable analysis revealed a statistically significant association between food security status and healthcare seeking behaviors with older people who are food secure (OR = 1.80, p < 0.01) and mildly food insecure (OR = 1.89, p < 0.05) being more likely to seek healthcare compared with their counterparts who are food insecure. CONCLUSION Our findings highlight the need for sustainable intervention programs to improve food access and health service use among older adults in Ghana and similar contexts.
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Affiliation(s)
- Joseph Asumah Braimah
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | | | - Daniel Amoak
- Department of Geography and Environment, Western University, London, Canada
| | - Yujiro Sano
- Department of Sociology, Nipissing University, North Bay, Canada
| | - Roger Antabe
- Department of Health and Society, University of Toronto Scarborough, Toronto, Canada
| | - Ebenezer Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Attafuah PYA, Everink IH, Lohrmann C, Abuosi A, Schols JM. Health and social needs of older adults in slum communities in Ghana: a phenomenological approach used in 2021. Arch Public Health 2023; 81:74. [PMID: 37106445 PMCID: PMC10134515 DOI: 10.1186/s13690-023-01056-9] [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: 11/15/2022] [Accepted: 03/08/2023] [Indexed: 04/29/2023] Open
Abstract
Slum-dwellers lack several essential amenities (such as water, sanitation, and electricity) which make them more vulnerable than non-slum dwellers. As there is limited to no access to health and social care services in slums, the slum environment is expected to be an even more dangerous environment for older adults, negatively impacting their quality of life (QoL). To provide an overview of the perceived (unmet) health and social care needs and how it affects the QoL, this study aims to explore the self-perceived health and social needs of older adults in urban slums in Ghana. Using a phenomenological approach, 25 semi-structured interviews were conducted between May and June 2021, in the homes of older adults in two slums in Ghana. After coding and analysing the transcripts, five main themes emerged: (a) perception of health; (b) (de)motivators of health service use; (c) perception of social care, (d) social needs, and (e) influence of phenomena on QoL. It appeared that older adults believed that spiritual powers were causing illnesses and influenced their use of formal health services. Other factors such as expired insurance cards and the attitude of healthcare workers served as demotivators for using health services.Perceived health needs were mainly current disease conditions (arthritis, diabetes, hypertension, vision/hearing challenges), challenges with health insurance, the behaviour of some health professionals, the proximity of health facilities, and unnecessary queues at major health facilities. Unmet social needs identified by this study were a sense of neglect by family (need for companionship), requiring assistance with activities of daily living, and the need for financial support. Participants had more health needs than social needs. Health providers do not usually prioritize the care of slum-dwelling older adults. Most participants still have challenges with the National Health Insurance Scheme (NHIS). Their social needs were mainly related to financial difficulties and help with some activities of daily living. Participants expressed that they desired companionship (especially the widowed or divorced ones) and the lack of it made them feel lonely and neglected. Home visits by health professionals to older adults should be encouraged to monitor their health condition and advocate for family members to keep older adults company. Healthcare providers should exhibit positive attitudes and educate older patients on the advantages of formal health services use, as well as the need to seek early treatment as this will influence their QoL to a large extent.
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Affiliation(s)
- Priscilla Yeye Adumoah Attafuah
- School of Nursing and Midwifery, University of Ghana, Legon, Ghana.
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands.
| | - Irma Hj Everink
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Christa Lohrmann
- Institute of Nursing Science, Medical University of Graz, Graz, Austria
| | - Aaron Abuosi
- Health Services Management Department, University of Ghana Business School, Legon, Ghana
| | - Jos Mga Schols
- Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
- Department of Family Medicine and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Agyemang-Duah W, Asante D, Oduro Appiah J, Morgan AK, Mensah IV, Peprah P, Mensah AA. System, institutional, and client-level factors associated with formal healthcare utilisation among older adults with low income under a social protection scheme in Ghana. Arch Public Health 2023; 81:68. [PMID: 37088819 PMCID: PMC10123979 DOI: 10.1186/s13690-023-01063-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/15/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND In sub-Saharan African context, effect of system, institutional and client-level factors on formal healthcare utilisation among older adults with low income, especially those under a social protection scheme (called Livelihood Empowerment against Poverty [LEAP] programme) is least explored in the literature. However, an adequate understanding of how these factors contribute to formal healthcare utilisation among older adults who are classified as poor (in terms of low income) is important to inform health policy decisions. The aim of this study, therefore, was to examine the contributions of system, institutional and client-level factors in formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana. METHODS Data associated with this study were obtained from an Ageing, Health, Lifestyle and Health Services survey conducted between 1 and 20 June 2018 (N = 200) in the Atwima Nwabiagya Municipal and Atwima Nwabiagya North District of Ghana. Multivariable logistic regressions were used to determine system, institutional and client-level factors associated with formal healthcare utilisation among older adults with low income under the LEAP programme in Ghana. The significance of the test was set at a probability value of 0.05 or below. RESULTS The study revealed that participants who relied on the LEAP programme and/or health insurance subscription to cater for their healthcare expenses (AOR: 11.934, CI: 1.151-123.777), those whose family/caregivers decided on when and where to use formal healthcare (AOR:12.409; CI: 2.198-70.076) and those who did not encounter communication problem with healthcare providers (AOR: 1.358; CI: 1.074-3.737) were significantly more likely to utilise formal healthcare services compared with their counterparts. The study further found that participants who perceived the attitude of healthcare providers as poor (AOR: 0.889; CI: 0.24-0.931) and those who spent 20-40 minutes at the healthcare facility were significantly less likely to utilise formal healthcare services compared with their counterparts (AOR: 0.070; CI: 0.006-0.195). CONCLUSION Our findings suggest that reducing waiting time at healthcare facilities, improving social protection and/or health insurance schemes, improving patient-doctor communication and promoting attitudinal change programmes (such as orientations and supportive supervision) for healthcare providers may help to facilitate the use of needed formal healthcare services by older adults with low income in Ghana.
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Affiliation(s)
| | - Dennis Asante
- College of Medicine & Public Health, Rural and Remote Health, Flinders University, Adelaide, South Australia, Australia
| | - Joseph Oduro Appiah
- Department of Geography, Environment & Spatial Analysis, Cal Poly Humboldt, Arcata, California, United States
| | - Anthony Kwame Morgan
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Verberk Mensah
- Department of Social Sciences, St. Ambrose College of Education, Wamfie, Bono Region, Ghana
| | - Prince Peprah
- Social Policy Research Centre, Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - Anthony Acquah Mensah
- Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
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Hossain B, James KS, Nagargoje VP, Barman P. Differentials in private and public healthcare service utilization in later life: do gender and marital status have any association? J Women Aging 2023; 35:183-193. [PMID: 34851802 DOI: 10.1080/08952841.2021.2011562] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The present study investigates whether the differentials in private and public inpatient healthcare utilization are associated with marital status for men and women aged 60 years and above in India. Binary logistic regression was applied to examine the association of private and public inpatient healthcare utilization with the marital status of the elderly. The study found that widowed men and women generally used public healthcare for hospitalization, while married men and women preferred private healthcare. Our findings also indicated that private inpatient health services expenditure was higher for married elderly than widowed elderly. After controlling all covariates, widowhood was significantly associated with higher use of public healthcare services for women but not for men. India's current health care policy and program may be required to focus on improving the infrastructure quality of current public healthcare systems. It also needs to be favorable for vulnerable sections of society, especially widowed women, to avail better treatment at an affordable cost.
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Affiliation(s)
- Babul Hossain
- International Institute for Population Sciences (IIPS), Mumbai, India
| | - K S James
- International Institute for Population Sciences (IIPS), Mumbai, India
| | | | - Papai Barman
- International Institute for Population Sciences (IIPS), Mumbai, India
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Abudu-Birresborn D, Brennenstuhl S, Puts M, McCleary L, Yakong V, Chu CH, Cranley L. Evaluating knowledge and attitudes scales for the care of older adults among nursing students in Ghana. BMC Nurs 2023; 22:47. [PMID: 36805691 PMCID: PMC9942360 DOI: 10.1186/s12912-023-01195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/31/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Understanding nursing students' knowledge about and attitudes toward older adults' using context-specific survey instruments can help to identify and design effective learning and teaching materials to improve the care for persons 60 years and above. However, there are no validated instruments to examine nursing students' knowledge and attitudes toward the care for older adults in the African context. The study aimed to evaluate the items on the Knowledge about Older Patients Quiz and Kogan's Attitudes towards Old People Scale suitable for the African context. METHODS A cross-sectional study was conducted using second-and third-year nursing students from two public Nursing Training Institutions in Ghana. Using Sahin's rule of sample size estimate of at least 150 participants for unidimensional dichotomous scales, 170 nursing students were recruited to participate after an information session in their classrooms. Data were collected from December 2019-March 2020 using the Knowledge about Older Patients Quiz and Kogan's Attitudes Towards Old People Scale. Item response theory was employed to evaluate the Knowledge about Older Patients Quiz difficulty level and discrimination indices. Corrected item-to-total correlation analysis was conducted for Kogan's Attitudes towards Old People Scale. The internal consistency for both scales was examined. RESULTS Of the 170 participants, 169 returned completed surveys. The mean age of participants was 21 years (SD = 3.7), and (54%) were female. Of the 30-items of the Knowledge about Older Patients Quiz, seven items were very difficult for most students to choose the correct response, and one was easy, as most of the students chose the correct response. Although 22 items demonstrated appropriate difficulty level, discrimination indices were used to select the final 15- items that discriminated moderately between upper and lower 25% performing students. The Kuder-Richardson-20 reliability was. 0.30, which was low. Considering Kogan's Attitudes towards Old People scale, 10-items were removed following negative and low corrected item-to-total correlation and a high Alpha coefficient if items were deleted. The final 22-items had a Cronbach alpha coefficient of 0.65, which was moderately satisfactory. CONCLUSION Evaluation of the scales demonstrated essential content validity and moderate internal consistency for the context of our study. Further research should focus on ongoing context-specific refinement of the survey instruments to measure nursing students' knowledge about and attitudes toward caring for older adults in the African context.
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Affiliation(s)
- Diana Abudu-Birresborn
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON, M5T 1P8, Canada.
| | - Sarah Brennenstuhl
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada
| | - Martine Puts
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada
| | - Lynn McCleary
- grid.411793.90000 0004 1936 9318Department of Nursing, Brock University, 1812 Sir Isaac Brock Way, St. Catharine’s, ON L2S 3A1 Canada
| | - Vida Yakong
- grid.442305.40000 0004 0441 5393School of Nursing and Midwifery, University for Development Studies, Box 1350, Tamale, Ghana
| | - Charlene H. Chu
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada
| | - Lisa Cranley
- grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada
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Asante D, McLachlan CS, Pickles D, Isaac V. Understanding Unmet Care Needs of Rural Older Adults with Chronic Health Conditions: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3298. [PMID: 36833993 PMCID: PMC9960497 DOI: 10.3390/ijerph20043298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Rural populations experience poorer access to the necessary health services for chronic health conditions. Although studies of rural healthcare access continue to expand, most are based on quantitative data, yet normative views and lived experiences of rural adults might offer a better understanding of healthcare access and their specific unmet needs. This qualitative study sought the views of both rural-centric older people and healthcare professionals to understand health needs, barriers, and enablers of accessing health services, with a focus on chronic health condition(s). METHODS Between April and July 2022, separate in-depth interviews were conducted with 20 older people (≥60 years) in a rural South Australian community. Additionally, focus group interviews were conducted with 15 healthcare professionals involved in providing health services to older adults. Transcripts were coded using the NVivo software and data were thematically analysed. RESULTS Participants described a range of unmet care needs including chronic disease management, specialist care, psychological distress, and the need for formal care services. Four barriers to meeting care needs were identified: Workforce shortages, a lack of continuity of care, self-transportation, and long waiting times for appointments. Self-efficacy, social support, and positive provider attitudes emerged as crucial enabling factors of service use among rural ageing populations. DISCUSSION Older adults confront four broad ranges of unmet needs: Chronic disease management care, specialist care, psychological care, and formal care. There are potential facilitators, such as self-efficacy, provider positive attitudes, and social support, that could be leveraged to improve healthcare services access for older adults.
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Affiliation(s)
- Dennis Asante
- College of Medicine & Public Health, Rural and Remote Health, Flinders University, Renmark, SA 5341, Australia
| | - Craig S. McLachlan
- Health Vertical Centre for Healthy Futures, Torrens University, Sydney, NSW 2007, Australia
| | - David Pickles
- College of Nursing and Health Sciences, Flinders University, Renmark, SA 5341, Australia
| | - Vivian Isaac
- College of Medicine & Public Health, Rural and Remote Health, Flinders University, Renmark, SA 5341, Australia
- School of Allied Health, Exercise and Sports Sciences/Faculty of Sciences and Health, Charles Sturt University, Albury, NSW 2640, Australia
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Rahaman M, Chouhan P, Roy A, Rana MJ, Das KC. Examining the predictors of healthcare facility choice for outpatient care among older adults in India using Andersen's revised healthcare utilization framework model. BMC Geriatr 2022; 22:949. [PMID: 36482338 PMCID: PMC9733055 DOI: 10.1186/s12877-022-03634-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In India, the demand for outpatient care is substantially higher than inpatient care among older adults. Therefore, the current study examines the level, patterns, and factors associated with outpatient care use. METHODS The present research used data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18). A total of 34,588 older adults (45 years and above) who accessed outpatient healthcare services in one year prior to the survey were included in this study. A bivariate chi-square test was applied to present the percentage distribution of types of outpatient healthcare utilization by background characteristics and healthcare responsiveness. Multinomial logistic regression analyses were employed to explore the interplay of outpatient healthcare utilization and allied predisposing, enabling, and need factors. RESULTS About 63.7% of total older adults used a private facility, followed by 22.8% used a public facility, and 13.5% used other facilities. Years of schooling, household wealth status, place of residence, self-rated health, and health insurance were all found to be significant determinants of public or private facility use. In contrast, respondents' sex was found to be a significant determinant of private healthcare use only. The study finds that there was inadequate healthcare reaction to public health facilities. CONCLUSION The current study revealed that the use of private facility for outpatient care is noticeably high in India. Older adults' educational attainments, health insurance coverage, and household level economic background were found to be significant factors in healthcare choice. The current study emphasizes the need to strengthen public healthcare services for outpatient care.
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Affiliation(s)
- Margubur Rahaman
- grid.419349.20000 0001 0613 2600Senior Research Fellow, Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, 400088 India
| | - Pradip Chouhan
- grid.449720.cProfessor, Department of Geography, University of Gour Banga, Malda, 732103 India
| | - Avijit Roy
- State Aided College Teacher, Department of Geography, Malda College, Malda, 732101 India
| | - Md. Juel Rana
- grid.411343.00000 0001 0213 924XAssistant Professor, Govind Ballabh Pant Social Science Institute (GBPSSI), Allahabad, 211019 India
| | - Kailash Chandra Das
- grid.419349.20000 0001 0613 2600Professor, Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, 400088 India
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Does Health System Responsiveness Differ between Insured and Uninsured Outpatients in Primary Health Care Facilities in Asagirt District, Ethiopia? A Cross-Sectional Study. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/3857873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background. An effective designation of health facilities improves the facility’s ability to respond to patients’ legitimate expectations. Limited evidence exists regarding the association between health system responsiveness and financial fairness in Sub-Saharan Africa, particularly in Ethiopia. The purpose of the study was, therefore to evaluate the health system responsiveness among insured and uninsured outpatients in primary healthcare facilities and determine the association between health insurance and health system responsiveness among outpatients. Methods. A facility-based cross-sectional study was conducted between March 30 and April 30,2021. The study sampled 423 participants using a systematic random sampling technique, and the data was collected with structured and pretested questionnaires administered by interviewers. Responsiveness was measured using the short version of the World Health Organization’s multicountry responsiveness survey, which has seven dimensions including autonomy, communication, confidentiality, attention, dignity, choice, and amenities. Using quantile regression, a specific association between health insurance and the health system responsiveness index was examined, adjusting for sociodemographic, quality, and satisfaction-related factors. Results. Of a total of 417 outpatients, 70.74% had health insurance. There was no statistical difference in health system responsiveness among insured and uninsured outpatients. Possession of health insurance was not associated with responsiveness (−0.67; 95%CI: −1.59, 0.25). There was a statistically significant negative relationship between age and responsiveness (−1.33; 95% CI: −2.47, −0.19) among 30–39 year olds and (−1.66; 95% CI: −3.02, −0.32) among 40–49 year olds. However, there was a positive statistical association between responsiveness with urban residence (+1.33; 95%CI: 0.37, 2.29), perceived quality of healthcare (+2.96; 95%CI: 1.95, 4.05), and patient satisfaction (3; 95%CI: 1.94, 4.07). Conclusions. There was no difference in the responsiveness of the health system between insured and uninsured outpatients. All domains need further improvement, particularly those more closely related to patients’ concerns, such as waiting time to get service and choices of healthcare providers. Furthermore, health facility administrators and the government should enhance responsive healthcare services in parallel with quality improvement and patient satisfaction, based on feedback from service users for better performance.
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Anis-Syakira J, Jawahir S, Abu Bakar NS, Mohd Noh SN, Jamalul-Lail NI, Hamidi N, Sararaks S. Factors Affecting the Use of Private Outpatient Services among the Adult Population in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13663. [PMID: 36294242 PMCID: PMC9602948 DOI: 10.3390/ijerph192013663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
The proportion of Malaysians of all ages who use private outpatient services has dropped over time, highlighting the overstretched condition of public outpatient facilities compared to their private counterparts. This paper aims to determine the prevalence of outpatient care, characteristics of outpatient care users by sector, and the factors affecting the utilisation of private outpatient services among the adult population of Malaysia using Andersen's behavioural model. Data from the National Health Morbidity Survey 2019 (NHMS 2019), a nationwide survey, were analysed. Logistic regression analysis was performed to explore the association of predisposing (locality, age, sex, ethnicity, education level, and marital status), enabling (working status, health care coverage, and household income), and need factors (perceived and evaluated needs) with the use of private outpatient services. Variables with a statistical significance ≤ 0.25 in the univariate regression analysis were included in the final multivariable logistic regression analysis. A total of 11,674 respondents, estimated to represent 22.4 million adults aged 18 years and above in Malaysia, were included for analysis. Overall, 8.3% of the adult population of Malaysia used outpatient care and 33.9% used the private sector. Those living in urban areas (OR = 1.80, 95% CI = 1.02, 3.18), non-Malays (OR = 1.74, 95% CI = 1.04, 2.93), those working (OR = 2.47, 95% CI = 1.48, 4.10), those with employer coverage (OR = 4.73, 95% CI = 2.79, 8.01), and those with health problems (OR = 2.26, 95% CI = 1.26, 4.05) were more likely to utilise private outpatient services. Those who self-rated their health status as fair (OR = 0.54, 95% CI = 0.33, 0.91) and who had diabetes, hypertension, or hypercholesterolemia (OR = 0.56, 95% CI = 0.31, 1.02) were less likely to utilise private outpatient services. The predisposing and enabling factors were associated with the use of private outpatient services, and the need factors were strong predictors of private outpatient care utilisation among adults. Understanding the factors associated with the utilisation of private outpatient services could aid in the development of effective initiatives designed to enhance outpatient care access among the population of Malaysia and balance the burden of outpatient care provision on the public and private sector.
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Affiliation(s)
- Jailani Anis-Syakira
- Centre for Health Outcomes Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Suhana Jawahir
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Centre for Health Equity Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Nurul Salwana Abu Bakar
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Centre for Health Policy Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Sarah Nurain Mohd Noh
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Centre for Health Equity Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Nurul Iman Jamalul-Lail
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Centre for Health Services Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Normaizira Hamidi
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Centre for Health Quality Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Sondi Sararaks
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Director Office, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
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Abu Bakar NS, Ab Hamid J, Mohd Nor Sham MSJ, Sham MN, Jailani AS. Count data models for outpatient health services utilisation. BMC Med Res Methodol 2022; 22:261. [PMID: 36199028 PMCID: PMC9533534 DOI: 10.1186/s12874-022-01733-3] [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: 03/03/2022] [Revised: 07/15/2022] [Accepted: 09/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Count data from the national survey captures healthcare utilisation within a specific reference period, resulting in excess zeros and skewed positive tails. Often, it is modelled using count data models. This study aims to identify the best-fitting model for outpatient healthcare utilisation using data from the Malaysian National Health and Morbidity Survey 2019 (NHMS 2019) and utilisation factors among adults in Malaysia. METHODS The frequency of outpatient visits is the dependent variable, and instrumental variable selection is based on Andersen's model. Six different models were used: ordinary least squares (OLS), Poisson regression, negative binomial regression (NB), inflated models: zero-inflated Poisson, marginalized-zero-inflated negative binomial (MZINB), and hurdle model. Identification of the best-fitting model was based on model selection criteria, goodness-of-fit and statistical test of the factors associated with outpatient visits. RESULTS The frequency of zero was 90%. Of the sample, 8.35% of adults utilized healthcare services only once, and 1.04% utilized them twice. The mean-variance value varied between 0.14 and 0.39. Across six models, the zero-inflated model (ZIM) possesses the smallest log-likelihood, Akaike information criterion, Bayesian information criterion, and a positive Vuong corrected value. Fourteen instrumental variables, five predisposing factors, six enablers, and three need factors were identified. Data overdispersion is characterized by excess zeros, a large mean to variance value, and skewed positive tails. We assumed frequency and true zeros throughout the study reference period. ZIM is the best-fitting model based on the model selection criteria, smallest Root Mean Square Error (RMSE) and higher R2. Both Vuong corrected and uncorrected values with different Stata commands yielded positive values with small differences. CONCLUSION State as a place of residence, ethnicity, household income quintile, and health needs were significantly associated with healthcare utilisation. Our findings suggest using ZIM over traditional OLS. This study encourages the use of this count data model as it has a better fit, is easy to interpret, and has appropriate assumptions based on the survey methodology.
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Affiliation(s)
- Nurul Salwana Abu Bakar
- Centre for Health Policy Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia.
| | - Jabrullah Ab Hamid
- Centre for Health Equity Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
| | - Mohd Shaiful Jefri Mohd Nor Sham
- Centre for Health Economics Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
| | - Mohd Nor Sham
- Centre for Health Economics Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
| | - Anis Syakira Jailani
- Centre for Health Outcome Research, Institute for Health Systems Research, National Institutes of Health, Ministry of Health, Shah Alam, Malaysia
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Muhammad T, Irshad C, Rajan SI. BMI mediates the association of family medical history with self-reported hypertension and diabetes among older adults: Evidence from baseline wave of the longitudinal aging study in India. SSM Popul Health 2022; 19:101175. [PMID: 35898561 PMCID: PMC9310107 DOI: 10.1016/j.ssmph.2022.101175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/14/2022] [Accepted: 07/14/2022] [Indexed: 12/09/2022] Open
Abstract
Background This study explored the association between family history of hypertension and diabetes with their diagnosis among older Indian adults. The study further examined the role of body mass index (BMI) as a potential mediator in these associations. Methods Data from the Longitudinal Ageing Study in India (LASI, 2017-18), wave-1 were used. The sample for the study included 31,464 older adults aged 60 years and above. Descriptive statistics and bivariate analysis has been conducted to assess the prevalence of self-reported hypertension and diabetes. Further, multivariable logistic regression models were used to test the research hypotheses of this study. The Karlson-Holm-Breen (KHB) mediation analysis was conducted to recover the direct and indirect effects of BMI in the association of family medical history and diagnosis of hypertension and diabetes. Results A proportion of 32.70% of older adults were diagnosed with hypertension and 14.23% of older adults were diagnosed with diabetes. A proportion of 19.48% and 14.69% of older adults had a family history of hypertension and diabetes, respectively. Also, 16.57% and 5.53% of older adults were overweight and obese, respectively in the current study. Older adults who had family history of hypertension had higher odds of being diagnosed with hypertension [aOR: 2.23, CI: 2.07-2.39] than those who had no such family history. This association was mediated by BMI (percent mediated: 6.31%). Similarly, older adults who had family history of diabetes had higher odds of being diagnosed with diabetes [aOR: 2.63, CI: 2.41-2.88] than those who had no such family history. This association was mediated by BMI (percent effect mediated: 6.66%). Conclusion The study highlights the relevance of using family medical history data along with information on BMI as potential source for the control and management of hypertension and diabetes among older population.
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Affiliation(s)
- T. Muhammad
- Department of Family & Generations, International Institute for Population Sciences, Mumbai, 400088, India
| | - C.V. Irshad
- Department of Humanities & Social Sciences, Indian Institute of Technology, Madras, 600036, India
| | - S. Irudaya Rajan
- The International Institute of Migration and Development, Thiruvananthapuram, 695011, India
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Askari MH, Gupta K. Understanding the health care utilization behavior to achieve the sustainable development goals—a comparative study of Malda District, India. SN SOCIAL SCIENCES 2022; 2:166. [PMID: 35996415 PMCID: PMC9387417 DOI: 10.1007/s43545-022-00474-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
Abstract
The Sustainable Development Goals were finalized in September 2015 by following and expanding Millennium Development Goals with newer targets under the principle of ‘leaving no one behind’. One of the 17 goals is devoted to health (Goal number 3). Understanding the health care utilization behavior is essential to attain the health goal by providing adequate and quality health services. The study seeks to understand the health care utilization behavior and its determinants in Malda district, India. For this study, the primary data are collected through a household survey with a pre-designed schedule. For that, for a comparative discussion, Englishbazar and Chanchal- II blocks have been chosen by purposive sampling considering the best and worst health conditions, respectively. The sample size was 100 families for each block. Analytical methods like chi-square, correlation, and regression analysis are used for the study. The four categories of treatment patterns that have been recognized in the study area; are self-treatment, government institution, qualified doctors and private institution, and the presence of quack doctors. People’s education and income were the confounding factors of such treatment patterns. Many of the respondents are getting treatment from quack doctors or rely on self-treatment based on their very little knowledge of medicine, resulting from a lack of awareness among local communities. It may be concluded that besides socio-economic factors, the availability of insufficient health care facilities influences the health care utilization behavior in the study area.
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Affiliation(s)
- Md. Hasan Askari
- Department of Geography, Turku Hansda Lapsa Hemram Mahavidyalay, Mallarpur, Birbhum, West Bengal 731216 India
| | - Krishnendu Gupta
- Department of Geography, Visva Bharati, Birbhum, West Bengal India
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Adelabu A, Akinyemi O, Adebayo A, Oladokun B. Assessment of the level and distribution of health system responsiveness in Oyo State, Nigeria. BMC Health Serv Res 2022; 22:905. [PMID: 35831823 PMCID: PMC9281151 DOI: 10.1186/s12913-022-08276-9] [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: 04/07/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Health systems need to be evaluated to ascertain if they are meeting their objectives. There is an increased interest in health system responsiveness (HSR) as a means to appraise health systems. This becomes vital as we put people at the centre of integrated health systems and put a premium on their rights and perspectives. Thus, this study assessed the levels, distribution and factors associated with HSR in Oyo State. Methods The study was a cross-sectional study with 717 adults, who had used an out-patient health facility in the preceding 12 months, interviewed using a semi-structured, interviewer-administered questionnaire. HSR was measured on a multi-domain and multi-item (7 domains and 20 items) 5-point Likert scale that was developed by the WHO to measure HSR globally. Summary scores were computed for level, distribution and the most important domains of HSR. Determinants of poor HSR were determined using binomial logistic regression. The level of statistical significance was set at 5%. Results The overall level of HSR was 47%. The highest-rated domains were confidentiality (72%), dignity (64%) and choice (60%), while the least rated were prompt attention (43%) and communication (52%). The overall distribution of HSR was 0.228 (range of 0 to 1) with the domains of prompt attention (0.595) and choice (0.506) being the most unequally distributed. The most important domains were communication, prompt attention and dignity. The least important domains were choice and confidentiality. The factors associated with poor HSR (overall) were no formal education, (OR = 2.81; 95% CI: 1.35–5.86), primary education as the highest level of education (OR = 2.19; 95% CI: 1.28–3.75), poor socioeconomic class (OR = 1.86; 95% CI: 1.23–2.80), using a government-owned facility (OR = 1.56; 95% CI: 1.11–2.19) and not using the usual health facility (OR = 1.69; 95% CI: 1.13–2.53). Conclusions The overall level of HSR in Oyo State was low with the domains of prompt attention, communication and autonomy being the least rated domains. Therefore, concerted efforts should be targeted at improving HSR as this will improve wellbeing, health system utilization, and the overall health system. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08276-9.
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Affiliation(s)
| | - Oluwaseun Akinyemi
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Ayodeji Adebayo
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Blessing Oladokun
- Department of Mathematics and Statistics, East Tennessee State University, Tennessee, USA
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Rethinking Public Private Mix (PPM) Performance in the Tuberculosis Program: How Is Care Seeking Impacting This Model in High TB Burden Countries? Healthcare (Basel) 2022; 10:healthcare10071285. [PMID: 35885812 PMCID: PMC9317713 DOI: 10.3390/healthcare10071285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
In many high TB burden countries with enormous private-sector presence, up to 60–80% of the initial health-seeking behavior occurs in the private sector when people fall sick. Private-sector providers are also perceived to offer poorer-quality health service, and contribute to TB notification gaps and the spread of multidrug-resistant tuberculosis (MDR-TB). Recent efforts have focused on the expansion of TB services among private providers through public–private mix (PPM) initiatives. However, whether such efforts have matched the contribution of the private sector in TB notification, considering its enormous health-seeking volume, is debatable. Here, we argue that evaluating PPM program performance on the basis of the proportion of private-sector health seeking and level of undernotification is an imperfect approach due to differentials in tuberculosis risk profiles and access among patient populations seeking private care when compared with the public sector. We suggest a uniform definition of what constitutes PPM, and the standardization of PPM reporting tools across countries, including the ability to track patients who might initially seek care in the private sector but are ultimately publicly notified. PPM programs continue to gain prominence with rapid urbanization in major global cities. A universal health coverage framework as part of the PPM expansion mandate would go a long way to reduce the catastrophic cost of seeking TB care.
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Wickramarachchi BI, Siop SJ, Perera B. Associated factors of doctor visits made by urban-dwelling older adults in Sri Lanka: an application of Anderson's model of health service utilization. BMC Geriatr 2022; 22:571. [PMID: 35820836 PMCID: PMC9275041 DOI: 10.1186/s12877-022-03249-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
Background Although universal free healthcare is available for all Sri Lankan citizens, older adults face somewhat unique obstacles when utilizing available healthcare services. The aim of this study was to examine some vital predisposing, enabling, and need factors associated with doctor visits made by urban-dwelling older adults in Sri Lanka. Methods A representative sample of 880 urban-dwelling older adults (aged 60 years and above) was surveyed using an interviewer-administered questionnaire. Number of doctor visits, self-rated health, physical activity, and socio-demographic and self-report health conditions were collected. The data were analyzed using chi-squared tests and multinomial logistic regression. Results Participants’ mean age was 70.01 (± 6.02) years. The majority was women (75.0%). The mean number of doctor visits was 6.77 (± 5.92) per year. Nearly half of the participants (47.0%) had made, on average, at least one doctor visit per month. Older men and those of aged 80 years and above were the least likely to make frequent doctor visits. Participants who were physically active and who rated their health as poor were more likely to make frequent doctor visits after adjustment for age, gender, and educational level. Conclusions Doctor visits made by Sri Lankan older adults are satisfactory. The factors that best explain high frequency of doctor visits by older adults are female gender, younger age, higher physical activity and poor self-rated health. Attention should be paid to examine possible accessible and affordable issues related to doctor visits by bedridden or physically dependent older adults in advanced age categories. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03249-3.
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Affiliation(s)
- Bimba I Wickramarachchi
- Department of Nursing, Faculty of Medicine and Heath Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia.,Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Galle, Sri Lanka
| | - Sidiah J Siop
- Department of Nursing, Faculty of Medicine and Heath Sciences, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia
| | - Bilesha Perera
- Department of Community Medicine, Faculty of Medicine, University of Ruhuna, Galle, 80000, Sri Lanka.
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Oliveira ECT, Louvison MCP, Teixeira DSDC, de Menezes TN, Rosa TEDC, Duarte YADO. Difficulties in accessing health services among the elderly in the city of São Paulo-Brazil. PLoS One 2022; 17:e0268519. [PMID: 35588124 PMCID: PMC9119537 DOI: 10.1371/journal.pone.0268519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
To identify difficulties in accessing health services by the elderly in the city of São Paulo/Brazil and the contributory factors that reflect inequalities. This is a cross-sectional study that used data from the Health, Well-being and Aging Study (SABE). The population is composed of elderly ≥ 60 years old, of both sexes, living in the urban area of São Paulo. For this analysis, we used data from the 2015 cohort of the SABE study, containing a sample of 1,221 individuals. The proportions of access difficulty and, through logistic regression, the associated factors were verified, based on Andersen’s Behavioral Model, which considers factors of predisposition, enabling and need as individual determinants of access to health care. It was observed that 37.0% of the elderly reported difficulty accessing health services when they needed it. This difficulty was greatest among females (42.3%), aged 60 to 69 years (40.9%), black race/color (58.8%), illiterate (44.5%), single/separated/divorced (44.3%), with income slower than one salary minimum (46.8%), without health insurance (51.9%), with poor/very poor self-assessment of health (54.7%), with multimorbidity (40.1%), frail (47.2%) and among those who used polypharmacy (40.8%). After multivariate analysis, in the final model, there was a positive association between difficulty of access and predisposing factors (female gender, age group 60 to 69 years, black race/color, illiterate), enabling factors (possession of health insurance) and need factors (regular and poor/very poor self-assessment of health and pre-fragility and frailty condition). The presence of difficulty in access associated with predisposing, enabling and need factors reflect the existence of inequalities caused by barriers that point to weaknesses in the organization of services. The identification of these barriers that hinder access highlights important points that can have an impact on the equity and resolution of care.
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Affiliation(s)
| | - Marília Cristina Prado Louvison
- Department of Policy, Management and Health, Faculty of Public Health, University of São Paulo (USP), São Paulo, São Paulo, Brazil
| | | | | | | | - Yeda Aparecida de Oliveira Duarte
- Coordinator of the Health, Well-Being and Aging Study (SABE), School of Nursing, Faculty of Public Health, University of São Paulo (USP), São Paulo, São Paulo, Brazil
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Pengpid S, Peltzer K. Health Care Responsiveness by Conventional, Traditional and Complementary Medicine Providers in a National Sample of Middle-Aged and Older Adults in India in 2017–2018. J Multidiscip Healthc 2022; 15:773-782. [PMID: 35422625 PMCID: PMC9005073 DOI: 10.2147/jmdh.s357761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/28/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction This study aimed to determine the prevalence and correlates of health care responsiveness by conventional, traditional and complementary medicine providers in middle-aged and older community-dwelling adults from the India Longitudinal Ageing Study in India (LASI) Wave 1 in 2017–2018. Methods The cross-sectional sample included 37,852 participants who received outpatient health care in the past 12 months, of which 33,615 had visited a conventional health facility, 2120 an AYUSH facility, and 2117 a traditional health practitioner (THP). Results The prevalence of poor health care responsiveness was 10.1% overall, and 10.7% for the conventional health facility, 8.3% for AYUSH, and 5.7% for the THP. In adjusted logistic regression analysis using the whole sample, the prevalence of poor health care responsiveness was significantly lower among AYUSH and THP clients than among conventional health care clients. Having higher education, higher socioeconomic status and being a Sikh decreased the odds of poor health care responsiveness, while being a member of a caste, having two or more chronic diseases, functional disability, and visiting the health facility for immunisation increased the odds of poor health care responsiveness. In regard to the AYUSH provider, older age decreased the odds and member of a caste, being a Christian and functional disability increased the odds of poor health care responsiveness, and in terms of the THP, being a Sikh decreased the odds and older age, functional disability and visiting the THP for immunisation and for treatment for injury/accident increased the odds of poor health care responsiveness. Discussion One in ten middle-aged or older adults in India reported poor health care responsiveness, and several sociodemographic and health factors were identified associated with poor health care responsiveness by different service providers.
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Affiliation(s)
- Supa Pengpid
- Department of Health Education and Behavioral Sciences, Faculty of Public Health Mahidol University, Bangkok, Thailand
- Department of Research Administration and Development, University of Limpopo, Turfloop, South Africa
| | - Karl Peltzer
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
- Correspondence: Karl Peltzer, Department of Psychology, University of the Free State, Bloemfontein, South Africa, Email
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Guo W, Liu G, Ma L, Gao B, Wang W, Hu Z, Tian Y, Xiao W, Qiao H. The impact of healthcare reform on the dynamic changes in health service utilization and equity: a 10-year follow-up study. Sci Rep 2022; 12:3576. [PMID: 35246561 PMCID: PMC8897404 DOI: 10.1038/s41598-022-07405-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 02/16/2022] [Indexed: 11/10/2022] Open
Abstract
In the past decade, the government of China has implemented healthcare reforms to provide universal access to healthcare by 2020. We aimed to systematically analyse the dynamic changes in health services and equity during the past 10 years to understand the correlation between health services and social-economic status. We performed a longitudinal study in which we extracted aggregated data mainly from a project (2009, 2011, 2012, 2015, 2019). A multi-stage stratified cluster randomized design was used to obtain a representative sample in each county. Concentration indexes were used to analyse the equity of the changes in utilization. We built multivariate random-effects generalized least squares regression models with the panel data to test whether the rate of receiving a medical consultation in the last 2 weeks or the rate of hospital admission or the prevalence of chronic illness was associated with social-economic status including education level and rural disposable income per capita. We found declines in both the rate of not receiving a medical consultation during the last 2 weeks (P < 0.05 intervention group) and the rate of hospital avoidance (P < 0.05) from 2009 to 2019. The equity in residents' health service utilization has improved constantly. We additionally found that rural disposable income per capita is a protective factor for the rate of a receiving a medical consultation during the last 2 weeks and the rate of hospital admission. China's 2009 healthcare reform have positively influenced utilization rates and equity in health service utilization in the past decade, a range of health service-targeted strategies are needed including strengthen the prevention and treatment of chronic diseases, focus attention on the health status of elderly residents and improve social-economic status, especially the level of education.
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Affiliation(s)
- Wenqin Guo
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China.,Key Laboratory of Environmental Factors and Chronic Disease Control, No.1160, Shengli Street, Xingqing District, Yinchuan, Ningxia, China
| | - Gangjun Liu
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China.,Key Laboratory of Environmental Factors and Chronic Disease Control, No.1160, Shengli Street, Xingqing District, Yinchuan, Ningxia, China
| | - Li Ma
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China.,Key Laboratory of Environmental Factors and Chronic Disease Control, No.1160, Shengli Street, Xingqing District, Yinchuan, Ningxia, China
| | - Baokai Gao
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China.,Key Laboratory of Environmental Factors and Chronic Disease Control, No.1160, Shengli Street, Xingqing District, Yinchuan, Ningxia, China
| | - Wenlong Wang
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China.,Key Laboratory of Environmental Factors and Chronic Disease Control, No.1160, Shengli Street, Xingqing District, Yinchuan, Ningxia, China
| | - Zhaoyan Hu
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China.,Key Laboratory of Environmental Factors and Chronic Disease Control, No.1160, Shengli Street, Xingqing District, Yinchuan, Ningxia, China
| | - Yanmei Tian
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China.,Key Laboratory of Environmental Factors and Chronic Disease Control, No.1160, Shengli Street, Xingqing District, Yinchuan, Ningxia, China
| | - Wenwen Xiao
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China.,Key Laboratory of Environmental Factors and Chronic Disease Control, No.1160, Shengli Street, Xingqing District, Yinchuan, Ningxia, China
| | - Hui Qiao
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China. .,Key Laboratory of Environmental Factors and Chronic Disease Control, No.1160, Shengli Street, Xingqing District, Yinchuan, Ningxia, China.
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Negash WD, Tsehay CT, Yazachew L, Asmamaw DB, Desta DZ, Atnafu A. Health system responsiveness and associated factors among outpatients in primary health care facilities in Ethiopia. BMC Health Serv Res 2022; 22:249. [PMID: 35209882 PMCID: PMC8867670 DOI: 10.1186/s12913-022-07651-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background Health system responsiveness is defined as the outcome of designing health facility relationships so that they are familiar and responsive to patients’ universally legitimate expectations. Even though different strategies have been implemented to measure responsiveness, only limited evidence exists in Sub-Saharan Africa. In Ethiopia, information about health system responsiveness among outpatients is limited. Assessing responsiveness could help facilities in improving service delivery based on patient expectations. Objective The study aimed to assess health system responsiveness and associated factors among outpatients in primary health care facilities, Asagirt District, Ethiopia, 2021. Methods Facility-based cross-sectional quantitative study was implemented between March 30 and April 30/2021. A systematic random sampling technique was employed to select 423 participants, and interviewer-administered data were collected using structured and pretested questionnaires. Both bivariable and multivariable logistic regressions were employed to identify factors associated with health system responsiveness. Adjusted Odds Ratio with their corresponding 95% CI was used to declare factors associated with health system responsiveness. A p-value less than 0.05 was used to declare significant statistical variables. Results The overall health system responsiveness performance was 66.2% (95% CI: 61.4—70.7). Confidentiality and dignity were the highest responsive domains. Health system responsiveness was higher among satisfied patients (AOR: 9.9, 95% CI: 5.11–19.46), utilized private clinics (AOR: 8.8, 95% CI: 4.32–18.25), and no transport payment (AOR: 1.7, 95% CI: 1.03–2.92) in the study setting. Conclusion Overall, health system responsiveness performance was higher than a case-specific study in Ethiopia. To improve the health systems responsiveness and potentially fulfil patients’ legitimate expectations, we need to facilitate informed treatment choice, provide reasonable care within a reasonable time frame, and give patients the option of consulting a specialist. Aside from that, enhancing patient satisfaction, using input from service users, Collaboration, and exchanging experiences between public and private facilities will be important interventions to improve HSR performance.
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Affiliation(s)
- Wubshet Debebe Negash
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Chalie Tadie Tsehay
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Lake Yazachew
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Dawit Zenamarkos Desta
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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The Mediating Effect of Healthcare Utilization on Livelihood Empowerment against Poverty (LEAP) and Health Security of Older Adults in Ghana: A Case Study on the Ga-West Municipality in Accra, Ghana. Healthcare (Basel) 2022; 10:healthcare10020370. [PMID: 35206984 PMCID: PMC8872544 DOI: 10.3390/healthcare10020370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 02/04/2023] Open
Abstract
The concept of health security has aroused several interpretations because of theoretical technique indifferences or academic methodology. The focus has been on human security, old age health security (OAHS), whereas there remain issues of low healthcare utilization by older people from rural Ghana while there are social assistance programs. The study aimed at investigating the mediating effect of healthcare utilization on Livelihood Empowerment against Poverty (LEAP) and old age health security OAHS. With purposive sampling technique, participants were selected to participate in the study with standardized quantitative questionnaire to measure the variables involved in the study and a regression technique to analyze the data. The result of the mediation analysis showed a partial mediation between LEAP and Healthcare Utilization (HU) was found to have bridged the gap between the LEAP and OAHS. The LEAP policy also caused an increase in Health Utilization and, subsequently, an increase in old age health security (OAHS). The study is essential to help the National Health Insurance Authority NHIA in restructuring health care premiums to incite utilization of health facilities by the aged.
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Kundu J, Bharadwaz MP, Kundu S, Bansod DW. The interregional disparity in the choice of health care utilization among elderly in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Yiengprugsawan VS, Dorj G, Dracakis JG, Batkhorol B, Lkhagvaa U, Battsengel D, Ochir C, Naidoo N, Kowal P, Cumming RG. Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument. BMC Health Serv Res 2021; 21:1183. [PMID: 34717613 PMCID: PMC8556801 DOI: 10.1186/s12913-021-07156-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 10/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background Mongolia has made significant progress towards achieving Universal Health Coverage (UHC), but there are still challenges ahead with population ageing and non-communicable diseases (NCDs). The purpose of this study was to investigate patterns and determinants of outpatient and inpatient health service use amongst older people in Mongolia. Methods Data were collected using a questionnaire developed for the World Health Organization’s Study on global AGEing and adult health (WHO SAGE). There were 478 participants from rural areas and 497 participants from Ulaanbaatar (further divided into 255 ger/yurt district and 242 apartment district residents). Multivariable logistic regression analyses were used to investigate determinants of outpatient and inpatient health service use with reported adjusted Odds Ratios (AORs) and 95 % Confidence Intervals (CIs). Results Participants were aged 60 to 93 years. About 55 % of respondents used outpatient services in the past 12 months and 51 % used inpatient services in the past three years. Hypertension was the most common reason for health service use. Rural residents had longer travel times and were more likely to incur out-of-pocket expenditure (OOP). Multivariable logistic regression revealed that women were more likely to use outpatient services (AOR 1.88; 1.34-2.63). Compared to apartment residents in urban areas, ger residents in urban areas were less likely to use outpatient services (AOR 0.54; 0.36-0.83). There was no statistically significant differences in inpatient service by location. Increasing numbers of chronic conditions (1 and 2+ compared to none) were associated with both outpatient (AORs 2.59 and 2.78) and inpatient (AORs 1.97 and 3.01) service use. Conclusions This study highlights the needs to address disparities in outpatient service use for rural and urban ger populations. Compared with other WHO-SAGE countries, older Mongolians have relatively higher use of inpatient health care services. With a high prevalence of hypertension and an ageing population, efforts to achieve UHC would benefit from reorienting care services towards prevention and primary care management of NCDs to reduce the costs from hospital-based care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07156-y.
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Affiliation(s)
- Vasoontara Sbirakos Yiengprugsawan
- Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia.
| | - Gantuya Dorj
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Jocelyn G Dracakis
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Bilegt Batkhorol
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Undram Lkhagvaa
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Dulamsuren Battsengel
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Chimedsuren Ochir
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Paul Kowal
- World Health Organization, Geneva, Switzerland.,International Health Transitions, Canberra, Australia
| | - Robert G Cumming
- Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Mojdehkar R, Jahangiri K, Hajinabi K, Riahi L. Adapted fairness benchmarks for the evaluation of Iran health system reform. Int J Health Plann Manage 2021; 36:2118-2128. [PMID: 34240457 DOI: 10.1002/hpm.3266] [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: 10/21/2020] [Revised: 05/04/2021] [Accepted: 06/17/2021] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION This study has been designed to localize fairness benchmarks for the evaluation of health system reform with an ethical approach. METHODS A descriptive-analytic study was applied in which a questionnaire with selected indicators and based on main fairness benchmarks was validated. Besides, the final indicators were chosen for surveys of 255 health equity experts from 31 provinces of Iran to localize fairness benchmarks using the exploratory factor analysis through the SPSS software. RESULTS Seven fairness benchmarks were adopted: (1) Efficacy, Efficiency, and Quality of Health Care; (2) Impact of Information Infrastructure on Health Reform; (3) Responsiveness; (4) Equitable Access, and Universal Health Coverage; (5) Equitable Financing; (6) Social Determinant of Health; and (7) Financial Barriers to Equitable Access. CONCLUSION The priorities of fairness benchmarking through localization included focusing on the quantity and quality of primary health care, allocating resources based on the need; for equitable efficiency, and paying attention to community-based information infrastructure, and social determinants for fair reform. Moreover, respecting patient rights as a part of democratic accountability was more close to equity. Elimination of financial and nonfinancial barriers for health access and coverage based on vulnerability, through fair financing, was also confirmed.
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Affiliation(s)
- Reyhaneh Mojdehkar
- Department of Health Services Administration, Faculty of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Katayoun Jahangiri
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kamran Hajinabi
- Department of Health Services Administration, Faculty of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Leila Riahi
- Department of Health Services Administration, Faculty of Medical Science and Technology, Science and Research Branch, Islamic Azad University, Tehran, Iran
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Haw NJL, Uy J, Ho BL. Association of SHI coverage and level of healthcare utilization and costs in the Philippines: a 10-year pooled analysis. J Public Health (Oxf) 2021; 42:e496-e505. [PMID: 31781739 DOI: 10.1093/pubmed/fdz142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Philippine Health Insurance Corporation (PhilHealth), which manages the Philippine national health insurance program, is a critical actor in the country's strategy for universal health coverage. Over the past decade, PhilHealth has passed significant coverage, benefits and payment reforms to contain costs and improve the affordability care for high-cost diseases, inpatient care and select outpatient services. METHODS We studied the association of PhilHealth with health care utilization and health care costs using three rounds of the Philippine Demographic and Health Survey with data on individual outpatient and inpatient visits from 2008 to 2017. RESULTS PhilHealth membership was associated with 42% greater odds of outpatient utilization and 47-100% greater odds inpatient utilization depending on survey year. Depending on facility type, use of PhilHealth to pay for care was associated with higher average health care costs of 244-865% for outpatient care and 135-206% for inpatient care. CONCLUSIONS PhilHealth has likely decreased barriers to health care utilization but may have inadvertently driven up health care costs in the country. Results align with past studies that suggest that reforms in the prior decade have done little to contain health care costs for Filipinos.
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Affiliation(s)
- Nel Jason L Haw
- School of Science and Engineering, Ateneo de Manila University, Quezon City 1108, Philippines
| | - Jhanna Uy
- School of Science and Engineering, Ateneo de Manila University, Quezon City 1108, Philippines
| | - Beverly Lorraine Ho
- Health Policy Development and Planning Bureau, Department of Health Philippines, Manila City 1003, Philippines
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Nguyen TA, Giang LT. Factors Influencing the Vietnamese Older Persons in Choosing Healthcare Facilities. Health Serv Insights 2021; 14:11786329211017426. [PMID: 34177269 PMCID: PMC8193656 DOI: 10.1177/11786329211017426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 04/23/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The rapidly growing aging population poses major challenges for health systems in Vietnam. This study was therefore aimed to examine factors influencing the choices of healthcare facilities among older patients in Vietnam, using a national survey on older people. METHODS We applied multinomial logistic regression models based on Andersen's Behavioral Model with various predisposing factors, enabling factors and healthcare-needs factors associated with different types of healthcare facilities where older patients utilized services. DATA We used data from the Vietnam Aging Survey (VNAS) in 2011. This was the first-ever nationally representative survey on older persons in Vietnam. RESULTS Among those who used healthcare services, 15.1% visited central hospitals; 23.6% visited provincial hospitals; 28.0% visited district hospitals; 8.8% visited commune heath centres; 18.3% visited private hospitals/clinics; and 6.2% visited other facilities. The results showed that "having to pay cost" and "having sufficient income" were strong predictors for using commune health centres, district hospitals, and private facilities, while "having health insurance" was not a significant predictor for using these facilities. Also, we showed that apart from enabling factors (such as age, gender, educational levels, employment status, living regionand place of residence), predisposing factor (such as health insurance, perceived sufficient income, household wealth and having to pay medical cost) as well as need factors (such as self-rated health and chronic disease) were also associated with the choice of healthcare facilities. CONCLUSIONS Based on the findings, we discussed the implications of the results for organizing healthcare finance and delivery to achieve efficiency and equity for older people in Vietnam.
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Affiliation(s)
- Tuyet Anh Nguyen
- The Osaka School of International Public Policy, Osaka University, Japan
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Novignon J, Atakorah YB, Chijere Chirwa G. Exemption for the poor or the rich? An assessment of socioeconomic inequalities in Ghana's national health insurance exemption policies. Health Policy Plan 2021; 36:1058-1066. [PMID: 34050736 DOI: 10.1093/heapol/czab059] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 04/18/2021] [Accepted: 05/19/2021] [Indexed: 11/14/2022] Open
Abstract
Out-of-pocket payments for health are considered a major limitation to universal health coverage (UHC). Policymakers across the globe are committed to achieving UHC through the removal of financial barriers to health care. In Ghana, a national health insurance scheme was established for this purpose. A unique feature of the scheme is its premium exemption policies for vulnerable groups. In this article, we access the nature of socioeconomic inequality in these exemption policies. We used data from the Ghana Living Standards Survey rounds six and seven. Socioeconomic inequality was assessed using concentration curves and indices. Real household annual total consumption expenditure adjusted by adult equivalence scale was used as a wealth indicator. Four categories of exemption were used as outcome variables. These were exemptions for indigents, individuals <18 years, the aged and free maternal service. The analysis was also disaggregated by rural and urban locations of individuals. We found that while overall national health insurance scheme (NHIS) coverage was concentrated among the wealthy, all categories of premium exemption were concentrated among the poor. There was also evidence of a general decline in the magnitude of inequality over the survey years. With the specific exemptions, inequalities in exemption for indigents and maternal services were most relevant in rural locations, while inequalities in exemption for individuals <18 years and the aged were significant in urban areas. The findings suggest that the exemption policies under the NHIS are generally progressive and achieve the objective of inclusion for the underprivileged. However, it also provides lessons for better targeting and effective implementation. There may be a need for separate efforts to better target individuals in rural and urban locations to improve enrolment.
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Affiliation(s)
- Jacob Novignon
- Private Mail Bag, Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Yaw Boateng Atakorah
- Private Mail Bag, Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Wambiya EOA, Otieno PO, Mutua MK, Donfouet HPP, Mohamed SF. Patterns and predictors of private and public health care utilization among residents of an informal settlement in Nairobi, Kenya: a cross-sectional study. BMC Public Health 2021; 21:850. [PMID: 33941131 PMCID: PMC8091493 DOI: 10.1186/s12889-021-10836-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/13/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Knowledge of health care utilization is important in low-and middle-income countries where inequalities in the burden of diseases and access to primary health care exist. Limited evidence exists on health seeking and utilization in the informal settlements in Kenya. This study assessed the patterns and predictors of private and public health care utilization in an urban informal settlement in Kenya. METHODS This study used data from the Lown scholars study conducted between June and July 2018. A total of 300 households were randomly selected and data collected from 364 household members who reported having sought care for an illness in the 12 months preceding the study. Data were collected on health-seeking behaviour and explanatory variables (predisposing, enabling, and need factors). Health care utilization patterns were described using proportions. Predictors of private or public health care use were identified using multinomial logistic regression with the reference group being other providers. RESULTS Majority of the participants used private (47%) and public facilities (33%) with 20% using other providers including local pharmacies/drug shops and traditional healers. In the model comparing public facilities vs other facilities, members who were satisfied with the quality of health care (vs not satisfied) were less likely to use public facilities (adjusted relative risk ratio (aRRR) 0.29; CI 0.11-0.76) while members who reported an acute infection (vs no acute infection) were more likely to use public facilities (aRRR 2.31; 95% CI 1.13-4.99) compared to other facilities. In the second model comparing private facilities to other facilities, having health insurance coverage (aRRR 2.95; 95% CI 1.53-5.69), satisfaction with cost of care (aRRR 2.08; CI 1.00-4.36), and having an acute infection (aRRR 2.97; 95% CI 1.50-5.86) were significantly associated with private facility use compared to other facilities. CONCLUSIONS The majority of urban informal settlement dwellers seek care from private health facilities. As Kenya commits to achieving universal health coverage, interventions that improve health care access in informal and low-resource settlements are needed and should be modelled around enabling and need factors, particularly health care financing and quality of health care.
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Affiliation(s)
- Elvis O. A. Wambiya
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Peter O. Otieno
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Martin Kavao Mutua
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Hermann Pythagore Pierre Donfouet
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
| | - Shukri F. Mohamed
- African Population and Health Research Center, APHRC Campus, 2nd Floor, Manga Close, Off Kirawa Road, P.O. Box: 10787-00100, Nairobi, Kenya
- Department of Global Health and Population, Lown Scholars Program, Harvard T.H. Chan School of Public Health, Boston, MA USA
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Fallah R, Bazrafshan A. Participation of delivering private hospital services in universal health coverage: A systematic scoping review of the developing countries' evidence. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:113. [PMID: 34084860 PMCID: PMC8150068 DOI: 10.4103/jehp.jehp_957_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/23/2020] [Indexed: 06/12/2023]
Abstract
There is a lack of conceptual clarity about the role of delivering private hospital services (DPHS) accompanied by major gaps in evidence. The purpose of this systematic scoping review was to identify and map the available evidence regarding the developing countries to scrutinize the participation of DPHS exclusively in the universal health coverage (UHC) through providing graphical/tabular classifications of the bibliometric information, sources of the records, frequent location, contribution of the private hospital services in the health system, and roles of DPHS in UHC. This study was performed following the published methodological guidance of the Joanna Briggs Institute for the conduct of scoping review, applying some major databases and search engines. In addition, a narrative-thematic synthesis integrated with the systematic analysis using the policy framework of the World Health Organization was employed. The 28 included records in English which met the inclusion criteria were found between 2014 and January 2020. The chronological trend of records was progressive until 2019. India was the most frequent location (12%). China and Sri Lanka on the one end of the spectrum and Somalia along with South Korea from the other end were, respectively, the least and the most contributed countries in terms of DPHS. Overall, 90% of the roles were concerned with UHC goals. Although evidence has revealed inconsistency in the identified roles, a continuous chain of positive or negative effects in the UHC objectives and goals was observed. Some knowledge gaps about the roles, causes of the increasing and decreasing DPHS contribution, and its behaviors around the privatization types and circumstances of the delivery were recommended as prioritized research agendas for evidence-based policymaking in future.
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Affiliation(s)
- Razieh Fallah
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Azam Bazrafshan
- Department of Medical Library and Information Science, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Nyantakyi-Frimpong H. Climate change, women's workload in smallholder agriculture, and embodied political ecologies of undernutrition in northern Ghana. Health Place 2021; 68:102536. [PMID: 33639447 DOI: 10.1016/j.healthplace.2021.102536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/02/2021] [Accepted: 02/12/2021] [Indexed: 11/30/2022]
Abstract
The burden of child undernutrition across Africa remains extraordinarily high. Among children under age five, chronic and acute undernutrition is responsible for more ill-health than any other cause. While climate change exacerbates the multiple burdens of undernutrition, we know very little about the embodied effects on women's workload in agriculture and implications for feeding practices, especially for infants whose nutrition depends on mothers' time. In this article, political ecologies of health, with its nested, place-based analysis, is used as a framework to address this knowledge gap. The study took place in Ghana's Upper West Region, a semi-arid and resource-poor setting with higher undernutrition rates. In-depth interviews were conducted with smallholder farmers (n = 33) whose infants have sub-optimal growth, and key informants (n = 7) with expertise in nutrition and health. Findings from the study demonstrate how climate change puts pressure on women's productive time, leading to poor child feeding practices and undernutrition. Ultimately, the article argues that there are hidden impacts of climate change on undernutrition. Global undernutrition interventions should therefore move beyond biomedical solutions to address these hidden impacts, some of which are social, gendered, and structural in nature.
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Affiliation(s)
- Hanson Nyantakyi-Frimpong
- University of Denver, Department of Geography & the Environment, 2050 East Iliff Avenue, Denver, CO, 80210, USA.
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Tew MM, Hatah E, Arif F, Abdul Wahid MA, Makmor-Bakry M, Abdul Maulad KN. Geospatial analysis of distribution of community pharmacies and other health care facilities providing minor ailments services in Malaysia. J Pharm Policy Pract 2021; 14:24. [PMID: 33627199 PMCID: PMC7903721 DOI: 10.1186/s40545-021-00308-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/15/2021] [Indexed: 11/27/2022] Open
Abstract
Background Minor ailments are defined as common, self-limiting, or uncomplicated conditions that may be diagnosed and managed without a medical intervention. Previous studies reported that pharmacists were able to help patients self-manage minor ailments that led to a reduction of health care burden in other facilities. Nevertheless, public access to community pharmacy and other health care facilities offering services for minor ailments has not yet been explored in Malaysia. Hence, this study aims to determine population access to the above-mentioned services. Method According to the reported practice address in 2018, the spatial distribution of health care facilities was mapped and explored using the GIS mapping techniques. The density of health care facilities was analyzed using thematic maps with hot spot analysis. Population to facility ratio was calculated using the projection of the population growth based on 2010 census data, which was the latest available in the year of analysis. Results The study included geographical mapping of 7051 general practitioner clinics (GPC), 3084 community pharmacies (CP), 139 public general hospitals (GHs) and 990 public primary health clinics (PHC). The health care facilities were found to be highly dense in urban areas than in the rural ones. There were six districts that had no CP, 2 had no GPC, and 11 did not have both. The overall ratio of GPC, CP, GH, and PHC to the population was 1:4228, 1:10,200, 1:223,619 and 1:31,397, respectively. Should the coverage for minor ailment services in public health care clinics be extended to community pharmacies, the ratio of facilities to population for each district would be better with 1:4000–8000. Conclusions The distribution of health care facilities for minor ailment management in Malaysia is relatively good. However, if the scheme for minor ailments were available to community pharmacies, then the patients’ access to minor ailments services would be further improved.
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Affiliation(s)
- Mei Mei Tew
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.,Clinical Research Centre, Hospital Sultan Abdul Halim, Sungai Petani, 08000, Kedah, Malaysia
| | - Ernieda Hatah
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia.
| | - Faiz Arif
- Earth Observation Centre, Institute of Climate Change, Universiti Kebangsaan Malaysia, Bandar Baru Bangi, 43650, Selangor, Malaysia
| | - Muhammad Aqiff Abdul Wahid
- Earth Observation Centre, Institute of Climate Change, Universiti Kebangsaan Malaysia, Bandar Baru Bangi, 43650, Selangor, Malaysia
| | - Mohd Makmor-Bakry
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300, Kuala Lumpur, Malaysia
| | - Khairul Nizam Abdul Maulad
- Earth Observation Centre, Institute of Climate Change, Universiti Kebangsaan Malaysia, Bandar Baru Bangi, 43650, Selangor, Malaysia.,Department of Civil Engineering, Faculty of Engineering & Built Management, Universiti Kebangsaan Malaysia, Bandar Baru Bangi, 43650, Selangor, Malaysia
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Aglozo EY, Akotia CS, Osei-Tutu A, Annor F. Spirituality and subjective well-being among Ghanaian older adults: optimism and meaning in life as mediators. Aging Ment Health 2021; 25:306-315. [PMID: 31814428 DOI: 10.1080/13607863.2019.1697203] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE This cross-sectional study investigated the relationship between spirituality and subjective well-being (positive affect, negative affect, and life satisfaction), and whether this relationship is mediated by optimism and meaning in life. METHOD Participants were 235 older adults (≥60 years) conveniently sampled from Ghanaian communities. Structural equation modeling (SEM) was used to test the direct and indirect relationships. Sobel test was also used to test specific mediating effects of optimism and meaning in life. RESULTS Spirituality was positively related with positive affect and life satisfaction, but negatively related with negative affect. The SEM results revealed that the relationship between spirituality and subjective well-being was indirect. Sobel test showed that the mediating effect of optimism was only statistically significant for negative affect but not positive affect and life satisfaction. In contrast, the mediating effect of meaning in life was statistically significant for the three components of subjective well-being. CONCLUSION The study has demonstrated that spirituality indirectly influences subjective well-being through optimism and meaning in life. It also showed the relative importance of meaning in life over optimism as a mediator. Theoretical and practical implications of these findings have been discussed.
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Affiliation(s)
- Eric Yao Aglozo
- Department of Psychology, University of Ghana, Legon, Accra, Ghana
| | | | | | - Francis Annor
- Department of Psychology, University of Ghana, Legon, Accra, Ghana
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Modern Health Service Utilization and Associated Factors among Adults in Southern Ethiopia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:8835780. [PMID: 33505477 PMCID: PMC7814934 DOI: 10.1155/2021/8835780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 11/25/2020] [Accepted: 12/31/2020] [Indexed: 11/18/2022]
Abstract
Background The Ethiopian government is striving to improve the health status of its population through the expansion and strengthening of primary health care services in both rural and urban settings of the country. The study aimed to measure modern health service utilization and associated factors in Wolaita Sodo town, Ethiopia. Method A cross-sectional study design was implemented from May to June 2019 in Wolaita Sodo town, Ethiopia. All 786 study participants were selected by multistage systematic random sampling. Data were collected by face-to-face interviews using a pretested structured questionnaire. Data were collected by an open data kit. Stata window version 15.0 was also employed for statistical analysis. Multiple logistic regression was conducted, and a 95% confidence interval was considered for interpretation. Result Health service utilization was 77.2% with (95% CI of 74.1%, 80.0%). In terms of health facilities in which they visit, first 50.6% were at the public health center and 25.5% of them were at Teaching and Referral Hospital. Respondents with marital status married and widowed have higher odds of utilizing health services compared to single marital status (AOR: 2.96; 95% CI: 1.7-5.2 and 9.0; 95% CI: 1.69-48.0), respectively. Respondents with middle and highest wealth status have higher odds of health service utilization than poor wealth status with AOR (1.75 95% CI 1.03-2.97 and 1.58 95% CI; 1.01, 2.77). Similarly, respondents who had chronic disease and perceived poor health status have higher odds of health service utilization. Conclusion Modern health services utilization was found to be unsatisfactory. Being married, wealth status being middle and high, having chronic health conditions, and having poor perceived health status were found to have a statistically significant association with health service utilization.
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Yamson P, Tetteh J, DeGraft-Amoah D, Quansah H, Mensah G, Biritwum R, Yawson AE. Unmet Needs of Healthcare Services and Associated Factors among a Cohort of Ghanaian Adults: A Nationally Stratified Cross-Sectional Study Design. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211028172. [PMID: 34180280 PMCID: PMC8243108 DOI: 10.1177/00469580211028172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/26/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
We estimated the prevalence of unmet needs of healthcare services (UNHS) and its associated factors among a cohort of older Ghanaian adults. World Health Organization (WHO) Study on Global AGEing and Adult Health for Ghana was used with a total of 4735 participants. Logistics regression analysis was performed using Stata 16 to assess associated factors. The overall UNHS was 3.7% (95% CI = 2.7-4.8) and the prevalence was significantly high amongst older adults aged 60 to 69 years (5.9%). Could not afford the healthcare (56.4%) was the main contender for UNHS. UNHS was influenced by; those aged 60 to 69 years [OR (95% CI) = 1.86 (1.19-2.91)]; no formal educational [aOR (95% CI) = 4.71 (1.27-17.38)], and no NHIS [OR (95% CI) = 1.78 (1.03-3.09)]. Participants needed care for joint pain (25.4%), and communicable diseases (19.1%). The inability to access healthcare was relatively higher for older adults more advanced in age, with low education, and for those without health insurance. Health system strengthening including financial protection by expanding the National Health Insurance Scheme to all Ghanaians in line with Ghana's Universal Health Coverage Roadmap would reduce the unmet healthcare needs of older adults.
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Affiliation(s)
- Phaedra Yamson
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - John Tetteh
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Daniel DeGraft-Amoah
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Henry Quansah
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - George Mensah
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Richard Biritwum
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
| | - Alfred Edwin Yawson
- Department of Community Health,
University of Ghana Medical School, College of Health Sciences, University of Ghana,
Accra, Ghana
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47
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Pati S, Sinha A, Varanasi R. Kaleidoscopic use of World Health Organization's Study on global AGEing and adult health data set to explore multimorbidity and its outcomes in low and middle-income countries: An insider view. J Family Med Prim Care 2021; 10:4623-4625. [PMID: 35280606 PMCID: PMC8884332 DOI: 10.4103/jfmpc.jfmpc_1598_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/29/2021] [Indexed: 11/16/2022] Open
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Gharaee H, Dewey RS, Jahanian R, Ebrahimoghli R, Tapak L, Hamidi Y. The Effect of Health Evolution Plan on Health System Responsiveness: An Experience of Health System Reform from Iran. Hosp Top 2020; 99:81-91. [PMID: 33337971 DOI: 10.1080/00185868.2020.1859342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to investigate the effect of the Health Evolution Plan (HEP) on Health System Responsiveness (HSR) in hospitals of Hamadan, Iran. Data were collected before and after the implementation of the HEP by interviewing hospital inpatient referrals about factors relating to responsiveness. The difference between the mean responsiveness scores before (2014) and after (2018) implementation of the HEP was not significant. The study findings demonstrate that, even though one of the most important goals of the HEP was the improvement of HSR, the responsiveness of hospitals was unchanged.
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Affiliation(s)
- Hojatolah Gharaee
- Health Center of Hamadan City, Hamadan university of Medical Science, Hamadan, Iran
| | - Rebecca Susan Dewey
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK
| | - Razieh Jahanian
- Vice Chancellor for Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Reza Ebrahimoghli
- Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leili Tapak
- Department of Biostatistics, School of Public Health and Modeling of Non-communicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Yadollah Hamidi
- Department of Health Management and Economics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Amani PJ, Tungu M, Hurtig AK, Kiwara AD, Frumence G, San Sebastián M. Responsiveness of health care services towards the elderly in Tanzania: does health insurance make a difference? A cross-sectional study. Int J Equity Health 2020; 19:179. [PMID: 33046058 PMCID: PMC7549195 DOI: 10.1186/s12939-020-01270-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Responsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients' expectations. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population. METHODS A community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) living in Igunga and Nzega districts, was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and 12 months were selected. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance adjusted for sociodemographic factors. RESULTS A total of 1453 and 744 elderly, of whom 50.1 and 63% had health insurance, used outpatient and inpatient health services, respectively. All domains were rated relatively highly but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (- 1; 95% CI: - 1.45, - 0.45) and inpatient (- 2; 95% CI: - 2.69, - 1.30) care. CONCLUSION The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked poorly. Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. A continuous monitoring of health care system responsiveness is recommended.
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Affiliation(s)
- Paul Joseph Amani
- Department of Health Systems Management, School of Public Administration and Management, Mzumbe University, Morogoro, Tanzania.
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden.
| | - Malale Tungu
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Anna-Karin Hurtig
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
| | - Angwara Denis Kiwara
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gasto Frumence
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Miguel San Sebastián
- Epidemiology and Global Health, Umeå International School of Public Health, Umeå University, Umeå, Sweden
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50
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Bell G, Macarayan EK, Ratcliffe H, Kim JH, Otupiri E, Lipsitz S, Hirschhorn L, Awoonor-Williams JK, Nimako BA, Ofosu A, Leslie H, Bitton A, Schwarz D. Assessment of Bypass of the Nearest Primary Health Care Facility Among Women in Ghana. JAMA Netw Open 2020; 3:e2012552. [PMID: 32785634 PMCID: PMC7424402 DOI: 10.1001/jamanetworkopen.2020.12552] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Recent reports have highlighted that expanding access to health care is ineffective at meeting the goal of universal health coverage if the care offered does not meet a minimum level of quality. Health care facilities nearest to patient's homes that are perceived to offer inadequate or inappropriate care are frequently bypassed in favor of more distant private or tertiary-level hospital facilities that are perceived to offer higher-quality care. OBJECTIVE To estimate the frequency with which women in Ghana bypass the nearest primary health care facility and describe patient experiences, costs, and other factors associated with this choice. DESIGN, SETTING, AND PARTICIPANTS This nationally representative survey study was conducted in 2017 and included 4203 households to identify women in Ghana aged 15 to 49 years (ie, reproductive age) who sought primary care within the last 6 months. Women who sought care within the past 6 months were included in the study. Data were analyzed from 2018 to 2019. EXPOSURES Bypass was defined as a woman's report that she sought care at a health facility other than the nearest facility. MAIN OUTCOMES AND MEASURES Sociodemographic characteristics, reasons why women sought care, reasons why women bypassed their nearest facility, ratings for responsiveness of care, patient experience, and out-of-pocket costs. All numbers and percentages were survey-weighted to account for survey design. RESULTS A total of 4289 women met initial eligibility criteria, and 4207 women (98.1%) completed the interview. A total of 1993 women reported having sough health care in the past 6 months, and after excluding those who were ineligible and survey weighting, the total sample included 1946 women. Among these, 629 women (32.3%) reported bypassing their nearest facilities for primary care. Women who bypassed their nearest facilities, compared with women who did not, were more likely to visit a private facility (152 women [24.5%] vs 202 women [15.6%]) and borrow money to pay for their care (151 women [24.0%] vs 234 women [17.8%]). After adjusting for covariates, women who bypassed reported paying a mean of 107.2 (95% CI, 79.1-135.4) Ghanaian Cedis (US $18.50 [95% CI, $13.65-$23.36]) for their care, compared with a mean of 58.6 (95% CI, 28.1-89.2) Ghanaian Cedis (US $10.11 [95% CI, $4.85-15.35]) for women who did not bypass (P = .006). Women who bypassed cited clinician competence (136 women [34.3%]) and availability of supplies (93 women [23.4%]) as the most important factors in choosing a health facility. CONCLUSIONS AND RELEVANCE The findings of this survey study suggest that bypassing the nearest health care facility was common among women in Ghana and that available services at lower levels of primary care are not meeting the needs of a large proportion of women. Among the benefits women perceived from bypassing were clinician competence and availability of supplies. These data provide insights to policy makers regarding potential gaps in service delivery and may help to guide primary health care improvement efforts.
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Affiliation(s)
- Griffith Bell
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Erlyn K. Macarayan
- Lancet Commission on High Quality Health Systems, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hannah Ratcliffe
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - June-Ho Kim
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine & Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Easmon Otupiri
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Stuart Lipsitz
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lisa Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Anthony Ofosu
- Policy Planning Monitoring and Evaluation Division, Ghana Health Service, Accra, Ghana
| | - Hannah Leslie
- Lancet Commission on High Quality Health Systems, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Asaf Bitton
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Internal Medicine & Primary Care, Brigham and Women’s Hospital, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Dan Schwarz
- Ariadne Labs, Brigham and Women’s Hospital, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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