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Measuring evolution of income-related inequalities in health and health care utilization in selected Latin American and Caribbean countries; Medición de la evolución de las desigualdades en la salud y la utilización de la atención sanitaria relacionadas con los ingresos en países seleccionados de América Latina y el Caribe

Almeida, Gisele; Sarti, Flávia Mori
Fonte: Washington DC Publicador: Washington DC
Tipo: Artigo de Revista Científica
ENG
Relevância na Pesquisa
76.19%
OBJECTIVE: To describe the methodology used to measure and explain income-related inequalities in health and health care utilization over time in selected Latin American and Caribbean countries. METHODS: Data from nationally representative household surveys in Brazil, Chile, Colombia, Jamaica, Mexico, and Peru were used to analyze income-related inequalities in health status and health care utilization. Health was measured by self-reported health status, physical limitations, and chronic illness when available. Hospitalization, physician, dentist, preventive, curative, and preventive visits were proxies for health care utilization. Household income was a proxy for socioeconomic status except in Peru, which used household expenditures. Concentration indices were calculated before and after standardization for all dependent variables. Standardized concentration indices are also referred to as horizontal inequity index. Decomposition analysis was used to identify the main determinants of inequality in health care utilization. RESULTS: Results of analysis of the evolution of income-related inequality in health and health care utilization in Brazil, Chile, Colombia, Jamaica, Mexico, and Peru are presented in separate articles in this issue. CONCLUSIONS: The methodology used for analysis of equity in all six country research studies attempts not to determine causality but to describe and explain income-related inequalities in health status and health care utilization over time. While this methodology is robust...

Health care utilization and survival among patients with AIDS in Belo Horizonte, Minas Gerais, Brazil

Acurcio,Francisco de Assis; Cesar,Cibele Comini; Guimarães,Mark Drew Crosland
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/1998 EN
Relevância na Pesquisa
86.05%
A historical cohort study was conducted in three public AIDS referral services in Belo Horizonte, Minas Gerais, to assess the relationship between health care utilization and patient survival following AIDS diagnosis. A review of medical and laboratory records was performed for HIV-infected patients seeking care for the first time in 1989-92. Among 291 patients initially categorized as "A" [asymptomatic, acute HIV, or persistent generalized lymphadenopathy-PGL] or "B" [symptomatic, non-"A", or AIDS-indicator conditions] (CDC, 1992) and who progressed to AIDS, 57.0% died. Mortality rate was 34.9/1.000 person-months. Overall median survival time following AIDS diagnosis was 14.3 months. Multivariate analysis showed that lack of AZT use (RR = 1.87; 95% CI = 1.34-2.61), advanced initial staging (RR = 1.68; 95% CI = 1.20-2.35), 9 or more inpatient days (RR = 1.55; 95% CI = 1.11-2.17), and intervals between outpatient visits longer than 6 months (RR = 0.30; 95% CI = 0.16-0.56) were associated with death. The analysis suggests that: Patients who used health services more often had poorer prognosis; Patients who received AZT survived longer than those who did not; and Variables used to assess health care utilization actually express the end of a process involving seeking and obtaining care.

Using Health Care Utilization and Publication Patterns to Characterize the Research Portfolio and to Plan Future Research Investments

Katz, Luba; Fink, Rebecca V.; Bozeman, Samuel R.; McNeil, Barbara J.
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
86.12%
Objective: Government funders of biomedical research are under increasing pressure to demonstrate societal benefits of their investments. A number of published studies attempted to correlate research funding levels with the societal burden for various diseases, with mixed results. We examined whether research funded by the Department of Veterans Affairs (VA) is well aligned with current and projected veterans’ health needs. The organizational structure of the VA makes it a particularly suitable setting for examining these questions. Methods: We used the publication patterns and dollar expenditures of VA-funded researchers to characterize the VA research portfolio by disease. We used health care utilization data from the VA for the same diseases to define veterans’ health needs. We then measured the level of correlation between the two and identified disease groups that were under- or over-represented in the research portfolio relative to disease expenditures. Finally, we used historic health care utilization trends combined with demographic projections to identify diseases and conditions that are increasing in costs and/or patient volume and consequently represent potential targets for future research investments. Results: We found a significant correlation between research volume/expenditures and health utilization. Some disease groups were slightly under- or over-represented...

Predictors of primary health care utilization by former residents of institutions in Ontario

Cox, Alison
Fonte: Brock University Publicador: Brock University
Tipo: Electronic Thesis or Dissertation
ENG
Relevância na Pesquisa
86.12%
For years institutionalization has been the primary method of service delivery for persons with developmental disabilities (DD). However, in Ontario the last institution was closed on March 31, 2009 with former residents now residing in small, communitybased homes. This study investigated potential predictors of primary health care utilization by former residents. Several indirect measures were employed to gather information from 60 participants on their age, health status, adaptive functioning level, problem behaviour, mental health status and, total psychotropic medication use. A direct measure was used to gather primary health care utilization information, which served as the dependent variable. A stepwise linear regression failed to reveal significant predictors of health care utilization. The data were subsequently dichotomized and the outcomes of a logistic regression analysis indicated that mental health status, psychotropic medication use and, an interaction between mental health status and health status significantly predicted higher primary health care usage.

Do Subsidized Health Programs in Armenia Increase Utilization among the Poor?

Angel-Urdinola, Diego F.; Jain, Shweta
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
76.19%
This article analyzes the extent to which the Basic Benefit Package (BBP), a subsidized health program in Armenia, increases utilization and affordability of outpatient health care among the poor. The authors find that beneficiaries of the BBP pay approximately 45 percent less in fees for doctor visits (and display 36 percent higher outpatient utilization rates) than eligible users not receiving the BBP. However, even among BBP beneficiaries the level of outpatient health care utilization remains low. This occurs because the program mainly provides discounted fees for doctor visits, but fees do not constitute the main financial constraint for users. The authors estimate suggest that other non-fee expenditures, such as prescription medicines, constitute a more significant financial constraint and are not subsidized by the BBP. As a result, outpatient health care remains expensive even for BBP beneficiaries.

The Impact of Health Insurance on the Access to Health Care and Financial Protection in Rural Developing Countries : The Example of Senegal

Jutting, Johannes Paul
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
86.09%
Community-based health insurance schemes are becoming increasingly recognized as an instrument to finance health care in developing countries. Taking the example of "les mutuelles de santes" (mutual health organization) in rural Senegal this paper analyzes whether or not members in a mutual health insurance scheme have better access to health care than nonmembers. A binary probit model is estimated for the determinants of participation in a mutual and a logit/log linear model is used to measure the impact on health care utilization and financial protection. The results show that, while the health insurance schemes reach otherwise excluded people, the very poorest in the communities are not covered. Regarding the impact on the access to health care, members have a higher probability of using hospitalization services than nonmembers and pay substantially less when they need care. Given the results of this study, community financing schemes have the potential to improve the risk-management capacity of rural households. To reduce identified limitations of the schemes...

Patterns of Health Care Utilization in Vietnam : Analysis of 1997-98 Vietnam Living Standards Survey Data

Trivedi, Pravin K.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
96.19%
The author provides an econometric analysis of health care utilization in Vietnam based on individual and household level data from the 1997-98 Vietnam Living Standards Survey. The author focuses on the major features of health care utilization patterns, including the determinants of largely self-prescribed use of pharmaceutical drugs, and the use of government hospitals, commune health centers, and private health facilities. The role of income and health insurance is emphasized. Econometric models are estimated for use probability and frequency of contact for all major categories of care, and for individual and household medical expenditure. Econometric results reveal differential responses to income changes at different levels of income. Commune health centers and self-medication are normal goods at lower income levels but inferior goods at higher income levels. The author discusses the policy implications of these results.

Economic Analysis of Health Care Utilization and Perceived Illness : Ethnicity and Other Factors

Paqueo, Vicente B.; Gonzalez, Christian Y.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
86.15%
Paqueo and Gonzalez look at the determinants of health-seeking behavior of the Mexican population and within this context focus on the effect of ethnicity. They address the following questions: To what extent are the indigenous people at a disadvantage health care-wise and in what particular health services are they disadvantaged? Is the health care gap due to indigenous cultures by itself as opposed to the impact of socioeconomic differences? What policy instruments can be used to reduce the gap? The authors find that contrary to expectations, the indigenous people in Mexico tend to have a positive behavior toward modern preventive care compared with the nonindigenous population, holding socioeconomic factors constant. Apparently, there is no cultural barrier in regard to these services. But ethnicity remains negatively associated with the use of inpatient hospital care and medical and dental consultations. Insurance has a significant and positive effect on health care use. Therefore, it appears to be an effective instrument for addressing the health care disadvantages faced by the indigenous population in regard to inpatient care and the use of outpatient services of doctors...

The Effects of a Fee-Waiver Program on Health Care Utilization among the Poor : Evidence from Armenia

Chaudhury, Nazmul; Hammer, Jeffrey; Murrugarra, Edmundo
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
96.23%
This study examines the impact of a fee-waiver program for basic medical services on health care utilization in Armenia. Because of the reduction in public financing of health services and decentralization and increased privatization of health care provision, private out-of-pocket contributions are increasingly becoming a significant component of health costs in Armenia. To help poor families cope with this constraint, the Armenian government provided a free-of-charge basic package service to eligible individuals in vulnerable groups, such as the disabled and children from single parent households. Drawing on the 1996 and 1998-99 Armenia Integrated Survey of Living Standards (AISLS), which allows the identification of eligible individuals under this program, the authors estimate the impact of the fee-waiver program on utilization of health services, particularly among the poor. Across the two survey rounds utilization rates have indeed declined despite comparable levels of income, and this decline has occurred among both the poor and the rich...

Timor Leste : Health Equity and Financial Protection Project

World Bank
Fonte: Washington, DC Publicador: Washington, DC
EN_US
Relevância na Pesquisa
76.16%
This report analyses equity and financial protection in the health sector of Timor-Leste. In particular, it examines inequalities in health outcomes, health behavior and health care utilization; benefit incidence analysis; financial protection; and the progressivity of health care financing. Data are drawn from the 2009/2010 Demographic and Health Survey, the 2001-2002 and 2007-2008 Living Standards and Measurement Surveys as well as 2011-2012 Household Income Expenditure Survey, and the Ministry of Finance. All analyses are conducted using original data and performed using the health modules of the ADePT software.

Arab Republic of Egypt : Management and Service Quality in Primary Health Care Facilities in the Alexandria and Menoufia Governorates

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Public Sector Study; Economic & Sector Work
ENGLISH; EN_US
Relevância na Pesquisa
76.19%
This report provides an assessment of the performance of public primary facilities in the Alexandria and Menoufia governorates. The performance is evaluated against the standards introduced with the Health Sector Reform Program; analyzes the quality perceptions, health situation, utilization and economic situation of households living in the catchment areas of the facilities; and examines the management processes of different institutions involved in primary care. Despite Egypt's health sector reform efforts, evidence suggests that issues remain in the quality of service and management in both reformed and non-reformed public primary care facilities, including availability of supplies, correct co-payment exemptions for the poor, and consequently, utilization through the population. There is also increasing evidence that the demand-side empowerment of beneficiaries could improve the governance of health care, which would lead to a quality increase and higher utilization of health care. This suggests the need to explore the potential for demand-side mechanisms to improve service delivery and help ensure improvements in individual and population health.

Tajikistan : Review of Public Expenditures on Health

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Public Expenditure Review
ENGLISH; EN_US
Relevância na Pesquisa
76.19%
This policy note is part of the World Bank's Programmatic Public Expenditure Review (PER) work program for FY2012-2014. The PER consists of a series of fiscal policy notes, which aim at providing the Government of Tajikistan with recommendations to strengthen budgetary processes and analysis. This policy note, the second in the series, examines public expenditures on health in Tajikistan. After an introductory section, the note describes the institutional and administrative structure of the health sector. Section 3 presents health outcomes and health care utilization indicators. Section 4 describes health financing in Tajikistan and presents the main options to expand fiscal space for health. Section 5 reviews the health financing and organizational reforms implemented in Tajikistan. Section 6 provides the main conclusions: 1) despite progress, health sector outcomes are mixed in Tajikistan and utilization pattern of health services is characterized by significant inequalities; 2) public spending on health is relatively low and skewed towards hospitals rather than outpatient care; 3) the hospital sector is characterized by oversupply of beds...

Health Care During Financial Crisis : What Can We Learn from the Indonesian National Socioeconomic Survey?

Saadah, Fadia; Pradhan, Menno; Surbakti, Soedarti
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
ENGLISH; EN_US
Relevância na Pesquisa
86.07%
This paper presents the results of a trend analysis of key health indicators in Indonesia. The analysis is based on data from the National Socioeconomic Survey for Indonesia (SUSENAS) for the years 1995, 1997, and 1998. The analysis is part of an effort to monitor the impact of the country's current economic crisis on health outcomes and to identify groups that may have benefited or been disadvantaged in recent years. The economic crisis could affect health outcomes in a number of ways. Changes in employment patterns and incomes that occurred as a result of the crisis are likely to have had an effect on health outcomes and the demand for health care. In this paper, the authors attempt to analyze the health information available through the SUSENAS to establish baselines against which to compare future trends and possible impacts on the health sector. The paper discusses some possible hypotheses for how the crisis may be affecting health care utilization.

The association between usual health care utilization and stage at diagnosis in laryngeal cancer

LEUNG, FELICIA GA-YIN
Fonte: Quens University Publicador: Quens University
Tipo: Tese de Doutorado
EN; EN
Relevância na Pesquisa
96.23%
Background: A significant number of laryngeal cancer patients are diagnosed with advanced-stage disease. Since stage at diagnosis is an important prognostic factor, it is necessary to understand the characteristics of individuals at risk of being diagnosed at an advanced stage. Objectives: (1) Compare usual health care utilization between laryngeal cancer patients and the general population. (2) Evaluate the association between usual health care utilization and stage at diagnosis in laryngeal cancer. Methods: The study population included 1,702 laryngeal cancer patients diagnosed from 2005–2008, and 8,510 matched-controls from the general population. Demographic, clinical, and health administrative data from Ontario were used to measure usual health care utilization in a two-year period (i.e. frequency of encounters, continuity of care, primary care model enrolment, and preventive services use), stage at diagnosis, and covariates. Results: Laryngeal cancer patients had fewer health care encounters and a greater propensity for using preventive services than the general population. Comparisons of usual health care utilization among laryngeal cancer patients showed significant trends across Stage I–IV for the frequency of encounters (p=0.002)...

Health Care Utilization and Health Status of NCMS Elderly Enrollees in China: Evidence from CHARLS Data

Li, Amy; Wang, Pengpeng
Fonte: Universidade Duke Publicador: Universidade Duke
Publicado em 16/04/2012 EN_US
Relevância na Pesquisa
96.06%
This study explores the effect of benefit designs and demographic factors on health care utilization and health status of elderly rural enrollees in the New Cooperative Medical Scheme, a rural health insurance program implemented by the Chinese government in 2003. Using the new data from CHARLS pilot study, we find that immediate reimbursement does not have a statistically significant effect on health utilization as suggested in a previous study, but instead on health status. Other policy-related factors neither have a significant effect due to limited data and large standard deviation nor display a consistent effect.; Honors thesis

Measuring evolution of income-related inequalities in health and health care utilization in selected Latin American and Caribbean countries

Almeida,Gisele; Sarti,Flavia Mori
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2013 EN
Relevância na Pesquisa
76.18%
OBJECTIVE: To describe the methodology used to measure and explain income-related inequalities in health and health care utilization over time in selected Latin American and Caribbean countries. METHODS: Data from nationally representative household surveys in Brazil, Chile, Colombia, Jamaica, Mexico, and Peru were used to analyze income-related inequalities in health status and health care utilization. Health was measured by self-reported health status, physical limitations, and chronic illness when available. Hospitalization, physician, dentist, preventive, curative, and preventive visits were proxies for health care utilization. Household income was a proxy for socioeconomic status except in Peru, which used household expenditures. Concentration indices were calculated before and after standardization for all dependent variables. Standardized concentration indices are also referred to as horizontal inequity index. Decomposition analysis was used to identify the main determinants of inequality in health care utilization. RESULTS: Results of analysis of the evolution of income-related inequality in health and health care utilization in Brazil, Chile, Colombia, Jamaica, Mexico, and Peru are presented in separate articles in this issue. CONCLUSIONS: The methodology used for analysis of equity in all six country research studies attempts not to determine causality but to describe and explain income-related inequalities in health status and health care utilization over time. While this methodology is robust...

Income-related inequality in health and health care utilization in Chile, 2000 - 2009

Vásquez,Felipe; Paraje,Guillermo; Estay,Manuel
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2013 EN
Relevância na Pesquisa
76.21%
OBJECTIVE: To measure and explain income-related inequalities in health and health care utilization in the period 2000 - 2009 in Chile, while assessing variations within the country and determinants of inequalities. METHODS: Data from the National Socioeconomic Characterization Survey for 2000, 2003, and 2009 were used to measure inequality in health and health care utilization. Income-related inequality in health care utilization was assessed with standardized concentration indices for the probability and total number of visits to specialized care, generalized care, emergency care, dental care, mental health care, and hospital care. Self-assessed health status and physical limitations were used as proxies for health care need. Standardization was performed with demographic and need variables. The decomposition method was applied to estimate the contribution of each factor used to calculate the concentration index, including ethnicity, employment status, health insurance, and region of residence. RESULTS: In Chile, people in lower-income quintiles report worse health status and more physical limitations than people in higher quintiles. In terms of health service utilization, pro-rich inequities were found for specialized and dental visits with a slight pro-rich utilization for general practitioners and all physician visits. All pro-rich inequities have decreased over time. Emergency room visits and hospitalizations are concentrated among lower-income quintiles and have increased over time. Higher education and private health insurance contribute to a pro-rich inequity in dentist...

Income-related inequalities and inequities in health and health care utilization in Mexico, 2000 - 2006

Barraza-Lloréns,Mariana; Panopoulou,Giota; Díaz,Beatriz Yadira
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2013 EN
Relevância na Pesquisa
76.19%
OBJECTIVE: To measure income-related inequalities and inequities in the distribution of health and health care utilization in Mexico. METHODS: The National Health Survey (NHS) 2000 and the National Health and Nutrition Survey (NHNS) 2006 were used to estimate concentration indices for health outcomes and health care utilization variables before and after standardization. The study analyzed 110 460 individuals 18 years or older for NHS 2000 and 124 149 individuals for NHNS 2006. Health status variables were self-assessed health, physical limitations, and chronic illness. Health care utilization included curative visits and dental, hospital, and preventive care. Individuals were ranked by three standard-of-living measures: household income, wealth, and expenditure. Other independent variables were area of residence, geographic region, education, employment, ethnicity, and health insurance. Decomposition analysis allowed for assessing the contributions of independent variables to the distribution of health care among individuals. RESULTS: The worse-off population reports less good self-assessed health and more physical limitations, whereas better-off individuals report more chronic illnesses. Utilization of curative visits and hospitalization is more concentrated among the better-off population. No significant changes in these results can be established between 2000 and 2006. According to available evidence...

Improving equity in the provision of primary health care: lessons from decentralized planning and management in Namibia

Bell,Ruth; Ithindi,Taathi; Low,Anne
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2002 EN
Relevância na Pesquisa
86.16%
This paper draws lessons from a review of primary health care services in Windhoek, the capital of Namibia, undertaken by a regional health management team. The review was carried out because of perceived increases in workload and inadequate staffing levels, arising from the rapid expansion of the city associated with inward migration. A survey of the utilization of government clinics was used to develop a more equitable allocation of primary health care services between localities. The survey revealed disparities between patterns of utilization of the services and the allocation of staff: the poorer localities were relatively underprovided. Decisions made centrally on resource allocation had reinforced the inequities. On the basis of the results of the review, the regional health management team redistributed nursing and medical staff and argued for a shift in the allocation of capital expenditure towards the poorer communities. The review demonstrates the potential for regional and provincial health management teams to make effective assessments of the needs of their populations and to promote the equitable delivery of primary health care services. In order to achieve this they need not only to become effective managers, but also to develop population-based planning skills and the confidence and authority to influence the allocation of resources between and within their regions and provinces.

Health care utilization and survival among patients with AIDS in Belo Horizonte, Minas Gerais, Brazil

Acurcio,Francisco de Assis; Cesar,Cibele Comini; Guimarães,Mark Drew Crosland
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/1998 EN
Relevância na Pesquisa
86.05%
A historical cohort study was conducted in three public AIDS referral services in Belo Horizonte, Minas Gerais, to assess the relationship between health care utilization and patient survival following AIDS diagnosis. A review of medical and laboratory records was performed for HIV-infected patients seeking care for the first time in 1989-92. Among 291 patients initially categorized as "A" [asymptomatic, acute HIV, or persistent generalized lymphadenopathy-PGL] or "B" [symptomatic, non-"A", or AIDS-indicator conditions] (CDC, 1992) and who progressed to AIDS, 57.0% died. Mortality rate was 34.9/1.000 person-months. Overall median survival time following AIDS diagnosis was 14.3 months. Multivariate analysis showed that lack of AZT use (RR = 1.87; 95% CI = 1.34-2.61), advanced initial staging (RR = 1.68; 95% CI = 1.20-2.35), 9 or more inpatient days (RR = 1.55; 95% CI = 1.11-2.17), and intervals between outpatient visits longer than 6 months (RR = 0.30; 95% CI = 0.16-0.56) were associated with death. The analysis suggests that: Patients who used health services more often had poorer prognosis; Patients who received AZT survived longer than those who did not; and Variables used to assess health care utilization actually express the end of a process involving seeking and obtaining care.