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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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2
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Mammography prevalence in Mexico from 2001-2018: Results from the Mexican Health and Aging study. Prev Med Rep 2023; 32:102150. [PMID: 36865396 PMCID: PMC9971542 DOI: 10.1016/j.pmedr.2023.102150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 01/02/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023] Open
Abstract
After introducing guidelines for breast cancer screening in 2003, Mexico began to prioritize the implementation of mammography screening nationally. Since then, there have been no studies assessing changes in mammography in Mexico using the two-year prevalence interval that corresponds to national guidelines for screening frequency. The present study analyzes the Mexican Health and Aging Study (MHAS), a national population-based panel study of adults aged 50 and older, to evaluate changes in 2-year mammography prevalence among women aged 50 to 69 across five survey waves from 2001 to 2018 (n = 11,773). We calculated unadjusted and adjusted mammography prevalence by survey year and health insurance type. Overall prevalence increased substantially from 2003 to 2012 and leveled off in the period from 2012 to 2018 (2001: 20.2 % [95 % CI 18.3, 22.1]; 2003: 22.7 % [20.4, 25.0]; 2012: 56.5 % [53.2, 59.7]; 2015: 62.0 % [58.8, 65.2]; 2018: 59.4 % [56.7,62.1]; unadjusted prevalence). Prevalence was higher among respondents with social security insurance, who are more likely to work in the formal economy, than among respondents without social security, who are more likely to work in the informal economy or be unemployed. The overall prevalence estimates observed were higher than previously published estimates of mammography prevalence in Mexico. More research is needed to confirm findings regarding two-year mammography prevalence in Mexico and to better understand the causes of observed disparities.
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Khodakarami R, Abdi Z, Ahmadnezhad E, Sheidaei A, Asadi-Lari M. Prevalence, awareness, treatment and control of diabetes among Iranian population: results of four national cross-sectional STEPwise approach to surveillance surveys. BMC Public Health 2022; 22:1216. [PMID: 35717151 PMCID: PMC9206740 DOI: 10.1186/s12889-022-13627-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background Diabetes as a leading cause of death imposes a heavy burden on health systems worldwide. This study investigated the trends in prevalence, awareness, treatment and control of diabetes among Iranian population aged 25 to 65 years over 12 years (2004-2016). Methods Secondary data analysis was performed using data from a national population-based survey, STEPwise approach to surveillance (STEPS) for non-communicable diseases (NCDs) in four rounds (2004, 2007, 2011, 2016). The sample sizes were 89,404, 29,991, 12,103 and 30,541 individuals, respectively across the country in both rural and urban areas. Data were analyzed using descriptive statistics and a logistic regression model with odds ratio at a significance level of less than 5% with no adjustment for age and sex. Logistic regression was used to identify socio-demographic factors associated with the levels of awareness, treatment and control of diabetes mellitus. Results The prevalence of diabetes in four rounds was 8.4, 9, 11.1 and 13.2%, respectively. Among people with diabetes, 53.5, 65.6, 70.5 and 82.2% were aware of their condition and 35.9, 42, 46 and 39.6% were treated for this condition, respectively. In four rounds of study, 14.5, 20.8, 20.4 and 18.5% of all diabetic patients had adequate glycemic control, respectively. In the multivariable logistic regression analysis, there was a significant relationship between female gender, age over 40, living in the urban area, being in the third wealth quintile and having health insurance with diabetes prevalence. Female participants were more likely to be aware of the disease. Older participants were more likely to receive treatment and had adequate glycemic control. Conclusion The prevalence of diabetes in Iran has been increasing and despite the great awareness of the disease, receiving treatment and effective control of the disease are suboptimal. While several national policies to improve diabetes screening and care have been passed in recent years, it seems large gaps remain in disease detection and treatment. It is suggested that more attention be paid to the treatment and control of diabetes by NCDs national policies to prevent the growing burden associated with the disease.
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Affiliation(s)
- Rahmkhoda Khodakarami
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Zhaleh Abdi
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran (TUMS), No 70, Bozorgmehr St. Vesale Shirazi St., Tehran, Iran.
| | - Elham Ahmadnezhad
- National Institute of Health Research (NIHR), Tehran University of Medical Sciences, Tehran (TUMS), No 70, Bozorgmehr St. Vesale Shirazi St., Tehran, Iran
| | - Ali Sheidaei
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences (IUMS), Tehran, Iran.,Oncopathology Research Centre, Iran University of Medical Sciences (IUMS), Tehran, Iran
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Nshakira-Rukundo E, Mussa EC, Nshakira N, Gerber N, von Braun J. Impact of community-based health insurance on utilisation of preventive health services in rural Uganda: a propensity score matching approach. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2021; 21:203-227. [PMID: 33566252 PMCID: PMC8192361 DOI: 10.1007/s10754-021-09294-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
The effect of voluntary health insurance on preventive health has received limited research attention in developing countries, even when they suffer immensely from easily preventable illnesses. This paper surveys households in rural south-western Uganda, which are geographically serviced by a voluntary Community-based health insurance scheme, and applied propensity score matching to assess the effect of enrolment on using mosquito nets and deworming under-five children. We find that enrolment in the scheme increased the probability of using a mosquito net by 26% and deworming by 18%. We postulate that these findings are partly mediated by information diffusion and social networks, financial protection, which gives households the capacity to save and use service more, especially curative services that are delivered alongside preventive services. This paper provides more insight into the broader effects of health insurance in developing countries, beyond financial protection and utilisation of hospital-based services.
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Affiliation(s)
- Emmanuel Nshakira-Rukundo
- Center for Development Research (ZEF), University of Bonn, Genscherallee 3, 53117, Bonn, Germany.
- Institute for Food and Resource Economics, University of Bonn, Nussallee 19, 53115, Bonn, Germany.
| | - Essa Chanie Mussa
- Department of Agriculture Economics, University of Gondar, Gondar, Ethiopia
| | | | - Nicolas Gerber
- Center for Development Research (ZEF), University of Bonn, Genscherallee 3, 53117, Bonn, Germany
| | - Joachim von Braun
- Center for Development Research (ZEF), University of Bonn, Genscherallee 3, 53117, Bonn, Germany
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Access to healthcare services between insured and uninsured adults aged ≥50 years with diabetes in Mexico: the Mexican Health and Aging Study (MHAS-2018). Public Health 2021; 194:176-181. [PMID: 33962093 DOI: 10.1016/j.puhe.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/11/2021] [Accepted: 03/03/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Analyze the association between health insurance coverage and the use of health care services, dentist visits, and self-medication in a national sample of Mexican adults aged ≥50 years with diabetes. METHODS Participants with diabetes taken from a subsample of the Mexican Health and Aging Study (MHAS-2018) (n = 3667) were examined, with data pertaining to the frequency of their doctor and dentist visits, residence, years of education, self-medication, and health insurance coverage (insured/uninsured) also collected. A logistic regression model was used to identify the association between independent variables and health insurance coverage, whereas Poisson regression models were also estimated to ascertain whether health insurance coverage was associated with the number of doctor and dentist visits. RESULTS The prevalence of self-reported diabetes was 24.6%, whereas approximately 93.3% of subjects had visited a doctor, 40.6% had visited a dentist, and 20.3% self-medicated. Individuals with insurance coverage were 75% (Odds ratio [OR] = 1.75 [95% confidence interval {CI}1.32-2.31]; P < 0.001) more likely to have visited a doctor and 57% more likely to have visited a dentist (OR = 1.57 [95% CI 1.35-1.83]; P < 0.001) than uninsured adult subjects, while adults living in rural areas were 77% less likely to be insured than adults living in urban areas. Doctor and dentist visits [rate ratio {RR} = 1.32 (95% CI 1.28-1.35); P < 0.001] and [RR = 1.47 (95% CI 1.37-1.58); P < 0.001, respectively] were found to be positively associated with the insured members of the study population. CONCLUSION A positive association was found between doctor and dentist visits in the population insured with diabetes. A major public health challenge is the population of diabetics who report being uninsured, wherein this population requires coverage to access the necessary clinical follow-up and control to prevent complications.
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Macinko J, Cristina Drumond Andrade F, Bof de Andrade F, Lima-Costa MF. Universal Health Coverage: Are Older Adults Being Left Behind? Evidence From Aging Cohorts In Twenty-Three Countries. Health Aff (Millwood) 2020; 39:1951-1960. [DOI: 10.1377/hlthaff.2019.01570] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- James Macinko
- James Macinko is a professor in the Fielding School of Public Health at the University of California Los Angeles, in Los Angeles, California
| | - Flavia Cristina Drumond Andrade
- Flavia Cristina Drumond Andrade is an associate professor in the School of Social Work at the University of Illinois at Urbana-Champaign, in Urbana, Illinois
| | - Fabiola Bof de Andrade
- Fabiola Bof de Andrade is an assistant professor in the Rene Rachou Research Institute at the Fundação Oswaldo Cruz, in Belo Horizonte, Minas Gerais, Brazil
| | - Maria Fernanda Lima-Costa
- Maria Fernanda Lima-Costa is a professor in the Rene Rachou Research Institute, Fundação Oswaldo Cruz, and the Public Health Postgraduate Program at the Federal University of Minas Gerais, in Belo Horizonte, Brazil
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Rana RH, Alam K, Gow J. Selection of private or public hospital care: examining the care-seeking behaviour of patients with private health insurance. BMC Health Serv Res 2020; 20:380. [PMID: 32375869 PMCID: PMC7201676 DOI: 10.1186/s12913-020-05253-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 04/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to examine the healthcare-seeking (hospital, primary and preventive care) and healthcare utilisation behaviour of patients with private health insurance (PHI) in Australia. It also aimed to examine the socioeconomic, demographic and lifestyle factors that influence the choice of hospital care in Australia. Method A logistic regression model with repeated measure t-test and Pearson’s Chi-square test were used to identify the factors that affect the choice of care. Data from waves 9 (2009) and 13 (2013) of the nationally-representative Household, Income and Labour Dynamics in Australia (HILDA) survey were used in the analysis. Results Patients with PHI had a higher number of hospital nights’ stay despite having a lower number of hospital admissions than those without private cover. Significant disparities were identified in preventive and specialist care use between patients with cover and without cover. No significant variations were observed in healthcare utilisation for PHI patients before and after dropping PHI. One in four patients chose to use public hospitals despite holding PHI cover. Moreover, those insured and from lower socioeconomic backgrounds and those who were younger and without long-term health conditions showed a higher probability of selecting public rather than private care. Conclusions It is evident that PHI cover encourages people to use private care. However, a considerable number of PHI patients are using public care, even though eligible for private care may indicate consumer information asymmetry.
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Affiliation(s)
- Rezwanul Hasan Rana
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.
| | - Khorshed Alam
- School of Commerce, Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Jeff Gow
- School of Commerce, University of Southern Queensland, Toowoomba, Australia.,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, South Africa
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Impact of voluntary community-based health insurance on child stunting: Evidence from rural Uganda. Soc Sci Med 2019; 245:112738. [PMID: 31855728 DOI: 10.1016/j.socscimed.2019.112738] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 01/07/2023]
Abstract
While community-based health insurance increasingly becomes part of the health financing landscape in developing countries, there is still limited research about its impacts on health outcomes. Using cross-sectional data from rural south-western Uganda, we apply a two-stage residual inclusion instrumental variables method to study the impact of insurance participation on child stunting in under-five children. We find that one year of a household's participation in community-based health insurance was associated with a 4.3 percentage point less probability of stunting. Children of two years or less dominated the effect but there were also statistically significant benefits of enrolling in insurance after a child's birth. The expansion of community-based health insurance might have more dividends to improving health, in addition to financial protection and service utilisation in rural developing countries.
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Ortiz-Mendoza CM, Sánchez-Hernández AG. Employment Condition Modifies the Using Patterns of Screening Mammography in Workers Insured by the Mexican Government: A Case-Control Study. Int J Prev Med 2019; 10:133. [PMID: 31516674 PMCID: PMC6710918 DOI: 10.4103/ijpvm.ijpvm_455_18] [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: 10/06/2018] [Accepted: 05/29/2019] [Indexed: 11/11/2022] Open
Abstract
Background: Our main aim was to investigate whether the employment condition modifies the use patterns of the screening mammography in workers insured by the Mexican government (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE; medical facilities of the Mexican government). Methods: A case–control study age-matched was done in women insured by the Mexican government, aged 40–69 years, attending a general hospital (ISSSTE). All subjects were submitted to an interview and anthropometric data registry. In the interview were obtained: demographic data, of schooling, breast cancer family history, and reproductive history; besides, mammography history during the past 2 years and place of performance (in or outside of the ISSSTE). Finally, it was evaluated whether the mammography use in the ISSSTE was related to their employment condition: Active workers (cases) vs. dependents or retired workers (controls). Results: The sample was of 252 women: 126 cases and 126 controls. Cases obtained less mammograms in the ISSSTE (P = 0.03, odds ratio = 0.54, 95% confidence interval, CI 0.30–0.96), than their dependents or the retired workers. Furthermore, cases with high education (university or higher) also obtained fewer mammograms in the ISSSTE (P = 0.03, odds ratio = 0.26, 95% CI 0.05–0.93). Conclusions: Women active workers with higher education are obtaining less screening mammograms in the ISSSTE than their dependents or the retired workers.
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Affiliation(s)
- Carlos M Ortiz-Mendoza
- Department of Surgical Oncology, Hospital General Tacuba, ISSSTE, Mexico City, Mexico.,Department of Surgery, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
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10
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Dong W, Gao J, Zhou Z, Bai R, Wu Y, Su M, Shen C, Lan X, Wang X. Effects of China's urban basic health insurance on preventive care service utilization and health behaviors: Evidence from the China Health and Nutrition Survey. PLoS One 2018; 13:e0209890. [PMID: 30596751 PMCID: PMC6312240 DOI: 10.1371/journal.pone.0209890] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 12/13/2018] [Indexed: 11/19/2022] Open
Abstract
Background Lifestyle choices are important determinants of individual health. Few studies have investigated changes in health behaviors and preventive activities brought about by the 2007 implementation of Urban Resident Basic Health Insurance (URBMI) in China. This study, therefore, aimed to explore whether URBMI has reduced individuals’ incentives to adopt healthy behaviors and utilize preventive care services. Methods Data were drawn from two waves of the China Health and Nutrition Survey. Respondents were categorized according to their insurance situation before and after the URBMI reform in 2006 and 2011. Propensity score matching and difference-in-differences methods were used to measure levels of preventive care and behavior changes over time. Estimations were also made based on gender, self-reported health, and income. Results We found that URBMI implementation did not change residents’ utilization of preventive care services or their smoking habits, drinking habits, or other risky behaviors overall. However, the likelihood of sedentariness did increase by five percentage points. Females tended to be more sedentary while males were less likely to drink soft drinks. Residents with poor self-reported health exercised less while those who reported good health were more likely to be sedentary. Low- and middle-income residents were likely to be sedentary while middle-income people tended to smoke after becoming insured. Conclusion Since URBMI implementation, some unhealthy behaviors like sedentariness have increased among those who were newly insured, and different subgroups have reacted differently. This suggests that the insurance design needs to be optimized and effective measures need to be adopted to help improve people’s lifestyle choices.
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Affiliation(s)
- Wanyue Dong
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Jianmin Gao
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- * E-mail:
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Ruhai Bai
- Global Health Institute, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Yue Wu
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Min Su
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xin Lan
- School of Public Health, Health Science Center, Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Xiao Wang
- International Business School Suzhou, Xi’an Jiaotong-Liverpool University, Suzhou, Jiangsu, People’s Republic of China
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Xie X, Wang N, Liu Y. Gender disparities in the associations of behavioral factors, serious psychological distress and chronic diseases with type 2 diabetes screening among US adults. Glob Health Res Policy 2018; 3:9. [PMID: 29619411 PMCID: PMC5881180 DOI: 10.1186/s41256-018-0065-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 03/06/2018] [Indexed: 01/01/2023] Open
Abstract
Background The increasing prevalence of undiagnosed and diagnosed type 2 diabetes (T2D) posed a major challenge for public health and thus screening for T2D becomes essentially important. The social-demographical factors associated with the use of T2D screening have been widely studied, however, little is known about the impact of behavioral factors, mental health and chronic diseases on prevalence of screening, especially by gender and age groups. Methods We investigated the impact of behavioral factors, mental health and chronic diseases across gender and age groups on the usage rate of T2D screening. To analyze the likelihood of the use of T2D screening, we performed weighted binomial logistic regression analyses. Results Obesity, physical activity and smoking increased the use of T2D screening for females more than for males, and alcohol use increased screenings only for females. Serious psychological distress (SPD) was found to have a positive association with the use of T2D screening for females rather than for males; whereas hypertension and diabetes increased the use of T2D screening for males more than for females. Physical activity was an effective predictor of screening for T2D in the groups of 45-64 years and 65 years or older. Former drinking was positively associated with T2D screening for people aged 65 or older, and smoking was found to increase the odds of screening for T2D for people aged less than 65. Conclusions Behavioral factors, mental health, and chronic diseases were significantly associated with the use of T2D screening and further demonstrated that gender differences exist in the role of above factors.
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Affiliation(s)
- Xin Xie
- 1Department of Economics and Finance, College of Business and Technology, East Tennessee State University, PO Box 70686, 227 Sam Wilson Hall, Johnson City, TN 37614 USA
| | - Nianyang Wang
- 2Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611 USA
| | - Ying Liu
- 3Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614 USA
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Hunter LM, Simon DH. Might Climate Change the "Healthy Migrant" Effect? GLOBAL ENVIRONMENTAL CHANGE : HUMAN AND POLICY DIMENSIONS 2017; 47:133-142. [PMID: 29430082 PMCID: PMC5802421 DOI: 10.1016/j.gloenvcha.2017.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Lori M Hunter
- University of Colorado Boulder, Institute of Behavioral Science, CU Population Center, Department of Sociology, Campus Box UCB 483, Boulder, CO 80309
| | - Daniel H Simon
- University of Colorado Boulder, Institute of Behavioral Science, CU Population Center, Department of Sociology, Campus Box UCB 483, Boulder, CO 80309
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Tian WH. The Effect of Free Adult Preventive Care Services on Subsequent Utilization of Inpatient Services in Taiwan. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:547-65. [DOI: 10.1177/0020731416654661] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals’ utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program.
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Affiliation(s)
- Wei-Hua Tian
- Department of Economics, College of Social Science, National Cheng Kung University, Tainan, Taiwan
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Jacob ME, Lo-Ciganic WH, Simkin-Silverman LR, Albert SM, Newman AB, Terhorst L, Bilt JV, Zgibor JC, Schlenk EA. The preventive services use self-efficacy (PRESS) scale in older women: development and psychometric properties. BMC Health Serv Res 2016; 16:71. [PMID: 26897364 PMCID: PMC4761175 DOI: 10.1186/s12913-016-1321-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/11/2016] [Indexed: 01/09/2023] Open
Abstract
Background Preventive services offered to older Americans are currently under-utilized despite considerable evidence regarding their health and economic benefits. Individuals with low self-efficacy in accessing these services need to be identified and provided self-efficacy enhancing interventions. Scales measuring self-efficacy in the management of chronic diseases exist, but do not cover the broad spectrum of preventive services and behaviors that can improve the health of older adults, particularly older women who are vulnerable to poorer health and lesser utilization of preventive services. This study aimed to evaluate the psychometric properties of a new preventive services use self-efficacy scale, by measuring its internal consistency reliability, assessing internal construct validity by exploring factor structure, and examining differences in self-efficacy scores according to participant characteristics. Methods The Preventive Services Use Self-Efficacy (PRESS) Scale was developed by an expert panel at the University of Pittsburgh Center for Aging and Population Health - Prevention Research Center. It was administered to 242 women participating in an ongoing trial and the data were analyzed to assess its psychometric properties. An exploratory factor analysis with a principal axis factoring approach and orthogonal varimax rotation was used to explore the underlying structure of the items in the scale. The internal consistency of the subscales was assessed using Cronbach’s alpha coefficient. Results The exploratory factor analysis defined five self-efficacy factors (self-efficacy for exercise, communication with physicians, self-management of chronic disease, obtaining screening tests, and getting vaccinations regularly) formed by 16 items from the scale. The internal consistency of the subscales ranged from .81 to .94. Participants who accessed a preventive service had higher self-efficacy scores in the corresponding sub-scale than those who did not. Conclusions The 16-item PRESS scale demonstrates preliminary validity and reliability in measuring self-efficacy in the use of preventive services among older women. It can potentially be used to evaluate the impact of interventions designed to improve self-efficacy in the use of preventive services in community-dwelling older women.
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Affiliation(s)
- Mini E Jacob
- Graduate School of Public Health Department of Epidemiology, University of Pittsburgh, Pittsburgh, USA.
| | | | - Laurey R Simkin-Silverman
- Graduate School of Public Health Department of Epidemiology, University of Pittsburgh, Pittsburgh, USA.
| | - Steven M Albert
- Graduate School of Public Health Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, USA.
| | - Anne B Newman
- Graduate School of Public Health Department of Epidemiology, University of Pittsburgh, Pittsburgh, USA.
| | - Lauren Terhorst
- School of Health and Rehabilitation Sciences Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, USA.
| | - Joni Vander Bilt
- Graduate School of Public Health Department of Epidemiology, University of Pittsburgh, Pittsburgh, USA.
| | - Janice C Zgibor
- Graduate School of Public Health Department of Epidemiology, University of Pittsburgh, Pittsburgh, USA.
| | - Elizabeth A Schlenk
- School of Nursing Department of Health and Community Systems, University of Pittsburgh, Pittsburgh, USA.
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15
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Rivera-Hernandez M, Galarraga O. Type of Insurance and Use of Preventive Health Services Among Older Adults in Mexico. J Aging Health 2015; 27:962-82. [PMID: 25804897 PMCID: PMC4720256 DOI: 10.1177/0898264315569457] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The main purpose of this article was to assess the differences between Seguro Popular (SP) and employer-based health insurance in the use of preventive services, including screening tests for diabetes, cholesterol, hypertension, cervical cancer, and prostate cancer among older adults at more than a decade of health care reform in Mexico. METHOD Logistic regression models were used with data from the Mexican Health and Nutrition Survey, 2012. RESULTS After adjusting for other factors influencing preventive service utilization, SP enrollees were more likely to use screening tests for diabetes, cholesterol, hypertension, and cervical cancer than the uninsured; however, those in employment-based and private insurances had higher odds of using preventive care for most of these services, except Pap smears. DISCUSSION Despite all the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in health care access and utilization still exist in Mexico.
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Affiliation(s)
| | - Omar Galarraga
- Department of Health Services, Policy and Practice Brown University, Providence, RI, USA
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Aggarwal A, Unger-Saldaña K, Lewison G, Sullivan R. The challenge of cancer in middle-income countries with an ageing population: Mexico as a case study. Ecancermedicalscience 2015; 9:536. [PMID: 26015805 PMCID: PMC4435755 DOI: 10.3332/ecancer.2015.536] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Indexed: 11/06/2022] Open
Abstract
Mexico is undergoing rapid population ageing as a result of its epidemiological transition. This study explores the interface between this rapid population ageing and the burden of cancer. The number of new cancer cases is expected to increase by nearly 75% by 2030 (107,000 additional cases per annum), with 60% of cases in the elderly (aged ≥ 65). A review of the literature was supplemented by a bibliometric analysis of Mexico's cancer research output. Cancer incidence projections for selected sites were estimated with Globocan software. Data were obtained from recent national census, surveys, and cancer death registrations. The elderly, especially women and those living in rural areas, face high levels of poverty, have low rates of educational attainment, and many are not covered by health insurance schemes. Out of pocket payments and private health care usage remain high, despite the implementation of Seguro Popular that was designed to achieve financial protection for the lowest income groups. A number of cancers that predominate in elderly persons are not covered by the scheme and individuals face catastrophic expenditure in seeking treatment. There is limited research output in those cancer sites that have a high burden in the elderly Mexican population, especially research that focuses on outcomes. The elderly population in Mexico is vulnerable to the effects of the rising cancer burden and faces challenges in accessing high quality cancer care. Based on our evidence, we recommend that geriatric oncology should be an urgent public policy priority for Mexico.
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Affiliation(s)
- Ajay Aggarwal
- Institute of Cancer Policy, Kings College London, Guys Campus, Department of Research Oncology, Bermondsey Wing, London, SE1 9RT, UK
- Department of Clinical Oncology, Guys and St Thomas’ NHS Trust, London SE1 9RT, UK
| | | | - Grant Lewison
- Institute of Cancer Policy, Kings College London, Guys Campus, Department of Research Oncology, Bermondsey Wing, London, SE1 9RT, UK
| | - Richard Sullivan
- Institute of Cancer Policy, Kings College London, Guys Campus, Department of Research Oncology, Bermondsey Wing, London, SE1 9RT, UK
- International Prevention Research Institute (iPRI), Lyon 69006, France
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Mitchell-Fearon K, Willie-Tyndale D, Waldron N, Holder-Nevins D, James K, Laws H, Eldemire-Shearer D. Cardio-Vascular Disease and Cancer: A Dichotomy in Utilization of Clinical Preventive Services by Older Adults in a Developing Country. Gerontol Geriatr Med 2015; 1:2333721415611821. [PMID: 28138475 PMCID: PMC5119902 DOI: 10.1177/2333721415611821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 09/16/2015] [Indexed: 11/15/2022] Open
Abstract
Objective: To report the level of utilization of clinical preventive services by older adults in Jamaica and to identify independent factors associated with utilization. Method: A nationally representative, community-based survey of 2,943 older adults was undertaken. Utilization frequency for six preventive, cardiovascular or cancer-related services was calculated. Logistic regression models were used to determine the independent factors associated with each service. Results: A dichotomy in annual utilization rates exists with cardiovascular services having much higher uptake than those for cancer (83.1% for blood pressure, 76.7% blood glucose, 68.1% cholesterol, 35.1% prostate, 11.3% mammograms, and 9.6% papanicolaou smears). Age, source of routine care, and having a chronic disease were most frequently associated with uptake. Discussion: Education of providers and patients on the need for utilizing preventive services in older adults is important. Improved access to services in the public sector may also help increase uptake of services.
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Affiliation(s)
| | | | - N. Waldron
- The University of the West Indies, Kingston, Jamaica
| | | | - K. James
- The University of the West Indies, Kingston, Jamaica
| | - H. Laws
- The University of the West Indies, Kingston, Jamaica
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Wong R, Michaels-Obregón A, Palloni A, Gutiérrez-Robledo LM, González-González C, López-Ortega M, Téllez-Rojo MM, Mendoza-Alvarado LR. Progression of aging in Mexico: the Mexican Health and Aging Study (MHAS) 2012. SALUD PUBLICA DE MEXICO 2015; 57 Suppl 1:S79-89. [PMID: 26172238 PMCID: PMC4705907 DOI: 10.21149/spm.v57s1.7593] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/14/2015] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To describe the third wave of the Mexican Health and Aging Study (MHAS), completed in 2012, and present preliminary results. MATERIALS AND METHODS Descriptive analyses by gender and age group of demographic and socioeconomic characteristics, health conditions and health behaviors, as well as social support and life satisfaction measures are presented. In addition, external validations are presented by comparing MHAS 2012 indicators with other national data sources. RESULTS For the panel of older adults in the sample, the rate of health care insurance coverage increased greatly between 2001 and 2012, a significantly higher change in rural compared to urban areas. The results for 2012 are consistent with the previous two waves for the main indicators of health and physical disability prevalence, risk factors,and behaviors. CONCLUSIONS The MHAS offers a unique opportunity to study aging in Mexico, as well as to complete cross-national comparisons. The cumulative number of deaths in the cohort should support the study of mortality and its association with health outcomes and behaviors over the life cycle. In addition, the sub-samples of objective markers will enable methodological research on self-reports and associations of biomarkers in old age with similar health outcomes and behaviors.
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Affiliation(s)
- Rebeca Wong
- Sealy Center on Aging, WHO/PAHO Collaborating Center on Aging and Health, University of Texas Medical Branch. The United States
| | - Alejandra Michaels-Obregón
- Sealy Center on Aging, WHO/PAHO Collaborating Center on Aging and Health, University of Texas Medical Branch. The United States
| | - Alberto Palloni
- Center for Demography and Ecology, University of Wisconsin. The United States
| | | | - César González-González
- Instituto Nacional de Geriatría. Mexico
- Instituto Nacional de Salud Pública. Mexico
- University of Texas Medical Branch. The United States
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Salinas JJ. Preventive health screening utilization in older Mexicans before and after healthcare reform. SALUD PUBLICA DE MEXICO 2015; 57 Suppl 1:S70-8. [PMID: 26172237 PMCID: PMC4720260 DOI: 10.21149/spm.v57s1.7592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 05/27/2014] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To assess changes in preventive screening utilization in older Mexicans, pre- and post-Seguro Popular. MATERIALS AND METHODS Data from the Mexican Health and Aging Study (MHAS/Enasem) 2001 and 2012 were used. Logistic and ordinary least squares regression adjusted models were used to predict preventive care in 2012 by insurance status categories in 2001-2012, as the focus explanatory variable. RESULTS Participants who were uninsured in 2001 and had Seguro Popular in 2012 were significantly more likely to be tested for diabetes, high blood pressure and receive a tetanus shot than the continually uninsured. CONCLUSIONS While disparities in preventive screening between the insured and uninsured continue to exist in Mexico, Seguro Popular seems to have provided better access to health services to prevent chronic and infectious diseases for the otherwise uninsured population.
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Affiliation(s)
- Jennifer J Salinas
- School of Public Health, University of Texas, Houston, Texas, Estados Unidos de América
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Riosmena F, Wong R, Palloni A. Migration selection, protection, and acculturation in health: a binational perspective on older adults. Demography 2013; 50:1039-64. [PMID: 23192395 PMCID: PMC3613435 DOI: 10.1007/s13524-012-0178-9] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In this article, we test for four potential explanations of the Hispanic Health Paradox (HHP): the "salmon bias," emigration selection, and sociocultural protection originating in either destination or sending country. To reduce biases related to attrition by return migration typical of most U.S.-based surveys, we combine data from the Mexican Health and Aging Study in Mexico and the U.S. National Health Interview Survey to compare self-reported diabetes, hypertension, current smoking, obesity, and self-rated health among Mexican-born men ages 50 and older according to their previous U.S. migration experience, and U.S.-born Mexican Americans and non-Hispanic whites. We also use height, a measure of health during childhood, to bolster some of our tests. We find an immigrant advantage relative to non-Hispanic whites in hypertension and, to a lesser extent, obesity. We find evidence consistent with emigration selection and the salmon bias in height, hypertension, and self-rated health among immigrants with less than 15 years of experience in the United States; we do not find conclusive evidence consistent with sociocultural protection mechanisms. Finally, we illustrate that although ignoring return migrants when testing for the HHP and its mechanisms, as well as for the association between U.S. experience and health, exaggerates these associations, they are not fully driven by return migration-related attrition.
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Trujillo AJ, Mroz TA, Piras C, Angeles G, Tran N. Caregiving and elderly health in Mexico. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2013; 42:667-94. [PMID: 23367799 DOI: 10.2190/hs.42.4.f] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Using the National Mexican Health and Aging Study panel dataset, the authors estimate the effect of having informal care on the probability of dying and on the change in elderly health over a two-year period. Three measures of functional health were used: self-reported health, activities of daily living, and instrumental activities of daily living. We develop an empirical strategy that relies on the panel structure of the dataset to sort out the possible correlation between unobservable characteristics that affect both elderly health and an individual's decision to provide informal care. Our findings suggest that informal care provided by daughters reduces the probability of dying. In addition, informal care provided by daughters reduces the probability of having a decline in activities of daily living and instrumental activities of daily living, while it has no effect on the observed changes in self-reported health status. The protective effect of informal care provided by sons is not statistically significant for any health outcomes. A discussion of the policy options to increase elderly health and to improve the role of caregivers is included.
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Affiliation(s)
- Antonio J Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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López-López E, Gutiérrez-Soria D, Idrovo AJ. Evaluation of a diabetes care program using the effective coverage framework. Int J Qual Health Care 2012; 24:619-25. [PMID: 23042797 DOI: 10.1093/intqhc/mzs056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To measure the effective coverage of a program to control type 2 diabetes. DESIGN Observational study combining multiple DATA SOURCES SETTING Hidalgo state, Mexico. PARTICIPANTS Adults without social security health benefits and patients with a diagnosis of diabetes participating in the program. MAIN OUTCOME MEASURES Detection of diabetes; glucose, cholesterol, triglyceride and blood pressure control; education; diabetic retinopathy, diabetic foot and nephropathy prevention. RESULTS Only 7.1% of individuals with diabetes participated in the control program. Fasting glucose and HbA1c values were available for 95.6 and 35.6 of patients, respectively. There were measurements of total cholesterol (52.1%), triglyceride (50.6%) and blood pressure (99.6%). Educative activities were realized for 64.8% of patients. The most important gaps were related with detection of illness, low-density lipoprotein cholesterol control, glucose control with HbA1c and nephropathy prevention. Effective coverage of these medical actions was 6.22, 5.07, 5.01 and 0.34%, respectively. CONCLUSIONS The greatest challenge to overcome is the detection of individuals with illness because a large number of individuals with type 2 diabetes do not use health services and the health system does not systematically search them out. Medical actions that require resources that must be paid for by patients tend to be used less and to be of lower quality. The use of effective coverage to measure the performance of diabetes care program provides practical information to improve health services.
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Affiliation(s)
- Erika López-López
- Coordination of Research, Ministry of Health, Pachuca, Hidalgo, Mexico
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Jahangir E, Irazola V, Rubinstein A. Need, enabling, predisposing, and behavioral determinants of access to preventative care in Argentina: analysis of the national survey of risk factors. PLoS One 2012; 7:e45053. [PMID: 22984608 PMCID: PMC3440415 DOI: 10.1371/journal.pone.0045053] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 08/15/2012] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Health care utilization is an important step to disease management, providing opportunities for prevention and treatment. Anderson's Health Behavior Model has defined utilization by need, predisposing, and enabling determinants. We hypothesize that need, predisposing, and enabling, highlighting behavioral factors are associated with utilization in Argentina. METHODS We performed a logistic regression analysis of the 2005 and 2009 Argentinean Survey of Risk Factors, a cohort of 41,392 and 34,732 individuals, to explore the association between need, enabling, predisposing, and behavioral factors to blood pressure measurement in the last year. RESULTS In the 2005 cohort, blood pressure measurement was associated with perception of health, insurance coverage, basic needs met, and income. Additionally, female sex, civil state, household type, older age groups, education, and alcohol use were associated with utilization. The 2009 cohort showed similar associations with only minor differences between the models. CONCLUSIONS We explored the association between utilization of clinical preventive services with need, enabling, predisposing, and behavioral factors. While predisposing and need determinants are associated with utilization, enabling factors such as insurance coverage provides an area for public intervention. These are important findings where policies should be focused to improve utilization of preventive services in Argentina.
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Affiliation(s)
- Eiman Jahangir
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
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Mier N, Wang X, Smith ML, Irizarry D, Treviño L, Alen M, Ory MG. Factors influencing health care utilization in older Hispanics with diabetes along the Texas-Mexico border. Popul Health Manag 2012; 15:149-56. [PMID: 22313441 DOI: 10.1089/pop.2011.0044] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Little is known about predictors of health care utilization for older Hispanics with chronic conditions. This study aimed to determine: (1) the level of health care access for older Hispanics with type 2 diabetes living in a US-Mexico border area; and (2) personal and health correlates to health care utilization (ie, physician visits, eye care, emergency room [ER] use). This was a cross-sectional study based on a community assessment conducted at a clinic, senior centers, and colonias. Colonias are impoverished neighborhoods with substandard living conditions along the US-Mexico border. Hispanics living in colonias are one of the most disadvantaged minority groups in the United States. The study sample consisted of 249 Hispanics age 60 years and older who have type 2 diabetes. Descriptive analyses, multiple linear regression, and generalized linear models were conducted. Older age (P = 0.02) and affordability of physician fees (P = 0.02) were significant correlates to more frequent physician visits. Factors significantly associated with eye care were being insured (P = 0.001) and reporting high cholesterol (P = 0.005). ER use was significantly associated with younger age (60-64 years old; P = 0.03) and suffering from hypertension (P = 0.02). Those who received diabetes education (P = 0.04) were less likely to use the ER. Identifying patterns of health care utilization services in aging underserved minorities who are disproportionately affected by diabetes may lead to culturally appropriate preventive practices and timely access to health care. Adequate health care access can decrease or delay the onset of diabetes complications in older Hispanics with type 2 diabetes who live along the US-Mexico border.
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Affiliation(s)
- Nelda Mier
- Department of Social and Behavioral Health, School of Rural Public Health, McAllen Campus, Texas A&M Health Science Center, McAllen, Texas 78503, USA.
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Cárdenas-Turanzas M, Torres-Vigil I, Tovalín-Ahumada H, Nates JL. Hospital versus home death: results from the Mexican Health and Aging Study. J Pain Symptom Manage 2011; 41:880-92. [PMID: 21146354 PMCID: PMC3723140 DOI: 10.1016/j.jpainsymman.2010.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 07/26/2010] [Accepted: 07/29/2010] [Indexed: 10/18/2022]
Abstract
CONTEXT Characterizing where people die is needed to inform palliative care programs in Mexico. OBJECTIVES To determine whether access to health care influences the place of death of older Mexicans and examine the modifying effects of demographic and clinical characteristics. METHODS We analyzed 2001 baseline and 2003 follow-up data from the Mexican Health and Aging Study. Cases included adults who completed the baseline interview and died before the follow-up interview and for whom a proxy interview was obtained in 2003. The main outcome variable was the place of death (hospital vs. home). The predictors of the place of death were identified using logistic regression analysis. RESULTS The study group included 473 deceased patients; 52.9% died at home. Factors associated with hospital death were having spent at least one night in a hospital during the last year of life (odds ratio [OR]: 6.73; 95% confidence interval [CI]: 3.29, 13.78) and dying in a city other than the city of usual residence (OR: 4.68, 95% CI: 2.56, 8.57). Factors associated with home death were not having health care coverage (OR: 2.78, 95% CI: 1.34, 5.88), living in a city of less than 100,000 residents (OR: 2.44, 95% CI: 1.43, 4.17), and older age (OR: 1.03, 95% CI: 1.01, 1.05). CONCLUSION Older Mexicans with access to health care services were more likely to die in the hospital even after controlling for important clinical and demographic characteristics. Findings from the study may be used to plan the provision of accessible end-of-life hospital and home-based services.
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Affiliation(s)
- Marylou Cárdenas-Turanzas
- Department of Critical Care Medicine, Center for Research on Minority Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
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Trujillo AJ, Vecino Ortiz AI, Ruiz Gómez F, Steinhardt LC. Health insurance doesn't seem to discourage prevention among diabetes patients in Colombia. Health Aff (Millwood) 2011; 29:2180-8. [PMID: 21134918 DOI: 10.1377/hlthaff.2010.0463] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In the South American nation of Colombia, as elsewhere, patients with type 2 diabetes often avoid care that could prevent their condition from worsening. Availability of health insurance may play a role in explaining this behavior. Some patients with diabetes skip preventive measures because they have insurance and calculate that they can access curative services later in life. Insurers may limit preventive services coverage because they can't be assured of sharing in the eventual savings that emerge when a chronic condition such as diabetes is managed properly. Our analysis of a nationally representative sample of Colombians who have type 2 diabetes and who pay premiums into the country's "contributory" insurance program, found no evidence that insurance influences those individuals to avoid preventive services. The evidence is less clear for those participating in a different, fully subsidized insurance program, who-despite the availability of preventive care-are no more likely to seek preventive visits than are uninsured patients. We propose controlled experiments to identify and measure the true causal effects of insurance on prevention and, more broadly, steps to increase patients' understanding of the benefits of prevention.
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Affiliation(s)
- Antonio J Trujillo
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, in Baltimore, Maryland, USA.
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Wang W, Fu C, Zhuo H, Luo J, Xu B. Factors affecting costs and utilization of type 2 diabetes healthcare: a cross-sectional survey among 15 hospitals in urban China. BMC Health Serv Res 2010; 10:244. [PMID: 20727137 PMCID: PMC2936377 DOI: 10.1186/1472-6963-10-244] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 08/20/2010] [Indexed: 12/24/2022] Open
Abstract
Background Type 2 Diabetes mellitus (T2DM) affects persons of all ages, while also placing heavy economic burdens on national economies and healthcare systems. The study aims to investigate the determinants of direct medical cost (DMC), out-of-pocket (OOP) proportion of the cost, and healthcare utilization associated with T2DM. Methods This cross-sectional study was conducted in four major cities in China. Eligible subjects were adult outpatients who received treatment at one of 15 sampled secondary or tertiary hospitals and consecutively enrolled between March 2007 and May 2007. Generalized estimating equations were used to determine impact factors associated with DMC and healthcare utilization. Results Insurance schemes and receiving insulin therapy were significantly associated with a higher annual DMC of T2DM. For each increase in number of complications, there was about 33% increase in annual DMC. Insurance schemes were significantly associated with the proportions of DMC from pocket. A 7% significantly lower proportion of DMC was paid and 23% more clinic visits (AOR = 1.232, P < 0.001) were made by patients admitted at secondary hospitals than tertiary hospitals. The group with higher income (> 2000 CNY/month) paid 23% less from their pocket, compared with the lower income group. The number of complications also significantly increased the outpatient visits (AOR = 1.064, P < 0.001). Conclusions It implies that preventing complications through the use of more effective treatment regimens is important in order to control the healthcare expenditures of the diseases. Healthcare reform needs to be focused on the medical insurance system and redistribution of patients in hospitals of different levels.
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Affiliation(s)
- Weibing Wang
- School of Public Health, Fudan University, China
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Health insurance and use of alternative medicine in Mexico. Health Policy 2010; 98:50-7. [PMID: 20546965 DOI: 10.1016/j.healthpol.2010.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 02/23/2010] [Accepted: 04/24/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES I analyze the effect of coverage by health insurance on the use of alternative medicine such as folk healers and homeopaths, in particular if it complements or substitutes conventional services. METHODS Panel data from the Mexican Health and Aging Study (MHAS) is used to estimate bivariate probit models in order to explain the use of alternative medicine while allowing the determinant of interest, access to health insurance, to be an endogenous factor. RESULTS The findings indicate that households with insurance coverage less often use alternative medicine, and that the effect is much stronger among poor than among rich households. CONCLUSIONS Poor households substitute away from traditional medicine towards conventional medicine.
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Salinas JJ, Al Snih S, Markides K, Ray LA, Angel RJ. The rural-urban divide: health services utilization among older Mexicans in Mexico. J Rural Health 2010; 26:333-41. [PMID: 21029168 PMCID: PMC2967463 DOI: 10.1111/j.1748-0361.2010.00297.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Mexico. PURPOSE Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. METHODS The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's "model of health services" of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semi-rural). FINDINGS Results showed that older Mexicans living in the most rural areas (populations of 2,500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. CONCLUSIONS Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health.
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Affiliation(s)
- Jennifer J Salinas
- University of Texas School of Public Health, Brownsville Regional Campus, Brownsville, Texas 78520-4956, USA.
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Brenes-Camacho G, Rosero-Bixby L. Differentials by socioeconomic status and institutional characteristics in preventive service utilization by older persons in Costa Rica. J Aging Health 2009; 21:730-58. [PMID: 19584413 DOI: 10.1177/0898264309338299] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective.The goals of this article are to assess the level of preventive service utilization by older persons in Costa Rica and to determine whether there are differentials in utilization across socioeconomic status (SES) and institutional characteristics. Method. Using data from the Costa Rican Study on Longevity and Healthy Aging (CRELES) project, a study of healthy aging in Costa Rica, the authors use self-reported information on preventive service utilization. The SES differentials are studied using logistic regressions. Results. Preventive services linked to cardiovascular disease prevention are frequently utilized; preventive services linked to cancer screening, vaccination, and sense impairments are not so widely used. Higher SES people are more likely to utilize most preventive services. Utilization rates among uninsured seniors are lower than among their insured peers. Home visits by community health workers are positively associated with higher utilization rates. Discussion. The SES disparities in preventive service utilization exist in Costa Rica, and institutional characteristics are positively associated with increasing utilization.
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Affiliation(s)
- Gilbert Brenes-Camacho
- Centro Centroamericano de Poblacion, University of Costa Rica, San José 2060, Costa Rica.
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Sosa-Rubi SG, Galárraga O, Harris JE. Heterogeneous impact of the "Seguro Popular" program on the utilization of obstetrical services in Mexico, 2001-2006: a multinomial probit model with a discrete endogenous variable. JOURNAL OF HEALTH ECONOMICS 2009; 28:20-34. [PMID: 18824268 PMCID: PMC2790917 DOI: 10.1016/j.jhealeco.2008.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Revised: 08/03/2008] [Accepted: 08/13/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE We evaluated the impact of Seguro Popular (SP), a program introduced in 2001 in Mexico primarily to finance health care for the poor. We focused on the effect of household enrollment in SP on pregnant women's access to obstetrical services, an important outcome measure of both maternal and infant health. DATA We relied upon data from the cross-sectional 2006 National Health and Nutrition Survey (ENSANUT) in Mexico. We analyzed the responses of 3890 women who delivered babies during 2001-2006 and whose households lacked employer-based health care coverage. METHODS We formulated a multinomial probit model that distinguished between three mutually exclusive sites for delivering a baby: a health unit specifically accredited by SP; a non-SP-accredited clinic run by the Department of Health (Secretaría de Salud, or SSA); and private obstetrical care. Our model accounted for the endogeneity of the household's binary decision to enroll in the SP program. RESULTS Women in households that participated in the SP program had a much stronger preference for having a baby in a SP-sponsored unit rather than paying out of pocket for a private delivery. At the same time, participation in SP was associated with a stronger preference for delivering in the private sector rather than at a state-run SSA clinic. On balance, the Seguro Popular program reduced pregnant women's attendance at an SSA clinic much more than it reduced the probability of delivering a baby in the private sector. The quantitative impact of the SP program varied with the woman's education and health, as well as the assets and location (rural vs. urban) of the household. CONCLUSIONS The SP program had a robust, significantly positive impact on access to obstetrical services. Our finding that women enrolled in SP switched from non-SP state-run facilities, rather than from out-of-pocket private services, is important for public policy and requires further exploration.
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Affiliation(s)
- Sandra G. Sosa-Rubi
- Center for Evaluation Research and Surveys, Division of Health Economics, National Institute of Public Health (Instituto Nacional de Salud Pública), Cuernavaca, Morelos 62508, México
| | - Omar Galárraga
- Center for Evaluation Research and Surveys, Division of Health Economics, National Institute of Public Health (Instituto Nacional de Salud Pública), Cuernavaca, Morelos 62508, México; and Institute of Business and Economic Research (IBER), University of California, Berkeley, California 94720, USA
| | - Jeffrey E. Harris
- Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts 02142, USA
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Couture MC, Nguyen CT, Alvarado BE, Velasquez LD, Zunzunegui MV. Inequalities in breast and cervical cancer screening among urban Mexican women. Prev Med 2008; 47:471-6. [PMID: 18675296 DOI: 10.1016/j.ypmed.2008.07.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 07/06/2008] [Accepted: 07/08/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To examine the equity of screening for breast and cervical cancer among women aged 50 and over living in Mexico City according to the Andersen behavioural model. METHODS Logistic regressions were used to analyze the associations of predisposing factors, enabling resources and health needs with mammography and Pap testing among 1323 women aged 50 and over living in Mexico City. The data were taken from SABE, a survey conducted in Latin American and Caribbean cities in 1999-2000. RESULTS Referring to the previous two years, use of mammography was less frequent (14.8%) than Pap testing (53.7%). Higher education and having private health insurance were associated with receiving both procedures. Being married was associated with receipt of Pap testing, while being unmarried was associated with mammography. Younger women were more likely to receive a Pap test. Other cancer prevention behaviours were strong predictors of mammography and Pap test use. CONCLUSIONS There are inequities in access to cancer screening services among women aged 50 and over in Mexico. Cancer prevention programs need to implement strategies that guarantee free and accessible services independently of social conditions or type of health insurance. The observed clustering of screening services suggests that packaging screening programs for gynaecological cancer could be used to increase coverage.
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Affiliation(s)
- Marie-Claude Couture
- Département de médecine sociale et préventive, Faculté de médecine, Université de Montréal, CP 6128, Succursale Centre Ville, Montréal, Québec, Canada H3C3J7.
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Maurer J. Assessing horizontal equity in medication treatment among elderly Mexicans: which socioeconomic determinants matter most? HEALTH ECONOMICS 2008; 17:1153-1169. [PMID: 18074405 DOI: 10.1002/hec.1313] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Many low- and middle-income countries are currently undergoing a dramatic epidemiological transition, with an increasing disease burden due to degenerative noncommunicable diseases. Inexpensive medication treatment often represents a cost-effective means to prevent, control or cure many of these health conditions. Using micro-data from the 2001 Mexican Health and Aging Study, we assess horizontal inequity in medication treatment among older Mexicans before the introduction of Popular Health Insurance in Mexico. In doing so, we investigate the role of various dimensions of socioeconomic status for obtaining indicated medication treatment within a comparatively fragmented health-care system that features relatively high out-of-pocket expenditures. Our empirical analysis suggests health insurance coverage as a key socioeconomic determinant of indicated medication use with large and statistically significant positive effects on take-up. The effects of insurance status thereby clearly dominate any other possible effects of socioeconomic status on medication treatment. Our results thus highlight the importance of access to reliable health care and comprehensive coverage for rational medication use in the management of degenerative diseases. In light of this evidence, we expect that recent Mexican health-care reforms, which expand health insurance coverage to the previously uninsured population, will alleviate socioeconomic gradients in medication treatment among older people in need.
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Affiliation(s)
- Jürgen Maurer
- Mannheim Research Institute for the Economics of Aging, University of Mannheim, Mannheim, Germany.
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