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Mar J, Larrañaga I, Ibarrondo O, González-Pinto A, Hayas CL, Fullaondo A, Izco-Basurko I, Alonso J, Mateo-Abad M, de Manuel E. Socioeconomic and gender inequalities in mental disorders among adolescents and young adults. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2024; 17:95-102. [PMID: 38720188 DOI: 10.1016/j.rpsm.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 06/02/2022] [Accepted: 07/10/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Socioeconomic status (SES) and gender play a key role in mental health. The objective of this study was to assess socioeconomic and gender mental health inequalities in adolescents and young adults using a population-based registry. MATERIALS AND METHODS We conducted a lifetime follow-up study of all residents in the Basque Country between 1 and 30 years old (n=609,381) as of 31 December 2018. Primary care, specialized outpatient, and hospital care records were searched for diagnoses. SES was assessed based on household income. We estimated disaggregated lifetime prevalence of substance use, behaviour, anxiety, depression, psychosis, and attention deficit hyperactivity disorder. The local Institute of Statistics validated the mortality data. The likelihood of risks was estimated using logistic regression. RESULTS Overall, 96,671 individuals (15.9%) had a diagnosed mental disorder, with clear gradients by gender and SES. Females of medium-to-high SES had the lowest prevalence of all mental disorders, except anxiety and depression. This group was followed by males of the same SES and females of low SES, while the highest prevalence of mental disorders was observed in low-SES males. The lower income categories had higher risks of psychiatric admission (adjusted odds ratio [AOR]: 3.64 for females; 6.66 for males) and death (AOR: 5.42). People with a mental health diagnosis had higher mortality (AOR: 2.38). CONCLUSIONS Our work evidenced important SES and gender inequalities in the mental health and premature mortality of adolescents and young adults, findings that should drive the development and implementation of early preventive interventions.
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Affiliation(s)
- Javier Mar
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, Arrasate-Mondragón, Spain; Biodonostia Health Research Institute, Donostia-San Sebastián, Spain; REDISSEC (Health Services Research on Chronic Patients Network), Bilbao, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain.
| | - Igor Larrañaga
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, Arrasate-Mondragón, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Oliver Ibarrondo
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, Arrasate-Mondragón, Spain
| | - Ana González-Pinto
- Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain; UPV/EHU - University of the Basque Country, Vitoria-Gasteiz, Spain; CIBERSAM, CIBER en Salud Mental, Madrid, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | | | - Ane Fullaondo
- Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | | | - Jordi Alonso
- Health Services Research Group, IMIM - Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain; CIBERESP, CIBER en Epidemiología y Salud Pública, Madrid, Spain; UPF - Pompeu Fabra University, Barcelona, Spain
| | - Maider Mateo-Abad
- REDISSEC (Health Services Research on Chronic Patients Network), Bilbao, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain
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Aguiar-Díaz I, Ruiz-Mallorquí MV. Financial Knowledge and Private Health Insurance: Does Age Matter? Healthcare (Basel) 2023; 11:2738. [PMID: 37893812 PMCID: PMC10606321 DOI: 10.3390/healthcare11202738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: The paper focuses on the relationship between financial knowledge (FK) and holding private health insurance (PHI), and also focuses on the effect of age on the aforementioned relationship. (2) Method: The study was carried out on a sample of 8055 individuals taken from the 2016 Financial Competences Survey (the only one available), prepared by the Bank of Spain. Unlike previous studies that limited themselves to considering numeracy as a proxy for FK, in this study, two levels of FK-basic and advanced-are considered. (3) Results: The results indicate that a higher level of FK, specifically advanced FK, increases the probability of an individual holding PHI. Regarding age, it has been observed that the relationship between FK and PHI is only relevant in middle and older age, but not in younger and adults. Therefore, it is appropriate to differentiate between basic and advanced FK, and we confirm that age exerts a moderating effect on the influence of FK on PHI. (4) Conclusion: We conclude that FK-specifically, advanced FK for middle-aged and older people-is relevant to the likelihood of an individual holding PHI, which can improve health and financial wellbeing.
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Affiliation(s)
| | - María Victoria Ruiz-Mallorquí
- Department of Financial Economics and Accounting, Faculty of Economy, Business and Tourism, University of Las Palmas de Gran Canaria, 35001 Las Palmas, Spain;
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Lavaste K. Private health insurance in the universal public healthcare system: The role of healthcare provision in Finland. Health Policy 2023; 132:104820. [PMID: 37071960 DOI: 10.1016/j.healthpol.2023.104820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 02/26/2023] [Accepted: 04/04/2023] [Indexed: 04/20/2023]
Abstract
Voluntary private health insurance (VPHI) has gained popularity in universal public healthcare systems. We studied how the local provision of healthcare services correlated with VPHI take-up in Finland. Nationwide register data from a Finnish insurance company was aggregated to the local level and augmented with high-quality data on public and private primary care providers' geographical closeness and fees. We found that the sociodemographic characteristics explained the VPHI take-up more than public or private healthcare provision. The VPHI take-up was negatively associated with distance to the nearest private clinic, while the associations with distance to public health stations were statistically weak. Fees and co-payments for healthcare services were not associated with insurance take-up, meaning that the geographical closeness of providers explained the take-up more than the price of services. On the other hand, we found that VPHI take-up was higher when local employment, income and education levels were higher.
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Affiliation(s)
- Konsta Lavaste
- Jyväskylä University School of Business and Economics, University of Jyväskylä, PO Box 35, FI-40014 Finland.
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Larrañaga I, Ibarrondo O, Mar-Barrutia L, Soto-Gordoa M, Mar J. Excess healthcare costs of mental disorders in children, adolescents and young adults in the Basque population registry adjusted for socioeconomic status and sex. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2023; 21:18. [PMID: 36859271 PMCID: PMC9975849 DOI: 10.1186/s12962-023-00428-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/12/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Mental illnesses account for a considerable proportion of the global burden of disease. Economic evaluation of public policies and interventions aimed at mental health is crucial to inform decisions and improve the provision of healthcare services, but experts highlight that nowadays the cost implications of mental illness are not properly quantified. The objective was to measure the costs of excess use of all healthcare services by 1- to 30-year-olds in the Basque population as a function of whether or not they had a mental disorder diagnosis. METHODS A real-world data study was used to identify diagnoses of mental disorders and to measure resource use in the Basque Health Service Registry in 2018. Diagnoses were aggregated into eight diagnostic clusters: anxiety, attention deficit hyperactivity disorder, conduct disorders, mood disorders, substance use, psychosis and personality disorders, eating disorders, and self-harm. We calculated the costs incurred by each individual by multiplying the resource use by the unit costs. Annual costs for each cluster were compared with those for individuals with no diagnosed mental disorders through entropy balancing and two-part models which adjusted for socioeconomic status (SES). RESULTS Of the 609,381 individuals included, 96,671 (15.9%) had ≥ 1 mental disorder diagnosis. The annual cost per person was two-fold higher in the group diagnosed with mental disorders (€699.7) than that with no diagnoses (€274.6). For all clusters, annual excess costs associated with mental disorders were significant. The adjustment also evidenced a social gradient in healthcare costs, individuals with lower SES consuming more resources than those with medium and higher SES across all clusters. Nonetheless, the effect of being diagnosed with a mental disorder had a greater impact on the mean and excess costs than SES. CONCLUSIONS Results were consistent in showing that young people with mental disorders place a greater burden on healthcare services. Excess costs were higher for severe mental disorders like self-harm and psychoses, and lower SES individuals incurred, overall, more than twice the costs per person with no diagnoses. A socioeconomic gradient was notable, excess costs being higher in low SES individuals than those with a high-to-medium SES. Differences by sex were also statistically significant but their sizes were smaller than those related to SES.
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Affiliation(s)
- Igor Larrañaga
- Research Unit, Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Avenida Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain. .,Kronikgune Institute for Health Services Research, Barakaldo, Spain.
| | - Oliver Ibarrondo
- grid.426049.d0000 0004 1793 9479Research Unit, Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Avenida Navarra 16, 20500 Arrasate-Mondragón, Gipuzkoa Spain ,grid.432380.eBiodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Lorea Mar-Barrutia
- grid.468902.10000 0004 1773 0974Osakidetza Basque Health Service, Araba University Hospital, Vitoria-Gasteiz, Spain
| | - Myriam Soto-Gordoa
- grid.436417.30000 0001 0662 2298Faculty of Engineering, Mondragon Unibertsitatea, Arrasate-Mondragón, Gipuzkoa Spain
| | - Javier Mar
- grid.426049.d0000 0004 1793 9479Research Unit, Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Avenida Navarra 16, 20500 Arrasate-Mondragón, Gipuzkoa Spain ,grid.424267.1Kronikgune Institute for Health Services Research, Barakaldo, Spain ,grid.432380.eBiodonostia Health Research Institute, Donostia-San Sebastián, Spain
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Anis-Syakira J, Jawahir S, Abu Bakar NS, Mohd Noh SN, Jamalul-Lail NI, Hamidi N, Sararaks S. Factors Affecting the Use of Private Outpatient Services among the Adult Population in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13663. [PMID: 36294242 PMCID: PMC9602948 DOI: 10.3390/ijerph192013663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
The proportion of Malaysians of all ages who use private outpatient services has dropped over time, highlighting the overstretched condition of public outpatient facilities compared to their private counterparts. This paper aims to determine the prevalence of outpatient care, characteristics of outpatient care users by sector, and the factors affecting the utilisation of private outpatient services among the adult population of Malaysia using Andersen's behavioural model. Data from the National Health Morbidity Survey 2019 (NHMS 2019), a nationwide survey, were analysed. Logistic regression analysis was performed to explore the association of predisposing (locality, age, sex, ethnicity, education level, and marital status), enabling (working status, health care coverage, and household income), and need factors (perceived and evaluated needs) with the use of private outpatient services. Variables with a statistical significance ≤ 0.25 in the univariate regression analysis were included in the final multivariable logistic regression analysis. A total of 11,674 respondents, estimated to represent 22.4 million adults aged 18 years and above in Malaysia, were included for analysis. Overall, 8.3% of the adult population of Malaysia used outpatient care and 33.9% used the private sector. Those living in urban areas (OR = 1.80, 95% CI = 1.02, 3.18), non-Malays (OR = 1.74, 95% CI = 1.04, 2.93), those working (OR = 2.47, 95% CI = 1.48, 4.10), those with employer coverage (OR = 4.73, 95% CI = 2.79, 8.01), and those with health problems (OR = 2.26, 95% CI = 1.26, 4.05) were more likely to utilise private outpatient services. Those who self-rated their health status as fair (OR = 0.54, 95% CI = 0.33, 0.91) and who had diabetes, hypertension, or hypercholesterolemia (OR = 0.56, 95% CI = 0.31, 1.02) were less likely to utilise private outpatient services. The predisposing and enabling factors were associated with the use of private outpatient services, and the need factors were strong predictors of private outpatient care utilisation among adults. Understanding the factors associated with the utilisation of private outpatient services could aid in the development of effective initiatives designed to enhance outpatient care access among the population of Malaysia and balance the burden of outpatient care provision on the public and private sector.
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Affiliation(s)
- Jailani Anis-Syakira
- Centre for Health Outcomes Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Suhana Jawahir
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Centre for Health Equity Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Nurul Salwana Abu Bakar
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Centre for Health Policy Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Sarah Nurain Mohd Noh
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Centre for Health Equity Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Nurul Iman Jamalul-Lail
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Centre for Health Services Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Normaizira Hamidi
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Centre for Health Quality Research, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
| | - Sondi Sararaks
- National Institutes of Health, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
- Director Office, Institute for Health Systems Research, Ministry of Health Malaysia, Shah Alam 40170, Malaysia
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Ibarrondo O, Aguiar M, Stollenwerk N, Blasco-Aguado R, Larrañaga I, Bidaurrazaga J, Estadilla CDS, Mar J. Changes in Social and Clinical Determinants of COVID-19 Outcomes Achieved by the Vaccination Program: A Nationwide Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12746. [PMID: 36232048 PMCID: PMC9566423 DOI: 10.3390/ijerph191912746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The objective of this study was to assess changes in social and clinical determinants of COVID-19 outcomes associated with the first year of COVID-19 vaccination rollout in the Basque population. METHODS A retrospective study was performed using the complete database of the Basque Health Service (n = 2,343,858). We analyzed data on age, sex, socioeconomic status, the Charlson comorbidity index (CCI), hospitalization and intensive care unit (ICU) admission, and COVID-19 infection by Cox regression models and Kaplan-Meier curves. RESULTS Women had a higher hazard ratio (HR) of infection (1.1) and a much lower rate of hospitalization (0.7). With older age, the risk of infection fell, but the risks of hospitalization and ICU admission increased. The higher the CCI, the higher the risks of infection and hospitalization. The risk of infection was higher in high-income individuals in all periods (HR = 1.2-1.4) while their risk of hospitalization was lower in the post-vaccination period (HR = 0.451). CONCLUSION Despite the lifting of many control measures during the second half of 2021, restoring human mobility patterns, the situation could not be defined as syndemic, clinical determinants seeming to have more influence than social ones on COVID-19 outcomes, both before and after vaccination program implementation.
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Affiliation(s)
- Oliver Ibarrondo
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, 20500 Arrasate-Mondragón, Spain
- Biodonostia Health Research Institute, 20014 Donostia-San Sebastián, Spain
| | - Maíra Aguiar
- Basque Center for Applied Mathematics, 48009 Bilbao, Spain
- Ikerbasque, Basque Foundation for Science, 48009 Bilbao, Spain
- Dipartimento di Matematica, Universita degli Studi di Trento, 38122 Trento, Italy
| | - Nico Stollenwerk
- Basque Center for Applied Mathematics, 48009 Bilbao, Spain
- Dipartimento di Matematica, Universita degli Studi di Trento, 38122 Trento, Italy
| | | | - Igor Larrañaga
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, 20500 Arrasate-Mondragón, Spain
- Kronikgune Institute for Health Services Research, 48902 Barakaldo, Spain
| | | | - Carlo Delfin S. Estadilla
- Basque Center for Applied Mathematics, 48009 Bilbao, Spain
- Public Health Department, University of the Basque Country, 48940 Leioa, Spain
| | - Javier Mar
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, 20500 Arrasate-Mondragón, Spain
- Biodonostia Health Research Institute, 20014 Donostia-San Sebastián, Spain
- Kronikgune Institute for Health Services Research, 48902 Barakaldo, Spain
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Kullberg L, Blomqvist P, Winblad U. Does voluntary health insurance reduce the use of and the willingness to finance public health care in Sweden? HEALTH ECONOMICS, POLICY, AND LAW 2022; 17:380-397. [PMID: 33752779 DOI: 10.1017/s1744133121000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Voluntary private health insurance (VHI) has generally been of limited importance in national health service-type health care systems, especially in the Nordic countries. During the last decades however, an increase in VHI uptake has taken place in the region. Critics of this development argue that voluntary health insurance can undermine support for public health care, while proponents contend that increased private funding for health services could relieve strained public health care systems. Using data from Sweden, this study investigates empirically how voluntary health insurance affects the public health care system. The results of the study indicate that the public Swedish health care system is fairly resilient to the impact of voluntary health insurance with regards to support for the tax-based funding. No difference between insurance holders and non-holders was found in willingness to finance public health care through taxes. A slight unburdening effect on public health care use was observed as VHI holders appeared to use public health care to a lesser extent than those without an insurance. However, a majority of the insurance holders continued to use the public health care system, indicating only a modest substitution effect.
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Affiliation(s)
- Linn Kullberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Paula Blomqvist
- Department of Government, Uppsala University, Uppsala, Sweden
| | - Ulrika Winblad
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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8
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Medina-Perucha L, López-Jiménez T, Holst AS, Jacques-Aviñó C, Munrós-Feliu J, Martínez-Bueno C, Valls-Llobet C, Pinzón-Sanabria D, Vicente-Hernández MM, Berenguera A. Self-Reported Menstrual Alterations During the COVID-19 Syndemic in Spain: A Cross-Sectional Study. Int J Womens Health 2022; 14:529-544. [PMID: 35444473 PMCID: PMC9013667 DOI: 10.2147/ijwh.s354655] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Available evidence suggests that there might be an association between the stressors experienced during the COVID-19 syndemic and changes in menstrual patterns. The aim of this study was to assess self-reported menstrual alterations during the COVID-19 syndemic among women and people who menstruate aged 18-55 in Spain. Materials and Methods A cross-sectional online survey-based study was conducted (March-July 2021). Descriptive statistics were calculated and multivariate logistic regression models were constructed. This study was conducted as part of the "Equity and Menstrual Health in Spain" research project. Results Among participants (N=17,455), 39.4% reported menstrual alterations since the start of the syndemic. Participants self-reporting long COVID-19 presented higher odds of menstrual alterations (aOR: 1.34, 95% CI, 1.15-1.57). In participants with no history of COVID-19, the risk for self-reported menstrual alterations was significantly higher based on employment situation, among participants experiencing financial issues (eg, financial issues always/many times <12 months: aOR: 1.68, 95% CI, 1.48-1.90), poorer self-perceived health (eg, poor: aOR: 2.00, 95% CI, 1.31-3.07), and those diagnosed with polycystic ovary syndrome (aOR: 1.13, 95% CI, 1.02-1.26). Among participants with a self-reported COVID-19 diagnosis, factors that significantly increased the odds for menstrual alterations were experiencing financial strains (eg, financial issues always/many times <12 months: aOR: 1.53, 95% CI, 1.09-2.14), poorer self-perceived health (eg, poor: aOR: 3.09, 95% CI, 1.01-9.52). Overall, factors that decreased the odds of reporting menstrual alterations included age >25, being a carer, not having a gynecological condition and using hormonal contraception. Discussion and conclusions Findings suggest an impact of the COVID-19 syndemic on menstrual patterns. Social inequities in reporting menstrual alterations were identified. While the risk of reporting menstrual alterations was higher among participants with long COVID-19, evidence is not conclusive. Further research on menstrual health in the context of COVID-19 is needed, also to inform policy and practice.
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Affiliation(s)
- Laura Medina-Perucha
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Tomàs López-Jiménez
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Anna Sofie Holst
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain
| | - Jordina Munrós-Feliu
- Atenció a la Salut Sexual i Reproductiva (ASSIR) Muntanya/La Mina, Institut Català de la Salut, Barcelona, Spain.,Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain
| | - Cristina Martínez-Bueno
- Sexual and Reproductive Health Care Research Group (GRASSIR), Barcelona, Spain.,Servei d'Atenció a la Salut Sexual i Reproductiva (ASSIR), Direcció Assistencial d'Atenció Primària, Institut Català de la Salut, Barcelona, Spain
| | | | | | | | - Anna Berenguera
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain.,Departament d'Infermeria, Universitat de Girona, Girona, Spain
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Adherence of long-term breast cancer survivors to follow-up care guidelines: a study based on real-world data from the SURBCAN cohort. Breast Cancer Res Treat 2022; 193:455-465. [PMID: 35290544 PMCID: PMC9090857 DOI: 10.1007/s10549-022-06563-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/02/2022] [Indexed: 11/25/2022]
Abstract
Purpose To identify adherence to follow-up recommendations in long-term breast cancer survivors (LTBCS) of the SURBCAN cohort and to identify its determinants, using real-world data. Methods We conducted a retrospective study using electronic health records from 2012 to 2016 of women diagnosed with incident breast cancer in Spain between 2000 and 2006 and surviving at least 5 years. Adherence to basic follow-up recommendations, adherence according to risk of recurrence, and overall adherence were calculated based on attendance at medical appointments and imaging surveillance, by year of survivorship. Logistic regression models were fitted to depict the association between adherence and its determinants. Results A total of 2079 LTBCS were followed up for a median of 4.97 years. Of them, 23.6% had survived ≥ 10 years at baseline. We estimated that 79.5% of LTBCS were overall adherent to at least one visit and one imaging test. Adherence to recommendations decreased over time and no differences were found according to recurrence risk. Determinants of better overall adherence were diagnosis in middle age (50–69 years old), living in a more-deprived area, having fewer years of survival, receiving primary treatment, and being alive at the end of follow-up. Conclusion We identified women apparently not complying with surveillance visits and tests. Special attention should be paid to the youngest and eldest women at diagnosis and to those with longer survival.
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Al-Hanawi MK, Mwale ML, Qattan AMN. Health Insurance and Out-Of-Pocket Expenditure on Health and Medicine: Heterogeneities along Income. Front Pharmacol 2021; 12:638035. [PMID: 33995042 PMCID: PMC8120147 DOI: 10.3389/fphar.2021.638035] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/17/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Achieving universal health coverage is an important objective enshrined in the 2015 global Sustainable Development Goals. However, the rising cost of healthcare remains an obstacle to the attainment of the universal health coverage. Health insurance is considered an option to reduce out-of-pocket (OOP) expenditure on health and medicine. Nevertheless, the relationship between insurance and the OOP along welfare distributions is not well understood. This study investigates the heterogeneous association between health insurance and OOP expenditure on health and medicine, along income, using data from the Kingdom of Saudi Arabia. Methods: This study used data of 8655 individuals drawn from the Saudi Family Health Survey conducted in 2018. The study adopts Tobit models to account for possible corner solution due to individuals with zero expenditure on health. We minimize the confounding effects of non-random selection into the insurance program by estimating the Tobit equations on a sample weighted by inverse propensity scores of insurance participation. In addition, we test whether the health insurance differently relates to OOP on health and medicine amongst people with access to free medical care as opposed to those without this privilege. The study estimates separate models for OOP expenditure on health and on medicines. Results: Health insurance reduces OOP expenditure on health by 2.0% and OOP expenditure on medicine by 2.4% amongst the general population while increasing the OOP expenditure on health by 0.2% and OOP expenditure on medicine by 0.2%, once income of the insured rises. The relationship between the insurance and OOP expenditure is robust only amongst the citizens, a sub-sample that also has access to free public healthcare. Specifically, the insurance reduces OOP expenditure on health by 3.6% and OOP on medicine by 5.2% and increases OOP expenditure on health by 0.4% and OOP expenditure on medicine by 0.5% once income of the insured increases amongst Saudi citizens. In addition, targeting medicines can lead to greater changes in OOP. The relationship between insurance and OOP is stronger for medicine relative to that observed on health expenditure. Conclusion: Our findings suggest that insurance induces different effects along the income spectrum. Hence, policy needs to be aware of the possible welfare distribution impacts of upscaling or downscaling the coverage of insurance amongst the populations, while pursuing universal healthcare coverage.
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Affiliation(s)
- Mohammed Khaled Al-Hanawi
- Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Martin Limbikani Mwale
- Department of Economics, Faculty of Economic and Management Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ameerah M N Qattan
- Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia
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11
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Jansana A, Domingo L, Ibañez B, Prados A, Del Cura I, Padilla-Ruiz M, Sanz T, Poblador B, Tamayo I, Gimeno A, Alberquilla A, Abizanda M, Comas M, Lanzuela M, Burgui R, Holgado AD, Duarte-Salles T, Moreno C, Louro J, Baquedano J, Molina C, Del Carmen Martinez M, Gorricho J, Redondo M, Castells X, Sala M. Use of health services among long-term breast cancer survivors in Spain: longitudinal study based on real-world data. J Cancer Surviv 2021; 16:132-141. [PMID: 33759086 DOI: 10.1007/s11764-021-01011-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/17/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to evaluate health service utilization in Spain among long-term breast cancer survivors and to compare it with that among women with no history of breast cancer. METHODS Study based on the SURBCAN cohort includes a sample of long-term breast cancer survivors and a sample of women without breast cancer from 5 Spanish regions. Healthcare utilization was assessed through primary care, hospital visits, and tests during the follow-up period (2012 to 2016) by using electronic health records. Annual contact rates to healthcare services were calculated, and crude and multivariate count models were fitted to estimate the adjusted relative risk of healthcare services use. RESULTS Data were obtained from 19,328 women, including 6512 long-term breast cancer survivors. Healthcare use was higher among breast cancer survivors (20.9 vs 16.6; p < 0.0001) and decreased from >10 years of survival. Breast cancer survivors who underwent a mastectomy were more likely to have a primary care visit (RR = 3.10 95% CI 3.08-3.11). Five to ten years survivors were more likely to have hospital inpatient visits and imaging test compared to women without breast cancer (RRa = 1.35 95% CI 1.30-1.39 and RRa = 1.27 95% CI 1.25-1.29 respectively). CONCLUSION This study shows higher use of health services in long-term breast cancer survivors than in women without breast cancer regardless of survival time. IMPLICATIONS FOR CANCER SURVIVORS These results help to estimate the health resources needed for the growing group of breast cancer survivors and to identify risk factors that drive higher use of health services.
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Affiliation(s)
- Anna Jansana
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,European Higher Education Area Doctoral Program in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Berta Ibañez
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Irunlarrea, s/n, 31008, Pamplona, Spain
| | - Alexandra Prados
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,IIS Aragon, Miguel Servet University Hospital, EpiChron Research Group, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - Isabel Del Cura
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, 6-5ª planta, 28035, Madrid, Spain.,Department of Preventive Medicine and Public Health, University Rey Juan Carlos, Avenida de Atenas, 28922, Alcorcón, Madrid, Spain
| | - Maria Padilla-Ruiz
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Teresa Sanz
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, 6-5ª planta, 28035, Madrid, Spain
| | - Beatriz Poblador
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,IIS Aragon, Miguel Servet University Hospital, EpiChron Research Group, Aragon Health Sciences Institute (IACS), Zaragoza, Spain
| | - Ibai Tamayo
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Irunlarrea, s/n, 31008, Pamplona, Spain
| | - Antonio Gimeno
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Navarrabiomed-Complejo Hospitalario de Navarra-Universidad Pública de Navarra, IdiSNA, Irunlarrea, s/n, 31008, Pamplona, Spain
| | - Angel Alberquilla
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Madrid Health Service, Primary Care Research Unit, Calle San Martín de Porres, 6-5ª planta, 28035, Madrid, Spain
| | - Mercè Abizanda
- Department of Organization and Communication, Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Manuela Lanzuela
- Radiotherapy Department, Miguel Servet University Hospital, Saragossa, Spain
| | - Rossana Burgui
- Instituto de Salud Pública y Laboral de Navarra (ISPLN), IdiSNA, Pamplona, Spain
| | - Antonio Diaz Holgado
- Madrid Health Service, Technical Direction of Sanitary Information System, Calle San Martín de Porres, 6- 5ª planta, 28035, Madrid, Spain
| | - Talita Duarte-Salles
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Conchi Moreno
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Instituto de Salud Pública y Laboral de Navarra (ISPLN), IdiSNA, Pamplona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain
| | - Javier Baquedano
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Servicio Navarro de Salud-Osasunbidea, Gerencia de Atención Primaria, Pamplona, Spain
| | - Cristobal Molina
- Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Maria Del Carmen Martinez
- Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Javier Gorricho
- Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Servicio de Evaluación y Difusión de resultados en Salud, Servicio Navarro de Salud-Osasunbidea, Pamplona, Spain
| | - Maximino Redondo
- Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.,Autonomous University of Barcelona (UAB), 08193, Bellaterra, Barcelona, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain. .,Health Services Research on Chronic Patients Network (REDISSEC), Institute of Health Carlos III, Madrid, Spain.
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12
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Pinilla J, López-Valcárcel BG. Income and wealth as determinants of voluntary private health insurance: empirical evidence in Spain, 2008-2014. BMC Public Health 2020; 20:1262. [PMID: 32814549 PMCID: PMC7437046 DOI: 10.1186/s12889-020-09362-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 08/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have quantitatively estimated the income elasticity of demand of voluntary private health insurance (VPHI) in countries with a universal National Health Service. Most studies to date have uses cross-sectional data. METHODS In this paper we used a longitudinal database from the Bank of Spain to analyse the financial behaviour of approximately six thousand families per wave. We used three waves (2008, 2011 and 2014). We estimated income and wealth semi-elasticities of VPHI in Spain considering personal and family characteristics (age, sex, level of health, education, composition of the household), i.e. changes in the probability of buying VPHI as result of 1% change in income or wealth. We estimated cross-sectional models for each wave and longitudinal models for families remaining for at least two waves, taking account of possible selection bias due to attrition. RESULTS Cross-sectional models suggest that the income effect on the probability of buying a VPHI increased from 2008 to 2014. The positive impact was observed for, wealth. In 2008 a 1% increase in income is associated with an increase in the probability of having VPHI of 0.064 [95%-CI: 0.023; 0.104] - on the probability scale (0.1) - whereas in 2014, this effect is of 0.116 [95%-CI, 0.094; 0.139]. In 2011 and 2014 the wealth effect is not significant at 5%. The estimation of the longitudinal model leads to different results where both, income and wealth are associated with non- significant results. CONCLUSION Our three main conclusions are: 1) Cross-sectional estimates of semi-elasticities of VPHI might be biased upwards; 2) Wealth is alongside income are economic determinants, of the decision to buy VPHI in high-income countries; 3) The effects of income and wealth on the probability of buying VHPI are neither linear nor log-linear. There are no significant differences among 60% of the most disadvantaged families, while the families of the two upper wealth quintiles show clearly differentiated behaviour with a higher probability of insurance.
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Affiliation(s)
- Jaime Pinilla
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Campus de Tafira sn, 35017, Las Palmas de Gran Canaria, Spain. .,Centre for Research in Health Economics, University Pompeu Fabra, Barcelona, Spain.
| | - Beatriz G López-Valcárcel
- Department of Quantitative Methods for Economics and Management, University of Las Palmas de Gran Canaria, Campus de Tafira sn, 35017, Las Palmas de Gran Canaria, Spain.,Centre for Research in Health Economics, University Pompeu Fabra, Barcelona, Spain
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13
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A two-tiered public-private health system: Who stays in (private) hospitals in Ireland? Health Policy 2020; 124:765-771. [DOI: 10.1016/j.healthpol.2020.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/10/2020] [Accepted: 04/14/2020] [Indexed: 11/23/2022]
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14
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Filc D, Rasooly A, Davidovitch N. From public vs. private to public/private mix in healthcare: lessons from the Israeli and the Spanish cases. Isr J Health Policy Res 2020; 9:31. [PMID: 32580782 PMCID: PMC7315494 DOI: 10.1186/s13584-020-00391-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 06/08/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Different forms of public/private mix have become a central mode of the privatization of healthcare, in both financing and provision. The present article compares the processes of these public/private amalgams in healthcare in Spain and Israel in order to better understand current developments in the privatization of healthcare. MAIN TEXT While in both Spain and Israel combinations between the public and the private sectors have become the main forms of privatization, the concrete institutional forms differ. In Spain, these institutional forms maintain relatively clear boundaries between the private and the public sectors. In Israel, the main forms of public/private mix have blurred such boundaries: nonprofit health funds sell private insurance; public nonprofit health funds own private for-profit hospitals; and public hospitals sell private services. CONCLUSIONS Comparison of the processes of privatization of healthcare in Spain and Israel shows their variegated characters. It reveals the active role played by national and regional state apparatuses as initiators and supporters of healthcare reforms that have adopted different forms of public/private mix. While in Israel, until recently, these processes have been perceived as mainly technical, in Spain they have created deep political rifts within both the medical community and the public. The present article contains lessons each country can learn from the other, to be adapted in each one's local context: The failure of the Alzira model in Spain warns us of the problems of for-profit HMOs and the Israeli private private/public mix shows the risk of eroding trust in the public system, thus reinforcing market failures and inefficient medical systems.
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Affiliation(s)
- Dani Filc
- Department of Politics and Government, Ben-Gurion University, Beersheba, Israel
| | - Alon Rasooly
- School of Public Health, Ben-Gurion University, Beersheba, Israel
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15
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Borra C, Pons-Pons J, Vilar-Rodríguez M. Austerity, healthcare provision, and health outcomes in Spain. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:409-423. [PMID: 31853673 DOI: 10.1007/s10198-019-01141-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 11/25/2019] [Indexed: 06/10/2023]
Abstract
The recession that started in the United States in December 2007 has had a significant impact on the Spanish economy through a large increase in the unemployment rate and a long recession which led to tough austerity measures imposed on public finances. Taking advantage of this quasi-natural experiment, we use data from the Spanish Ministry of Health from 1996 to 2015 to provide novel causal evidence on the short-term impact of changes in healthcare provision and regulations on health outcomes. The fact that regional governments have discretionary powers in deciding healthcare budgets and that austerity measures have not been implemented uniformly across Spain helps isolate the impact of these policy changes on health indicators of the Spanish population. Using Ruhm's (Q J Econ 115(2):617-650, 2000) fixed effects model, we find that medical staff and hospital bed reductions account for a significant increase in mortality rates from circulatory diseases and external causes, but not from other causes of death. Similarly, mortality rates do not seem to be robustly affected by the 2012 changes in retirees' pharmaceutical co-payments and access restrictions for illegal immigrants. Our results are robust to changes in model specification and sample selection and are primarily driven by accidental and emergency deaths rather than in-hospital mortality, which suggests a larger role for decreases in accessibility rather than decreases in healthcare quality as impact channels.
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16
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Risk of liver fibrosis progression in patients with suboptimal diagnosis of hepatitis C virus infection. Eur J Gastroenterol Hepatol 2020; 32:528-534. [PMID: 31490420 DOI: 10.1097/meg.0000000000001534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Many hepatitis C virus (HCV)-infected patients have a suboptimal diagnosis. Particularly, the characteristics and risk of fibrosis progression of HCV antibody-positive patients without RNA testing are unknown. METHODS Patients with a positive HCV antibody performed during 2005-2007 were classified based on RNA request and result until January 2017. Fibrosis was estimated with serologic scores. RESULTS Of the 38 246 HCV tests performed, 791 (2.01%) patients tested positive. At the end of the follow-up (median 128.6 months, range 109.8-145.9), 49.43% (n = 391) of the subjects did not have RNA testing, 13.02% (n = 103) had undetectable RNA, and 37.55% (n = 297) had detectable RNA. After excluding patients without data for AST to platelet ratio index calculation (n = 334), patients without RNA testing (n = 122) compared with RNA undetectable (n = 92) were more frequently men (68.9 versus 46.7%), alcohol (52.6 versus 38.2%) and drug (53.0 versus 39.1%) users, lacking social support (50.4 versus 29.3%), and showed higher basal fibrosis. Patients without RNA testing had a significantly higher increase in the percentage of patients with ≥F2 (P = 0.035) and cirrhosis (P = 0.022). The relative risk for ≥F2 and cirrhosis in patients without RNA testing was 3.03 [95% confidence interval (CI): 1.54-5.98] and 4.31 (95% CI: 1.42-13.10), respectively. Non-RNA request was an independent predictor factor for progression to cirrhosis. CONCLUSION In our cohort, patients with positive HCV antibody without RNA testing were more likely to be people at risk of social exclusion with an increased risk of fibrosis progression, because non-RNA request was a predictor for cirrhosis. Therefore, we urge support measures and strategies to link to care these difficult-to-treat populations.
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Morales-Arraez D, Alonso-Larruga A, Diaz-Flores F, García Dopico JA, de Vera A, Quintero E, Hernández-Guerra M. Predictive factors for not undergoing RNA testing in patients found to have hepatitis C serology and impact of an automatic alert. J Viral Hepat 2019; 26:1117-1123. [PMID: 31077515 DOI: 10.1111/jvh.13122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/18/2022]
Abstract
The process of diagnosis and linkage to care in cases of hepatitis C virus (HCV) infection remains an obstacle to disease control. The aims of this study were to evaluate predictive factors for not undergoing RNA testing among patients with positive HCV serology and impact of incorporating an automated electronic alert with recommendations in clinical practice. We collected HCV antibody tests requested from October 2011 to September 2014 to evaluate the rate of RNA testing and predictive factors for not undergoing RNA testing. Since October 2014, an automated alert notification has been implemented to remind physicians for testing RNA after a positive HCV test and referral to specialist care. 41 403 HCV antibody tests were requested from 34 073 patients. 870 (2.55%) patients tested positive. After a median of follow-up of 57.0 months (range 45.6-82.1), 37.6% did not have RNA testing. The independent predictors for not undergoing RNA testing were primary care serology requests (P < 0.001), no history of drug use (P = 0.005) and a lack of social support (P = 0.015). The intervention impact was evaluated in a pre-alert cohort (October 2011-September 2014) and a post-alert cohort (October 2014-September 2015). After the incorporation of the alert, the rate of RNA testing increased from 62.4% to 77.7% (P < 0.001). Incomplete assessment of HCV infection is a challenge in primary care. The implementation of an automated alert for recommending RNA testing after a positive HCV antibody test is feasible in clinical practice and increases the rate of patients with RNA testing.
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Affiliation(s)
- Dalia Morales-Arraez
- Liver Unit, Hospital Universitario de Canarias, Tenerife, Spain.,Instituto Universitario de Tecnologías Biomédicas CIBICAN, Departamento de Medicina Interna, Psiquiatría y Dermatología, Universidad de La Laguna, Tenerife, Spain
| | - Ana Alonso-Larruga
- Central Laboratory Department, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Jose A García Dopico
- Central Laboratory Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Antonia de Vera
- Central Laboratory Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - Enrique Quintero
- Liver Unit, Hospital Universitario de Canarias, Tenerife, Spain.,Instituto Universitario de Tecnologías Biomédicas CIBICAN, Departamento de Medicina Interna, Psiquiatría y Dermatología, Universidad de La Laguna, Tenerife, Spain
| | - Manuel Hernández-Guerra
- Liver Unit, Hospital Universitario de Canarias, Tenerife, Spain.,Instituto Universitario de Tecnologías Biomédicas CIBICAN, Departamento de Medicina Interna, Psiquiatría y Dermatología, Universidad de La Laguna, Tenerife, Spain
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18
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Golinelli D, Bucci A, Toscano F, Filicori F, Fantini MP. Real and predicted mortality under health spending constraints in Italy: a time trend analysis through artificial neural networks. BMC Health Serv Res 2018; 18:671. [PMID: 30157828 PMCID: PMC6116437 DOI: 10.1186/s12913-018-3473-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/16/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND After 2008 global economic crisis, Italian governments progressively reduced public healthcare financing. Describing the time trend of health outcomes and health expenditure may be helpful for policy makers during the resources' allocation decision making process. The aim of this paper is to analyze the trend of mortality and health spending in Italy and to investigate their correlation in consideration of the funding constraints experienced by the Italian national health system (SSN). METHODS We conducted a 20-year time-series study. Secondary data has been extracted from a national, institution based and publicly accessible retrospective database periodically released by the Italian Institute of Statistics. Age standardized all-cause mortality rate (MR) and health spending (Directly Provided Services - DPS, Agreed-Upon Services - TAUS, and private expenditure) were reviewed. Time trend analysis (1995-2014) through OLS and Multilayer Feed-forward Neural Networks (MFNN) models to forecast mortality and spending trend was performed. The association between healthcare expenditure and MR was analyzed through a fixed effect regression model. We then repeated MFNN time trend forecasting analyses on mortality by adding the spending item resulted significantly related with MR in the fixed effect analyses. RESULTS DPS and TAUS decreased since 2011. There was a mismatch in mortality rates between real and predicted values. DPS resulted significantly associated to mortality (p < 0.05). In repeated mortality forecasting analysis, predicted MR was found to be lower when considering the pre-constraints health spending trend. CONCLUSIONS Between 2011 and 2014, Italian public health spending items showed a reduction when compared to prior years. Spending on services directly provided free of charge appears to be the financial driving force of the Italian public health system. The overall mortality was found to be higher than the predicted trend and this scenario may be partially attributable to the healthcare funding constraints experienced by the SSN.
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Affiliation(s)
- Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Bucci
- Department of Economics and Social Sciences, Marche Polytechnic University, Ancona, Italy
| | - Fabrizio Toscano
- Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, USA
| | - Filippo Filicori
- The Oregon Clinic, Division of Minimally Invasive Gastrointestinal Surgery, Portland, OR USA
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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