Studying Healthcare Affordability during an Economic Recession: The Case of Greece

Trends in Financial Affordability of Healthcare Among Tribal Women of Reproductive Age: A Cross-Sectional Study From India

BACKGROUND

Universal health coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship. UHC is one of the targets of Sustainable Development Goal (SDG) 3 which India is trying to achieve with various initiatives and health programs. Tribal communities form an integral part of India's population. Due to various geographic barriers to access to the location of their settlements, it becomes problematic to provide essential services including healthcare without good expenditure. Moreover, as a result of various disadvantages, employment and subsequently the affordability for tribal groups poses an issue for availing healthcare services or those which are affordable are far away from the usual reach. With this study we would like to track the progress towards SDG 3 for the tribal communities in India.

OBJECTIVES

To assess the trends of ability to afford healthcare for self among tribal women in India over five years and to assess the determinants of this affordability among the same population.

METHODS

We used the Individual Recode (IR) datasets of Demographic & Health Surveys (DHS) data of Fourth and Fifth round for secondary data analysis. 670,384 and 689,454 cases from National Family Health Survey (NFHS) 4 and 5 were included for analysis. Under "svy" command, design adjusted chi square test was used, followed by binary logistic regression to derive unadjusted and adjusted odds ratio for various determinants.

RESULTS

6.38% and 6.23% of women belonged to tribal communities during NFHS 4 and NFHS 5 respectively. Only 0.24% and 0.35% had education above secondary education during NFHS 4 and NFHS 5. Majority of the tribal women were married during both surveys and around 0.3% were pregnant during the interviews. Consequently, most of the women were the wife of the head of household. Majority of the tribal women were followers of the Hindu religion and resided in the rural areas of the country. During NFHS 4, the major proportion of women belonged to the East zone and during NFHS 5, they belonged to the Northeast zone of India. For women in the age group of 25 to 29 years the odds of facing difficulty was the highest (aOR: 1.55 during NFHS 4 and 1.88 during NFHS 5). Moreover, those with no education showed highest odds of facing difficulty in arranging money for healthcare for self during both surveys (aOR: 1.69 during NFHS 4 and 1.45 during NFHS 5) when compared with those with higher education. In addition, the odds of facing affordability issues had increased from NFHS 4 to NFHS 5 for poorest tribal women (aOR 6.65 during NFHS 4 to aOR 8.91 during NFHS 5). There has been significant decrease in odds of facing affordability as a barrier among tribal women residing in Northeast zone of India (aOR: 5.01 during NFHS 4 and aOR: 3.45 during NFHS 5). The odds for facing affordability issues for tribal women residing in rural areas remained similar during both surveys.

CONCLUSION

There has been a slight decrease in the proportion of tribal women facing financial affordability as a barrier to accessing healthcare. Further factors like middle age groups of 25 to 29 years, no education, divorced or separated marital status, and belonging to poorest category of the Wealth Index were significant determinants due to which financial affordability has become a barrier to avail healthcare for self.

Where does residents' choice of primary medical treatment come from?-A logical analysis based on the perspective of service accessibility and residents' cognition

The uneven distribution of medical and health resources leads to changes in the choice of patients for medical treatment, which is the key to restrict the reform of medical services in China currently. Taking service accessibility and residents' cognition as the starting point, this study utilized the data from the questionnaire and applied logistic regression and mediation test. By taking service accessibility as an explanatory variable and residents' cognition as an intermediary variable, the study examined the differences between residents' choice of medical treatment at the primary and non-primary levels. Thus, the influencing factors of residents' choice of medical treatment at the primary level were explored. The research statistics came from questionnaires of 1,589 residents in Nanjing, Jiangsu Province, China. The results showed that service accessibility and residents' cognition were significantly correlated with the residents' choice of primary medical treatment. Household registration, age, the signing situation with family doctors, hospital service fees, and distance to the hospital were positively related to residents' choice of primary medical treatment; while the reputation, scale, residents' income, and the reimbursement ratio of residents' medical insurance were negatively correlated with the choice. In addition, residents' cognition played an intermediary effect between service accessibility and the residents' choice of primary medical treatment. The signing situation with family doctors indirectly affected the choice of primary medical treatment through residents' cognition, and residents' cognition masked some negative influence of the reimbursement ratio of residents' medical insurance on the choice of primary medical treatment.

A cross-sectional population-based study on the influence of the COVID-19 pandemic on incomes in Greece

The Coronavirus Disease 2019 (COVID-19) pandemic induced economic shock in Greece, which translated into a decrease in household income. Thus, the objective of this study is to measure social inequality with regard to income loss due to the COVID-19 pandemic in Greece. In addition, we aim to identify the characteristics of those experiencing income loss due to the pandemic. The study uses data from the "Public Opinion in the European Union (EU) in Time of Coronavirus Crisis. Third Round" survey. The sample consists of 1036 individuals aged between 16 and 54 years. To measure inequality, the Erreygers' Concentration Index (CI) is calculated, using social class as the ranking variable. To identify the characteristics of those experiencing income loss, a logistic regression model is fitted using the region of residence and several demographic and socioeconomic variables as potential predictors. According to the results, social inequality does not exist with regard to income loss due to the COVID-19 pandemic. Thus, our findings indicate the negative influence of the pandemic on the incomes of individuals from all social classes in Greece. According to the results of the logistic regression model, the odds of experiencing income loss are higher for residents of the Aegean Islands and Crete but also for self-employed, part-time employed, and unemployed individuals. These findings indicate the negative influence of the pandemic on Greek tourism and on sectors employing a large proportion of non-standard workers. Although inequality does not exist, a substantial proportion of those losing income due to the pandemic is in line with the global picture.

Impact of Economic Accessibility on Realized Utilization of Home-Based Healthcare Services for the Older Adults in China

Home-based healthcare service has gradually become the most important model to cope with aging in China. However, the contradiction between oversupply and insufficient demand of healthcare services is becoming increasingly serious. How to effectively improve the realized utilization of healthcare resources has become a key issue in the development of healthcare services. Based on the social background of “getting old before getting rich”, this article explores the relationship between economic accessibility and realized utilization, and finds that the impact of economic accessibility on realized utilization is inverted U-shaped, not a linear positive effect. In addition, considering the moderating role of family support, it is found that family support can strengthen the inverted U-shaped effect of economic accessibility on realized utilization. Therefore, exerting the role of family and improving economic accessibility can effectively solve the dilemma of low utilization of healthcare services.