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Ngoma T, Adewole I, Ainsworth V, Chin D, Chin J, Elzawawy A, Joseph A, Mallum A, Ndlovu N, Ngoma M, Oladipo A, Swanson W, Ngwa W. Cancer control collaborations between China and African countries. Lancet Oncol 2024; 25:e164-e172. [PMID: 38547900 DOI: 10.1016/s1470-2045(23)00634-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 04/02/2024]
Abstract
Over the past decade, China has emerged as Africa's largest trade partner and source of foreign direct investment, with public health ranked as a top priority in China-Africa collaborations. During the same period, cancer has emerged as a leading cause of death in Africa, with more than 700 000 deaths per year and projections of more than 1 million deaths per year by 2030. In this Review, we explore the effects of increasing China-Africa collaborations on cancer control in Africa. We review the published literature on health-care assistance, research, education and training, and infrastructure and present the results of an institutional review board-approved survey of African oncology health-care professionals and institutional leaders that assessed their perception of the effects of China-Africa collaborations. From peer-reviewed articles and grey literature, we found that the number of China-Africa collaborations have grown substantially over the past decade in different areas, especially in patient care and infrastructure. Research publications have also surged in quantity in the past decade compared with previous years. However, the survey results suggest research collaborations remain infrequent and that medical professionals in African cancer centres rarely participate in direct research collaborations with Chinese institutions. The Review also highlights the challenges and benefits of increasing China-Africa collaborations. Challenges include insufficient monitoring and evaluation of the projects in Africa and poor coordination and alignment of the various initiatives. The benefits of these collaborations for Africa include improved health outcomes, strengthened health systems, and socioeconomic development. Benefits are also apparent for China, such as securing energy and resource supplies, expanded trade and investment opportunities, and improved diplomatic relations. Overall, China-Africa collaborations are increasing and having a substantial effect in both China and the African continent. Recommendations to minimise the challenges and maximise the benefits for more positive consequences on cancer control in Africa are discussed.
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Affiliation(s)
- Twalib Ngoma
- Department of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Isaac Adewole
- College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - David Chin
- United Health Services, Johnson City, NY, USA
| | - Jennifer Chin
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ahmed Elzawawy
- Suez Canal University, Ismailia, Egypt; Alsoliman Clinical and Radiation Oncology Center, Port Said, Egypt
| | - Adedayo Joseph
- Nigeria Sovereign Investment Authority-Lagos University Teaching Hospital Cancer Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Abba Mallum
- University of KwaZulu Natal, Durban South Africa and Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Ntokozo Ndlovu
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Mamsau Ngoma
- Academic Unit, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
| | - Aishat Oladipo
- Department of Clinical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - William Swanson
- Department of Clinical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Wilfred Ngwa
- The University of Massachusetts Lowell, Lowell, MA, USA; Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA; Rutgers Global Health Institute, Rutgers University, New Brunswick, NJ, USA; Department of Information and Sciences, Information and Communications Technology University, Yaoundé, Cameroon
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Berger F, Anindya K, Pati S, Ghosal S, Dreger S, Lee JT, Ng N. The moderating effect of mental health and health insurance ownership on the relationships between physical multimorbidity and healthcare utilisation and catastrophic health expenditure in India. BMC Geriatr 2024; 24:6. [PMID: 38172716 PMCID: PMC10762917 DOI: 10.1186/s12877-023-04531-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/29/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The current demographic transition has resulted in the growth of the older population in India, a population group which has a higher chance of being affected by multimorbidity and its subsequent healthcare and economic consequences. However, little attention has been paid to the dual effect of mental health conditions and physical multimorbidity in India. The present study, therefore, aimed to analyse the moderating effects of mental health and health insurance ownership in the association between physical multimorbidity and healthcare utilisation and catastrophic health expenditure (CHE). METHODS We analysed the Longitudinal Aging Study in India, wave 1 (2017-2018). We determined physical multimorbidity by assessing the number of physical conditions. We built multivariable logistic regression models to determine the moderating effect of mental health and health insurance ownership in the association between the number of physical conditions and healthcare utilisation and CHE. Wald tests were used to evaluate if the estimated effects differ across groups defined by the moderating variables. RESULTS Overall, around one-quarter of adults aged 45 and above had physical multimorbidity, one-third had a mental health condition and 20.5% owned health insurance. Irrespective of having a mental condition and health insurance, physical multimorbidity was associated with increased utilisation of healthcare and CHE. Having an additional mental condition strengthened the adverse effect of physical multimorbidity on increased inpatient service use and experience of CHE. Having health insurance, on the other hand, attenuated the effect of experiencing CHE, indicating a protective effect. CONCLUSIONS The coexistence of mental health conditions in people with physical multimorbidity increases the demands of healthcare service utilisation and can lead to CHE. The findings point to the need for multidisciplinary interventions for individuals with physical multimorbidity, ensuring their mental health needs are also addressed. Our results urge enhancing health insurance schemes for individuals with mental and physical multimorbidity.
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Affiliation(s)
- Finja Berger
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Kanya Anindya
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | | | - Stefanie Dreger
- Institute of Public Health and Nursing Research, Department of Social Epidemiology, University of Bremen, Bremen, Germany
| | - John Tayu Lee
- College of Health and Medicine, Australian National University, Canberra, ACT, Australia
| | - Nawi Ng
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hasan MS, Ghosal S. Gender differentials in the choice of in-patient healthcare services among the older adults in India: A cross-sectional study. Int J Health Plann Manage 2023; 38:1464-1482. [PMID: 37340537 DOI: 10.1002/hpm.3673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 05/14/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023] Open
Abstract
India is presently undergoing a rapid demographic transition and experiencing a gradual increase in an ageing population. As a result, the households were continuously exposed to catastrophic economic impacts, ultimately influencing the healthcare utilisation of older people. The study examined the gender differentials in the choice of in-patient private and public hospitalisation among Indian elderly using Andersen's Health Behaviour Model. The database was acquired from the nationally representative cross-sectional survey (NSSO, 2017-18). Bivariate chi-square and binomial logistic regression techniques were used to fulfill the objective. In addition, the poor-rich ratio and concentration index was used to understand the inherent socioeconomic inequalities in healthcare preferences. The findings suggest that aged men were 27 percent more prone to avail private healthcare facilities than aged women. Further, older adults, who are married, belong to the upper caste, have higher education and gone through surgery, and primarily reside in an affluent society were more likely to prefer private in-patient hospitalisation. It represents negligence of older women in access to better healthcare who had financial strain and economically dependent. The study can be used to reframe existing public health policies and programs, particularly focusing on the older women, to avail cost-effective treatment.
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Affiliation(s)
- Md Sayed Hasan
- Centre for Rural Development and Innovative Sustainable Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
| | - Somnath Ghosal
- Centre for Rural Development and Innovative Sustainable Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, India
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Dumka N, Ahmad T, Hannah E, Kotwal A. Health facility utilization and Healthcare-seeking behaviour of the elderly population in India. J Family Med Prim Care 2023; 12:902-916. [PMID: 37448939 PMCID: PMC10336929 DOI: 10.4103/jfmpc.jfmpc_553_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 07/18/2023] Open
Abstract
Background The increasing elderly population in India has generated an unmet need for healthcare services concerning them. To address some of those needs, the study aims to provide the current status of health facility utilization, health-seeking behaviour (HSB), and factors influencing them. Methodology Data from the Longitudinal Ageing Study in India (LASI)-Wave I was used to conduct multivariate analysis to assess the association between health facility utilization (inpatient and outpatient) and HSB across all age groups of the elderly. Results The likelihood of utilizing public health facilities increased with age for OPD and decreased with age for IPD. HSB was 23% less in the 80 years and above elderly as compared to other age groups. Healthcare service uptake was higher in the elderly with health insurance in a public health facility. Conclusion Improving health insurance coverage among the Indian elderly may potentially improve healthcare service uptake in public health facilities.
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Affiliation(s)
- Neha Dumka
- National Health Systems Resource Centre (NHSRC), Technical Support Institute with National Health Mission, Knowledge Management Division (KMD), NHSRC, Delhi, India
| | - Tarannum Ahmad
- National Health Systems Resource Centre (NHSRC), Technical Support Institute with National Health Mission, Knowledge Management Division (KMD), NHSRC, Delhi, India
| | - Erin Hannah
- National Health Systems Resource Centre (NHSRC), Technical Support Institute with National Health Mission, Knowledge Management Division (KMD), NHSRC, Delhi, India
| | - Atul Kotwal
- National Health Systems Resource Centre (NHSRC), Technical Support Institute with National Health Mission, Knowledge Management Division (KMD), NHSRC, Delhi, India
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Mohammadi A, Lotfi F, Ravangard R, Emadi M, Bayati M. Utilization and cost of outpatient services: A cross-sectional study on the Iran Health Insurance Organization insurees in Fars province. Health Sci Rep 2023; 6:e1230. [PMID: 37081997 PMCID: PMC10111117 DOI: 10.1002/hsr2.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/23/2023] [Accepted: 04/04/2023] [Indexed: 04/22/2023] Open
Abstract
Background and Aims Analyzing the utilization of health services is necessary for allocating the resources and planning the provision of health services. The present study aimed at investigating the utilization and cost of outpatient services and the factors affecting it among the insurees of the Iran Health Insurance Organization in Fars province in 2019. Methods The study population consisted of all Iran Health Insurance Organization insurees in Fars province in 2019 (n = 2,618,973). The data on the utilization and cost of the services were extracted from the information systems of Fars Health Insurance Organization. The descriptive statistics of the utilization and cost of outpatient services were provided by gender, age, and type of insurance fund. The effects of different factors on the utilization and cost of various services were also investigated using univariate analysis as well as cross-sectional regression. The data analysis was done using EXCEL and STATA 15 software as well. Results The average utilization rates of laboratory, drug, and radiology services were 0.940, 0.945, and 0.108 prescriptions per year, respectively. In addition, the mean costs of laboratory, drug, and radiology services were $1.13, $7.44, and $2.26 per year, respectively. The univariate and multivariate analyses showed that gender, type of insurance fund, and age had significant effects on the utilization and costs of laboratory, drug, and radiology services (p < 0.05). Conclusion The utilization and expenditure of outpatient services were higher among the elderly and women. To control the costs of insurance organizations, it is helpful to identify the effective factors. In addition, due to the increasing trend of aging in Iran, it seems necessary to periodically monitor the pattern of the elderly people's utilization of health services and to plan to increase sustainable resources for insurance financing in the coming years.
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Affiliation(s)
- Ali Mohammadi
- Student Research Committee, School of Health Management and Information SciencesShiraz University of Medical SciencesShirazIran
| | - Farhad Lotfi
- School of Health Management and Information Sciences, Health Human Resources Research CenterShiraz University of Medical SciencesShirazIran
| | - Ramin Ravangard
- School of Health Management and Information Sciences, Health Human Resources Research CenterShiraz University of Medical SciencesShirazIran
| | - Mehrnoosh Emadi
- School of Health Management and Information Sciences, Health Human Resources Research CenterShiraz University of Medical SciencesShirazIran
| | - Mohsen Bayati
- School of Health Management and Information Sciences, Health Human Resources Research CenterShiraz University of Medical SciencesShirazIran
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Rahaman M, Chouhan P, Roy A, Rana MJ, Das KC. Examining the predictors of healthcare facility choice for outpatient care among older adults in India using Andersen's revised healthcare utilization framework model. BMC Geriatr 2022; 22:949. [PMID: 36482338 PMCID: PMC9733055 DOI: 10.1186/s12877-022-03634-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND In India, the demand for outpatient care is substantially higher than inpatient care among older adults. Therefore, the current study examines the level, patterns, and factors associated with outpatient care use. METHODS The present research used data from the first wave of the Longitudinal Ageing Study in India (LASI, 2017-18). A total of 34,588 older adults (45 years and above) who accessed outpatient healthcare services in one year prior to the survey were included in this study. A bivariate chi-square test was applied to present the percentage distribution of types of outpatient healthcare utilization by background characteristics and healthcare responsiveness. Multinomial logistic regression analyses were employed to explore the interplay of outpatient healthcare utilization and allied predisposing, enabling, and need factors. RESULTS About 63.7% of total older adults used a private facility, followed by 22.8% used a public facility, and 13.5% used other facilities. Years of schooling, household wealth status, place of residence, self-rated health, and health insurance were all found to be significant determinants of public or private facility use. In contrast, respondents' sex was found to be a significant determinant of private healthcare use only. The study finds that there was inadequate healthcare reaction to public health facilities. CONCLUSION The current study revealed that the use of private facility for outpatient care is noticeably high in India. Older adults' educational attainments, health insurance coverage, and household level economic background were found to be significant factors in healthcare choice. The current study emphasizes the need to strengthen public healthcare services for outpatient care.
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Affiliation(s)
- Margubur Rahaman
- grid.419349.20000 0001 0613 2600Senior Research Fellow, Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, 400088 India
| | - Pradip Chouhan
- grid.449720.cProfessor, Department of Geography, University of Gour Banga, Malda, 732103 India
| | - Avijit Roy
- State Aided College Teacher, Department of Geography, Malda College, Malda, 732101 India
| | - Md. Juel Rana
- grid.411343.00000 0001 0213 924XAssistant Professor, Govind Ballabh Pant Social Science Institute (GBPSSI), Allahabad, 211019 India
| | - Kailash Chandra Das
- grid.419349.20000 0001 0613 2600Professor, Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, 400088 India
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Mohanty SK, Sahoo U, Rashmi R. Old-age dependency and catastrophic health expenditure: Evidence from Longitudinal Ageing Study in India. Int J Health Plann Manage 2022; 37:3148-3171. [PMID: 35929614 DOI: 10.1002/hpm.3546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 06/15/2022] [Accepted: 07/12/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Out-of-pocket (OOP) payments and catastrophic health expenditure (CHE) have a strong age gradient. Though studies have examined the socio-demographic and geographic inequality in OOP payments and CHE in India, the role of old-age dependency in financial catastrophe remains unclear. Disaggregated estimates of CHE by the level of old-age dependency of households may help identify the most vulnerable sub-group and provide evidence for specific policies for the financial protection and health care of the elderly. The present study aims to estimate the incidence and intensity of CHE by the old-age dependency of households among middle-aged adults and the elderly in India. METHODS A total of 42,949 households from the Longitudinal Aging Study in India (LASI), 2017-18, covering households with at least one-member aged 45+ years, were included in the analysis. Households were classified into three mutually exclusive groups: no old-age dependency, low old-age dependency, and high old-age dependency. The incidence and intensity of CHE were estimated using the capacity-to-pay (CTP) approach. Concentration indices and concentration curves examine the extent of socioeconomic inequality in CHE. Binary logistic regression helps to understand the potential predictors of CHE across each type of old-age-dependent household. RESULTS We estimated the overall incidence of CHE at 24.6% (95% CI: 23.3-25.8) among middle-aged adults and the elderly in India. The incidence was 33.2% (95% CI: 31.4-35.1) among households with high old-age dependency, 23.1% (95% CI: 20.8-25.5) among those with low old-age dependency, and 20.4% (95% CI: 19.0-21.7) among no old-age dependency households. CHE intensity was highest among households with low old-age dependency compared to those no old-age dependents. Catastrophic health expenditure was higher among the poorer households in each type of old-age dependency. Among all households, the odds of incurring CHE were higher among households with high old-age dependency (AOR: 1.52; 95% CI: 1.36-1.69) than those with no old-age dependency. Lower-income households, households with pensions as the main source of income, households belonging to scheduled castes, and households residing in rural areas had higher odds of incurring CHE. The co-variates of CHE varied significantly across the type of old-age dependency households. A household's enrolment into a health insurance scheme did not necessarily lower its CHE. CONCLUSION Households with high old-age dependency had a higher probability of incurring CHE in India. Providing preventive and curative geriatric care in primary health centres (PHC) is recommended.
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Affiliation(s)
- Sanjay K Mohanty
- Department of Population and Development, International Institute for Population Sciences, Mumbai, India
| | - Umakanta Sahoo
- Department of Population and Development, International Institute for Population Sciences, Mumbai, India.,Department of Statistics, Sambalpur University, Burla, India
| | - Rashmi Rashmi
- Department of Population and Development, International Institute for Population Sciences, Mumbai, India
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Kundu J, Bharadwaz MP, Kundu S, Bansod DW. The interregional disparity in the choice of health care utilization among elderly in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2021.100929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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MuhammadJoy TM. Does childhood financial status relate to satisfaction in late life: Findings from the Longitudinal Aging Study in India. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Gender Differences in Health Care Utilization Among the Elderly. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2019-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The unstoppable process of demographic aging of population has profound consequences on the economic, health, social and political spheres of society, because of the specific and diverse needs of the older population. The aim of the study was to examine gender differences of health care utilization among elderly in Serbia. The survey was conducted as a part of the national study "Health Survey of the Serbian population" in 2013. In the past year, 87.4% of the older population visited their chosen doctor. Women were significantly more likely to use primary health care compared to men, while the frequency of hospitalization is significantly higher in men. When it comes to female population, age, region of residence and financial situation stood out as the most important predictors of primary care services usage. In men, the residence stood out as the most important predictor of primary health care services usage. Multivariate binary logistic regression distinguishes gender, education and region of residence as the most important factors associated with hospital treatment.
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Yiengprugsawan VS, Dorj G, Dracakis JG, Batkhorol B, Lkhagvaa U, Battsengel D, Ochir C, Naidoo N, Kowal P, Cumming RG. Disparities in outpatient and inpatient utilization by rural-urban areas among older Mongolians based on a modified WHO-SAGE instrument. BMC Health Serv Res 2021; 21:1183. [PMID: 34717613 PMCID: PMC8556801 DOI: 10.1186/s12913-021-07156-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 10/11/2021] [Indexed: 11/26/2022] Open
Abstract
Background Mongolia has made significant progress towards achieving Universal Health Coverage (UHC), but there are still challenges ahead with population ageing and non-communicable diseases (NCDs). The purpose of this study was to investigate patterns and determinants of outpatient and inpatient health service use amongst older people in Mongolia. Methods Data were collected using a questionnaire developed for the World Health Organization’s Study on global AGEing and adult health (WHO SAGE). There were 478 participants from rural areas and 497 participants from Ulaanbaatar (further divided into 255 ger/yurt district and 242 apartment district residents). Multivariable logistic regression analyses were used to investigate determinants of outpatient and inpatient health service use with reported adjusted Odds Ratios (AORs) and 95 % Confidence Intervals (CIs). Results Participants were aged 60 to 93 years. About 55 % of respondents used outpatient services in the past 12 months and 51 % used inpatient services in the past three years. Hypertension was the most common reason for health service use. Rural residents had longer travel times and were more likely to incur out-of-pocket expenditure (OOP). Multivariable logistic regression revealed that women were more likely to use outpatient services (AOR 1.88; 1.34-2.63). Compared to apartment residents in urban areas, ger residents in urban areas were less likely to use outpatient services (AOR 0.54; 0.36-0.83). There was no statistically significant differences in inpatient service by location. Increasing numbers of chronic conditions (1 and 2+ compared to none) were associated with both outpatient (AORs 2.59 and 2.78) and inpatient (AORs 1.97 and 3.01) service use. Conclusions This study highlights the needs to address disparities in outpatient service use for rural and urban ger populations. Compared with other WHO-SAGE countries, older Mongolians have relatively higher use of inpatient health care services. With a high prevalence of hypertension and an ageing population, efforts to achieve UHC would benefit from reorienting care services towards prevention and primary care management of NCDs to reduce the costs from hospital-based care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07156-y.
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Affiliation(s)
- Vasoontara Sbirakos Yiengprugsawan
- Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia.
| | - Gantuya Dorj
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Jocelyn G Dracakis
- Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
| | - Bilegt Batkhorol
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Undram Lkhagvaa
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Dulamsuren Battsengel
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Chimedsuren Ochir
- School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Paul Kowal
- World Health Organization, Geneva, Switzerland.,International Health Transitions, Canberra, Australia
| | - Robert G Cumming
- Australian Research Council Centre of Excellence in Population Ageing Research (CEPAR), University of New South Wales, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
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Whitehall L, Rush R, Górska S, Forsyth K. The General Self-Efficacy of Older Adults Receiving Care: A Systematic Review and Meta-Analysis. THE GERONTOLOGIST 2021; 61:e302-e317. [PMID: 32373938 PMCID: PMC8361502 DOI: 10.1093/geront/gnaa036] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives General self-efficacy (GSE) encourages health-promoting behaviors in older adults. It is unsurprising then that older adults receiving health care services are reported to have a greater risk of low GSE than older adults who are not. Despite this, there is currently limited evidence investigating whether the effect differs based on the environment in which care is received. This review aims to determine whether the GSE of older adults is affected by the receipt of health care services and whether GSE varies based on the setting in which care is received. Research Design and Methods In accordance with PRISMA guidelines (PROSPERO registration number CRD42018092191), a systematic search was undertaken across 7 databases. Standardized mean differences (SMD) and mean General Self-Efficacy Scale scores, with 95% confidence intervals (CI), were pooled for meta-analysis. Results A total of 40 studies were identified, they consisted of 33 population cohorts that were included in the meta-analysis. Older adults receiving health care services were found to be at greater risk of having lower GSE than those who do not (SMD = −0.62; 95% CI: −0.96 to −0.27, p < .0001). Following identification of sources of heterogeneity, older adults receiving acute inpatient care were more likely to have lower GSE than those receiving care in other health care settings. Discussion and Implications Older adults receiving inpatient care have a greater risk of lower GSE, and consequently, poorer health-promoting behaviors. Further research is recommended that focuses on the GSE of older adults and health outcomes following discharge from inpatient care.
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Affiliation(s)
- Lucy Whitehall
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Robert Rush
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Sylwia Górska
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Kirsty Forsyth
- School of Health Sciences, Queen Margaret University, Edinburgh, UK
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Rattanavipapong W, Wang Y, Butchon R, Kittiratchakool N, Thammatacharee J, Teerawattananon Y, Isaranuwatchai W. Retrospective secondary data analysis to identify high-cost users in inpatient department of hospitals in Thailand, a middle-income country with universal healthcare coverage. BMJ Open 2021; 11:e047330. [PMID: 34321299 PMCID: PMC8319992 DOI: 10.1136/bmjopen-2020-047330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The study aims to identify high-cost users (HCUs) in the inpatient departments of hospitals in Thailand including their common characteristics, patterns of healthcare utilisation and expenditure compared with low-cost users, and to explore potential factors associated with HCUs so the healthcare system can be prepared to support the HCUs including those who have increased chances of becoming HCUs. DESIGN AND SETTING A retrospective secondary data analysis using hospitalisation data from Thailand's Universal Coverage Scheme (UCS) obtained from the National Health Security Office over a 5-year period from October 2014 to September 2019 (fiscal year 2014-2018). PARTICIPANTS Study participants included Thai citizens who had at least one inpatient admission to hospitals under the UCS over the study period. RESULTS Over the 5-year period, the top 5% of the hospitalised population (or HCUs) consumed almost 50% of the health expenditure each year. HCUs were more likely to have longer hospital stays, a higher annual number of visits and be admitted to multiple hospitals each year when compared with the low-cost users (the bottom 50% of the hospitalised population). The study further reported that the chance of becoming an HCU is associated with several factors such as increasing age, being male, having a comorbidity and being admitted to hospitals in Bangkok. CONCLUSIONS This study confirmed that the HCU phenomenon existed in Thailand, where a majority of inpatient care spending is concentrated in the top 5% of the hospitalised population. The study findings call attention to potential initiatives that can help monitor the magnitude and trend of HCUs and develop policies to prevent HCUs.
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Affiliation(s)
- Waranya Rattanavipapong
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Yi Wang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Rukmanee Butchon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Nitichen Kittiratchakool
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
| | | | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wanrudee Isaranuwatchai
- Health Intervention and Technology Assessment Program, Ministry of Public Health, Nonthaburi, Thailand
- Institute or Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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14
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Haw NJL, Uy J, Ho BL. Association of SHI coverage and level of healthcare utilization and costs in the Philippines: a 10-year pooled analysis. J Public Health (Oxf) 2021; 42:e496-e505. [PMID: 31781739 DOI: 10.1093/pubmed/fdz142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Philippine Health Insurance Corporation (PhilHealth), which manages the Philippine national health insurance program, is a critical actor in the country's strategy for universal health coverage. Over the past decade, PhilHealth has passed significant coverage, benefits and payment reforms to contain costs and improve the affordability care for high-cost diseases, inpatient care and select outpatient services. METHODS We studied the association of PhilHealth with health care utilization and health care costs using three rounds of the Philippine Demographic and Health Survey with data on individual outpatient and inpatient visits from 2008 to 2017. RESULTS PhilHealth membership was associated with 42% greater odds of outpatient utilization and 47-100% greater odds inpatient utilization depending on survey year. Depending on facility type, use of PhilHealth to pay for care was associated with higher average health care costs of 244-865% for outpatient care and 135-206% for inpatient care. CONCLUSIONS PhilHealth has likely decreased barriers to health care utilization but may have inadvertently driven up health care costs in the country. Results align with past studies that suggest that reforms in the prior decade have done little to contain health care costs for Filipinos.
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Affiliation(s)
- Nel Jason L Haw
- School of Science and Engineering, Ateneo de Manila University, Quezon City 1108, Philippines
| | - Jhanna Uy
- School of Science and Engineering, Ateneo de Manila University, Quezon City 1108, Philippines
| | - Beverly Lorraine Ho
- Health Policy Development and Planning Bureau, Department of Health Philippines, Manila City 1003, Philippines
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15
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Tungu M, Amani PJ, Hurtig AK, Dennis Kiwara A, Mwangu M, Lindholm L, San Sebastiån M. Does health insurance contribute to improved utilization of health care services for the elderly in rural Tanzania? A cross-sectional study. Glob Health Action 2021; 13:1841962. [PMID: 33236698 PMCID: PMC7717594 DOI: 10.1080/16549716.2020.1841962] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Health care systems in developing countries such as Tanzania depend heavily on out-of-pocket payments. This mechanism contributes to inefficiency, inequity and cost, and is a barrier to patients seeking access to care. There are efforts to expand health insurance coverage to vulnerable groups, including older adults, in Sub-Saharan African countries. Objective: To analyse the association between health insurance and health service use in rural residents aged 60 and above in Tanzania. Methods: Data were obtained from a household survey conducted in the Nzega and Igunga districts. A standardised survey instrument from the World Health Organization Study on global AGEing and adult health was used. This comprised of questions regarding demographic and socio-economic characteristics, health and insurance status, health seeking behaviours, sickness history (three months and one year prior to the survey), and the receipt of health care. A multistage sampling method was used to select wards, villages and respondents in each district. Local ward and hamlet officers guided the researchers in identifying households with older people. Crude and adjusted logistic regression methods were used to explore associations between health insurance and outpatient and inpatient health care use. Results: The study sample comprised 1,899 people aged 60 and above of whom 44% reported having health insurance. A positive statistically significant association between health insurance and the utilisation of outpatient and inpatient care was observed in all models. The odds of using outpatient (adjusted OR = 2.20; 95% CI: 1.54, 3.14) and inpatient services (adjusted OR = 3.20; 95% CI: 2.46, 4.15) were higher among the insured. Conclusion: Health insurance is a predictor of outpatient and inpatient health services in people aged 60 and above in rural Tanzania. Further research is needed to understand the perceptions of both the insured and uninsured regarding the quality of care received.
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Affiliation(s)
- Malale Tungu
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences , Dar es Salaam, Tanzania.,Epidemiology and Global Health, Umeå University , Umeå, Sweden
| | - Paul Joseph Amani
- Epidemiology and Global Health, Umeå University , Umeå, Sweden.,Department of Health Systems Management, School of Public Administration and Management, Mzumbe University , Morogoro, Tanzania
| | | | - Angwara Dennis Kiwara
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences , Dar es Salaam, Tanzania
| | - Mughwira Mwangu
- Department of Development Studies, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences , Dar es Salaam, Tanzania
| | - Lars Lindholm
- Epidemiology and Global Health, Umeå University , Umeå, Sweden
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16
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Spatial Effects of Environmental Pollution on Healthcare Services: Evidence from China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041784. [PMID: 33673128 PMCID: PMC7918594 DOI: 10.3390/ijerph18041784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022]
Abstract
With the rapid development of urbanization and industrialization in China, environmental issues have become an urgent problem, especially issues related to air, water, and solid-waste pollution. These pollutants pose threats to the health of the population and to that of communities and have a vicious influence on the healthcare system. Additionally, pollution also exhibits spill-over effects, which means that pollution in the local region could affect the healthcare services in a neighboring region. Therefore, it is necessary to explore the relationship between pollution and healthcare. A spatial autocorrelation analysis was conducted and spatial panel econometric models were constructed to explore the characteristics of pollution and healthcare services in China and the relationship between them using data on all 31 provinces over 12 consecutive years (2006-2017). The results showed that the utilization of healthcare services and environmental pollution were not randomly distributed; unsurprisingly, air pollution and solid-waste pollution were mainly found in parts of northern China, while water pollution was highest in southern and coastal China. In addition, environmental pollution exhibited spill-over effects on healthcare services. For example, a 1% increase in solid waste in one specific geographical unit was estimated to increase the inpatient visits per capita in adjacent counties by 0.559%. Specifically, pollution showed different degrees of influence on healthcare services, which means that the impact of environmental pollution on the number of outpatient visits is greater than on the number of inpatient visits. Our results provide the government with evidence for effectively formulating and promulgating policies, especially policies aimed at tackling spill-over effects among different regions.
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17
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Ghimire S, Singh DR, McLaughlin SJ, Maharjan R, Nath D. Health Care Utilization by Older Adults in Nepal: An Investigation of Correlates and Equity in Utilization. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 52:236-245. [PMID: 33430683 DOI: 10.1177/0020731420981928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aims to evaluate factors associated with health care utilization (HCU) and to assess vertical and horizontal equity in utilization among Nepali older adults. Data are from an existing cross-sectional study involving systematic random sampling of 260 older adults in Far-Western (Sudurpaschim) Province of Nepal. Andersen's theoretical framework was used to assess predisposing, enabling, and need factors that have the potential to influence health care utilization. Multivariable logistic regression analyses were conducted to examine potential correlates of HCU. Horizontal and vertical equity were assessed using concentration curve and index. More than one-third of participants had not visited a health facility in the prior 12 months. Nine in 10 participants did not know about the government's free health service for older adults. Joint/extended family type, Ayurvedic/Homeopathic health care preference, higher-income tertile, and presence of chronic conditions were associated with higher odds of health care utilization in adjusted analyses. The concentration curve for HCU lies below the line of equity, and the subsequent index is positive, indicating that HCU was concentrated among richer individuals. If the government of Nepal is to achieve its goal of universal health care, the existing pro-rich inequity in HCU needs to be addressed.
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Affiliation(s)
- Saruna Ghimire
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA.,Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Devendra Raj Singh
- Department of Public Health, Asian College for Advanced Studies, Purbanchal University, Lalitpur, Nepal.,Research and Innovation Section, Southeast Asia Development Actions Network (SADAN), Lalitpur, Nepal
| | - Sara J McLaughlin
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Renusha Maharjan
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Dhirendra Nath
- Department of Public Health, Asian College for Advanced Studies, Purbanchal University, Lalitpur, Nepal.,Grande International Hospital, Kathmandu, Nepal
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18
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Tortorella GL, Fogliatto FS, Espôsto KF, Mac Cawley AF, Vassolo R, Tlapa D, Narayanamurthy G. Healthcare costs’ reduction through the integration of Healthcare 4.0 technologies in developing economies. TOTAL QUALITY MANAGEMENT & BUSINESS EXCELLENCE 2020. [DOI: 10.1080/14783363.2020.1861934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Guilherme Luz Tortorella
- School of Engineering, University of Melbourne Faculty of Science, Victoria, Australia
- Universidade Federal de Santa Catarina, Florianopolis, Brazil
| | - Flavio Sanson Fogliatto
- Department of Industrial Engineering, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Alejandro Francisco Mac Cawley
- Pontificia Universidad Catolica de Chile, Industrial and Systems Engineering, Macul, Chile
- Pontificia Universidad Católica de Chile, Agricultural Economics, Santiago, Chile
| | | | - Diego Tlapa
- Universidad Autonoma de Baja California - Campus Ensenada, Ensenada, Mexico
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19
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CK V, Dsouza B, Unnikrishnan B, Kamath R, Apuri N. Need assessment and operational feasibility indices for a geriatric inpatient facility in a tertiary care teaching hospital. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2018.1500186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Vasudha CK
- Masters in Hospital Administration, Manipal Academy of Higher Education, Manipal, India
| | - Bryal Dsouza
- Masters in Hospital Administration, Manipal Academy of Higher Education, Manipal, India
| | - Bhaskaran Unnikrishnan
- Community Medicine, Kasturba Medical College (Manipal Academy of Higher Education), Mangalore, India
| | - Rajesh Kamath
- Masters in Hospital Administration, Manipal Academy of Higher Education, Manipal, India
| | - Nikitha Apuri
- Masters in Hospital Administration, Manipal Academy of Higher Education, Manipal, India
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20
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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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21
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Wang Y, Jing Z, Ding L, Tang X, Feng Y, Li J, Chen Z, Zhou C. Socioeconomic inequity in inpatient service utilization based on need among internal migrants: evidence from 2014 national cross-sectional survey in China. BMC Health Serv Res 2020; 20:984. [PMID: 33109188 PMCID: PMC7590715 DOI: 10.1186/s12913-020-05843-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Providing equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China. METHODS The data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level. RESULTS Of the total internal migrants, 18.75% unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p < 0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p = 0.017) and 2.04 (95% CI 1.45, 2.88, p = 0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p = 0.044) and 1.37 (95% CI 1.02, 1.83, p = 0.035), respectively. CONCLUSION This study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.
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Affiliation(s)
- Yi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Zhengyue Jing
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Lulu Ding
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Xue Tang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Yuejing Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Jie Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
| | - Zhuo Chen
- College of Public Health, University of Georgia, Athens, GA, 30606, USA.,School of Economics, University of Nottingham, Ningbo, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China. .,NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China.
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22
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Asiimwe SB, Farrell M, Kobayashi LC, Manne-Goehler J, Kahn K, Tollman SM, Kabudula CW, Gómez-Olivé FX, Wagner RG, Montana L, Berkman LF, Glymour MM, Bärnighausen T. Cognitive differences associated with HIV serostatus and antiretroviral therapy use in a population-based sample of older adults in South Africa. Sci Rep 2020; 10:16625. [PMID: 33024208 PMCID: PMC7539005 DOI: 10.1038/s41598-020-73689-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 09/15/2020] [Indexed: 12/29/2022] Open
Abstract
Previous clinical studies have reported adverse cognitive outcomes for people living with HIV (PLWH), but there are no population-based studies comparing cognitive function between older PLWH and comparators without HIV in sub-Saharan Africa. We analyzed baseline data of 40 + years-old participants in "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa" (HAALSI) cohort. We measured cognition using a battery of conventional instruments assessing orientation, immediate- and delayed-recall, and numeracy (N = 4560), and the Oxford Cognitive Screen [OCS]-Plus, a novel instrument for low-literacy populations, assessing memory, language, visual-spatial ability, and executive functioning (N = 1997). Linear regression models comparing cognitive scores between participants with and without HIV were adjusted for sex, education, age, country of birth, father's occupation, ever-consumed alcohol, and asset index. PLWH scored on average 0.06 (95% CI 0.01-0.12) standard deviation (SD) units higher on the conventional cognitive function measure and 0.02 (95% CI - 0.07 to 0.04) SD units lower on the OCS-Plus measure than HIV-negative participants. We found higher cognitive function scores for PLWH compared to people without HIV when using a conventional measure of cognitive function but not when using a novel instrument for low-literacy settings.
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Affiliation(s)
- Stephen B Asiimwe
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., Mission Hall, 2nd Floor, San Francisco, CA, USA.
| | - Meagan Farrell
- Havard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Lindsay C Kobayashi
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Jen Manne-Goehler
- Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kathleen Kahn
- INDEPTH Network, Accra, Ghana
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Tollman
- INDEPTH Network, Accra, Ghana
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Livia Montana
- Havard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Lisa F Berkman
- Havard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - M Maria Glymour
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St., Mission Hall, 2nd Floor, San Francisco, CA, USA
| | - Till Bärnighausen
- Havard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Heidelberg Institute of Global Health (HIGH), Faculty of Medicine and University Hospital, University of Heidelberg, Baden-Württemberg, Germany
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23
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Kumar K, Singh A, James KS, McDougal L, Raj A. Gender bias in hospitalization financing from borrowings, selling of assets, contribution from relatives or friends in India. Soc Sci Med 2020; 260:113222. [PMID: 32707443 PMCID: PMC7441313 DOI: 10.1016/j.socscimed.2020.113222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/16/2020] [Accepted: 07/13/2020] [Indexed: 01/11/2023]
Abstract
Background Studies from India have documented gender differentials in hospitalization financing. Much of this work focused either on children or adults, but not across age-groups. No research to date has focused on gender differentials in case of catastrophic hospitalization expenditures. This study assesses gender differentials in distressed financing (borrowing, selling of assets, contributions from relatives or friends) for hospitalization in cases of catastrophic expenditures for hospitalization in India, for young, adult and older adult patients. Methods We conducted a cross-sectional analysis of India’s 2017-18 National Sample Survey, which collected data on hospitalization and expenditures. We used multivariable probit regression and adjusted marginal effects to assess the associations between gender and the use of distressed financing for catastrophic hospitalization expenditures. Models were stratified by age, and run both with and without sample selection. Secondary analyses assessed gender differentials in the use of distressed financing for hospitalization in case of health insurance cover or not. Results Multivariable sample selection-adjusted probit regression shows that in households which incurred severe catastrophic hospitalization expenditures, the probability of using distressed financing for hospitalization of young or older females was 10% points lower than their male counterparts. In households which did not incur severe catastrophic hospitalization expenditures, there was no significant gender differential in use of distressed financing for hospitalization for any age group. In households which incurred severe catastrophic hospitalization expenditures, the probability of using distressed financing for hospitalization was lower for older females than for older males irrespective of health insurance cover. Conclusion There appears to be a clear gender discrimination in distressed financing of hospitalization costs among younger and older individuals in households that incurred severe catastrophic hospitalization expenditures in India. Health systems should consider how to otherwise support necessary hospitalization financing for girls and older women. Young and older females experience bias in hospitalization financing. Biases were concentrated in severe catastrophic hospitalization expenditures. Health insurance did not protect older females against this gender bias.
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Affiliation(s)
| | - Abhishek Singh
- International Institute for Population Sciences, Mumbai, India
| | - K S James
- International Institute for Population Sciences, Mumbai, India
| | - Lotus McDougal
- Center on Gender Equity and Health, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Department of Medicine, University of California San Diego, San Diego, CA, USA; Department of Education Studies, Division of Social Sciences, University of California San Diego, San Diego, CA, USA
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Siongco KLL, Nakamura K, Seino K. Reduction in inequalities in health insurance coverage and healthcare utilization among older adults in the Philippines after mandatory national health insurance coverage: trend analysis for 2003-2017. Environ Health Prev Med 2020; 25:17. [PMID: 32517677 PMCID: PMC7285735 DOI: 10.1186/s12199-020-00854-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 05/17/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Health policies in the Philippines have evolved in response to increasing health demands of older adults. However, there is a lack of research on equity among the ageing population in low-middle income countries. The objective of this study was to identify the trends in National Health Insurance Program (NHIP) coverage and healthcare utilization among older adults in the Philippines for the period from 2003 to 2017, during which NHIP expansion policies were implemented, focusing on reductions in socio-economic inequalities. METHODS A literature search of policies for older adults and an analysis of four Philippine National Demographic and Health Surveys (2003, 2008, 2013, and 2017) with data from 25,217 older adults who were 60 years or older were performed. The major outcome variables were NHIP coverage, self-reported illness, outpatient healthcare utilization, and inpatient healthcare utilization. Inequalities in NHIP coverage and healthcare utilization according to wealth were evaluated by calculating the concentration index for individual years, followed by a regression-based decomposition analysis. RESULTS NHIP coverage among older adults increased from 9.4 (2003) to 87.6% (2017). Although inequalities according to wealth quintile were observed in all four surveys (all P < 0.001), the concentration index declined from 0.3000 (2003) to 0.0247 (2017), showing reduced inequalities in NHIP coverage over time as observed for self-reported illness and healthcare utilization. NHIP coverage expansion for older adults in 2014 enabled equal opportunity for access to healthcare. CONCLUSION The passage of mandatory NHIP coverage for older Filipino adults in 2014 was followed by a reduction in inequality in NHIP coverage and healthcare utilization according to wealth.
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Affiliation(s)
- Kathryn Lizbeth Lucena Siongco
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8519, Japan.
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8519, Japan
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Patel R, Chauhan S. Gender differential in health care utilisation in India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Llop-Gironés A, Julià M, Chicumbe S, Dulá J, Odallah AAP, Alvarez F, Zahinos I, Mazive E, Benach J. Inequalities in the access to and quality of healthcare in Mozambique: evidence from the household budget survey. Int J Qual Health Care 2020; 31:577-582. [PMID: 30388229 DOI: 10.1093/intqhc/mzy218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/16/2018] [Accepted: 10/15/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To assess the inequalities in the access to and quality of care and its related direct payments. DESIGN Secondary analysis of the cross-sectional Mozambican Household Budget Survey (HBS). SETTING Nationally-representative sample of households in Mozambique. PARTICIPANTS 11 480 households (58 118 individuals) interviewed during HBS 2014/15. INTERVENTION None. MAIN OUTCOME MEASURES Equity, utilization of healthcare, access to quality care and direct payments. RESULTS About 12.2% of women and 10.1% of men of the survey report a perceive health need. About 72.1% of women and 72.9% men use healthcare. Population in a disadvantaged position living in rural areas have less probabilities of using healthcare for equal health compared to the individuals of a wealthier position and living in urban settings. With regard to quality care, 47.7% women and 46.8% men do not report quality problems. No differences for women's wealth. Men in a disadvantaged position report less chances of accessing quality care compared to men of advantaged position. Also, women and men living in rural areas have less probabilities of accessing quality care. Finally, the majority of people who access healthcare paid 1 Mt during their visit. CONCLUSIONS This study tackles a fundamental policy concern for health systems of Sub-Saharan Africa and points to areas that urge action to address the existent of socioeconomic and geographical inequalities in the access to and quality of care for women and men, including the strengthening of health facilities in rural and deprived areas to ensure that access to adequate care of acceptable quality is distributed according to need.
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Affiliation(s)
- Alba Llop-Gironés
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Mireia Julià
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Sergio Chicumbe
- Programa de Sistemas de Saúde, Instituto Nacional de Saúde, Ministry of Health, Estrada national 1, Marracuene
| | - Janeth Dulá
- Programa de Sistemas de Saúde, Instituto Nacional de Saúde, Ministry of Health, Estrada national 1, Marracuene
| | - Anita Aunda Pedro Odallah
- Department of Community Health, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique, Salvador Allende Avenue 702, 257
| | - Francesc Alvarez
- Medicus Mundi Mediterrània, Secretari Coloma st 112, Barcelona, Spain
| | - Ivan Zahinos
- Medicus Mundi Mediterrània, Secretari Coloma st 112, Barcelona, Spain
| | - Elisio Mazive
- National Institute of Statistics of Mozambique, Maputo, Mozambique, Avenue 24 de Julho 1989, 493
| | - Joan Benach
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra Public Policy Center, Barcelona, Spain.,Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid
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Hao L, Xu X, Dupre ME, Guo A, Zhang X, Qiu L, Zhao Y, Gu D. Adequate access to healthcare and added life expectancy among older adults in China. BMC Geriatr 2020; 20:129. [PMID: 32272883 PMCID: PMC7146971 DOI: 10.1186/s12877-020-01524-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 03/19/2020] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Adequate access to healthcare is associated with lower risks of mortality at older ages. However, it is largely unknown how many more years of life can be attributed to having adequate access to healthcare compared with having inadequate access to healthcare. METHOD A nationwide longitudinal survey of 27,794 older adults aged 65+ in mainland China from 2002 to 2014 was used for analysis. Multivariate hazard models and life table techniques were used to estimate differences in life expectancy associated with self-reported access to healthcare (adequate vs. inadequate). The findings were assessed after adjusting for a wide range of demographic factors, socioeconomic status, family/social support, health practices, and health conditions. RESULTS At age 65, adequate access to healthcare increased life expectancy by approximately 2.0-2.5 years in men and women and across urban-rural areas compared with those who reported inadequate access to healthcare. At age 85, the corresponding increase in life expectancy was 1.0-1.2 years. After adjustment for multiple confounding factors, the increase in life expectancy was reduced to approximately 1.1-1.5 years at age 65 and 0.6-0.8 years at age 85. In women, the net increase in life expectancy attributable to adequate access to healthcare was 6 and 8% at ages 65 and 85, respectively. In men, the net increases in life expectancy were generally greater (10 and 14%) and consistent after covariate adjustments. In contrast, the increase in life expectancy was slightly lower in rural areas (2.0 years at age 65 and 1.0 years at age 85) than in urban areas (2.1 years at age 65 and 1.1 years age 85) when no confounding factors were taken into account. However, the increase in life expectancy was greater in rural areas (1.0 years at age 65 and 0.6 years at age 85) than in urban areas (0.4 years at age 65 and 0.2 years at age 85) after accounting for socioeconomic and other factors. CONCLUSIONS Adequate access to healthcare was associated with longer life expectancy among older adults in China. These findings have important implications for efforts to improve access to healthcare among older populations in China.
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Affiliation(s)
- Lisha Hao
- School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Xin Xu
- School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Matthew E Dupre
- Department of Population Health Sciences, Department of Sociology, & Duke Clinical Research Institute, Duke University, Durham, NC, USA.
| | - Aimei Guo
- Ginling College, Nanjing Normal University, Nanjing, China
| | - Xufan Zhang
- Ginling College, Nanjing Normal University, Nanjing, China
| | | | - Yuan Zhao
- Ginling College & School of Geographic Sciences, Nanjing Normal University, Nanjing, China
| | - Danan Gu
- Independent Researcher, New York, USA.
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Yeoh EK, Yam CHK, Chong KC, Chow TY, Fung VLH, Wong ELY, Griffiths SM. An evaluation of universal vouchers as a demand-side subsidy to change primary care utilization: A retrospective analysis of longitudinal services utilisation and voucher claims data from a survey cohort in Hong Kong. Health Policy 2019; 124:189-198. [PMID: 31898988 DOI: 10.1016/j.healthpol.2019.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/12/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Abstract
To incentivize private primary care utilization and reduce reliance on public healthcare services, Elderly Healthcare Voucher Scheme has been implemented to provide a voucher entitlement to entire older resident population for subsidising their purchase of unspecified primary healthcare services in the private sector. Our study assessed whether voucher usage is associated with reduced utilization of public healthcare services. We retrieved the public healthcare services utilization and voucher transaction data of a survey cohort of 551 participants, who were age eligible for the scheme since 2009, over the period 2009-2015. Our results showed that voucher usage was not associated with reduced utilization of public healthcare services and has encouraged dual utilization of public and private healthcare. It may be due to a generated supply-induced demand and price inflation. The finding suggests the voucher is specifically designed to address the health systems issues to achieve the effective policy objectives. Defining the specific services to be provided and the prices at which they should be offered based on the needs of specified populations is a fundamental design parameter which needs to be incorporated. The alternatives of whether primary care services should be expanded and provided in the public sector or purchased using supply/demand side instruments should be considered taking the context and goals of the health system into account.
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Affiliation(s)
- Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Carrie H K Yam
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Ka-Chun Chong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Tsz-Yu Chow
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Valerie L H Fung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Eliza L Y Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
| | - Sian M Griffiths
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, PR China.
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Naidoo K, van Wyk J. Protocol for a scoping review of age-related health conditions among geriatric populations in sub-Saharan Africa. Syst Rev 2019; 8:133. [PMID: 31174593 PMCID: PMC6554952 DOI: 10.1186/s13643-019-1055-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/26/2019] [Indexed: 11/10/2022] Open
Affiliation(s)
- Keshena Naidoo
- Discipline of Family Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Jacqueline van Wyk
- Discipline of Clinical and Professional practice, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Zhang X, Dupre ME, Qiu L, Zhou W, Zhao Y, Gu D. Age and sex differences in the association between access to medical care and health outcomes among older Chinese. BMC Health Serv Res 2018; 18:1004. [PMID: 30594183 PMCID: PMC6310939 DOI: 10.1186/s12913-018-3821-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 12/17/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Whether the association between access to medical care and health outcomes differs by age and gender among older adults in China is unclear. We aimed to investigate the associations between self-reported inadequate access to care and multiple health outcomes among older men and women in mainland China. METHODS Based on four latest waves available so far from a national longitudinal study in mainland China in 2005-2014, we used multilevel random-effect logistic models to estimate the contemporaneous relationships between inadequate access to care and disabilities in instrumental activities of daily living (IADL) and cognitive impairment in men and women at ages 65-74, 75-84, 85-94, and 95+, separately. We also used multilevel hazard models to investigate the relationships between reported access to care and mortality in 2005-2014. Nested models were used to adjust for survey design, sociodemographic background, enrollment in health insurance, and health behaviors. RESULTS Approximately 6.5% of older adults in China reported inadequate access to care in the period of 2005-2014; and the percentages increased with age and were higher among women at older ages (≥75 years). Overall, older adults with self-reported inadequate access to care had greater odds of IADL and ADL disabilities and cognitive impairment than those with adequate access to healthcare. The elevated odds ratios (ORs) in men were higher in middle-old (75-84) and old-old (85-94) age groups compared to other age groups; whereas the elevated ORs in women were higher in young-old (65-74) and middle-old (75-84) age groups. The relationship between access to care and the health outcomes was generally weakest at the oldest-old ages (95+). Inadequate access to care was also linked with higher mortality risk, primarily in adults aged 75-84, and it was somewhat more pronounced in women than in men. CONCLUSIONS Increased odds of physical disability and cognitive impairment and increased risk of mortality are linked with inadequate access to care. The associations were generally stronger in women than in men and varied across age groups. The findings of the present study have important implications for further improving access to health care and improving health outcomes of older adults in China.
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Affiliation(s)
- Xufan Zhang
- Ginling Colleague, Nanjing Normal University, Nanjing, China
| | - Matthew E. Dupre
- Department of Population Health Sciences and Department of Sociology, Duke University, Durham, NC USA
| | - Li Qiu
- Independent Researcher, New York, NY USA
| | - Wei Zhou
- Ginling Colleague, Nanjing Normal University, Nanjing, China
| | - Yuan Zhao
- School of Geographical Science Ginling College, Nanjing Normal University, and Jiangsu Center for Collaborative Innovation in Geographical Information Resource Development and Application Nanjing, Nanjing, China
| | - Danan Gu
- United Nations Population Division, Two UN Plaza, New York, NY DC2-1910 USA
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Gyasi RM, Phillips DR, Amoah PA. Multidimensional Social Support and Health Services Utilization Among Noninstitutionalized Older Persons in Ghana. J Aging Health 2018; 32:227-239. [DOI: 10.1177/0898264318816217] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives: This study examines multidimensional social supports as predictors of health services utilization among community-dwelling older Ghanaians. Method: Using data from a 2016/2017 Aging, Health, Psychological Wellbeing and Health-Seeking Behavior Study ( N = 1,200), Poisson regression models estimated the associations of aspects of informal social support and health facility utilization among older people. Results: Findings suggest that regular contacts with family/close friends (odds ratio [OR] = 1.299; 95% confidence interval [CI] = [1.111, 1.519]), social participation (OR = 1.021; 95% CI = [1.140, 1.910]), and remittances from adult children (OR = 1.091; 95%CI = [1.086, 1.207]) were associated with increased health services utilization with some gender variations. Having caregivers increased health care use generally (OR = 1.108; 95% CI = [1.016, 1.209]) and among men (OR = 1.181; 95% CI = [1.015, 1.373]). However, we found decrease in health care use among those who received pecuniary assistance (OR = 0.893; 95% CI = [0.805, 0.990]). Discussion: Perceived structural and functional social support domains appear influential in health care utilization among older adults in Ghana. The findings underscore the need for intervention programs and social policies targeted at both micro-factors and wider social factors, including the novel area of remittances to older adults.
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Affiliation(s)
- Razak M. Gyasi
- African Population and Health Research Center (APHRC), Nairobi, Kenya
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Predictors of hypertension awareness, treatment and control in South Africa: results from the WHO-SAGE population survey (Wave 2). J Hum Hypertens 2018; 33:157-166. [PMID: 30382179 DOI: 10.1038/s41371-018-0125-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 08/16/2018] [Accepted: 09/27/2018] [Indexed: 11/08/2022]
Abstract
South Africa has one of the highest levels of hypertension globally, coupled with poor rates of diagnosis, treatment and control. Risk factors that predict hypertension in high income countries may perform differently in the African context, where communicable disease, obesity and malnutrition co-exist. This study investigated traditional risk factors alongside other health and sociodemographic indicators to determine predictors of hypertension prevalence and management. Participants were recruited from households across South Africa as part of WHO's Study on global AGEing and adult health (WHO SAGE) Wave 2 (2015). Blood pressure (BP) was measured in triplicate and sociodemographic and health data collected by survey (n = 1847; 30% 18-39 years, 39% 40-59 years, 31% 60 years+; median age 51 years; 68% female). Of all adults, 43% were hypertensive (n = 802), of which 58% (n = 398) were unaware, 33% (n = 267) were on medication, with only 18% (n = 141) controlled on medication (BP < 140/90 mmHg). Multivariate logistic regression showed waist-to-height ratio > 0.5 and diabetes comorbidity were the most significant predictors of hypertension presence, awareness and treatment. Individuals with diabetes were twice as likely to have hypertension, 7.0 times more likely to be aware, 3.3 times more likely to be on antihypertensive medication, and 2.4 times more likely to be controlled on medication. Women and individuals reporting lower salt use were more likely to be aware and treated for hypertension. Applying the 2017 AHA/ACC hypertension guidelines showed only 1 in 4 adults had normal BP. As with HIV, similarly intensive efforts are now needed in the region to improve non-communicable disease diagnosis and management.
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Chatterjee C, Nayak NC, Mahakud J, Chatterjee SC. Factors affecting the choice of health care utilisation between private and public services among the elderly population in India. Int J Health Plann Manage 2018; 34:e736-e751. [PMID: 30378705 DOI: 10.1002/hpm.2686] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 11/06/2022] Open
Abstract
India is experiencing rapid population ageing in recent years. One of the most concomitant issues is the choice of health care services among the elderly, leading to its impact on the magnitude of health expenditure. Applying Andersen's Health Behavioural Model, this study identifies the predictors of the choice of inpatient health care services among the Indian elderly between private and public services. It also examines the nature of interregional disparity in the choice of health care services. Using NSSO data, the results suggest that the elderly belonging to upper caste and having higher levels of education, higher incomes, larger family size, and needing surgery are likely to choose private health care, while those experiencing higher economic dependence, chronic diseases, and higher duration of hospitalisation tend to prefer public inpatient services. The magnitude and significance of these factors, however, vary across regions. The findings of the study provide an understanding of the preferences of the India's geriatric population over hospital services, which may help policymakers better understand their health care needs.
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Affiliation(s)
- Chandrima Chatterjee
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Narayan Chandra Nayak
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Jitendra Mahakud
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
| | - Suhita Chopra Chatterjee
- Department of Humanities and Social Sciences, Indian Institute of Technology Kharagpur, West Bengal, India
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Inotai A, Nguyen HT, Hidayat B, Nurgozhin T, Kiet PHT, Campbell JD, Németh B, Maniadakis N, Brixner D, Wijaya K, Kaló Z. Guidance toward the implementation of multicriteria decision analysis framework in developing countries. Expert Rev Pharmacoecon Outcomes Res 2018; 18:585-592. [PMID: 30092151 DOI: 10.1080/14737167.2018.1508345] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Multiple Criteria Decision Analysis (MCDA) is increasingly used in health care mainly because it moves decision-making from ad hoc to an evidence-based and comprehensive process. Developing countries with more restricted financial and human research capacities, however, should consider their own methods of MCDA development and implementation. Areas covered: An MCDA framework to improve procurement decisions of off-patent pharmaceuticals was developed for developing countries and adapted to Indonesia, Kazakhstan and Vietnam during three policy workshops. Based on the experience of these workshops and one joint workshop with international experts and decision makers from multiple developing countries, general recommendations were formulated on how to implement MCDA specifically in developing countries. We provide 17 practical MCDA implementation recommendations in four major areas, including (1) MCDA objectives; (2) technical considerations of MCDA tool; (3) development and customization of MCDA tool and (4) policy implementation of MCDA in decision-making. Expert commentary: These practical MCDA recommendations for developing countries contribute to feasible, transparent, stepwise, iterative and standardized decision-making in health care.
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Affiliation(s)
- András Inotai
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy and Health Economics , Eötvös Loránd University (ELTE) , Budapest , Hungary
| | - Huong Thanh Nguyen
- c Department of Health Policy , Hanoi University of Public Health , Hanoi , Vietnam
| | - Budi Hidayat
- d Center for Health Economics and Policy Studies (CHEPS), Faculty of Public Health , Universitas Indonesia , Depok , Indonesia
| | - Talgat Nurgozhin
- e Asfendiyarov Kazakh National Medical University , Almaty , Kazakhstan
| | - Pham Huy Tuan Kiet
- f Department of Health Economics , Hanoi Medical University , Hanoi , Vietnam
| | - Jonathan D Campbell
- g Department of Clinical Pharmacy , University of Colorado , Aurora , CO , USA
| | | | - Nikos Maniadakis
- h Department of Health Services Organization and Management , National School of Public Health , Athens , Greece
| | - Diana Brixner
- i Department of Pharmacotherapy , University of Utah , Salt Lake City , UT , USA
| | - Kalman Wijaya
- j Abbott Established Pharmaceutical Division, Abbott , Basel , Switzerland
| | - Zoltán Kaló
- a Syreon Research Institute , Budapest , Hungary.,b Department of Health Policy and Health Economics , Eötvös Loránd University (ELTE) , Budapest , Hungary
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Koyanagi A, Stubbs B, Vancampfort D. Correlates of sedentary behavior in the general population: A cross-sectional study using nationally representative data from six low- and middle-income countries. PLoS One 2018; 13:e0202222. [PMID: 30096192 PMCID: PMC6086470 DOI: 10.1371/journal.pone.0202222] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/30/2018] [Indexed: 11/30/2022] Open
Abstract
Background Sedentary behavior (SB) is associated with adverse health outcomes independent of levels of physical activity. However, data on its correlates are scarce from low- and middle-income countries (LMICs). Thus, we assessed the correlates of SB in six LMICs (China, Ghana, India, Mexico, Russia, South Africa) using nationally representative data. Methods Cross-sectional, community-based data on 42,469 individuals aged ≥18 years from the World Health Organization’s Study on Global Ageing and Adult Health were analyzed. Self-reported time spent sedentary per day was the outcome. High SB was defined as ≥8 hours of SB per day. The correlates (sociodemographic and health-related) of high SB were estimated by multivariable logistic regression analyses. Results The overall prevalence (95%CI) of high SB was 8.3% (7.1–9.7%). In the overall sample, the most important sociodemographic correlates of high SB were unemployment and urban residence. Physical inactivity, morbid obesity (BMI≥30.0 kg/m2), higher number of chronic conditions, poor self-reported health, higher disability levels, and worse health status in terms of mobility, pain/discomfort, affect, sleep/energy and cognition were associated with high SB. Several between-country differences were found. Conclusion The current data provides important guidance for future interventions across LMICs to assist sedentary people to reduce their SB levels.
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Affiliation(s)
- Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- * E-mail:
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, United Kingdom
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, United Kingdom
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Davy Vancampfort
- Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium
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Dei V, Sebastian MS. Is healthcare really equal for all? Assessing the horizontal and vertical equity in healthcare utilisation among older Ghanaians. Int J Equity Health 2018; 17:86. [PMID: 29925401 PMCID: PMC6011249 DOI: 10.1186/s12939-018-0791-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 05/31/2018] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There is a lack of focused research on the older population in Ghana and about issues pertaining to their access to healthcare services. Furthermore, information is lacking regarding the fairness in the access to these services. This study aimed to ascertain whether horizontal and vertical equity requirements were being met in the healthcare utilisation among older adults aged 50 years and above. METHODS This study was based on a secondary cross-sectional data from the World Health Organization's Study on global AGEing (SAGE) and adult health wave 1 conducted from 2007 to 2008 in Ghana. Data on 4304 older adults aged 50 years-plus were analysed. Bivariate and multivariable analyses were carried out to analyse the association between outpatient/inpatient utilisation and (1) socioeconomic status (SES), controlling for need variables (horizontal equity) and (2) need variables, controlling for SES (vertical equity). Odds ratios with 95% confidence intervals were calculated to analyse the association between relevant variables. RESULTS Horizontal and vertical inequities were found in the utilisation of outpatient services. Inpatient healthcare utilisation was both horizontally and vertically equitable. Women were found to be more likely to use outpatient services than men but had reduced odds of using inpatient services. Possessing a health insurance was also significantly associated with the use of both inpatient and outpatient services. CONCLUSION Whilst equity exists in inpatient care utilisation, more needs to be done to achieve equity in the access to outpatient services. The study reaffirms the need to evaluate both the horizontal and vertical dimensions in the assessment of equity in healthcare access. It provides the basis for further research in bridging the healthcare access inequity gap among older adults in Ghana.
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Affiliation(s)
- Vincent Dei
- International SOS, Ghana, No. 2 Mankata Close Link, Airport Residential Area, Accra, Ghana
| | - Miguel San Sebastian
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, SE-901 85 Umea, Sweden
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van der Wielen N, Channon AA, Falkingham J. Does insurance enrolment increase healthcare utilisation among rural-dwelling older adults? Evidence from the National Health Insurance Scheme in Ghana. BMJ Glob Health 2018; 3:e000590. [PMID: 29527348 PMCID: PMC5841530 DOI: 10.1136/bmjgh-2017-000590] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/17/2017] [Accepted: 12/18/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This paper examines the relationship between national health insurance enrolment and the utilisation of inpatient and outpatient healthcare for older adults in rural areas in Ghana. The Ghanaian National Health Insurance Scheme (NHIS) aims to improve affordability and increase the utilisation of healthcare. However, the system has been criticised for not being responsive to the needs of older adults. The majority of older adults in Ghana live in rural areas with poor accessibility to healthcare. With an ageing population, a specific assessment of whether the scheme has benefitted older adults, and also if the benefit is equitable, is needed. METHODS Using the Ghanaian Living Standards Survey from 2012 to 2013, this paper uses propensity score matching to estimate the effect of enrolment within the NHIS on the utilisation of inpatient and outpatient care among older people aged 50 and over. RESULTS The raw results show higher utilisation of healthcare among NHIS members, which persists after matching. NHIS members were 6% and 9% more likely to use inpatient and outpatient care, respectively, than non-members. When these increases were disaggregated for outpatient care, the non-poor and females were seen to benefit more than their poor and male counterparts. For inpatient care, the benefits of enrolment were equal by poverty status and sex. However, overall, poor older adults use health services much less than the non-poor older adults even when enrolled. CONCLUSION The results indicate that NHIS coverage does increase healthcare utilisation among rural older adults but that inequalities remain. The poor are still at a great disadvantage in their use of health services overall and benefit less from enrolment for outpatient care. The receipt of healthcare is significantly influenced by a set of auxiliary barriers to access to healthcare even where insurance should remove the financial burden of ad hoc out of pocket payments.
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Affiliation(s)
| | - Andrew Amos Channon
- Department of Social Statistics and Demography Social Sciences, University of Southampton, Southampton, UK
| | - Jane Falkingham
- Department of Social Statistics and Demography Social Sciences, University of Southampton, Southampton, UK
- Centre for Population Change, University of Southampton, Southampton, UK
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Pandey A, Ploubidis GB, Clarke L, Dandona L. Horizontal inequity in outpatient care use and untreated morbidity: evidence from nationwide surveys in India between 1995 and 2014. Health Policy Plan 2017; 32:969-979. [PMID: 28419286 PMCID: PMC5886081 DOI: 10.1093/heapol/czx016] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Abstract
Equity in healthcare has been a long-term guiding principle of health policy in India. We estimate the change in horizontal inequities in healthcare use over two decades comparing the older population (60 years or more) with the younger population (under 60 years). We used data from the nationwide healthcare surveys conducted in India by the National Sample Survey Organization in 1995-96 and 2014 with sample sizes 633 405 and 335 499, respectively. Bivariate and multivariate logit regression analyses were used to study the socioeconomic differentials in self-reported morbidity (SRM), outpatient care and untreated morbidity. Deviations in the degree to which healthcare was distributed according to need were measured by horizontal inequity index (HI). In each consumption quintile the older population had four times higher SRM and outpatient care rate than the younger population in 2014. In 1995-96, the pro-rich inequity in outpatient care was higher for the older (HI: 0.085; 95% CI: 0.066, 0.103) than the younger population (0.039; 0.034, 0.043), but by 2014 this inequity became similar. Untreated morbidity was concentrated among the poor; more so for the older (-0.320; -0.391, -0.249) than the younger (-0.176; -0.211, -0.141) population in 2014. The use of public facilities increased most in the poorest and poor quintiles; the increase was higher for the older than the younger population in the poorest (1.19 times) and poor (1.71 times) quintiles. The use of public facilities was disproportionately higher for the poor in 2014 than in 1995-96 for the older (-0.189; -0.234, -0.145 vs - 0.065; -0.129, -0.001) and the younger (-0.145; -0.175, -0.115 vs - 0.056; -0.086, -0.026) population. The older population has much higher morbidity and is often more disadvantaged in obtaining treatment. Health policy in India should pay special attention to equity in access to healthcare for the older population.
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Affiliation(s)
- Anamika Pandey
- Public Health Foundation of India, New Delhi, India
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - George B Ploubidis
- Centre for Longitudinal Studies, Department of Social Science, UCL-Institute of Education, University College London, UK
| | - Lynda Clarke
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Lalit Dandona
- Public Health Foundation of India, New Delhi, India
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Abstract
ABSTRACTUganda's population is ageing, which comes with increased and varied burdens of disease and health-care needs. At the same time, gerontological care in Uganda remains neglected. This paper examines the factors that cause older Ugandans to delay health-care access. We conduct a thematic analysis of data drawn from nine focus groups held with rural Ugandans aged 60-plus. Our analysis highlights the factors that delay older persons’ access to health care and how these align with the Three-Delay Model, which was originally developed to assess and improve obstetric care in low-resource settings. Our participants report delays in deciding to seek care related to mobility and financial limitations, disease aetiology, severity and stigma (Delay I); reaching care because of poor roads and limited transportation options (Delay II); and receiving appropriate care because of ageism among health-care workers, and poorly staffed and under-supplied facilities (Delay III). We find these delays to care are interrelated and impacted by factors at the individual, community and health-system levels. We conclude by arguing for multi-pronged interventions that will address these delays, improve access to care and ultimately enhance older Ugandans’ health and wellbeing.
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Akoria OA. Establishing in-hospital geriatrics services in Africa: Insights from the University of Benin Teaching Hospital geriatrics project. Ann Afr Med 2017; 15:145-53. [PMID: 27549420 PMCID: PMC5402812 DOI: 10.4103/1596-3519.188896] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Unawareness of the peculiar healthcare needs of the elderly and resource constraints may be some reasons why until recently, Nigerian hospitals have not been equipped with the human and infrastructural resources required to meet older adults’ special healthcare needs. There is paucity of specialized health services for the elderly in Africa. Nigeria, with a population of over 170 million, did not have any healthcare facility with dedicated services for the elderly until 2012. The University of Benin Teaching Hospital (UBTH) in Nigeria was established in 1973 and created its geriatrics unit in October 2013. A prepared environment and trained interdisciplinary teams are pivotal in providing effective healthcare services for the elderly. The ongoing UBTH geriatrics project aims to provide specialized interdisciplinary health services to older adults and to provide training and continuing professional development in geriatrics for healthcare staff. In developing our inpatient services, we adopted the acute care for elders (ACE) model and worked in tandem with the “ABCs” of implementing ACE units. Results: In the face of limited resources, it was possible to establish a functional geriatrics unit with a trained interdisciplinary team. Family participation is central in our practice. Since October 2013, residents and house officers in internal medicine have been undertaking 4- and 12-weekly rotations, respectively. There is also a robust academic program, which includes once-weekly geriatric pharmacotherapy seminars, once-weekly interdisciplinary seminars, and 2-weekly journal club meetings alternating with seminars on geriatric assessment tools. Conclusions: It is possible to establish geriatric services and achieve best practices in resource-limited settings by investing on improving available human resources and infrastructure. We also make recommendations for setting up similar services in other parts of Africa.
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Affiliation(s)
- Obehi Aituaje Akoria
- Department of Medicine, University of Benin Teaching Hospital, Benin City, Edo, Nigeria
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Sadana R, Blas E, Budhwani S, Koller T, Paraje G. Healthy Ageing: Raising Awareness of Inequalities, Determinants, and What Could Be Done to Improve Health Equity. THE GERONTOLOGIST 2017; 56 Suppl 2:S178-93. [PMID: 26994259 DOI: 10.1093/geront/gnw034] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Social and scientific discourses on healthy ageing and on health equity are increasingly available, yet from a global perspective limited conceptual and analytical work connecting both has been published. This review was done to inform the WHO World Report on Ageing and Health and to inform and encourage further work addressing both healthy aging and equity. DESIGN AND METHODS We conducted an extensive literature review on the overlap between both topics, privileging publications from 2005 onward, from low-, middle-, and high-income countries. We also reviewed evidence generated around the WHO Commission on Social Determinants of Health, applicable to ageing and health across the life course. RESULTS Based on data from 194 countries, we highlight differences in older adults' health and consider three issues: First, multilevel factors that contribute to differences in healthy ageing, across contexts; second, policies or potential entry points for action that could serve to reduce unfair differences (health inequities); and third, new research areas to address the cause of persistent inequities and gaps in evidence on what can be done to increase healthy ageing and health equity. IMPLICATIONS Each of these areas warrant in depth analysis and synthesis, whereas this article presents an overview for further consideration and action.
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Affiliation(s)
- Ritu Sadana
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland.
| | - Erik Blas
- International Public Health and Development, Copenhagen, Denmark
| | - Suman Budhwani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Theadora Koller
- Gender, Equity and Human Rights Team, World Health Organization, Geneva, Switzerland
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Gwatidzo SD, Stewart Williams J. Diabetes mellitus medication use and catastrophic healthcare expenditure among adults aged 50+ years in China and India: results from the WHO study on global AGEing and adult health (SAGE). BMC Geriatr 2017; 17:14. [PMID: 28077072 PMCID: PMC5225610 DOI: 10.1186/s12877-016-0408-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 12/27/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Expenditure on medications for highly prevalent chronic conditions such as diabetes mellitus (DM) can result in financial impoverishment. People in developing countries and in low socioeconomic status groups are particularly vulnerable. China and India currently hold the world's two largest DM populations. Both countries are ageing and undergoing rapid economic development, urbanisation and social change. This paper assesses the determinants of DM medication use and catastrophic expenditure on medications in older adults with DM in China and India. METHODS Using national standardised data collected from adults aged 50 years and above with DM (self-reported) in China (N = 773) and India (N = 463), multivariable logistic regression describes: 1) association between respondents' socio-demographic and health behavioural characteristics and the dependent variable, DM medication use, and 2) association between DM medication use (independent variable) and household catastrophic expenditure on medications (dependent variable) (China: N = 630; India: N = 439). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010). RESULTS Prevalence of DM medication use was 87% in China and 71% in India. Multivariable analysis indicates that people reporting lifestyle modification were more likely to use DM medications in China (OR = 6.22) and India (OR = 8.45). Women were more likely to use DM medications in China (OR = 1.56). Respondents in poorer wealth quintiles in China were more likely to use DM medications whereas the reverse was true in India. Almost 17% of people with DM in China experienced catastrophic healthcare expenditure on medications compared with 7% in India. Diabetes medication use was not a statistically significant predictor of catastrophic healthcare expenditure on medications in either country, although the odds were 33% higher among DM medications users in China (OR = 1.33). CONCLUSIONS The country comparison reflects major public policy differences underpinned by divergent political and ideological frameworks. The DM epidemic poses huge public health challenges for China and India. Ensuring equitable and affordable access to medications for DM is fundamental for healthy ageing cohorts, and is consistent with the global agenda for universal healthcare coverage.
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Affiliation(s)
- Shingai Douglas Gwatidzo
- Umeå International School of Public Health, Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-90185 Umeå, Sweden
| | - Jennifer Stewart Williams
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-90185 Umeå, Sweden
- Research Centre for Gender, Health and Ageing, Faculty of Health, University of Newcastle, New Lambton Heights, Newcastle, NSW 2305 New South Wales Australia
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Awoke MA, Negin J, Moller J, Farell P, Yawson AE, Biritwum RB, Kowal P. Predictors of public and private healthcare utilization and associated health system responsiveness among older adults in Ghana. Glob Health Action 2017; 10:1301723. [PMID: 28578615 PMCID: PMC5496095 DOI: 10.1080/16549716.2017.1301723] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/27/2017] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Previous studies investigating factors associated with healthcare utilization by older Ghanaians lack distinction between public and private health services. The present study examined factors associated with public and private healthcare service use, and the resulting perceived health system responsiveness. OBJECTIVES To identify factors associated with public and private healthcare utilization among older adults aged 50 and older in Ghana; and to compare perceived differences in health system responsiveness between the private and public sectors. METHODS Cross-sectional data was analyzed from the World Health Organization Study on global AGEing and adult health (SAGE) Wave 1 in Ghana. Using Andersen's conceptual framework, public and private outpatient care utilization was examined using multinomial logistic regression to estimate and identify predictor variables associated with the type of outpatient healthcare facility accessed. Health system responsiveness was compared using chi-square tests. RESULTS Of 2517 respondents who used outpatient care in the 12 months preceding interview, 51.7% of respondents used a public facility, 17.8% a private facility, and 30.5% used other facilities. Older age group, higher education and higher wealth were associated with the use of private outpatient healthcare services. Using public outpatient care facilities was associated with having health insurance. Respondents with two or more chronic conditions were more likely to use public and private outpatient care than other facilities. Perceived health system responsiveness was better in private for-profit than in public and private not-for-profit healthcare facilities. CONCLUSIONS This study suggested that higher wealth and multimorbidity were significant predictors of public and private outpatient healthcare utilization; however, health insurance was a predictor only for the use of public facilities. Future mixed-method studies could further elucidate factors influencing the choice of public and private outpatient healthcare use.
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Affiliation(s)
- Mamaru Ayenew Awoke
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- Monitoring, Evaluation and Research Unit, Amref Health Africa, Addis Ababa, Ethiopia
| | - Joel Negin
- School of Public Health, University of Sydney, Sydney, Australia
| | - Jette Moller
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Penny Farell
- School of Public Health, University of Sydney, Sydney, Australia
| | - Alfred E. Yawson
- Department of Community Health, University of Ghana, Accra, Ghana
| | | | - Paul Kowal
- Research Centre for Gender, Health & Ageing, University of Newcastle, Newcastle, Australia
- SAGE, World Health Organization, Geneva, Switzerland
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Mugisha JO, Schatz EJ, Negin J, Mwaniki P, Kowal P, Seeley J. Timing of Most Recent Health Care Visit by Older People Living With and Without HIV. Int J Aging Hum Dev 2016; 85:18-32. [PMID: 27913758 DOI: 10.1177/0091415016680071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this article is to document factors associated with the recency of health-care service utilization by people aged 50 years and over living with and without HIV in Uganda. A survey was conducted with 510 Ugandans aged 50 and older, living with and without HIV. The survey included information on sociodemographic characteristics, health state, self-reported chronic conditions, and timing of most recent visit to a health-care facility (time since last visit [TSLV]). We use ordinal logistic regression to identify independent factors associated TSLV. Independent factors associated with TSLV (>6 months) include age, OR = 2.40 [95% CI 1.08-5.37] for those aged 80 years and above, urban respondents, OR = 0.6 [95%CI 0.38-0.94], HIV-positive respondents, OR = 0.33 [95%CI 0.18-0.59], and better health. To understand the meaning of these finding, further investigation should examine (a) how best to define and measure older persons' health-care service needs and (b) older persons' decision-making processes around the timing of their access to health-care facilities.
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Affiliation(s)
- Joseph O Mugisha
- 1 MRC/UVRI, Uganda Research Unit on AIDS, Entebbe, Uganda.,2 Department of Health Sciences, University of Missouri, Columbia, USA
| | - Enid J Schatz
- 2 Department of Health Sciences, University of Missouri, Columbia, USA
| | - Joel Negin
- 3 School of Public Health, University of Sydney, Sydney, Australia
| | - Paul Mwaniki
- 1 MRC/UVRI, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Paul Kowal
- 4 World Health Organization Study on global AGEing and adult health, Geneva, Switzerland.,5 Research Centre for Generational Health and Ageing, University of Newcastle, NSW, Australia
| | - Janet Seeley
- 1 MRC/UVRI, Uganda Research Unit on AIDS, Entebbe, Uganda.,6 London School of Hygiene and Tropical Medicine, London, UK
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Achieving universal health coverage in South Africa through a district health system approach: conflicting ideologies of health care provision. BMC Health Serv Res 2016; 16:558. [PMID: 27717353 PMCID: PMC5054620 DOI: 10.1186/s12913-016-1797-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 09/24/2016] [Indexed: 11/25/2022] Open
Abstract
Background Universal Health Coverage (UHC) has emerged as a major goal for health care delivery in the post-2015 development agenda. It is viewed as a solution to health care needs in low and middle countries with growing enthusiasm at both national and global levels. Throughout the world, however, the paths of countries to UHC have differed. South Africa is currently reforming its health system with UHC through developing a national health insurance (NHI) program. This will be practically achieved through a decentralized approach, the district health system, the main vehicle for delivering services since democracy. Methods We utilize a review of relevant documents, conducted between September 2014 and December 2015 of district health systems (DHS) and UHC and their ideological underpinnings, to explore the opportunities and challenges, of the district health system in achieving UHC in South Africa. Results Review of data from the NHI pilot districts suggests that as South Africa embarks on reforms toward UHC, there is a need for a minimal universal coverage and emphasis on district particularity and positive discrimination so as to bridge health inequities. The disparities across districts in relation to health profiles/demographics, health delivery performance, management of health institutions or district management capacity, income levels/socio-economic status and social determinants of health, compliance with quality standards and above all the burden of disease can only be minimised through positive discrimination by paying more attention to underserved and disadavantaged communities. Conclusions We conclude that in South Africa the DHS is pivotal to health reform and UHC may be best achieved through minimal universal coverage with positive discrimination to ensure disparities across districts in relation to disease burden, human resources, financing and investment, administration and management capacity, service readiness and availability and the health access inequalities are consciously implicated. Yet ideological and practical issues make its achievement problematic.
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Dou L, Liu X, Zhang T, Wu Y. Health care utilization in older people with cardiovascular disease in China. Int J Equity Health 2015; 14:59. [PMID: 26219955 PMCID: PMC4518585 DOI: 10.1186/s12939-015-0190-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 07/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Population is ageing rapidly and prevalence of cardiovascular diseases is increasing in China. This study aims to examine the patterns of outpatient and inpatient health care utilization across different demographic and socioeconomic groups in older people with cardiovascular disease in China. METHODS Data were from World Health Organization (WHO) Study on Global Aging and Adult Health (SAGE) Wave 1. Chinese older people aged over 50 years with cardiovascular disease were included in the analysis. Outpatient and inpatient care utilization rates were presented and compared by demographic and socioeconomic characteristics. Multivariable logistic regression was used to examine the association between socioeconomic factors and health care utilization. RESULTS In total, 4162 older people with cardiovascular disease in SAGE China Wave 1 were included in the analysis. 86.4% of them had health insurance. 54.9% of the patients received outpatient care and 17.7% received inpatient care over the past 12 months. Outpatient care utilization rate was significantly associated with age. Patients in older groups used more outpatient care than those in younger groups (p = 0.010). Inpatient care utilization rate peaked at 70-79 years group (23.2%), and then reduced to 17.5% in 80 years plus group. Rich patients used more outpatient service than the poorer (p < 0.001). No association was found between household wealth status and inpatient service utilization. CONCLUSION Within the context of high health insurance coverage in China, the pattern of outpatient care utilization differs from that of inpatient care utilization among older patients aged over 50 years old with cardiovascular disease. Patients tend to use more outpatient care as they became older. As for inpatient care, the oldest patients aged over 80 years use less inpatient care than the 70-79 group. Household economic status plays an important role in outpatient care utilization, but it shows no association with inpatient care utilization in Chinese older patients.
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Affiliation(s)
- Lixia Dou
- School of Public Health, Peking University Health Science Center, No.38 Xueyuan Road, Beijing, China.
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University Health Science Center, No.38 Xueyuan Road, Beijing, China.
| | - Tuohong Zhang
- School of Public Health, Peking University Health Science Center, No.38 Xueyuan Road, Beijing, China.
| | - Yangfeng Wu
- School of Public Health, Peking University Health Science Center, No.38 Xueyuan Road, Beijing, China.
- The George Institute for Global Health at Peking University Health Science Center, No.6 Zhichun Road, Beijing, China.
- Peking University Clinical Research Institute, Peking University Health Science Center, No.38 Xueyuan Road, Beijing, China.
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