Consumption Of Health Care Services Research Articles

PMD52 - YIELD AND COSTS OF POINT-OF-CARE SCREENING TEST VERSUS CASE FINDING TO DIAGNOSE CELIAC DISEASE IN PEDIATRIC PATIENTS

Celiac Disease (CD) is an immune-mediated systemic disorder, common worldwide, caused by the ingestion of gluten in genetically-predisposed people. Low awareness of CD often leads to delays in diagnosis, which adds to medical costs because unrecognized CD is associated with excessive consumption of healthcare services and on-demand medications. This study has assessed the diagnostic yield and cost consequences of 2 strategies of pediatric CD in primary care: screening regardless of symptoms using a point-of-care test (POCT) for the detection versus case finding (CF). Children who went to their family pediatrician were offered POCT for anti-transglutaminase immunoglobulin A antibodies. Immediately after the test, but before knowing the results, a systematic search for one or more symptoms or conditions associated with higher risk for CD was performed. All POCT-positive subjects and those who were symptomatic at CF were referred to the CD Centers for disease confirmation. The costs of examinations and diagnostic and laboratory tests were estimated with regional outpatient tariffs (Sicily), and a price of €2.50 was used for each POCT. Two sensitivity analyses were performed, using ±20% of POCT price and a pediatrician visit cost of €15.31. POCT was offered to 3,358 children. This screening detected 16 new cases of CD; CF detected 5 new cases of CD, but all of these had positive POCT. In the base case, total costs and mean cost per CD patient detected were €10,932.83 and €683.30 for screening strategy with POCT, and €3,953.90 and €790.78 for CF, respectively. In both sensitivity analyses, POCT was less costly than CF. The results of our study suggest that mass screening may bridge the diagnostic gap for CD in children. The analysis has shown that POCT is more effective and less costly, for CD patient identified, than CF strategy.

The impact of accountable care organizations on spine care

ObjectivesThe purpose of this manuscript is to describe the origins of accountable care organizations and summarize their impact on spine care. FindingsThe unmitigated rise in capital expenditures for health care services in the latter half of the twentieth century gave rise to the development of cost-saving measures, including accountable care organizations. These have shown modest cost savings and improvements in quality measures but have largely ignored surgeons and surgical care. ConclusionsAs alternative payment models expand, spine surgery will be targeted for improvements. Spine surgeons should be involved in the structuring of those efforts.

Public hospital reform in Turkey: The “public hospital union” case (2012‐2017)

The issue of public hospital reform in Turkey was raised in the mid-1980s due to the desire to restrict public expenditures for health care services. In the last 30years, transformations of public hospitals into health enterprises with administrative and financial autonomy have been attempted in various ways. The process of subjecting public hospitals to reform evolved into the provincial "public hospital unions" model with the Decree Law No. 663 in November 2011. However, this model, which was created to use resources effectively and efficiently in the field of health, was terminated in 2017. The purpose of this study is to review and evaluate the "public hospital union" model of public hospital reform implemented between 2012 and 2017 as an integrated part of reforms in the Turkish health care system and to examine the factors and obstacles that led to the failure of this model. The level of autonomy, in terms of key management functions of unions and hospitals, was analyzed using the toolkit proposed by Chawla et al (1996), and Preker and Harding (2003). In the study, it is asserted that instead of autonomization and decentralization, such organizational reforms result in centralization and political control.

French home and leisure injury permanent survey: What contribution to epidemiological surveillance?

Introduction The literature and knowledge regarding home and leisure injuries (HLI) are far wider than they used to be a couple of decades ago. Each year in France (65 million of inhabitants), 14 million of admissions are registered in the 730 emergency departments (ED), of which 5 million are HLI. Different types of epidemiological surveillance have been carried out: cross-sectional, population, cohort studies. Nevertheless, little is known about the detailed circumstances of those injuries. The French home and leisure injury permanent survey (“Enquete permanente sur les accidents de la vie courante” - EPAC) provides detailed circumstances of HLI. Methods The French HLI permanent survey started in France in 1986 in a dozen of hospital emergency services and is fully standardized since 2004. All patients admitted for HLI are included. When patients arrive at an ED for HLI, they are informed by medical staff that they will be part of this survey, at this point they can refuse to participate (which happens very rarely). After consenting, patients are included and detailed information is collected: where, when, how, who, what product is involved as well as the chronology of the injury and the care given. Data collected in a fixed format in each hospital are centralized each month at national level. Results In France, like in other countries, several systems provide epidemiological indicators to describe HLI: incidence in population, consumption of health care services, and people at risk. However, when a specific injury needs to be more documented, the only system able to provide solid answers in France is the HLI permanent survey, which records around 120,000 annual injuries. EPAC database allowed providing many results on HLI: button battery ingestion, trampoline injuries, wasp stings, barbecue burns, traumatic sport injuries, elderly falls, traumatic brain injuries, ingestion of cannabis, etc. The strength of the survey is the robustness guaranteed by the annual quality analysis and evaluations making the figures reliable and allowing time series analysis. Incidence rates can be estimated thanks to different methods, including sophisticated models. Conclusion EPAC survey provides details regarding circumstances and products that cannot be found anywhere else in France. Ancillary studies can be run to deepen specific topics: dog bites, outcome of mild traumatic brain injured patients, sequelae of falls among elderly, etc. The possible link with hospitalization databases allows analyzing the most severe HLI. For prevention purposes, there are increasing demands about HLI from the Ministry of Health, organizations, and associations. The EPAC survey is a key tool to improve knowledge about incidence, severity, preventability, and contributes to the diminution of those injuries through specific prevention initiatives and regulations.

Living together with children and elderly: the impact of family structure on the consumption of migrants and residents in urban China

Using data from the first wave of the “China Family Dynamic Survey” conducted in 2014, this study compares the impact on consumption of the presence of children or elderly people in migrant households and to that in urban resident households, and then examines the extent to which lack of access to public services might explain the differences in consumption patterns that do exist. The results indicate that migrant households with infants and toddlers increase their consumption of healthcare services, while those with preschool children increase their consumption of educational services. Migrant households with elderly members significantly increase their consumption of healthcare services. The comparison of migrant households with urban resident households shows that there are considerable differences between migrant households and urban resident households in terms of how educational and healthcare expenditures are affected by the presence of children and elderly. The differences grow out of a huge gap in the accessibility of low-cost, subsidized public preschool education and government-funded health insurance programs.

Monetary and nonmonetary household consumption of health services and the role of insurance benefits: An analysis of the Mexico's National Household Income and Expenditure Survey.

To study the monetary and nonmonetary consumption of healthcare services at household level in Mexico and the magnitude of the contribution of public programs. By using the National Household Income and Expenditure Survey 2012, we performed a cross-sectional and observational analysis of actual household consumption of health services by insurance type (no insurance, social security, Seguro Popular (SP)). Household consumption was divided into 2 categories: consumption related to "monetary" expenditure in health care and "nonmonetary" consumption in health care by the household. Nonmonetary included self-consumption or gifts received from other households and institutional contributions such as government payments or private organization transfers. In SP households, monetary and nonmonetary consumption of health services represented the highest proportion of available household expenditure (11.2%) compared to uninsured (8.4%) and social security (5.9%) households. The prevalence of outpatient consultation and medicine use is the highest among the health service consumption categories regardless of insurance status. Distribution of nonmonetary versus monetary consumption of health services was pro-poor: The poorer the households, the larger the proportion of nonmonetary consumption. The higher probability of receiving nonmonetary resources as a component of health service consumption in SP households is likely to increase the affordability to health services and likely to reduce healthcare expenditures. Future research should focus on the type of nonmonetary consumption of health services at household level to better understand financial protection and access to health care in Mexico.

The economic burden of cancer care in Canada: a population-based cost study.

Resource and cost issues are a growing concern in health care. Thus, it is important to have an accurate estimate of the economic burden of care. Previous work has estimated the economic burden of cancer care for Canada; however, there is some concern this estimate is too low. The objective of this analysis was to provide a comprehensive revised estimate of this burden. We used a case-control prevalence-based approach to estimate direct annual cancer costs from 2005 to 2012. We used patient-level administrative health care data from Ontario to correctly attribute health care costs to cancer. We employed the net cost method (cost difference between patients with cancer and control subjects without cancer) to account for costs directly and indirectly related to cancer and its sequelae. Using average patient-level cost estimates from Ontario, we applied proportions from national health expenditures data to obtain the economic burden of cancer care for Canada. All costs were adjusted to 2015 Canadian dollars. Costs of cancer care rose steadily over our analysis period, from $2.9 billion in 2005 to $7.5 billion in 2012, mostly owing to the increase in costs of hospital-based care. Most expenditures for health care services increased over time, with chemotherapy and radiation therapy expenditures accounting for the largest increases over the study period. Our cost estimates were larger than those in the Economic Burden of Illness in Canada 2005-2008 report for every year except 2005 and 2006. The economic burden of cancer care in Canada is substantial. Further research is needed to understand how the economic burden of cancer compares to that of other diseases.

Healthcare to parents of young terrorism survivors: a registry-based study in Norway

ObjectivesTo assess changes in parents’ short-term and long-term primary and specialised healthcare consumption following a terrorist attack threatening the lives of their children.DesignRegistry-based study comparing parental healthcare service consumption in...

Supplemental health insurance in the Colombian managed care system: Adverse or advantageous selection?

The aim of this article is to estimate the type of selection that exists in the supplemental health insurance market in Colombia where compulsory coverage is implemented through managed care competition. We build a panel database that combines individuals’ information from the Ministry of Health and a database provided by two private health insurers. We perform the correlation test for consumption of health services frequency and supplemental coverage. Following Fang et al. (2008), we condition the estimation on health controls that are available to the econometrician but not to insurers. In both cases we obtain a positive correlation, suggesting that adverse selection predominates. In order to rule out some moral hazard effects, we estimate the correlation between previous frequency of healthcare service consumption and supplemental insurance purchase. The positive correlation obtained is robust to the inclusion of controls for diagnosis implemented by health insurers, suggesting that despite some risk selection strategies, they are not protected from adverse selection. We conclude that some subsidies to supplemental coverage purchase would lower public expenditure in Colombia.

Patterns of medical utilization before the first hospitalization for women with anorexia nervosa in Taiwan

ObjectiveThe aim of this paper was to analyze medical utilization patterns of female patients with anorexia nervosa before their first inpatient care visit for anorexia nervosa using the National Health Insurance Research Database (NHIRD) of Taiwan. MethodWe selected female anorexia nervosa patients (n=239) and control participants hospitalized for peptic ulcers (n=478) or appendectomy (n=478) who were matched by age and incident year from two subsets of the NHIRD. The number of visits, specialists, diagnosis distribution, and selected procedures used in ambulatory services during the 2-year period before the index admission were identified and compared. Healthcare service expenditures were also analyzed. ResultsCompared to the control groups, the female anorexia nervosa patients used more outpatient services (anorexia nervosa, 58.6±45.0 visits; peptic ulcers, 45.3±37.3 visits; appendectomy, 32.5±26.0 visits), mainly due to psychiatric visits. Anorexia nervosa patients were more likely to have received a diagnosis of digestive, endocrine/metabolic, and mental disorders than patients in the control groups. Although nearly equal percentages of patients in the three groups had obtained a diagnosis of a digestive disease, anorexia nervosa patients received digestive disease diagnoses with greater frequency. ConclusionsWe posit that the various physical symptoms of anorexia nervosa patients and physicians' low level of suspicion of anorexia nervosa led to delayed diagnoses and greater medical utilization than that of the controls groups. Education to raise awareness of anorexia nervosa and other eating disorders among physicians is warranted.

Lay agency and the generation of public-private mix health care maps.

This paper discusses part of the results obtained from a study carried out in two cities of the so-called ABCD Paulista Region in the period 2010-2012, in an attempt to spot the existence of non-state regulatory rationale towards access and consumption of health care services. The first stage includes interviews carried out with strategic stakeholders (managers and politicians) and key workers players. The second stage collected the stories of 18 very frequent users of health care services. This study revealed the leading role played by users to produce "health care maps", with emphasis on the frequent use of public and private resources in their itineraries, circumventing or merging with government regulation to obtain the care they need. The different formats of public-private mix transcend the still prevailing "official" concepts about the clear distinction between the two systems, which reveals the importance of this theme to public health management.

The Impact of Social Pensions on Intergenerational Relationships: Comparative Evidence from China.

China launched a new rural pension scheme (hereafter NRPS) for rural residents in 2009, now covering almost all counties with over 400 million people enrolled. This implementation of the largest social pension program in the world offers a unique setting for studying the economics of intergenerational relationships during development, given the rapidity of China's population aging, traditions of filial piety and co-residence, decreasing number of children, and dearth of formal social security, at a relatively low income level. We draw on rich household surveys from two provinces at distinct development stages - impoverished Guizhou and relatively well-off Shandong - to better understand heterogeneity in the impact of pension benefits. Employing a fuzzy regression discontinuity design, we find that around the pension eligibility age cut-off, the NRPS significantly reduces intergenerational co-residence, especially between elderly parents and their adults sons; promotes pensioners' healthcare service consumption; and weakens (but does not supplant) non-pecuniary and pecuniary transfers across three generations. These effects are much larger in less developed Guizhou province.

Social networks usage implications at the level of medical services consumption in Romania

The social networks usage degree increase is evident in recent years, this having implications for the consumption of the most types of products and services. A very special field of research is presented by the consumption of healthcare services, who, both in terms of consumption motivations, decisional buying process or consumer behavior is having peculiarities and specific traits. In this context, the present article aims to investigate the role that social networks use can have regarding changes within the consumer behavior in case of healthcare services consumption. In order to achieve the scientific endeavor, authors have conducted a quantitative marketing research as a field survey, using a questionnaire administered online to patients from different medical institutions, both from the public and private sector.The research results reveal key issues from the perspective of emotional involvement within consumption for the patients and the influence of key variables such as level of education, personality and lifestyle within social networks usage context.

The effects of payments for pharmaceuticals: a systematic literature review

The existence of different forms of out-of-pocket payments (OOPs) for pharmaceuticals across the globe provokes the question whether they can achieve more negative or positive consequences. A systematic literature review was conducted to assess the association between drug cost sharing and health care services utilization, health care costs as well as health outcomes. Studies published in The Cochrane Library, PubMed, Embase were searched with such keywords as: drug, pharmaceutical, cost sharing, out of pocket, co-payments paired with the following: impact, health outcomes, health care costs and utilization. The final review included 18 articles. A total of 11 publications reported the association between drug cost sharing and health care utilization patterns, of which nine found a statistically significant direct relationship. In all 10 publications concerned the association between drug copayments and health care costs. Majority were limited to the impact on the drug budget. Seven studies looked into the link between drug cost sharing and health outcomes, of which five reported statistically significant inverse relationship. There is some evidence for the association between drug copayments, health outcomes and health care services consumption. The optimal system of OOPs' payments for pharmaceuticals needs to prevent drugs' overconsumption and mitigate the risks of excessive cost sharing's burden.

The Impact of Social Pensions on Intergenerational Relationships: Comparative Evidence from China

China launched a new rural pension scheme (hereafter NRPS) for rural residents in 2009, now covering almost all counties with over 400 million people enrolled. This implementation of the largest social pension program in the world offers a unique setting for studying the economics of intergenerational relationships during development, given the rapidity of China's population aging, traditions of filial piety and co-residence, decreasing number of children, and dearth of formal social security, at a relatively low income level. We draw on rich household surveys from two provinces at distinct development stages – impoverished Guizhou and relatively well-off Shandong – to better understand heterogeneity in the impact of pension benefits. Employing a fuzzy regression discontinuity design, we find that around the pension eligibility age cut-off, the NRPS significantly reduces intergenerational co-residence, especially between elderly parents and their adults sons; promotes pensioners' healthcare service consumption; and weakens (but does not supplant) nonpecuniary and pecuniary transfers across three generations. These effects are much larger in less developed Guizhou province.

Levels of depression and satisfaction with life as indicators of health services consumption

Objective: To evaluate the correlation between depression, satisfaction with life, and primary healthcare services consumption.Methods: A random sample of primary healthcare clinic patients agreed to complete self-report questionnaires on demographics and physical activity, the Geriatric Depression Scale (GDS), Satisfaction with Life Scale and the Visual Analog Scale for Happiness. Treating physicians completed the Cumulative Illness Rating Scale (CIRS) for each patient. The relationships among psychometric, medical, the number of visits to health maintenance organization (HMO)-physicians during the previous year was assessed.Results: Positive correlation was found between visits to HMO-physicians and depression severity, as assessed by GDS (p = .049), and between visits/year and illness severity, as measured by CIRS (p < .001). Correlation was also found between depression and number of chronic medications used (p = .005). Physical activity correlated inversely with depression severity (p = .014). Gender and income had no impact on frequency of visits to HMO-physicians, depression, or satisfaction with life.Conclusions: The results indicate that there is a correlation between depression and healthcare service consumption, as represented by number of HMO-physician visits and medication use. Thus, early detection of depression, using tools such as GDS, and early initiation of antidepressive treatment may help to lower the burden on the health system.

Relating Hearing Aid Use to Social and Emotional Loneliness in Older Adults.

Hearing loss is a risk factor for social isolation and loneliness. We investigated the buffering effects of hearing aid use on perceived social and emotional loneliness. Forty older adults participated. Prior to and following the hearing aid fitting, participants completed the De Jong Gierveld Loneliness Scale (De Jong Gierveld & Kamphuis, 1985); a change in feelings of loneliness following hearing aid use was the outcome indicator. There was a significant decline in perceptions of loneliness following 4 to 6 weeks of hearing aid use. A dose effect emerged with persons with moderate-to-severe hearing loss experiencing the greatest reduction in perceived loneliness with hearing aid use. Associated with poorer health status and higher consumption of health care services, perceived loneliness is a challenge to treat. Hearing aid use appears to be a buffer against the experience of loneliness.

SOCIAL FACTORS INFLUENCE FROM THE PERSPECTIVE OF DENTAL HEALTHCARE SERVICES CONSUMERS’ BEHAVIOR

In case of dental care consumption, a very special influence will have the social factors. This influence, from the level of consumers’ behavior can be analyzed on two distinct levels – that of normatives impose by the social organization particular for the community that the individual live and that of the influences of the social groups that individual are interacting with. Dental healthcare services consumption is conditioned at the level of consumption motivations by complex needs which are not confined only to the physiological needs of removing pain caused by a certain dental condition, but are going towards the need of self-image improvement, increasing the appreciation offered by the others group members, the congruence with other consumers decisions within the group (family members, friends, colleagues etc). It is important to note in this context the fact that the influence exerted by consumers exogenous factors (external influences in which we can integrate those from the social groups also) will be combined with the one exerted by endogenous factors (personality, learning process, perceptions, attitudes, motivations etc), representing a continuum that shape consumers and allows in the same time the society shaping by them. The present article proposes a research conducted on dental healthcare services consumers. Results revealed the importance that a series of variables like the importance given to image in the workplace, family, friends and colleagues perception towards dental aesthetic, social class has in the context of consumer behavior. It is also noted that the influence of variables is mediated by the importance given to self-image, dental healthcare services consumption being determined by complex needs, consumption motivations being physiological – specific to some medical conditions and psychological – aesthetic or induced by the pressure corresponding to the need to comply with social norms.

The Impact of Community Based Health Insurance in Enhancing Better Accessibility and Lowering the Chance of Having Financial Catastrophe Due to Health Service Utilization: A Case Study of Savannakhet Province, Laos.

The Lao population mostly relies on out-of-pocket expenditures for health care services. This study aims to determine the role of community-based health insurance in making health care services accessible and in preventing financial catastrophe resulting from personal payment for inpatient services. A cross-sectional study design was applied. Data collection involved 126 insured and 126 uninsured households in identical study sites. Two logistic regression models were used to predict and compare the probability of hospitalization and financial catastrophe that occurred in both insured and uninsured households within the previous year. The findings show that insurance status does not significantly improve accessibility and financial protection against catastrophic expenditure. The reason is relatively simple, as catastrophic health expenditure refers to a total out-of-pocket payment equal to or more than 40% of household income minus subsistence. When household income declines as a result of inability to work due to illness, the 40% threshold is quickly reached. Despite this, results suggest that insured households are not significantly better off under community-based health insurance. However, compared to uninsured households, insured households do have better accessibility and a lower probability of reaching the financial catastrophe threshold.

Consumption of and satisfaction with health care among opioid users with chronic non-malignant pain.

Although persons with chronic pain are frequent users of the health care system, they report poor satisfaction with health care services. Participants with persistent opioid use in Nord-Trøndelag Health Study (HUNT)3 report severe pain in spite of treatment. The aim of the study was to test the hypothesis that subjects with persistent opioid use have both a higher consumption of health care services and a poorer satisfaction than the remaining subjects reporting chronic pain. This cross-sectional study was based on linkage of self-reported data from the substudy (10,238 were invited, 6927 met the inclusion criteria) of health care use in HUNT3; a population-based health survey during the years 2006-2008 and the complete national registers of the Norwegian Prescription Database and the Cancer Registry of Norway. Patients with chronic pain are stratified according to the level of opioid use as persistent users of opioids, intermittent users, and persons not using opioids. Persons with chronic non-malignant pain reported a higher consumption of all health care services compared to the control group. Consumption of health care services increased with increasing level of opioid use. Persons with persistent opioid use were highly satisfied with all health care services, although less satisfied than persons without chronic pain. Combined with previous findings of high levels of pain in spite of opioid treatment, the present findings indicate that symptomatic relief is not a prerequisite for patient satisfaction. The study shows higher patient satisfaction compared to previous studies.