Determinants Of Health Care Utilization Research Articles

Health care utilization for common childhood illnesses in rural parts of Ethiopia: evidence from the 2016 Ethiopian demographic and health survey

BackgroundGenerally, health care utilization in developing countries is low particularly rural community have lower health care utilization. Despite this fact, little is known about the magnitude and determinants of health care utilization for common childhood illnesses in Ethiopia. Thus, this study was conducted to determine the magnitude and to identify determinants of health care utilization for common childhood illnesses in the rural parts of Ethiopia.MethodsFor this study, data were obtained from the 2016 Ethiopian demographic and health survey. A total of 1576 mothers of under-five children were included in the analysis. Data analysis was performed using R software. Both univariable and multivariable logistic regression analysis were fitted to identify the determinants of health care utilization. Variables with a 95% confidence interval for odds ratio excluding one were considered as significant determinants of the outcome.ResultsThe findings of this study revealed that only half (49.7%) (95%CI: 46.1–53.4%), 40.9% (95%CI 37.6–44.2%), and 38.0% (95%CI: 34.7–41.4%) of the children utilized health care for diarrhea, fever, and cough, respectively. Children age between 12 and 23 months (AOR: 1.58, 95%CI: 1.08–2.31), maternal education (AOR: 1.96, 95%CI: 1.34–2.88), and giving birth at health facilities (AOR: 1.49, 95%CI: 1.04–2.13) were found to be the determinants of health care utilization for diarrhea. Marital status (AOR: 0.25, 95%CI: 0.06–0.81), husbands’ education (AOR: 1.37, 95%CI: 1.01–1.86), and giving birth at health facilities (AOR: 1.51, 95%CI: 1.09–2.10) were factors significantly associated with health care utilization for fever. Children age between 12 and 23 months (AOR: 1.51, 95%CI: 1.03–2.22), maternal education (AOR: 1.70, 95%CI: 1.18–2.44), and giving birth at health facilities (AOR: 1.74, 95%CI: 1.23–2.46) were significantly associated with health care utilization for cough.ConclusionsLow health care utilization for childhood illnesses was noticed. The health care utilization for diarrhea and cough was lower for children of ages between 0 and 11 months, mothers without formal education and home-delivered children’s. The health care utilization for fever was lower for separated parents, husbands without formal education, giving birth at home and from the poorest family. Programs to improve the educational status of a household are essential for better care utilization and children development.

Beyond DRG: The effect of socio-economic indicators on inpatient resource allocation in Australia

Financing in Australia's public hospital works through the Australian Refined Diagnosis Related Groups (AR-DRGs) with separations to specific DRG groups based on medical diagnosis or surgical procedure, patient's age, mode of separation, clinical complexity and complications. This paper aims at assessing how the AR-DRGs reflect the efficiency and equity of the hospitals resource allocation. Using administrative data of all acute public hospital admissions and length of stay (LOS) as a proxy for hospital costs, this paper showed that patients’ socio-economic (SES) characteristics are a strong determinant of health care utilization. Our results revealed that the lower the SES, the longer the LOS and hence more utilization of the inpatient resources. Therefore, omitting SES from the risk adjusters list and solely focusing on DRG- based compensation penalizes hospitals catering to lower SES populations. Our findings further support the idea of smaller/remote hospitals based on block funding.

Determinants of health care utilisation: the case of Timor-Leste.

BackgroundHealth financing and delivery reforms designed to achieve universal health coverage (UHC) need to be informed by an understanding of factors that both promote access to health care and undermine it. This study examines the level of health care utilisation in Timor-Leste and the factors that drive it.MethodsData from a nationally representative cross-sectional survey of health care utilisation in 1712 households were used to develop multilevel models exploring how need and predisposing and enabling factors explain health care utilisation at both primary and secondary care facilities.ResultsNeed was found to be the key driver in seeking both primary care and hospital services. Rural households were less likely to go to hospital (odds ratio 0.7) than urban households. The poorest quintile was also less likely to use more expensive hospital services than other socio-economic groups.ConclusionsUnderstanding the determinants of seeking health care in Timor-Leste is of considerable policy significance, because health care is free at the point of use. Our findings indicate that the public resources for health care are subsidising the rich more than the poor. Health care reforms in Timor-Leste need to reduce the ‘other’ costs of health care, such as distance barriers, to address these inequities.

Healthcare Utilization and Costs During the Initial Phase of Care Among Elderly Women With Breast Cancer.

Background: Understanding the patterns of healthcare utilization and costs during the initial phase of care (12 months after breast cancer [BC] diagnosis) in older women (aged ≥65 years) is crucial in the allocation of Medicare resources. The objective of this study was to determine healthcare utilization and costs during the initial phase of care in older, female, Medicare fee-for-service beneficiaries diagnosed with BC, and to determine the factors associated with higher costs. Methods: A retrospective observational study using the SEER-Medicare linked database was conducted in 69,307 women aged ≥66 years diagnosed with primary incident BC in 2003-2009 to determine healthcare utilization, average costs, and costs for specific services during the initial phase of care. Generalized linear model regression was conducted to identify the factors associated with higher costs in a multivariate framework. Results: A total of 96% of women were treated with surgery during the initial phase of BC care, whereas 21% and 54% underwent chemotherapy and radiotherapy, respectively. Costs during the initial phase of care totalled $28,075 in 2012 USD, comprising $13,344 for physician services and $7,456 for outpatient services. Factors associated with higher costs during the initial phase of care were younger age (66-69 years), African American race, higher household income, advanced stages of BC, initial BC treatment, higher number of primary care physician visits, and presence of comorbidities and/or a mental condition. Conclusions: The economic burden of BC is substantial during the initial phase of care. Physician and outpatient services accounted for the highest proportion of costs. Predisposing factors, need-related factors, healthcare use, and external environmental healthcare factors significantly predicted costs during the initial phase of care.

A Triage Tool to Assess Unmet Health Needs for Children Entering Foster Care

Children in foster care have high levels of health care needs, many of which are unmet at foster care entry. Health care coordination (HCC) is essential to ensure unmet needs are addressed rapidly. Data is lacking about how best to triage children at foster care entry so limited HCC resources can be allocated most effectively. Therefore, we aimed to: (1) utilize a Triage Tool (TT) at foster care entry to stratify children based on unmet health care needs and (2) determine if the TT is an accurate predictor of health care utilization as indicated by cost during a child’s first few weeks in care. A TT was developed and utilized during the initial foster care health exam (IFCHE) to stratify children based on unmet needs. Medicaid records were reviewed to determine health care utilization and cost during the first 60 days post-IFCHE. Most children (61.6%) had the lowest level of unmet needs (Level 3), 29.5% had a moderate level of unmet needs (Level 2), and 9.9% had the highest level of unmet needs (Level 1). Medicaid claims review revealed that triage level did not correlate to health care utilization or costs during the first 60 days post-IFCHE. Youth placed in a group home incurred significantly higher costs than those placed in foster homes. These results suggest that the TT is useful clinically but does not predict health care utilization and costs during the first weeks in care. Group home placement incurs more cost than foster home placement, independent of triage level assigned.

1 Chest Pain Care Patterns Across the Carolinas: Determining the Readiness for Widespread HEART Pathway Dissemination

Greater than 50% of patients who present to the ED with chest pain are admitted but <10% are ultimately diagnosed with ACS. This pervasive over-triage costs $10-13 billion annually. The HEART Pathway uses a validated clinical decision aid and serial troponin measures to provide real-time decision support to providers. In prior studies, the HEART Pathway decreased hospitalizations, stress testing, and hospital length of stay, without increasing adverse events, demonstrating efficacy at a single site. However, it is unclear what its effectiveness would be in a multicenter study. In preparation for possible widespread implementation of the HEART Pathway, we sought to determine health care utilization and ACS rates for ED patients with acute chest pain across the 4 Carolinas Collaborative health systems (Wake Forest Baptist Health, Duke University, University of North Carolina, and Medical University of South Carolina). We hypothesized that sites that had not implemented the HEART pathway would have higher hospitalization and stress testing rates compared to the one site that had done so. This multi-center observational study uses the Carolina Collaborative infrastructure to pool data from a common electronic health record platform across 4 academic university-affiliated health care systems. We included adult patients (≥21 years old) presenting to the ED from 1/1/2015-12/31/2015 with a chief complaint of “chest pain” or “heart problem,” for whom the provider ordered troponins. We excluded those with a diagnosis code of ST-segment elevation myocardial infarction (STEMI). We anticipate a total of 20,000 patients being eligible based on prior work. The Carolinas Collaborative has an existing ontology of variables including demographics, diagnoses, medications, and selected laboratory values. We assessed rates of hospitalization, stress testing, angiography, recurrent ED visits, readmissions, death, myocardial infarction, revascularization, and length of stay to determine the potential impact of implementing the HEART Pathway at included sites. Further variables were extracted and definitions harmonized across sites. Rates of hospitalization and stress testing from the Heart Pathway site, Wake Forest Baptist Health (WFBH) will be compared to other sites in the Collaborative. We will calculate p values with alpha =0.05 for these two comparisons with and without propensity score adjustment for comorbid conditions. We will report basic demographics, including age, sex, and race. We will report unadjusted rates of hospitalization and stress testing for non-STEMI patients with chest pain at the Heart Pathway site versus non-HEART pathway sites. After controlling for patient severity and comorbidity, we will determine whether patients at non-HEART pathway sites are more/less likely (odds ratios) to be admitted or to have stress testing. In this comprehensive multicenter EHR data analysis, we anticipate that rates of hospitalization and stress testing among eligible patients will vary across sites. We will be able to determine whether implementing the HEART Pathway is associated with more or less hospitalization and stress testing.

Examining predictors of utilization of an Interdisciplinary outpatient transitions of care service

Objective To determine the impact of need, enabling and predisposing factors on utilization of an interdisciplinary, postdischarge transitions of care (TOC) service. Methods This was a retrospective cohort study of patients discharged from an acute care hospital and scheduled for a TOC visit. Patients with a scheduled TOC appointment at the study clinic within 30 days of a hospital discharge from any of the three University of Pennsylvania Health System hospitals in Philadelphia between September 2013 and January 2015 were included in the study. Individual determinants of healthcare utilization from the Andersen model were extracted from the patients' electronic health record chart. Bivariate analyses were used to identify patient characteristics associated with utilizing the TOC service. A logistic regression model was used to identify independent predictors of TOC service utilization. Key findings TOC utilizers had higher Charlson Comorbidity Index (CCI) scores (OR 1.66, P < 0.01), greater number of internal medicine office visits (OR 1.20, P = 0.03) and took fewer medications (OR 0.89, P < 0.01) relative to non-utilizers. Conclusions Findings from this study can help healthcare administrators prioritize factors associated with the greatest impact on utilization with the ultimate goal of increasing utility of TOC services.

English

The article hinged upon exploring the patterns and determinants of healthcare utilization and financing amongst particularly vulnerable tribal groups (PVTG's) in Nilgiri district of Tamil Nadu. Three PVTG’s viz Paniyas (P), Kattunayakans (KN) and Bettakurumbas (BK) are explored in the study. These groups have some quint essential features impacting the healthcare seeking behaviour e.g. Paniyas were subject to historical repression after they were brought over from Kerala as agricultural labourers culminating into their seclusion and accentuated patient provider wedge. Kattunayackans have their behaviour embedded in using magico-religious beliefs and indigenous medicines. Bettakurumbas are the other forest dwellers residing in Nilgiris biosphere reserve and contemporaneously seek institutional care. Mixed method approach (amalgamation of quantitative and qualitative) was adopted and the households were selected through two stage stratified random sampling. The health seeking behaviour was captured by running a Logit model and Blinder Oaxaca decomposition analysis was conducted to decompose the health gap amongst the tribal groups. Key words: Health seeking behaviour, barriers to care, out of pocket expenses, vulnerable population, tribal group.

Inequalities in health care utilization for common childhood illnesses in Ethiopia: evidence from the 2011 Ethiopian Demographic and Health Survey

BackgroundGlobally, 5.9 million children under the age of five died in 2015. More than half and almost one-third of those deaths occurred in sub-Saharan Africa and South Asia, respectively. Diarrhea and Pneumonia, which were the major causes of the problem, accounted for more than two million deaths of the world’s youngest children every year. Like other developing countries, child health services utilization is low in Ethiopia. The aim of this study was to identify the determinant factors for the inequalities in medical treatment seeking behavior for common childhood illnesses in Ethiopia.MethodsData were obtained from the Ethiopian Demographic and Health Survey (EDHS) 2011. All children who had diarrhea, cough, and fever in the 2 weeks preceding the survey were included. A total of 1620 children with diarrhea, 2082 with fever, and 2134 with cough were included in the analyses. Multivariate logistic regression with a 95% confidence interval, adjusted odds-ratio, and a P < 0.05 were used to determine the independent effect of each variable.ResultsHousehold wealth-status, maternal and paternal education, and religion were found to be associated with the inequality in the use of child health services. Respondents from households with the richest, richer, and middle wealth status had higher odds of seeking medical treatment for childhood diarrhea, cough, and fever than that of the poorest ones. Maternal and paternal educational status was also associated with medical treatment seeking behavior for childhood diarrhea and fever, respectively.ConclusionHousehold wealth and educational status of parents were possible determinant factors for the inequalities observed in health care seeking behavior. Policy interventions aimed at improving the appropriate medical treatment seeking behavior for common childhood illnesses are desirable. Practical economic policies aimed at moving those in the lower wealth quintile are essential to bridge the gap between the rich and the poor. Studies comprising qualitative and quantitative methods are recommended to further explore other determinants of health care utilization.

The association of generalized anxiety disorder and Somatic Symptoms with frequent attendance to health care services: A cross-sectional study from the Northern Finland Birth Cohort 1966.

Objective Generalized anxiety disorder is associated with higher rate of physical comorbities, unexplained symptoms, and health care utilization. However, the role of somatic symptoms in determining health care utilization is unclear. The present study aims to assess the association of frequent attendance of health care services between generalized anxiety disorder symptoms and somatic symptoms. Method This study was conducted cross-sectionally using the material of the 46-year follow-up survey of the Northern Finland Birth Cohort 1966. Altogether, 5585 cohort members responded to the questionnaires concerning health care utilization, illness history, physical symptoms, and generalized anxiety disorder-7 screening tool. Odds ratios belonging to the highest decile in health care utilization were calculated for generalized anxiety disorder symptoms and all (n = 4) somatic symptoms of Hopkins Symptom Checklist-25 controlled for confounding factors. Results Adjusted Odds ratios for being frequent attender of health care services were 2.29 (95% CI 1.58-3.31) for generalized anxiety disorder symptoms and 1.28 (95% CI 0.99-1.64), 1.94 (95% CI 1.46-2.58), 2.33 (95% CI 1.65-3.28), and 3.64 (95% CI 2.15-6.18) for 1, 2, 3, and 4 somatic symptoms, respectively. People with generalized anxiety disorder symptoms had on average a higher number of somatic symptoms (1.8) than other cohort members (0.9). Moreover, 1.6% of people without somatic symptoms tested positive for generalized anxiety disorder, meanwhile 22.6% of people with four somatic symptoms tested positive for generalized anxiety disorder. Conclusions Both generalized anxiety disorder symptoms and somatic symptoms are associated with a higher risk for being a health care frequent attender.

Determinants of Healthcare Utilization Among Veterans with Inflammatory Bowel Disease.

Identifying patient-level and disease-specific predictors of healthcare utilization in inflammatory bowel disease (IBD) may allow targeted interventions to reduce costs and improve outcomes. To identify demographic and clinical predictors of healthcare utilization among veterans with IBD. We conducted a single-center cross-sectional study of veterans with IBD from 1998 to 2010. Demographics and disease characteristics were abstracted by manual chart review. Annual number of IBD-related visits was estimated by dividing total number of IBD-related inpatient and outpatient encounters by duration of IBD care. Associations between predictors of utilization were determined using stepwise multivariable linear regression. Overall, 676 patients (56% ulcerative colitis (UC), 42% Crohn's disease (CD), and 2% IBD unclassified (IBDU)) had mean 3.08 IBD-related encounters annually. CD patients had 3.59 encounters compared to 2.73 in UC (p<0.01). In the multivariable model, Hispanics had less visits compared to Caucasians and African-Americans (2.09 vs. 3.09 vs. 3.42), current smokers had more visits than never smokers (3.54 vs. 2.43, p=0.05), and first IBD visit at age <40 had more visits than age >65 (3.84 vs. 1.75, p=0.04). UC pancolitis was associated with more visits than proctitis (3.47 vs. 2.15, p=0.04). CD penetrating phenotype was associated with more encounters than inflammatory type (4.68 vs. 4.15, p=0.04). We found that current tobacco use, age <40 at first IBD visit, UC pancolitis, and CD fistuilizing phenotype in addition to Caucasian and African-American race were independent predictors of increased healthcare utilization. Interventions should be targeted at these groups to decrease healthcare utilization and costs.

An Econometric Analysis Of Health Care Utilization In Kenya

Background: Increasing access to health care has been a policy concern for many governments, Kenya included. The Kenyan government introduced and implemented a number of initiatives in a bid to address the healthcare utilization challenge. These initiatives include 10/20 policy, exemptions for user fees for some specific health services (treatment of children less than five years, maternity services in dispensaries and health centers, Tuberculosis treatment in public health facilities), and increase in the number of health facilities and health workforce. These initiatives notwithstanding, healthcare utilization in Kenya remains a challenge. The Kenya Household Health Expenditure and Utilization Survey of 2007 found that 17 percent of those who needed health care services could not access the services from both government and private health facilities largely due to financial constraints. This paper employed econometric analysis to examine what could be constraining health care utilization in Kenya despite all the efforts employed. Methods: Using the 2007 Kenya Household Health Expenditures and Utilization Survey (KHHEUS) data (n = 8414), this paper investigates the factors that affect health care utilization in Kenya by estimating a count data negative binomial model. The model was also applied to public and private health facilities to better understand the specificities of poverty in these two facility types. Common estimation problems of endogeneity, heterogeneity, multicollinearity and heteroskedasticity are addressed. Findings: The econometric analysis reveals that out-of-pocket expenditures, waiting time, distance, household size, income, chronic illness area of residence and working status of the household head are significant factors affecting health care utilization in Kenya. While income and distance are significant factors affecting public health care utilization they are not significant in explaining healthcare utilization in private facilities. In addition, working status of the household head, insurance cover and education are significant in explaining private and not public health care utilization. A striking finding is the positive relationship between distance and health care utilization implying that people will travel long distances to obtain treatment. This is perhaps associated with expectations of higher quality of care at far away higher level facilities, especially in rural areas. Conclusion: The paper confirms the existing evidence of the negative effects of Out-of-Pocket (OOP) expenditures and other determinants of health care utilization. With a better understanding of why people use or do not use health services, health care organizations can seek to improve the quality of human life. The bypassing of health facilities for higher level far away facilities implies that it is not so much about availing health facilities, but the quality of the services offered in those facilities. The government should therefore assure quality to increase utilization of the lower level facilities, especially in the rural areas.

Determinants of Healthcare Utilisation and Out-of-Pocket Payments in the Context of Free Public Primary Healthcare in Zambia.

Background: Access to appropriate and affordable healthcare is needed to achieve better health outcomes in Africa. However, access to healthcare remains low, especially among the poor. In Zambia, poor access exists despite the policy by the government to remove user fees in all primary healthcare facilities in the public sector. The paper has two main objectives: (i) to examine the factors associated with healthcare choices among sick people, and (ii) to assess the determinants of the magnitude of out-of-pocket (OOP) payments related to a visit to a health provider. Methods: This paper employs a multilevel multinomial logistic regression to model the determinants of an individual’s choice of healthcare options following an illness. Further, the study analyses the drivers of the magnitude of OOP expenditure related to a visit to a health provider using a two-part generalised linear model. The analysis is based on a nationally representative healthcare utilisation and expenditure survey that was conducted in 2014. Results: Household per capita consumption expenditure is significantly associated with increased odds of seeking formal care (odds ratio [OR] = 1.12, P = .000). Living in a household in which the head has a higher level of education is associated with increased odds of seeking formal healthcare (OR = 1.54, P = .000) and (OR = 1.55, P = .01), for secondary and tertiary education, respectively. Rural residence is associated with reduced odds of seeking formal care (OR = 0.706, P = .002). The magnitude of OOP expenditure during a visit is significantly dependent on household economic well-being, distance from a health facility, among other factors. A 10% increase in per capita consumption expenditure was associated with a 0.2% increase in OOP health expenditure while every kilometre travelled was associated with a K0.51 increase in OOP health expenditure. Conclusion: Despite the removal of user fees on public primary healthcare in Zambia, access to healthcare is highly dependent on an individual’s socio-economic status, illness type and region of residence. These findings also suggest that the benefits of free public healthcare may not reach the poorest proportionately, which raise implications for increasing access in Zambia and other countries in sub-Saharan Africa.

Who uses outpatient healthcare services under Ghana's health protection scheme and why?

BackgroundThe National Health Insurance Scheme (NHIS) was launched in Ghana in 2003 with the main objective of increasing utilisation to healthcare by making healthcare more affordable. Previous studies on the NHIS have repeatedly highlighted that cost of premiums is one of the major barriers for enrollment. However, despite introducing premium exemptions for pregnant women, older people, children and indigents, many Ghanaians are still not active members of the NHIS. In this paper we investigate why there is limited success of the NHIS in improving access to healthcare in Ghana and whether social exclusion could be one of the limiting barriers. The study explores this by looking at the Social, Political, Economic and Cultural (SPEC) dimensions of social exclusion.MethodsUsing logistic regression, the study investigates the determinants of health service utilisation using SPEC variables including other variables. Data was collected from 4050 representative households in five districts in Ghana covering the 3 ecological zones (coastal, forest and savannah) in Ghana.ResultsAmong 16,200 individuals who responded to the survey, 54 % were insured. Out of the 1349 who sought health care, 64 % were insured and 65 % of them had basic education and 60 % were women. The results from the logistic regressions show health insurance status, education and gender to be the three main determinants of health care utilisation. Overall, a large proportion of the insured who reported ill, sought care from formal health care providers compared to those who had never insured in the scheme.ConclusionThe paper demonstrates that the NHIS presents a workable policy tool for increasing access to healthcare through an emphasis on social health protection. However, affordability is not the only barrier for access to health services. Geographical, social, cultural, informational, political, and other barriers also come into play.

Social Determinants and Disparities in Health: Their Crucifixion, Resurrection, and Ultimate Triumph(?) in Health Policy.

David Mechanic has been a principal founder of modern sociological and social science approaches to health, especially in relation to health policy. These approaches have since the 1950s and 1960s resurrected ideas that had currency in the mid-nineteenth century but seemed crucified, dead, and buried by the rise of modern biomedicine from the mid-nineteenth century through the mid-twentieth century. Problems and lacunae in purely biomedical approaches to health in the later twentieth century, along with developments of new biopsychosocial approaches to health, have spawned a return toward ideas of Rudolf Virchow and mid-nineteenth-century social medicine that social determinants and disparities are major drivers of population health. Since individual health and population health constitute the major determinants of health care utilization and expenditures, social determinants and disparities in health are arguably the foundation of a new "demand-side" health policy that can resolve America's paradoxical health policy crisis of spending increasingly more than any nation on health care and insurance yet achieving increasingly worsening health outcomes relative to virtually all developed countries and some developing ones as well, something that current "supply-side" health policy, including Obamacare, cannot do, important as it is for expanding access to health insurance and care.

Determining Health Care Utilization of Children Placed into Foster Care from the Hospital Electronic Medical Record

Determining Health Care Utilization of Children Placed into Foster Care from the Hospital Electronic Medical Record

Factors associated with the health care cost in older Australian women with arthritis: an application of the Andersen's Behavioural Model of Health Services Use

ObjectiveFactors associated with the utilisation of health care have not been rigorously examined in people with arthritis. The objective of this study was to examine the determinants of health care utilisation and costs in older women with arthritis using the Andersen's behavioural model as a framework. Study designLongitudinal cohort study. MethodsParticipants of Surveys 3 to 5 of the Australian Longitudinal Study on Women's Health who reported arthritis were included in the study. Information about health care utilisation and unit prices were based on linked Medicare Australia data, which included prescription medicines and health services. Total health care costs of participants with arthritis were measured for the years 2002 to 2003, 2005 to 2006, and 2008 to 2009, which corresponded to the survey years. Potential explanatory variables of the health care cost and other characteristics of the participants were collected from the health surveys. Explanatory variables were grouped into predisposing characteristics, enabling factors and need variables conforming to the Andersen's Behavioural Model of Health Services Use. Longitudinal data analysis was conducted using generalized estimating equations. ResultsA total of 5834 observations were included for the three periods. Regression analysis results show that higher health care cost in older Australian women with arthritis was significantly associated with residing in an urban area, having supplementary health insurance coverage, more comorbid conditions, using complementary and alternative medicine, and worse physical functioning. It was also found that predisposing characteristics (such as the area of residence) and enabling factors (such as health insurance coverage) accounted for more variance in the health care cost than need variables (such as comorbid conditions). ConclusionThese results may indicate an inefficient and unfair allocation of subsidised health care among older Australian women with arthritis, where individuals with less enabling resources and more socio-economic disadvantages have a lower level of health care utilisation. Future research may focus on evaluating the effectiveness of policies designed to reduce excessive out-of-pocket costs and to improve equity in health care access in the older population.

Physician Payment Incentives and Associated Healthcare Utilization Outcomes in Medicaid Enrolled Asthmatic Children

Very few studies have captured the differences in the outcomes of Medicaid patients between fee-for-service and capitation plan. This study measures the impact of fee-for-service vs. capitation plan on the healthcare utilization and medication adherence in asthmatic children enrolled in Medicaid. A retrospective cohort study was utilized to analyze Medicaid data from 8 states. The data were comprised of medical records such as healthcare utilization, medication and eligibility records of 6435 Medicaid enrolled asthmatic children that had newly started pharmacotherapy for asthma. Quantile regression was used to study medication adherence and Poisson regression was used to determine healthcare utilization. Patients in fee-for-service plans were significantly associated with higher medication adherence rates (p<0.05). Compared to patients in fee-for-service plans, patients in capitation plans had 52% (p<0.05) more hospitalizations, 52% fewer outpatient visits and 32% (p<0.05) more emergency department visits. Medicaid programs primarily use capitation based managed care plans for keeping a check on the healthcare costs. Yet, these plans might not be that cost-effective for the long-term management of asthma. Hence, the policy makers and third party payers should consider disease specific needs of children in order to achieve improved access to care and medication for better management of a particular disease.

Glucocorticoid Use in Patients With Systemic Lupus Erythematosus: Association Between Dose and Health Care Utilization and Costs.

To investigate the determinants of health care utilization and costs with use of glucocorticoid (GC) drugs among adult systemic lupus erythematosus (SLE) patients. This cross-sectional study analyzed established SLE patients identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes from a large US insurance claims database in 2007-2011. Five patient groups were defined by their oral GC use during a 1-year period: non-GC users, <60 days of GC use, and ≥60 days of GC use in low dosage (≤7.5 mg/day), medium dosage (>7.5 to ≤15 mg/day), or higher dosage (>15 mg/day). Annual health care utilization and costs were compared across these groups. Incremental costs of GC groups, calculated as the difference in total health care costs compared with those of the non-GC group, were estimated from multivariable regressions adjusting for demographic/clinical characteristics and stratified by concomitant immunosuppressant use. A total of 50,230 SLE patients were identified (52% non-GC users, 20% <60 days of GC use, and 10% low dose, 10% medium dose, and 8% higher dose of ≥60 days of GC use). GC users had higher health care utilization and costs. Incremental costs were significant (all P < 0.01) for medium-dose ($5,319 and $6,913) and higher-dose ($12,517 and $15,019) GC groups, regardless of concomitant immunosuppressant use. The incremental costs for the low-dose GC group with concomitant immunosuppressants ($1,285; P = 0.04) were smaller than the incremental costs for the low-dose GC group without concomitant immunosuppressants ($2,514; P < 0.01). GC use, especially at higher doses, was associated with higher health care utilization and costs. Findings in users with concomitant immunosuppressants suggest that therapies with a GC-sparing effect may be associated with lower economic burden in SLE treatment.

Socio-Economic Status and Overnight Hospital Stays: Evidence from the Panel Component of the Nigerian Household Survey

An individual’s socioeconomic status is one of the most important determinants of health care utilization. Yet, income as an indicator of socio-economic status is often underreported in survey data. This problem is compounded in African countries due to the existence of a large informal sector and cultural practices. To overcome this situation, this paper constructs a five-scale index based on households’ assets. This alternate measure of one’s socio-economic status is included as an explanatory variable in a negative binomial regression that examines the determinants of overnight hospital stays in Nigeria. My analysis suggests overnight hospital stays tend to decrease in both monetary and asset-based measures of socioeconomic status; although income tends to overstate this effect. Since the poor are more likely to stay more nights in a hospital, this may be an indication that the poor generally delay visits to health care facilities due to the predominance of user fees in the Nigerian health care system. To reduce this trend, there is the need for an expanded and affordable primary health care system that takes into account the local socio-economic environment. Finally, the study finds that the severity of ill-health is the single most important determinant of overnight hospital stays.