Different Types Of Health Care Research Articles

Examining the impact of health insurance and socioeconomic factors on children’s hospitalization in Indonesia: an empirical analysis

ABSTRACT The purpose of this research is to examine the impact of different types of healthcare and insurance on the health of Indonesian youth. The study employs logistic regression, a statistical method used to analyze relationships between variables and predict outcomes. Data were collected through an Indonesia’s National Socio-Economic Survey, which gathers information from individuals within a household. The findings reveal that Indonesia’s National Health Insurance (with or without subsidies) reduces the likelihood of children being hospitalized. Families enrolled in the program, often from low- to middle-income backgrounds with limited access to healthcare, benefit significantly from this initiative, which provides affordable and essential health services. This program allows these families to access healthcare that would otherwise be unaffordable. However, private and employer-sponsored insurance did not reduce hospitalization rates, likely because families in these plans already benefit from better overall health, nutrition and access to health-promoting activities. In contrast, children without insurance are more likely to be hospitalized due to their location and economic and financial constraints. Other determinant factors affecting children’s health included age, sex, parent’s education, smoking behavior and house location. The results showed that older children were generally healthier, children of well-educated and non-smoking parents were less likely to be hospitalized and those living in urban areas had a higher likelihood of hospitalization than those in rural areas. This study highlights the importance of expanding access to health insurance and promoting parental education and non-smoking behavior to improve children’s overall health. Failing to address these issues could create challenges for the future, given that the current young generation will eventually become the nation’s leaders.

Longitudinal associations between loneliness, social isolation, and healthcare utilisation trajectories: a latent growth curve analysis

PurposeTo explore the longitudinal associations between eight-year trajectories of loneliness, social isolation and healthcare utilisation (i.e. inpatient, outpatient, and nursing home care) in US older adults.MethodsThe study used data from the Health and Retirement Study in 2006–2018, which included a nationally representative sample of American adults aged 50 and above (N = 6,832). We conducted latent growth curve models to assess the associations between trajectories of loneliness and isolation and healthcare utilisation over 8 years.ResultsIndependent of sociodemographic and health-related confounders, social deficits were associated with a lower likelihood of baseline physician visits (loneliness β= -0.15, SE = 0.08; social isolation β= -0.19, SE = 0.08), but there was a positive association between loneliness and number of physician visits (β = 0.06, SE = 0.03), while social isolation was associated with extended hospital (β = 0.07, SE = 0.04) and nursing home stays (β = 0.05, SE = 0.02). Longer nursing home stays also predicted better trajectories of loneliness and isolation over time.ConclusionLoneliness and social isolation are cross-sectionally related to complex patterns of different types of healthcare. There was no clear evidence that social deficits led to specific trajectories of healthcare utilisation, but nursing home stays may over time help provide social contact, supporting trajectories of isolation and potentially loneliness. Non-clinical services such as social prescribing could have the potential to address unmet social needs and further promote patients’ health-seeking profiles for improving healthcare equity.

Symptom patterns and health service use of women in early adulthood: a latent class analysis from the Australian Longitudinal Study on Women’s Health

BackgroundSymptoms can be strong drivers for initiating interaction with the health system, especially when they are frequent, severe or impact on daily activities. Research on symptoms often use counts of symptoms as a proxy for symptom burden, however simple counts don’t provide information on whether groups of symptoms are likely to occur together or whether such groups are associated with different types and levels of healthcare use. Women have a higher symptom burden than men; however studies of symptom patterns in young women are lacking. We aimed to characterise subgroups of women in early adulthood who experienced different symptom patterns and to compare women’s use of different types of health care across the different symptom subgroups.MethodsSurvey and linked administrative data from 7 797 women aged 22–27 years in 2017 from the 1989–95 cohort of the Australian Longitudinal Study on Women’s Health were analysed. A latent class analysis was conducted to identify subgroups of women based on the frequency of 16 symptom variables. To estimate the associations between the latent classes and health service use, we used the “Bolck, Croon and Hagenaars” (BCH) approach that takes account of classification error in the assignment of women to latent classes.ResultsFour latent classes were identified, characterised by 1) low prevalence of most symptoms (36.6%), 2) high prevalence of menstrual symptoms but low prevalence of mood symptoms (21.9%), 3) high prevalence of mood symptoms but low prevalence of menstrual symptoms, (26.2%), and high prevalence of many symptoms (15.3%). Compared to the other three classes, women in the high prevalence of many symptoms class were more likely to visit general practitioners and specialists, use more medications, and more likely to have had a hospital admission.ConclusionsWomen in young adulthood experience substantially different symptom burdens. A sizeable proportion of women experience many co-occurring symptoms across both physical and psychological domains and this high symptom burden is associated with a high level of health service use. Further follow-up of the women in our study as they enter their late 20 s and early 30 s will allow us to examine the stability of the classes of symptoms and their associations with general health and health service use. Similar studies in other populations are needed to assess the generalisability of the findings.

Health care utilization among individuals who die by suicide as compared to the general population: a population-based register study in Sweden

BackgroundGlobally, 700 000 people die every year by suicide. Health care consultation patterns the period before suicide could be one potential way to identify people at risk for suicide. Therefore, this study examines health care patterns up to one year prior to the suicide by age, sex and prior diagnoses and specifically investigates if and how this differs from the general population of Skåne, Sweden.MethodsThis cohort study includes all individuals, aged 15 and older, that died by suicide in Region Skåne, Sweden from 2004 to 2015 (n = 1653). The individuals were identified through the Cause of death register and then linked to the Skåne healthcare register. Health care data was analyzed as proportions consulting different types of health care the month and year preceding the suicide, we also investigated the impact of age, sex and the occurrence of prior psychiatric and pain diagnoses. Additionally, we compared the proportion of consulting care among the suicide victims and the general population of Skåne.ResultsIn the month before their death, 53% of the suicide victims had any health care consultation, compared with 20% in the general population of Skåne, a given month (p < 0.0001). The corresponding figures for the year prior to suicide was 86% among those who died by suicide, compared to 69% in the general population of Skåne, a given year (p < 0.0001). Women, and those having a documented history of psychiatric diagnosis were more likely to have health care consultations in the month and year preceding suicide (p < 0.001), compared to men and suicide victims without a history of psychiatric disease. Older adults that died by suicide, were less likely to consult psychiatric care compared to the younger suicide victims (p < 0.001).ConclusionA majority of the suicide victims consulted health care in the near time before death and the proportion of seeking health care was significantly higher than in the general population of Skåne and higher among female suicide victims as compared to males. Alternative preventive screening measures should be considered for individuals consulting health care, especially for older people and individuals outside the psychiatric care.

The impact of sources of stigma on health care avoidance among gay and bisexual men in Australia

ABSTRACT Stigma has a negative impact on health and wellbeing for gay and bisexual men (GBM). There is little research which assesses whether stigma from various sources affects access to different health care services. Further, those people who pay more attention to their stigmatised condition may be more likely to avoid health services. This study aimed to assess the association between sources of stigma and health care avoidance amongst a sample of GBM, as well as the role of heightened stigma sensitivity. The sample consisted of 1116 GBM in Australia who completed an online survey. Findings illustrate that those reporting any stigma were more likely to avoid health care services, while avoiding different types of health care was related to the source of the stigma. Greater stigma sensitivity was associated with avoidance of all health care services. GBM may come to health services with complex and potentially recurrent experiences of stigma. Working on the assumption that clients have a history of negative experiences in health care will increase the ability of services to work sensitively with GBM clients and ensure that access to health care amongst this group is increased.

Zoning and Identifying the Affecting Factors in Premature Death Registration

Zoning and Identifying the Affecting Factors in Premature Death Registration

Naturopathy utilisation by Australian women with diagnosed endometriosis: A cross-sectional survey

Background and purposeEndometriosis is a painful female reproductive disease resulting in unmet health needs. Women with endometriosis frequently access different types of health care, yet little is known about naturopathic use. The purpose of this study is to explore the naturopathic utilisation by women with endometriosis in Australia. Materials and methodsThis study reports a cross-sectional survey of Australian women with endometriosis. Participants were recruited through the not-for-profit organisations Endometriosis Australia and EndoActive social media platforms. Data was collected through a self-administered questionnaire by those eligible to participate. Participants were included if they self-reported a diagnosis of endometriosis via laparoscopic surgery and were an Australian resident. ResultsOf the recruited 303 women with endometriosis, 60 women reported consulting with a naturopath for endometriosis care. Women consulting with a naturopath, reported also consulting with a laparoscopic surgeon (66.7%, p = 0.01), acupuncturist (53.3%, p ≤ 0.01), physiotherapist (41.7%, p = 0.01), nutritionists/dietitians (n = 22, 36.7%, p = 0.01) or homeopath (15.0%, p ≤ 0.001), in addition to their naturopath in the previous 12 months for endometriosis management. Compared to non-naturopathic users, women reported frequently experiencing dyspareunia (OR 2.9, CI 1.4–5.9, p = 0.002) and reported a higher use of vitamin D supplementation for endometriosis management (OR 4.9, CI 2.5–9.9, p ≤ 0.001). ConclusionWomen who use naturopathy for endometriosis appear to be high users of health care services, both within complementary medicine and conventional medicine. The efficacy and role of naturopathic treatments and care for women with endometriosis requires further investigation.

Systems of care among children and youth with special health care needs with and without adverse childhood events: National Survey of Children's Health 2016–2017

BackgroundKnowledge of adverse childhood events (ACEs), the associated access to healthcare and unmet needs among children and youth with special health care needs (CYSHCN) is limited. ObjectivesOur objectives were to compare the likelihood of CYSHCN versus non-CYSHCN experiencing one or more ACEs and document differences in receipt of recommended and needed health care among CYSHCN with and without ACEs. MethodsWe combined two years of data from the 2016 and 2017 National Survey of Children's Health (N = 71,181), providing a sample of 16,304 CYSHCN. Our primary outcome measures included eight adverse childhood events, compared to singular and aggregated ACEs among non-CYSHCN. We calculated associations between ACEs and secondary outcome measures for six components of well-functioning systems of care and unmet need for different types of health care using bivariate and multivariate analyses. ResultsCYSHCN were more likely to have each of the ACEs measured and were likelier to experience aggregated levels of ACEs compared to non-CYSHCN. The likelihood of CYSHCN having a medical home with family-centered and coordinated care decreased with increased ACEs, while one or more ACES increased the likelihood of having unmet needs for mental health care. ConclusionThe findings of the current study extend our understanding of the additional adverse event burden associated with special health care needs status, the accompanying limitations in access to family-centered and coordinated care in a medical home and unmet need for mental health care, indicating that much work remains in establishing appropriate care systems for this very vulnerable population.

Socioeconomic differences in healthcare expenditure and utilization in The Netherlands

BackgroundWorldwide, socioeconomic differences in health and use of healthcare resources have been reported, even in countries providing universal healthcare coverage. However, it is unclear how large these socioeconomic differences are for different types of care and to what extent health status plays a role. Therefore, our aim was to examine to what extent healthcare expenditure and utilization differ according to educational level and income, and whether these differences can be explained by health inequalities.MethodsData from 18,936 participants aged 25–79 years of the Dutch Health Interview Survey were linked at the individual level to nationwide claims data that included healthcare expenditure covered in 2017. For healthcare utilization, participants reported use of different types of healthcare in the past 12 months. The association of education/income with healthcare expenditure/utilization was studied separately for different types of healthcare such as GP and hospital care. Subsequently, analyses were adjusted for general health, physical limitations, and mental health.ResultsFor most types of healthcare, participants with lower educational and income levels had higher healthcare expenditure and used more healthcare compared to participants with the highest educational and income levels. Total healthcare expenditure was approximately between 50 and 150 % higher (depending on age group) among people in the lowest educational and income levels. These differences generally disappeared or decreased after including health covariates in the analyses. After adjustment for health, socioeconomic differences in total healthcare expenditure were reduced by 74–91 %.ConclusionsIn this study among Dutch adults, lower socioeconomic status was associated with increased healthcare expenditure and utilization. These socioeconomic differences largely disappeared after taking into account health status, which implies that, within the universal Dutch healthcare system, resources are being spent where they are most needed. Improving health among lower socioeconomic groups may contribute to decreasing health inequalities and healthcare spending.

Association of depressive symptoms with health care utilization in older adults: Longitudinal evidence from the Survey of Health, Aging, and Retirement in Europe

Many older adults with depression do not receive adequate treatment. Differences in treatment utilization may reflect the heterogeneous nature of depression, encompassing multiple distinct symptoms. We assessed whether depressive symptoms are differentially associated with subsequent health care utilization with respect to three outcomes as follows: (1) contact with a medical doctor (MD), (2) depression-specific treatment, and (3) inpatient psychiatric admission. Longitudinal analyses were based on data from three follow-up cycles conducted between 2004 and 2013 among 53,139 participants from the Survey of Health, Aging, and Retirement in Europe. Depressive symptoms were self-reported at baseline of each follow-up cycle using the 12-item EURO-D scale. Health care utilization was self-reported at the end of each follow-up cycle. After adjustment for sex, age, country of interview, follow-up time, educational attainment, presence of a partner in household, body-mass index, the number of chronic diseases, disability, average/prior frequency of contact with an MD, and all other depressive symptoms, people with more frequent contact with an MD had most often reported sleep problems (IRR = 1.10) and fatigue (IRR = 1.10), followed by sad/depressed mood, tearfulness, concentration problems, guilt, irritability, and changes in appetite. Those treated for depression had most often reported sad/depressed mood (OR = 2.18) and suicidal ideation (OR = 1.72), but also sleep problems, changes in appetite, fatigue, concentration problems, hopelessness, and irritability. Sad/depressed mood (OR = 2.87) was also associated with psychiatric inpatient admission. Similarly to other outcomes, appetite change, fatigue, and sleep problems were associated with inpatient admission. Specific symptoms of depression may determine utilization of different types of health care among elderly.

Status and determinants of enrollment and dropout of health insurance in Nepal: an explorative study

BackgroundCompared to other countries in the South Asia Nepal has seen a slow progress in the coverage of health insurance. Despite of a long history of the introduction of health insurance (HI) and a high priority of the government of Nepal it has not been able to push rapidly its social health insurance to its majority of the population. There are many challenges while to achieve universal health insurance in Nepal ranging from existing policy paralysis to program operation. This study aims to identify the enrollment and dropout rates of health insurance and its determinants in selected districts of Nepal.MethodsThe study was conducted while using a mixed method including both quantitative and qualitative approaches. Numerical data related to enrollment and dropout rates were taken from Health Insurance Board (HIB) of Nepal. For the qualitative data, three districts, Bardiya, Chitwan, and Gorkha of Nepal were selected purposively. Enrollment assistants (EA) of social health insurance program were taken as the participants of study. Focus group discussions (FGD) were arranged with the selected EAs using specific guidelines along with unstructured questions. The results from numerical data and focus group discussions are synthesized and presented accordingly.ResultsThe findings of the study suggested variation in enrollment and dropout of health insurance in the districts. Enrollment coverage was 13,545 (1%), 249,104 (5%), 1,159,477 (9%) and 1,676,505 (11%) from 2016 to 2019 among total population and dropout rates were 9121(67%), 110,885 (44%) and 444,967 (38%) among total enrollment from 2016 to 2018 respectively. Of total coverage, more than one-third proportion was subsidy enrollment—free enrollment for vulnerable groups. The population characteristics of unwilling and dropout in social health insurance came from relatively well-off families, government employees, businessman, migrants’ people, some local political leaders as well as the poor class families. The major determinants of poor enrollment and dropout were mainly due to unavailability of enough drugs, unfriendly behavior of health workers, and indifferent behavior of the care personnel to the insured patients in health care facilities and prefer to take health service in private clinic for their own benefits. The long maturation time to activate health service, limited health package and lack of copayment in different types of health care were the factors related to inefficient program and policy implementation.ConclusionThere is a high proportion of dropout and subsidy enrollment, the key challenge for sustainability of health insurance program in Nepal. Revisiting of existing HI policy on health care packages, more choices on copayment, capacity building of enrollment assistants and better coordination between health insurance board and health care facilities can increase the enrollment and minimize the dropout.

Efflux MexAB-Mediated Resistance in P. aeruginosa Isolated from Patients with Healthcare Associated Infections.

Today, one of the most important challenges for physicians is the adequate treatment of infections due to multidrug resistant organism (MDR). Pseudomonas aeruginosa is considered an opportunistic organism causing different types of healthcare associated infections (HAIs). We aimed to investigate the MDR and pandrug resistance (PDR) rate in P. aeruginosa in our region and detect efflux-pump mexAB genes and the proposed binding interactions of five different categories of antimicrobial agents with the mexB pump. A total of 180 non-duplicated P. aeruginosa strains were isolated from patients with HAIs in the Suez Canal University Hospital. Phenotypically, minimum inhibitory concentration (MIC) was done for all MDR and PDR strains before and after addition of efflux pump inhibitor carbonyl cyanide m-chlorophenyl hydrazone (CCCP). Molecular detection of mexA and mexB genes was done by using polymerase chain reaction (PCR). Most of the isolated strains (126 strains) were MDR (70%); only 10 samples (5.5%) were PDR. MexA and mexB genes were detected in 88.2% (120 strains) and 70.5% (96 strains) of stains, respectively. All PDR strains (10 stains) carried both mexA and mexB genes. Efflux mexAB genes were detected in all MDR and PDR strains (136 strains). Molecular modeling studies were performed to investigate the modes of intermolecular binding interactions between the antimicrobial agents and mexB key amino acids that resulted in MDR and PDR. The current study reported high prevalence of MDR and PDR P. aeruginosa in patients with HAIs in the Suez Canal University Hospitals.

Outcome of a neuromuscular training program on recurrent ankle sprains. Does the initial type of healthcare matter?

ObjectivesTo study the impact of initial healthcare for a lateral ankle sprain on the outcome of neuromuscular training (NMT) on recurrent sprains and describe athlete characteristics receiving different types of healthcare. DesignSecondary analysis of three randomized trials. MethodFrom three previous trials evaluating NMT, data on athlete characteristics, type of initial healthcare and a recurrent sprain during one-year follow-up were collected (N = 705). Multilevel logistic regression analyses were used to test the impact of initial healthcare on the outcome of NMT on recurrent sprains. Potential differences in athlete characteristics between different types of healthcare were examined using one-way analysis of variance and Pearson chi-square test. ResultsAfter NMT, 39.7% of the athletes visiting paramedical care reported a recurrent sprain, 21.8% of secondary and 34.0% of primary care. Athletes who visited a physiotherapist reported more recurrent sprains, than those not visiting a physiotherapist (adjusted OR 3.15;95%CI 1.88-5.23). Athletes visiting paramedical (49.7%) and primary care (48.4%) used more braces and/or tape during sport than those not visiting any care (34.2%). ConclusionsThe initial type of healthcare of athletes with an ankle sprain, that consecutively received NMT, seems to impact the occurrence of recurrent sprains. Physiotherapists may be visited by athletes with a poorer prognosis, which may be explained by different athlete characteristics.

Chronic Diseases in High-Cost Users of Hospital, Primary Care, and Prescription Medication in the Capital Region of Denmark.

A small proportion of patients account for the majority of health care costs. This group is often referred to as high-cost users (HCU). A frequently described characteristic of HCU is chronic disease. Yet, there is a gap in understanding the economic burden of chronic diseases associated with HCU to different types of health care services. To analyze which frequent chronic diseases have the strongest association with HCU overall, and HCU in hospital, primary care, and prescription medication. This is a register-based observational study on Danish health service costs for various diseases in different medical settings. A total of 1,350,677 individuals aged ≥ 18years living in the Capital Region of Denmark by 1 January 2012 were included. Chronic diseases, costs, and sociodemographic data were extracted from the nationwide registers, including data from hospitals, primary care, and medicine consumption. These information were merged on an individual level. Cancer, mental disorders except depression, and heart diseases have the strongest association with HCU overall. Mental disorders except depression were in the three diseases most prevalent in HCU in all the three health care services. Our results show that the chronic diseases that have the strongest association with HCU differ between different types of health care services. Our findings may be helpful in informing future policies about health care organization and may guide to different prevention, treatment, and rehabilitation strategies that could lessen the burden in the hospital.

Communicating the detection capabilities of syndromic surveillance systems

ObjectiveTo communicate the detection capabilities of syndromic surveillance systems to public health decision makers.IntroductionIncreasingly public health decision-makers are using syndromic surveillance for real-time reassurance and situational awareness in addition to early warning1. Decision-makers using intelligence, including syndromic data, need to understand what the systems are capable of detecting, what they cannot detect and specifically how much reassurance should be inferred when syndromic systems report ‘nothing detected’. In this study we quantify the detection capabilities of syndromic surveillance systems used by Public Health England (PHE).The key measures for detection capabilities are specificity and sensitivity (although timeliness is also very important for surveillance systems)2. However, measuring the specificity and sensitivity of syndromic surveillance systems is not straight forward. Firstly, syndromic systems are usually multi-purpose and may be better at identifying certain types of public health threat than others. Secondly, whilst it is easy to quantify statistical aberration detection algorithms, surveillance systems involve other stages, including data collection and human decision-making, which also affect detection capabilities. Here, we have taken a ‘systems thinking’ approach to understand potential barriers to detection, and summarize what we know about detection capabilities of syndromic surveillance systems in England.MethodsWithin the systems thinking approach all stages in surveillance (data collection, automated statistical analysis, expert risk assessment and reporting of any aberrations) were considered. Sensitivity and specificity were then calculated for the system as a whole, and the separate impact of each process stage.To communicate these findings to decision-makers, we created an evidence synthesis. Evidence was synthesised from research involving PHE syndromic surveillance systems and retrospective incidents detected and/or investigated by PHE. We then summarized the evidence for different types of incident.ResultsWe identified the following stages which influence detection:The proportion of people who become symptomatic;The proportion of symptomatic people who present to different types of health care;The coding of symptomatic patients;Coverage of different health care systems by syndromic surveillance;Statistical algorithms used to identify unusual clusters within syndromic data;Risk assessment process used to determine action resulting following automated statistical alarms3.Stages 1 to 3 depend on the type of incident that is affecting peoples’ health or healthcare seeking behaviour: stages 3 to 6 depend on the capabilities of the syndromic surveillance system. In general, each stage increases the time until detection, and reduces sensitivity but should improve specificity.Our evidence synthesis identified a wide range of threats to public health including: seasonal outbreaks of respiratory infections; allergic rhinitis; insect bites; gastrointestinal outbreaks; air pollution; and heat waves. We ranked the available evidence, giving more weight to actual events detected and validated against independent evidence, and less to purely descriptive epidemiology or modelled simulations. We created different measures for sensitivity, specificity and timeliness depending on the type of evidence available. Sensitivity ranged from 100% for seasonal influenza to 0% for seasonal adenovirus. Specificity also varied, with high specificity where we had a specific syndromic indicators, e.g. sunstroke, and lower for those associated only with more generic multi-purpose indicators e.g. acute respiratory infections. Timeliness varied from being able to provide early warning of up to seven days prior to traditional surveillance methods for some respiratory illnesses, to being able to detect and report on the health impact of air pollution within four days of a period of poor air quality.ConclusionsThis study has shown that a syndromic surveillance systems’ utility depends on more than just an algorithm’s specificity and sensitivity measure. We’ve identified the impact of the different surveillance stages and separately considered different types of incident. Thus, we can identify the impact of issues such as local population coverage and an individual investigator’s risk assessment practices. Furthermore, the evidence synthesis will provide a summary for decision makers, and help identify gaps in our knowledge where more research is required.

Health Care Service Utilization and Cost Among Adults with Autism Spectrum Disorders in a U.S. Integrated Health Care System.

To compare health care utilization patterns and cost among insured adults with autism spectrum disorder (ASD), adults with attention-deficit and hyperactivity disorder (ADHD), and adults with neither condition (general population [GP] controls). We conducted a case-control study among adults (≥18 years) who were members of Kaiser Permanente Northern California (KPNC) for at least 9 months each year from 2008 to 2012. Cases (N = 1507) were adults with an ASD diagnosis (ICD-9-CM 299.0-299.8) recorded in the electronic medical record on at least two separate occasions by December 31, 2012. Two control groups, adults with ADHD (N = 9042) defined by ICD-9-CM code 314 and GP (N = 15,070), were randomly selected and frequency matched to cases on gender and age. Health care utilization and cost data were obtained from KPNC databases for the year 2012. Compared with adults with ADHD, adults with ASD had significantly higher utilization of outpatient visits for primary care (74.2% vs. 66.6%), mental health (43.3% vs. 33.2%), and laboratory services (60.9% vs. 54.4%). Hospitalizations for ambulatory care sensitive diagnoses (5.4% vs. 2.3%) were less frequent overall but more common among adults with ASD than with ADHD. Group differences were larger comparing adults with ASD with GP controls. Gynecology visits and screening for cervical cancer were significantly less common among women with ASD than among women with ADHD (35% vs. 50%) or GP (35% vs. 49%). Total annual mean healthcare costs for adults with ASD were 20% higher than costs for adults with ADHD and double costs for GP. Adults with ASD had significantly higher rates of utilization across most health care service areas compared with adults with ADHD or GP; however, women with ASD were significantly less likely to have gynecology visits and have screening for cervical cancer. We conducted a study among adults (≥18 years) who were members of Kaiser Permanente Northern California (KPNC) from 2008 to 2012. We compared how often people attended different types of health care and costs of health care among adults with autism spectrum disorder (ASD), adults with attention-deficit and hyperactivity disorder (ADHD), and adults with neither condition (general population [GP] controls). The study included 1507 adults with ASD, 9042 with ADHD but not ASD, and 15,070 GP controls with no ASD or ADHD. Health care and cost data were obtained from KPNC databases for the year 2012. The study found that adults with ASD used more outpatient visits for primary care, mental health, and laboratory services than adults with ADHD. Gynecology visits and screening for cervical cancer were less common among women with ASD than among women with ADHD or GP. Health care costs for adults with ASD were higher than costs for adults with ADHD and costs for GP. In conclusion, adults with ASD had higher rates of use of most health care service areas than adults with ADHD or GP; however, women with ASD were less likely to have gynecology visits and have screening for cervical cancer.

Spatial Equity of Multilevel Healthcare in the Metropolis of Chengdu, China: A New Assessment Approach.

The spatial equity of the healthcare system is an important factor in assessing how the different medical service demands of residents are met by different levels of medical institutions. However, previous studies have not paid sufficient attention to multilevel healthcare accessibility based on both the divergence of hierarchical healthcare supplies and variations in residents’ behavioral preferences for different types of healthcare. This study aims to propose a demand-driven “2R grid-to-level” (2R-GTL) method of analyzing the spatial equity in access to a multilevel healthcare system in Chengdu. Gridded populations, real-time travel distances and residents’ spatial behavioral preferences were used to generate a dynamic and accurate healthcare accessibility assessment. The results indicate that significant differences exist in the spatial accessibility to different levels of healthcare. Approximately 90% of the total population living in 57% of the total area in the city can access all three levels of healthcare within an acceptable travel distance, whereas multilevel healthcare shortage zones cover 42% of the total area and 12% of the population. A lack of primary healthcare is the most serious problem in these healthcare shortage zones. These results support the systematic monitoring of multilevel healthcare accessibility by decision-makers. The method proposed in this research could be improved by introducing nonspatial factors, private healthcare providers and other cultural contexts and time periods.

The impact of aging on different types of health care: The example of the Polish health insurance system.

The aging phenomenon, which is being observed all over the world, can strongly affect health policy and a planning in the health care sector. However, the impact of demographic changes on different parts of it can be varied. The main objective of this study was to check the possible impact of aging on health expenditure (HE) regarding different types of health care and to evaluate whether this impact is significant for all analyzed areas. To show a relationship between age and HE a special indicator (old-age sensitivity) was defined, showing a difference between the standardized value of HE per capita in the age group 65+ and in the group 20 to 64 (defined as the reference group). Then a simple prognosis of expenditure was prepared. Both analyses were done separately for 11 types of health care services and 2 types of goods reimbursement. The results show that while sensitivity varies between the different types of care, however, it is strong in most of them. Because of the prognosis, the expenditure will be increasing for the 9 types of care and decreasing for 4 of them. While in the case of the low values of sensitivity the HE is actually decreasing, the high value of sensitivity does not result in a growing tendency. Our main conclusion is that it is very important for health policy and planning to take into account the diversity of the types of health care and the different influences of changes in the size and structure of population on them.

The effect of a severe health shock on work behavior: Evidence from different health care regimes

In this paper, we use the policy variation of two different types of health insurance in the US and in Denmark – employer-provided and universal insurance combined with substantial differences in expected and actual medical out-of-pocket expenditures – to explore the effect of new severe health shocks on the labor force participation of older workers. Our results not only provide insight into how relative disease risk affects labor force participation at older ages, but also into how different types of health care and health insurance systems affect individual decisions of labor force participation. Although employer-tied health insurance and greater out-of-pocket medical expenditures give US Americans greater incentives to continue to work, we find only small differences in the work response between the two countries. We provide compelling evidence that our somewhat counterintuitive finding is the result of differential mortality and baseline health differences coupled with distinct treatment regimes under the respective health care systems.

Racial/Ethnic differences in health care visits made before suicide attempt across the United States.

Suicide is a public health concern, but little is known about the patterns of health care visits made before a suicide attempt, and whether those patterns differ by race/ethnicity. To examine racial/ethnic variation in the types of health care visits made before a suicide attempt, when those visits occur, and whether mental health or substance use diagnoses were documented. Retrospective, longitudinal study, 2009-2011. 22,387 individuals who attempted suicide and were enrolled in the health plan across 10 health systems in the Mental Health Research Network. Cumulative percentage of different types of health care visits made in the 52 weeks before a suicide attempt, by self-reported racial/ethnicity and diagnosis. Data were from the Virtual Data Warehouse at each site. Over 38% of the individuals made any health care visit within the week before their suicide attempt and ∼95% within the preceding year; these percentages varied across racial/ethnic groups (P<0.001). White individuals had the highest percentage of visits (>41%) within 1 week of suicide attempt. Asian Americans were the least likely to make visits within 52 weeks. Hawaiian/Pacific Islanders had proportionally the most inpatient and emergency visits before an attempt, but were least likely to have a recorded mental health or substance use diagnosis. Overall, visits were most common in primary care and outpatient general medical settings. This study provides temporal evidence of racial/ethnic differences in health care visits made before suicide attempt. Health care systems can use this information to help focus the design and implementation of their suicide prevention initiatives.