Financial Costs Of Healthcare Research Articles

Maternal and newborn healthcare utilization in Kampala urban slums: perspectives of women, their spouses, and healthcare providers

BackgroundIt is assumed that the health conditions of urban women are superior to their rural counterparts. However, evidence from Asia and Africa, show that poor urban women and their families have worse access to antenatal care and facility childbirth compared to the rural women. The maternal, newborn, and child mortality rates as high as or higher than those in rural areas. In Uganda, maternal and newborn health data reflect similar trend. The aim of the study was to understand factors that influence use of maternal and newborn healthcare in two urban slums of Kampala, Uganda.MethodsA qualitative study was conducted in urban slums of Kampala, Uganda and conducted 60 in-depth interviews with women who had given birth in the 12 months prior to data collection and traditional birth attendants, 23 key informant interviews with healthcare providers, coordinator of emergency ambulances/emergency medical technicians and the Kampala Capital City Authority health team, and 15 focus group discussions with partners of women who gave birth 12 months prior to data collection and community leaders. Data were thematically coded and analyzed using NVivo version 10 software.ResultsThe main determinants that influenced access to and use of maternal and newborn health care in the slum communities included knowledge about when to seek care, decision-making power, financial ability, prior experience with the healthcare system, and the quality of care provided. Private facilities were perceived to be of higher quality, however women primarily sought care at public health facilities due to financial constraints. Reports of disrespectful treatment, neglect, and financial bribes by providers were common and linked to negative childbirth experiences. The lack of adequate infrastructure and basic medical equipment and medicine impacted patient experiences and provider ability to deliver quality care.ConclusionsDespite availability of healthcare, urban women and their families are burdened by the financial costs of health care. Disrespectful and abusive treatment at hands of healthcare providers is common translating to negative healthcare experiences for women. There is a need to invest in quality of care through financial assistance programs, infrastructure improvements, and higher standards of provider accountability are needed.

Role interlake 18 in the course and progression of osteoarthritis in patients with obesityRole interlake 18 in the course and progression of osteoarthritis in patients with obesity

musculoskeletal disorders are an extremely common pathology. They are the most common cause of chronic pain and disability: every minute, more than 30% of adults suffer from joint pain or limited physical activity. These diseases significantly affect the psychosocial status of patients, their families, and caregivers. The course of joint diseases leads to loss of mobility, social autonomy; such patients have higher rates of hospitalization and mortality. That is, the quality of life significantly deteriorates, and the financial costs of health care for patients and society increase. It is proved that one of the predictors of arthrosis is overweight. In the pathogenesis of osteoarthritis and obesity, proinflammatory cytokines play an important role, the excess synthesis of which leads to the progression and chronicity of the process. Therefore, the aim of our study was to determine the dependence of interleukin-18 activity in patients with osteoarthritis, which occurs on the background of obesity and without it. The study presents the study of interleukin-18 in 75 people with osteoarthritis (OA), which occurred on the background of obesity (main group), and 50 patients with isolated OA (comparison group). The control group consisted of 37 healthy individuals. The diagnosis of OA was established based on the order of the Ministry of Health of Ukraine of 12.10.2006 "On medical care for patients with osteoarthritis", unified diagnostic criteria of the Association of Rheumatologists of Ukraine (2004), and the criteria of the American College of Rheumatologists. The presence and severity of obesity were assessed according to the criteria of the International Diabetes Federation (IDF, 2005) based on the calculation of body mass index (BMI) according to the Kettle formula. When determining the level of IL-18 in the main group, it was found that the content of this cytokine was almost two times higher than the reference values (p <0.05). In the comparison group, the activity of IL-18 increased 1.6 times (p <0.05). Comparison of the content of IL-18 between the study groups allowed us to determine its increase in the presence of obesity by almost 1.2 times. The increase in IL-18 content depended on the radiological stage of joint damage: the maximum value was recorded in patients of the main group with stage 2 symptoms. Apparently, such results are a consequence of the predominance of the inflammatory reaction in the progression of the pathology due to the comprehensive involvement of extra-articular components (ligaments, tendons, bags, etc.). Slightly lower levels of IL-18 in stage 1 OA are likely to be due to the involvement of a limited portion of joint tissue, while the 3rd radiological stage is characterized by a predominance of dystrophic processes. In patients with osteoarthritis, an increase in the content of IL-18 in the serum is determined, which is associated with the development of the inflammatory process in the components of the joint. The content of IL-18 has a direct correlation with overweight / obesity and the radiological stage of the process in the joints. Increased proinflammatory cytokine IL-18, which is a component of the immune system and simultaneously synthesized by adipocytes of adipose tissue, can be considered a factor that will contribute to the preservation of chronic pain and progression of the pathology. Dynamic control of IL-18 activity should be used as an indicator of the effectiveness of therapy.

Association of healthcare utilization with financial worry and anxiety in a general population sample

ABSTRACT This study examined the association of healthcare use (HCU) with financial outcomes in a general population sample (n = 395) to determine if HCU was associated with increased financial worry as most research has examined socioeconomic indicators and material financial problems. Participants reported six types of HCUin the previous year, financial anxiety (FA) and worry about affording healthcare (WAH) in an online survey. In bivariate comparisons, WAH was associated with all forms of HCU and FA was associated with all forms of HCU except outpatient visits. In multivariate analyses, WAH was associated with outpatient visits, emergency room visits, number of doctors, number of scans and number of blood tests (p’s<0.05) but not urgent care visits. FA was associated with emergency room visits, urgent care visits, and number of doctors (p’s<0.05) but not other forms of HCU in multivariate comparisons. As many forms of HCU were associated with more WAH and FA, policy initiatives and patient-level interventions should focus on managing costs rather than shifting from emergency to outpatient care. Results also suggest that the financial costs of healthcare, as indexed by HCU, may have an effect on anxiety and worry specific to healthcare even when controlling for socioeconomic factors.

Assessing Worry About Affording Healthcare in a General Population Sample.

This study adapted a measure on worry about affording healthcare. The financial costs of healthcare are increasingly being shifted to patients. Financial burden from healthcare costs can be material (such as bankruptcy) or psychological. Psychological distress can be either worry about affording future care or distress due to material consequences and, despite evidence from clinical psychology that differentiates these types of emotional symptoms, this distinction has largely been ignored for financial burden in healthcare. We adapted a worry about affording healthcare scale for use in the general population (n = 398) to facilitate comparisons between disease groups and across countries. Participants completed a survey through an online platform. The worry about affording healthcare measure showed good reliability and validity through associations with quality of life (QOL) and measures of other types of financial burden. Worry about affording healthcare was also associated with cost-related non-adherence to medical care. Future research on patient QOL should consider worry about affording healthcare.

Clinician perceptions of respiratory infection risk; a rationale for research into mask use in routine practice.

Outbreaks of emerging and re-emerging infectious diseases are global threats to society. Planning for, and responses to, such events must include healthcare and other measures based on current evidence. An important area of infection prevention and control (IPC) is the optimal use of personal protective equipment (PPE) by healthcare workers (HCWs), including masks for protection against respiratory pathogens. Appropriate mask use during routine care is a forerunner to best practice in the event of an outbreak. However, little is known about the influences on decisions and behaviours of HCWs with respect to protective mask use when providing routine care. In this paper we argue that there is a need for more research to provide a better understanding of the decision-making and risk-taking behaviours of HCWs in respect of their use of masks for infectious disease prevention. Our argument is based on the ongoing threat of emerging infectious diseases; a need to strengthen workforce capability, capacity and education; the financial costs of healthcare and outbreaks; and the importance of social responsibility and supportive legislation in planning for global security. Future research should examine HCWs' practices and constructs of risk to provide new information to inform policy and pandemic planning.

Overdoses and Substance Toxicity in Patients Admitted to Intensive Care Units in a Midwestern U.S. City.

Toxic exposures with serious outcomes have increased over the last decade. Limited data exists on the pattern and outcomes of overdose-exposure patients requiring intensive care unit (ICU) admission. The primary objective of this study was to characterize the causes, treatments, and outcomes of toxic exposures in a mid-sized Midwestern health system. The secondary objective was to report cumulative economic costs associated with these patients. Data were obtained from medical records of patients 18 years or older with a diagnosis code of overdose admitted to the ICU at 2 teaching hospitals between August 1, 2012, and July 31, 2014. There were 470 (10%) of the 4,495 total ICU admissions that met inclusion criteria during the study period. Average patient age was 39 (SD = 14.2) years, with 64% females. Intentional overdose exposure was the cause of 87% of admissions. The majority (70%) of exposures involved multiple pharmacological agents, including ethanol. Most patients did not require therapeutic maneuvers, nor used decontamination methods. Primary substance classes included analgesics, benzodiazepines, ethanol, selective serotonin reuptake inhibitor antidepressants, and methamphetamine. Two hundred sixty-five (56%) patients were ICU to direct home discharges, whereas 198 (42%) were transferred to a lower level of care. The mortality rate in the sample was 1%. Average hospital charges per admission were $20,375 and average ICU charges were $5,284, which summed to more than $2 million in total charges. Causes, treatments, and outcomes of toxic exposures admitted to the ICU in a mid-sized Midwestern city reveal a potential ICU burden. Financial health care costs associated with these toxic exposures were substantial. Greater public health efforts are needed to attempt to minimize preventable admissions and better understand antecedents.

Household Strategies for Coping with the Financial Costs of Health Care in Edo State, Nigeria

The cross-sectional survey design was used in the study to elicit data in Edo State, Nigeria to assess the strategies employed by households to cope with the financial costs of healthcare. Questionnaire data were collected from 508 household respondents in three randomly-selected Local Government Areas of the state including Esan-west, Etsako-west and Egor. Twelve Focus Group Discussions complemented survey data. The main strategies to cope with the financial costs of health care were mobilization of cash and savings (40.5%), and sale of produce and assets (16.0%). Level of income was a significant factors affecting the ability to mobilize cash and savings to cope with the financial costs of health care (X2 = 31.787, 4df, p&lt;0.05, critical value = 9.49). Diversion of money intended for food, education, and clothes to cope with the financial costs of health care was common, relatively, to respondents with low income level (X2 = 13.050, 4df, p&lt;0.05, critical value = 9.94). The findings of the study indicate that urban households have the ability to cope with the financial costs of health care, than rural households. It is therefore imperative that government should not only make healthcare facilities available but should also alleviate poverty in society to enable people defray the cost of healthcare with minimal effort.

Teaching the Cost of Hospital Care to Medical Students

Abstract Physicians significantly influence health care spending, yet little time is spent in medical education addressing the financial costs of health care. This resource is a 2-hour case-based i...

Health and Access to Health Care of Female Family Caregivers of Adults With Developmental Disabilities

The physical and mental health status of women providing care to adult relatives with developmental disabilities was compared with that of the general female population in the United States. There were no differences on physical health across four age groups. However, the mental health of midlife caregivers (45—54 years of age) and older caregivers (older than 65 years) was worse than national norms. This may be associated with two key periods: transitions to adulthood of individuals with disabilities and transitions when aging caregivers are no longer able to provide care. Greater unmet needs for services contributed to poorer mental health. Poorer access to health care also contributed to poorer mental and physical health. Unmet needs for services and out-of-pocket disability-related expenses appeared to pose difficulties for working age caregivers in affording the financial costs of health care for themselves.

Household strategies to cope with the economic costs of illness

The authors examine the strategies rural households in Burkina Faso used to cope with the costs of illness in order to avert negative effects for household production and assets. They use information from 51 qualitative interviews, a household time allocation study and a household survey. Both surveys use the same sample of n = 566 households. The authors analyze these strategies along four dimensions: the type of behavior, the sequence in which strategies employed, the level at which strategies are negotiated, i.e. the household level, the non-household extended kin level or the community level, and finally the success of strategies in protecting household production and assets. A taxonomy of 11 distinct types of coping behavior is developed which have the effect of either avoiding costs by ‘ignoring’ disease, or of minimizing the impact of costs on the household once illness is perceived. Intra-household labor substitution was the main strategy to compensate for any labor lost to illness. However, labor substitution did not eliminate production losses in the majority of households struck with severe illness of a productive member. Only wealthy household were able to fully compensate labor losses by hiring labor or by investing in equipment to enhance productivity. Sales of livestock was the main strategy to cope with the financial costs of health care. None of the households studied fell into calamity. However, the households' ability to avert the loss of production and/or assets was very varied and depended on household size, composition and assets, on the type and duration of illness and on clustering of crises (e.g. several repetitive or simultaneous illnesses or concurrent seasonal stress). Coping with the costs of illness largely occurred at the level of the household. Inter-household transfers of resources played only a small role. The authors develop the concept of risk households and suggest several policies with the potential to strengthen the ability of households to cope with the economic costs of illness.