Incidence Of Healthcare Utilization Research Articles

The effect of hosting 3.4 million refugees on native population mortality

As of the end of 2017, 3.4 million Syrian refugees lived in Turkey. These refugees left a country where the health system was utterly broken. Several studies report that Syrian refugees faced numerous diseases during their exodus, brought certain infectious diseases to the hosting communities, and have a high incidence of health care utilization. Moreover, they have much higher fertility rates than natives. We examine the effect of Syrian refugees on the health care resources in Turkey and on natives’ mortality—with a focus on infant, child, and elderly mortality. Our OLS results yield suggestive evidence of an adverse effect of the refugee shock on infant and child mortality. However, we find that this is a result of endogenous settlement patterns of refugees. Once we account for the endogeneity using a plausibly exogenous instrument, we find no evidence of an effect on native mortality for any age group. We also analyze the refugees’ pressure on the health care services in Turkey and the government's response to understand our findings on mortality outcomes.

The Effect of Hosting 3.4 Million Refugees on the Health System in Turkey and Infant, Child, and Elderly Mortality Among Natives

As of the end of 2017, 3.4 million Syrian refugees lived in Turkey. These refugees left a country where the health system was completely broken. Several studies report that Syrian refugees faced numerous diseases during their exodus, brought certain infectious diseases to the hosting communities, and have a high incidence of health care utilization. Moreover, they have much higher fertility rates than natives (5.3 to 2.3). We examine the effect of Syrian refugees on the health infrastructure in Turkey and on natives' mortality—with a focus on infant, child, and elderly mortality. Our OLS results yield suggestive evidence of a negative effect of the refugee shock on infant and child mortality. However, we find that this is a result of endogenous settlement patterns of refugees. Once we account for the endogeneity using a plausibly exogenous instrument, we find no evidence of an effect on native mortality for any age group. We also analyze the pressure that the refugees put on the health care services in Turkey, as well as the government's response, to understand our findings on mortality outcomes.

PAR15: COMPARISON OF HEALTH CARE RESOURCE UTILIZATION OF COPD PATIENTS ON CILOMILAST, 15 MG BID VERSUS PLACEBO

OBJECTIVES: Cilomilast is a potent and selective phosphodiesterase type 4 (PDE4) inhibitor currently under development for the treatment of chronic obstructive pulmonary disease (COPD) and asthma. METHODS: COPD-related health care resource utilization including physician visits, emergency room visits, hospitalizations and medication use were prospectively collected in a 6 month randomized, double-blind, placebo controlled, parallel group study of patients on cilomilast, 15 mg bid (n = 431) versus patients on placebo (n = 216). Methods of analysis included descriptive statistics, Kaplan-Meier estimates and Poisson regression. RESULTS: In the year prior to the study, COPD-related health care resource utilization was comparable between patients eventually randomized to cilomilast and those randomized to placebo; the majority of all patients had no or one emergency room visit or hospitalziation. During the entire 24-week study period, the cumulative incidence of health care utilization was significantly lower in the cilomilast group than the placebo group in terms of all utilization (11.0% vs. 21.1%, p = 0.004); including physician visits (11.9% vs. 23.1%, p = 0.002), emergency room visits (0.6% vs. 4.5%, p = 0.004) and hospitalization (0.5% vs. 3.4%, p = 0.021). The relative utilization rates per patient-month of follow-up for each of the utilization types were lower in the cilomilast group than in the placebo group. Treatment with cilomilast resulted in reduction of all utilization by 51% (C.I.: 31%, 65%), physician visits by 41% (C.I.: 15%, 59%). ER visits and hospitalizations were also significantly reduced. CONCLUSIONS: In this study, cilomilast was associated with significantly less COPD-related health care resource utilization, including hospitalizations, emergency room visits and physician visits than placebo.