Influence Health Care Utilization Research Articles

The impact of fruit and vegetable intake on healthcare costs and preventive care in older adults: evidence from SHARE data

Abstract Purpose This study aims to investigate the association between daily fruit and vegetable consumption and healthcare utilization among older European adults. Our findings inform policies aimed at optimizing healthcare resource allocation and promoting healthy ageing in Europe's growing elderly population. Methods Leveraging data from the 8th wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) conducted in 2019–2020, this cross-sectional analysis examines associations between daily fruit and vegetable intake and hospitalization rates, hospital length of stay, visits to general practitioners, and specialist consultations. Results Our results reveal no significant difference in hospitalization probability between individuals consuming fruits/vegetables daily versus less frequently. However, among hospitalized individuals, daily consumption is associated with fewer hospitalizations and shorter hospital stays. Moreover, daily fruit and vegetable intake is positively associated with increased likelihood of consulting general practitioners and specialists. This association may be indicative of a broader health consciousness and proactive approach to well-being management among individuals who prioritize dietary choices. Conclusion These findings suggest that while fruit and vegetable consumption alone may not prevent hospitalizations in this segment of the population, it is linked to reduced re-hospitalization risk and shorter inpatient durations when hospitalized. Additionally, a diet rich in fruits and vegetables appears to promote greater engagement with preventive primary and speciality care among older European adults. Overall, the study highlights dietary behaviour as a potential factor influencing healthcare utilization and expenditures for ageing populations.

How does undervaluation in medical savings accounts (MSAs) affect healthcare utilization? Evidence from administrative data in China

This study examines how the undervaluation of funds in Medical Savings Accounts (MSAs) influences healthcare utilization in China. Given that MSA funds are restricted to healthcare expenses, individuals may undervalue these funds relative to cash, leading to potential overuse of health care. Through an event study approach using administrative data, we find significant reductions in healthcare utilization after MSA balances are depleted—outpatient care expenses drop by 49 percent, and drugstore purchases decrease by 41 percent. These effects persist across socioeconomic groups, indicating that liquidity constraints are not a major factor. Our back-of-the-envelope calculations suggest that insured individuals undervalue MSA funds by 40–70 %. This research sheds light on the behavioral impacts of MSAs and the broader implications of perceived price distortions in health insurance.

Students’ perception of healthcare services and factors affecting their utilization at a Nigerian University: a cross-sectional study

Healthcare service utilization among university students is critical for ensuring their health and academic success. This study was performed to determine the level of utilization as well as the perception and factors influencing the utilization of healthcare services by students at Afe Babalola University, Ado-Ekiti (ABUAD). This research involved a cross-sectional survey in which a semi-structured online questionnaire was used to collect data and a multistage sampling technique was used to sample the students. The students’ perceptions were converted to scores by summing their responses across the questions. The total score for each student was compared against the midpoint of the possible score range. Perceptions with a total score greater than or equal to 12.5 were categorized as positive, while those with a total score less than 12.5 were categorized as negative. Logistic regression analysis was used to identify predictors of healthcare service utilization. Utilization of healthcare services, the key outcome variable, was defined as the frequency with which students accessed available health services. All analyses were carried out using Statistical Product and Service Solutions (SPSS) software. A total of 429 students participated in this study, majority of whom were females (304, 70.9%), with a mean age of 18.9 ± 1.7 years. Three hundred and seventy-five students (87.4%) reported utilizing healthcare services at the university of which 186 (43.4%) reported to occasionally utilize healthcare services in the university. A total of 33.1% perceived that the attitude of staff was poor, while 12.6% strongly disagreed that the healthcare staff were incompetent. Overall, the majority (287, 66.9%) of the students had a negative perception of the utilization of healthcare services. Approximately 16% agreed that the high cost of drugs affects their utilization, while 35.9% agreed that the services provided were too expensive. Predictors of healthcare service utilization included being over 20 years old (AOR = 3.6, 95% CI: 1.1–11.6), study level, with fourth-year students having the highest likelihood of utilization (AOR = 13.8, 95% CI: 5.1–37.4), and positive perception of healthcare staff attitude (AOR = 2.5, 95% CI: 1.1–5.9). Students from lower-income families (< 200,000 Naira) were significantly more likely to utilize healthcare services (AOR = 39.2, 95% CI: 12.6–121.5). The study revealed that, despite widespread usage of healthcare services, students have a predominantly negative perception of these services. Key factors influencing healthcare utilization include age, study level, attitude of staff and family income. Addressing these barriers through targeted interventions can improve health outcomes and promote equitable access to quality healthcare.

Psychological Factors Influencing Healthcare Utilization in Breast Cancer Survivors with Pain.

Pain is a prevalent side-effect seen in breast cancer survivors (BCS). Psychological factors are known role-players in pain mechanisms. Both pain and psychological factors contribute to or interact with healthcare use (HCU). However, the association between psychological factors and HCU has never been investigated in BCS with pain, which is aimed in this study. Belgian BCS with pain (n = 122) were assessed by the Medical Consumption Questionnaire, Injustice Experienced Questionnaire, Pain Catastrophizing Scale, Pain Vigilance and Awareness Questionnaire, Brief Illness Perceptions Questionnaire, and the Depression, Anxiety and Stress Scale. Associations were analyzed using logistic and Poisson regressions. Opioid use was related to more catastrophizing and less psychological distress. Psychotropic drug was related to more psychological distress. Endocrine therapy related to less vigilance and awareness. Psychological distress related to all types of healthcare provider (HCP), with psychological distress negatively related to physiotherapy, psychology, and other primary HCP visits, and positively with visiting a general practitioner and secondary HCP. Catastrophizing related to more visiting behavior in primary HCP, except to a general practitioner. Perceived injustice related to more general practitioner and other primary HCP visits, but to fewer psychology visits. Illness perceptions are only related to visiting other primary HCP. Vigilance and awareness was related to more psychologist and secondary HCP visits. Our findings underscore the complex interplay between HCU and psychological factors in BCS with pain. Psychological distress was overall the most important psychological factor related to HCU, whether catastrophizing and perceived injustice were the most relevant related to HCP visits.

Physical comorbidity is associated with overnight hospitalization in U.S. adults with asthma: an assessment of the 2005–2018 National Health and Nutrition Examination Surveys

Objective Identifying the effects of comorbidity on healthcare utilization is critical for understanding the benefits of improved comorbidity management. Asthma is a common respiratory condition, associated with gastrointestinal, metabolic, psychiatric, and other respiratory conditions. Adults with asthma represent a key population in understanding comorbidity and its consequences. The objective was to explore the relationship between comorbidity and overnight hospitalizations in U.S. adults with asthma. Study design and methods A cross-sectional sample of 3,887 subjects aged 20–79 was aggregated from seven cycles (2005–2018) of the National Health and Nutrition Examination Survey (NHANES). The survey design was created using the full seven cycles, then a subpopulation was used for the analysis. Design-based modified Poisson regression with robust standard errors compared the prevalence of overnight hospitalizations in subjects with and without comorbidities. Comorbidity was defined as the presence of one or more additional chronic conditions. Results Over half (61.6%) of patients with asthma reported having comorbidities. The overnight hospitalization prevalence was higher in those with comorbidities (21.6%) than those without (7.4%). The adjusted prevalence ratio of overnight hospitalizations in those with comorbidities vs. those without was 2.02 (95% CI: 1.54–2.66). Conclusions from sensitivity analyses remained the same. Conclusions Comorbidity in U.S. adult asthma patients is associated with increased overnight hospitalizations. Study results concur with examinations of other healthcare utilization outcomes, revealing how comorbidity influences healthcare utilization patterns in patients with asthma. The reduction of overnight hospitalizations should be a targeted goal when developing and evaluating interventions to manage comorbidities in patients with asthma.

Maximizing Satisfaction in Orthopedic Outpatient Clinics: Evidence From Ireland.

Background Patient satisfaction is a critical metric in healthcare, reflecting the quality of care provided and influencing clinical outcomes and healthcare utilization. In orthopedic outpatient clinics, patient satisfaction affects patient adherence to treatment plans and overall health outcomes. This study aims to identify and analyze key factors influencing patient satisfaction in orthopedic outpatient clinics. Methodology This cross-sectional study was conducted from April to May 2024 across 10 orthopedic outpatient clinics. In this study, family members were included as respondents to the Patient Satisfaction Questionnaire (PSQ) when patients were unable to complete the survey due to age, cognitive impairment, or physical disabilities. This approach was adopted to ensure that the experiences of all patients, particularly minors, elderly individuals, and those with disabilities, were accurately captured. The PSQ assessed various aspects of patient satisfaction, including communication, treatment plans, addressing concerns, clinic environment, and overall satisfaction. Quantitative data were analyzed using SPSS version 27.0 (IBM Corp., Armonk, NY, USA). Results The study included 172 respondents. High levels of overall satisfaction were reported, with 142 (82.6%) respondents very satisfied and 28 (16.2%) somewhat satisfied. Significant associations were found between overall satisfaction and several factors, namely, effective communication, thorough explanation of treatment plans, addressing patient concerns, and a clean, comfortable clinic environment. Shorter waiting times were also associated with higher satisfaction. Regression analysis revealed that staff rating and the thoroughness of treatment plans were significant predictors of overall satisfaction. Conclusions Effective communication, thorough treatment explanations, addressing patient concerns, and maintaining a clean clinic environment are key determinants of patient satisfaction in orthopedic outpatient clinics. Reducing waiting times and investing in staff training on communication and empathetic care can further enhance patient satisfaction. These findings provide valuable insights for healthcare providers and administrators aiming to improve patient experiences in orthopedic outpatient settings. Further research is recommended to explore these relationships in diverse settings and develop targeted interventions.

HPR40 Do State Direct Access Laws to Physical Therapy Influence Healthcare Utilization and Costs Among Medicare Patients With Atraumatic Rotator Cuff Tears? An Instrumental Variable Approach

HPR40 Do State Direct Access Laws to Physical Therapy Influence Healthcare Utilization and Costs Among Medicare Patients With Atraumatic Rotator Cuff Tears? An Instrumental Variable Approach

Health Care Facilities for Unorganised Sectors - Beedi, Cine, and Non-Coal Mine Workers: A Comprehensive Sociological Overview

This paper provides an in-depth review of healthcare facilities for unorganized sector workers in general and particularly in India. It also looks into the systemic lapse ealier in all governments across the globe and a serious and administrative, logistical support now being provided to the unorganised workers in India, particularly focusing on beedi workers, cine industry employees, and non-coal mine workers. Based on a systematic review of existing literature and analysis of dispensary-wise patient data from February 2024, sourced from the Directorate General of Labour Welfare, the study illuminates the disparities in healthcare access and quality across different states. The data includes a detailed breakdown of patient visits across 206 dispensaries, highlighting the heavier reliance on static (on-site) healthcare services compared to mobile services, with notable variations among states such as Karnataka and Madhya Pradesh. This quantitative analysis is graphically represented through charts that depict the distribution of healthcare services and the socio-economic factors influencing healthcare utilization in these sectors. Through critical evaluation of literature the review explores the necessity for more inclusive health insurance schemes and enhanced private sector involvement to mitigate the healthcare challenges faced by these workers. The findings suggest a significant gap in the provision and utilization of healthcare, influenced by logistical, financial, and informational barriers. Recommendations include the implementation of targeted health interventions, expansion of mobile health units, and the development of comprehensive health insurance models that cater specifically to the needs of the unorganized sectors. The study contributes to the broader goal of achieving health equity and improving socio-economic outcomes for these essential yet vulnerable segments of the workforce. Keywords: Unorganized sectors, healthcare accessibility, data analysis, health disparities, beedi workers, cine workers, non-coal mine workers, India, health policy, empirical research.

Analyzing the 20-year declining trend of hospital length-of-stay in European countries with different healthcare systems and reimbursement models

The study aims to investigate the last 20-year (2000–2019) of hospital length of stay (LOS) trends and their association with different healthcare systems (HS) among 25 European countries. A panel dataset was created using secondary data from Eurostat and Global Burden of Disease study databases, with dependent and control variables aggregated at the national level over a period of 20 years. A time trend analysis was conducted using a weighted least squares model for panel data to investigate the association between LOS, HS models [National Health Service (NHS), National Health Insurance, Social Health Insurance (SHI), and Etatist Social Health Insurance], healthcare reimbursement schemes [Prospective Global Budget (PGB), Diagnosis Related Groups (DRG), and Procedure Service Payment (PSP)], and control variables. The study showed a reduction of average LOS from 9.20 days in 2000 to 7.24 in 2019. SHI was associated with a lower LOS compared to NHS (b = − 0.6327, p < 0.05). Both DRG (b = 1.2399, p < 0.05) and PSP (b = 1.1677, p < 0.05) reimbursement models were positively associated with LOS compared to PGB. Our results confirmed the downward trend of LOS in the last 20 years, its multifactorial nature, and the influence of the SHI model of HS. This could be due to the financial incentives present in fee-for-service payment models and the role of competition in creating a market for healthcare services. These results offer insight into the factors influencing healthcare utilization and can inform the design of more effective, efficient, and sustainable HS.

Does Your Patient Need to Lose Weight? Weight Change Before and After Total Hip Arthroplasty Does Not Affect Health Care Utilization and Achievement of the Minimal Clinically Important Difference

BackgroundDespite the potential negative impact of preoperative obesity on total hip arthroplasty (THA) outcomes, the association between preoperative and postoperative weight change and outcomes is much less understood. Therefore, this study aimed to determine the impact of preoperative and postoperative weight change and preoperative body mass index (BMI) on health care utilization, satisfaction, and achievement of minimal clinically important difference (MCID) for Hip Disability and Osteoarthritis Outcome Score Physical Function Short-Form (HOOS PS) and HOOS Pain. MethodsPatients who underwent primary elective unilateral THA between January 2016 and December 2019 were included (N = 2,868). Multivariable logistic regression assessed the association between BMI and preoperative and postoperative weight change on outcomes while controlling for demographic characteristics. ResultsThere was no association between preoperative weight change and prolonged length of stay (> 3 days), 90-day readmission, nonhome discharge, patient dissatisfaction at 1 year, or achievement of HOOS Pain or HOOS PS MCID. Postoperative weight loss was an independent risk factor for patient dissatisfaction at 1 year but was not associated with achievement of either HOOS Pain or HOOS PS MCID at 1-year postoperative. Preoperative obesity classes I to III were independent risk factors for nonhome discharge. Nevertheless, preoperative obesity class I and class II were associated with an increased probability of reaching HOOS Pain MCID. Preoperative BMI was not associated with an increased risk of patient dissatisfaction. ConclusionsPreoperative weight change does not appear to influence health care utilization, satisfaction, or achievement of MCID in pain and function following THA. Postoperative weight loss may play a role as a risk factor for dissatisfaction following THA. Additionally, patients who had a higher baseline BMI may be more likely to see improvement in pain following THA. Therefore, when counseling obese patients for THA, surgeons must balance the risk of perioperative complications with the expectation of greater improvements in pain.

Factors affecting utilization of outpatient healthcare services among the elderly population in Butiama and Musoma districts, Tanzania: A community-based cross-sectional study.

In Tanzania and Sub-Saharan Africa, the elderly population has grown significantly due to improved quality of life, subsequently leading to prolonged life expectancy. Despite global development initiatives, elders still face insufficient care. Through a community-based investigation, this study assessed outpatient department (OPD) healthcare utilization and its determinants among the elderly in Butiama and Musoma districts, Tanzania. This study involved 415 elderly individuals aged 60 or older in Tanzania's Butiama and Musoma districts. Structured questionnaires were used to gather data, and the results were analyzed using SPSS 22. Univariate analysis utilized descriptive statistics, bivariate analysis involved cross-tabulation data, and multivariate logistic regression identified factors influencing OPD service utilization. Approximately 43.4% of participants used OPD services in the past year. Divorced or separated individuals were over two times more likely to utilize OPD services compared to single participants. This association was statistically significant (OR 1.958; 95% CI 1.001-3.829; p = 0.05). About 74.5% of surveyed elders held a positive perception of OPD utilization. Although not statistically significant (p>0.05), individuals with a positive perception had 1.167 times higher odds of using OPD services (95% CI 0.746-1.826). This study highlights a low overall utilization rate of OPD healthcare services among the elderly. Elderly individuals aged 80 years or older, along with widowed or divorced individuals, encounter specific barriers when accessing healthcare services. Positive perceptions play a crucial role in influencing healthcare utilization. It is essential to proactively offer tailored support and conduct further research, specifically addressing the distinct needs of divorced and widowed individuals when seeking healthcare services.

Exploring Preventive Health Care Utilization Among Black/African American Men.

Black/African American (BAA) men have the lowest life expectancy among other major demographic groups in the United States, with BAA male mortality rates 40% higher than their White male counterparts. Despite known benefits of preventive health care utilization, BAA men are 43% more likely to use the emergency department for usual care. Many intersecting factors like medical mistrust and religion have been identified as common barriers BAA men face in health care utilization with few studies exploring factors that impact their current preventive health care utilization. In addition, BAA men's perceptions of health and ability to identify or seek help have always been disproportionately lower than other racial groups despite higher rates of preventable diseases. Using the tenets of the Andersen Healthcare Utilization Model, this cross-sectional study of 176 BAA men explores BAA men's current preventive health care practices while examining the intersection of predisposing, enabling, and need factors on BAA men's preventive health care utilization. While it is well known that higher income levels and higher education positively influence health care utilization, the intersection of religious affiliation and higher levels of medical mistrust was associated with BAA men's decreased engagement with health care as religion posed as a buffer to health care utilization. This study demonstrated that BAA men's perception of health differed by sexual orientation, educational status, and income. However, across all groups the participants' perspective of their health was not in alignment with their current health outcomes. Future studies should evaluate the impact of masculine norms as potential enabling factors on BAA men's preventive health care utilization.

UNDERSTANDING HEALTHCARE UTILIZATION, FRAILTY, AND DELAYS AMONG OLDER SEXUAL AND GENDER MINORITY ADULTS

Abstract Older sexual and gender minority adults (OSGM) have a higher burden of frailty, mental health conditions, and healthcare delays compared to non-SGM older adults (non-OSGM). The study aimed to evaluate the impact of health disparities related to frailty and delays on the relationship between OSGM and healthcare utilization, we hypothesized that improving frailty and delays would reduce healthcare utilization. We used marginal structural models in the All of Us version 6 Controlled Tier Dataset to study the mediating role of frailty and delays on healthcare utilization (self-reported general doctor (PCP) and mental health (MH) visits) by SGM status. OSGM (n=4,763) compared to non-OSGM (n=68,146) were younger (mean [SD], 63 [8] vs 66 [8]), had higher frailty (26% vs 19%), reported more delays (30% vs 24%), less excellent mental health (23.2% vs 30.2%), and majority were insured (96% vs 97%). Minimal differences between the total effect and controlled direct effect between SGM status and visits for frailty (PCP -0.01, MH 0.15) and delays (PCP 0, MH 0.16), suggests visits would remain similar if all OSGM were not frail or reported no delays. Contrary to our hypothesis, improving frailty and delays did not impact healthcare utilization among OSGM. Factors other than frailty and healthcare delays may be influencing healthcare utilization among OSGM in All of Us. Further, bias due to self-report/volunteer bias may affect the ability to examine the association of interest. Future work should examine the consensus between survey and EHR reported healthcare utilization within All of Us.

Abstract PR011: Exploring factors influencing preventive cancer screenings for Native Hawaiian and Pacific Islander adults in Hawaiʻi

Abstract Background: This study aims to investigate cancer-related knowledge, attitudes, and beliefs among Pacific Islanders and Native Hawaiians in Hawaiʻi by examining social factors that influence healthcare utilization behaviors for cancer screenings. The National Cancer Institute developed the Health Information National Trends Survey (HINTS) to collect national data about the use of cancer-related information, access, as well as changing patterns and communications trends regarding health practices. However, HINTS data are not sufficient to address historically excluded demographic subpopulations as each year, an average of 7,393 Hawai‘i residents are diagnosed with invasive cancer and rates are disproportionate ethnically. Methods: We administered a cross-sectional survey during 2017-2018 to Native Hawaiians, Chuukese, and Marshallese in Hawaiʻi using Respondent Driven Sampling (RDS) to recruit these geographically hard-to-reach groups. The modified HINTS survey included questions about cancer knowledge, attitudes, behaviors, social interactions, and cultural practices. A total of 515 Native Hawaiians, 305 Chuukese, and 180 Marshallese completed the survey. Differences were found across a variety of cancer and health-related attitudes, knowledge, and behaviors. The Gelberg and Anderson (2000) Behavioral Model for Vulnerable Populations and biculturalism guided the theoretical and conceptual models for analysis. Logistic regression analysis was used adjusting for age, income, health insurance, and occupational status, to measure social constructs of interest and their interaction with colorectal, pap test, and mammography cancer screenings. To triangulate these findings, key thematic analyses were included from thirteen interviews with adults living within the communities first surveyed. Results: Significant multivariable influences on not having a pap test included never being married (P=.004) and having no health insurance (P&amp;lt;.0001); while influences over having a pap test included a high ethnic identity (P=.001). Significant influences over not having a mammogram included never being married (P=.04), having no health insurance (P&amp;lt;.0001), and not currently employed (P=.009). Significant influences on never having a test for colon cancer included being semi-religious (P=.0001), having no health insurance (P=.005), and not being able to rely on physicians (P=.02). Key findings relating to cancer screenings from the interviews included fear of finding out, lack of language assistance, limited discussion within social circles relating to health and cancer practices, and a belief in a higher intervening power. Conclusion: Cancer prevention education and culturally tailored programs are greatly needed for Pacific Islander and Native Hawaiians in Hawaiʻi. This study provides insight into influences, both positive and negative, on cancer screenings for these communities and areas for future cancer prevention/intervention efforts. Citation Format: Mark L. Willingham Jr., Kevin D. Cassel, Angela Sy, Munirih Taafaki, Tressa P. Diaz, Angelina G. Mummert, Wei Zhang. Exploring factors influencing preventive cancer screenings for Native Hawaiian and Pacific Islander adults in Hawaiʻi [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr PR011.

Influencing Healthcare Utilization: Exploring the Interplay of Education, Attitudes, and Distance in Access to Health Services

This study examines the relationship between education, attitudes, and distance as influencing factors on healthcare utilization patterns. 19 research articles published between 2018 and 2022 were analyzed using quantitative meta-analysis to synthesize existing evidence. The articles examined the effects of education, attitudes, and distance on the utilization of healthcare.The findings indicate that education has no substantial effect on healthcare utilization, suggesting that a higher level of education does not necessarily result in a greater utilization of health services. However, positive attitudes are significantly associated with a 4.42-fold increased likelihood of healthcare utilization, indicating that favorable perceptions of healthcare play a crucial role in encouraging service use.Regarding distance, the analysis determined that it does not have a significant effect on healthcare utilization. This suggests that, contrary to expectations, individuals living further from healthcare facilities do not necessarily encounter greater barriers to accessing health services. These findings provide policymakers and healthcare professionals with important insights for developing evidence-based measures to enhance healthcare access and public health outcomes. Promoting health services to families and communities, improving attitudes and perceptions toward healthcare, and removing barriers to healthcare utilization are examples of possible strategies. Additionally, comprehensive health promotion and healthcare services tailored to suit the needs of the community may increase healthcare utilization. By comprehending these connections, targeted programs can be developed to ensure equitable access to healthcare and enhance the health of the entire population.

Where you live matters: how degree of urbanization influences healthcare utilization in Portugal

Abstract Background The degree of urbanization is a health determinant, causing inequalities in exposure to risk factors, influencing health services’ territorial organization and enabling healthcare utilization. Since Portugal's proportion of population residing in urban areas is higher than the world average, we aimed to estimate the magnitude of the association between the place of residence's degree of urbanization and healthcare utilization in the country. Methods A cross-sectional study was conducted, using data from the Portuguese 2019 National Health Survey, a multi-stage clustered stratified sample. All participants, aged over 15, were included. Outcomes assessed included: going to general practitioner (n = 14 360) and specialist consultations (n = 14 334), taking a flu vaccine (n = 5 270), undergoing a colonoscopy (n = 9 075), too-long waiting times (n = 12 009) and waiting for healthcare due to distance/transportation (n = 12 117). Crude and adjusted prevalence ratios (aPR) and respective 95% confidence intervals (95%CI) were estimated using Poisson regression models. Results Compared to urban areas, living in less populated areas was significantly associated with waiting for healthcare due to distance/transportation (aPR=1.54, CI95% 1.06-2.24) and lower colonoscopy utilization (aPR=0.86, CI95% 0.78-0.95). Flu vaccination prevalence ratios were significantly higher for rural (aPR=1.15, CI95% 1.03-1.29) and suburban areas (aPR=1.16, CI95% 1.04-1.30) than urban areas. There was no significant association between degree of urbanization and attending general or specialist consultations nor too-long waiting times. Conclusions Healthcare needs are not being met in less populated areas likely due to geographic constraints. Against expectation, flu vaccination might not be optimized in urban areas, which could bring concerns for immunization rates in risk groups. Policies to improve universality and equity in population's access to healthcare are needed. Key messages • Differences in healthcare utilization related to place of residence's degree of urbanization show that universal health coverage is yet to be reached. • Less populated areas are more likely to wait too long to receive healthcare due to distance and mobility hindrances, representing a challenge for health systems which policies should help mitigate.

20 years of declining hospital length-of-stay in different European healthcare models and systems

Abstract Background Hospital length of stay (LOS) is an important indicator of healthcare systems’ performance. Several factors are closely related to LOS, which is characterized by high heterogeneity among countries. This study aims to investigate the 20-year time-trends of LOS and their association with different healthcare systems’ and reimbursement models among 25 European countries. Methods We conducted a 20-year time-trend analysis (2000-2019) using a Weighted Least Squares model for panel data to investigate the association between LOS, healthcare systems’ models (National Health Service, NHS, National Health Insurance, NHI, Social Health Insurance, SHI, and Etatist Social Health Insurance, ESH), reimbursement schemes (Prospective Global Budget, PGB, Diagnosis Related Groups, DRG, and Procedure Service Payment, PSP), and several control variables. Data were extracted from the Eurostat and GBD study databases. Results The analysis showed a generalized reduction of LOS across the 25 countries, ranging from 9.20 days in 2000 to 7.24 in 2019. SHI was associated with a lower LOS compared to the reference category (NHS) (b=−0.6327, p &amp;lt; 0.05). Both DRG (b = 1.2399, p &amp;lt; 0.05) and PSP (b = 1.1677, p &amp;lt; 0.05) reimbursement models were positively associated with LOS when compared to PGB. Conclusions Our results confirmed the downward trend of LOS in the last 20 years among European countries, highlighting the strong influence of the healthcare system model. The results of this study offer insight into the factors influencing healthcare utilization and can inform the design of more efficient and sustainable healthcare systems. Key messages • This study investigated the relationship between HS models, financing, regulation, service provision, reimbursement schemes, and LOS, across 25 European countries in the last 20 years. • This study found a dominant influence of the HS models on LOS. SHI models were associated with shorter LOS compared to National Health Systems, after accounting for several factors.

Maternal health policy environment and the relationship with service utilization in low- and middle-income countries

The extent to which a favorable policy environment influences health care utilization and outcomes for pregnant and postpartum women is largely unknown. In this study, we aimed to describe the maternal health policy environment and examines its relationship with maternal health service utilization in low- and middle-income countries (LMICs). We used data from World Health Organization's 2018-2019 sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) policy survey linked with key contextual variables from global databases, as well as UNICEF data on antenatal care (ANC), institutional delivery, and postnatal care (PNC) utilization in 113 LIMCs. We grouped maternal health policy indicators into four categories - national supportive structures and standards, service access, clinical guidelines, and reporting and review systems. For each category and overall, we calculated summative scores accounting for available policy indicators in each country. We explored variations of policy indicators by World Bank income group using χ2 tests and fitted logistic regression models for ≥85% coverage for each of four or more antenatal care visits (ANC4+), institutional delivery, PNC for the mothers, and for all ANC4+, institutional delivery, and PNC for mothers, adjusting for policy scores and contextual variables. The average scores for the four policy categories were as follows: 3 for national supportive structures and standards (score range = 0-4), 5.5 for service access (score range = 0-7), 6. for clinical guidelines (score range = 0-10), and 5.7 for reporting and review systems (score range = 0-7), for an average total policy score of 21.1 (score range = 0-28) across LMICs. After adjusting for country context variables, for each unit increase in the maternal health policy score, the odds of ANC4+>85% increased by 37% (95% confidence interval (CI) = 1.13-1.64) and the odds of all ANC4+, institutional deliveries and PNC>85% by 31% (95% CI = 1.07-1.60). Despite the availability of supportive structures and free maternity service access policies, there is a dire need for stronger policy support for clinical guidelines and practice regulations, as well as national reporting and review systems for maternal health. A more favorable policy environment for maternal health can improve adoption of evidence-based interventions and increase utilization of maternal health services in LMICs.

UTILIZATION AND CHOICE OF HEALTH CARE: EMPIRICAL EVIDENCE FROM INDIA

Utilization and choice of health care services are two important decision-making issues once an individual perceives or realizes illness. Identifying and measuring the factors that influence health care utilization and choice are important concern for policy makers, to reduce health system inequality. Both demand and supply side factors influence the above-mentioned choice decisions. However, the nature and severity of illness can also affect the above choice decisions. This study has identified and measured the role of disease specification as an important determinant of choice decision along with its influence on other factors. This study also explored the regional and socio-economic variation of factors which hinder the utilization of government-provided health care services. Analyzing the data of women and child household members, the study found that disease specification affects the choice of health care provider and even influences the role of other important factors.

Refugee Family Health Brokers' (FHBs') Experiences with Health Care Providers: A Thematic Analysis.

The resettlement and post-resettlement quality of life of refugees is often marred by chronic health/mental health conditions. To adequately care for refugees suffering these conditions, a promising strategy is the use of refugee Family Health Brokers (FHBs). FHBs are safe and trusted family members functioning as intermediaries between one's family and health care providers. Although FHBs are known to positively influence health care utilization in their families, little is known about them and this aspect of their family caregiving role and experiences, particularly with health care providers, necessitating further research. Fourteen Bhutanese and three Bosnian refugee FHBs participated in a 2-hr focus group discussing their experiences with health care providers after being surveyed about their FHB role. Thematic analysis yielded five themes centered around perceptions, knowledge, communication, behavior, and responsibilities reflective of FHBs' experiences, which can be understood as symptoms of existing structural inequalities. FHBs primarily conveyed problems, struggles, and dilemmas they experienced more so than rewarding aspects of being an FHB. Suggestions are provided on how to avert these negative experiences from occurring and becoming barriers to developing allyship with FHBs in the context of existing structural inequalities.