Private Health Insurance Coverage Research Articles

Laboratory-based surveillance of chronic kidney disease in people with private health coverage in Brazil

BackgroundAlthough approximately 25% of Brazilians have private health coverage (PHC), studies on the surveillance of chronic kidney disease (CKD) in this population are scarce. The objective of this study was to estimate the prevalence of CKD in individuals under two PHC regimes in Brazil, who total 8,335,724 beneficiaries.MethodsOutpatient serum creatinine and proteinuria results of individuals from all five regions of Brazil, ≥ 18 years of age, and performed between 10/01/2021 and 10/31/2022, were analyzed through the own laboratory network database. People with serum creatinine measurements were evaluated for the prevalence and staging of CKD, and those with simultaneous measurements of serum creatinine and proteinuria were evaluated for the risk category of the disease. CKD was classified according to current guidelines and was defined as a glomerular filtration rate (GFR) < 60 ml/min/1.73 m² estimated by the 2021 CKD-EPI equation.ResultsThe number of adults with serum creatinine results was 1,508,766 (age 44.0 [IQR, 33.9–56.8] years, 62.3% female). The estimated prevalence of CKD was 3.8% (2.6%, 0.8%, 0.2% and 0.2% in CKD stages 3a, 3b, 4 and 5, respectively), and it was higher in males than females (4.0% vs. 3.7%, p < 0.001, respectively) and in older age groups (0.2% among 18-29-year-olds, 0.5% among 30-44-year-olds, 2.0% among 45-59-year-olds, 9.4% among 60-74-year-olds, and 32.4% among ≥ 75-year-olds, p < 0.001) Adults with simultaneous results of creatinine and proteinuria were 64,178 (age 57.0 [IQR, 44.8–67.3] years, 58.1% female). After adjusting for age and gender, 70.1% were in the low-risk category of CKD, 20.0% were in the moderate-risk category, 5.8% were in the high-risk category, and 4.1% were in the very high-risk category.ConclusionThe estimated prevalence of CKD was 3.8%, and approximately 10% of the participants were in the categories of high or very high-risk of the disease. While almost 20% of beneficiaries with PHC had serum creatinine data, fewer than 1% underwent tests for proteinuria. This study was one of the largest ever conducted in Brazil and the first one to use the 2021 CKD-EPI equation to estimate the prevalence of CKD.

Socioeconomic mental health disparities and income mobility in Australia: A longitudinal factor decomposition analysis

In recent years mental health disparity has been rising in Australia. The contributing factors to this rising disparity are not well understood. We investigated this by measuring and decomposing socioeconomic mental health inequality in Australia using the Household, Income and Labour Dynamics in Australia (HILDA) panel survey datasets between 2009 and 2017 employing the longitudinal factor decomposition method. In this research, we decompose the Income-Related Health Mobility (IRHM) and the Health-Related Income Mobility (HRIM) index. The IRHM index reflects the effect of the relationship between relative health changes at a constant income level, and the HRIM index represents changes in income ranking or income mobility with a fixed health outcome over time. Our findings suggest that poorer individuals cannot procure private health insurance, experience more long-term health conditions and have larger exposure to life shocks than richer individuals. Thus, long-term health conditions, private health insurance coverage, and number of life disruptions are the primary factors that negatively impact the IRHM index, thereby contributing to an increase in socioeconomic inequality in mental health in Australia. Moreover, the HRIM index exhibits a more pronounced adverse impact from labour force status compared to the relatively weaker positive effects observed in the IRHM index, resulting in a net negative effect from labour force status in this period. To address this, Australian governments should focus on implementing cost-effective intervention policies targeting disadvantaged populations to maximise health system resources and minimise mental health disparity by addressing the socioeconomic determinants of mental health.

Healthcare cost coverage inequality and its impact on hypertension and diabetes: A five-year follow-up study in a Malaysian rural community.

Inequality in health care access is a socioeconomic driver for non-communicable disease related risk factors. This study examined the inequality trend in healthcare cost coverage (HCC) compared to private health insurance (PHI) coverage, a subtype of HCC, over 5 years. The study will also determine the association between HCC (and PHI) and the status of hypertension and diabetes diagnosis. The rich-poor ratio, concentration curve and concentration index were derived to determine the level of inequality. Furthermore, logistic regression was done to determine the association between HCC and the status of hypertension and diabetes. The PHI group (rich-poor ratio: 1.4 [rich: 454, poor: 314] and 2.6 [rich: 375, poor: 142]; concentration index: 0.123 [95% confidence interval, CI: 0.093-0.153] and 0.144 [95% CI: 0.109-0.178] in 2013 and 2018, respectively) has relatively higher inequality compared with the HCC group (rich-poor ratio: 0.9 [rich: 307, poor: 337] and 1.1 [rich: 511, poor: 475]; concentration index: -0.027 [95% CI: -0.053 to -0.000] and -0.014 [95% CI: -0.033 to 0.006] in 2013 and 2018, receptively). Contrasting to the observation with the HCC group, PHI was associated with higher odds for hypertension (adjusted odds ratio [aOR] = 1.252, p = 0.01, 95% CI: 1.051-1.493) and diabetes (aOR = 1.287, p = 0.02, 95% CI: 1.041-1.590) in 2018. Over 5 years, the inequality in PHI coverage remained higher compared with HCC, which suggests that the rich enjoyed private healthcare more. Furthermore, those with PHI were more likely to report known hypertension and diabetes in 2018. It is reasonable to assume that those with PHI are more likely to have earlier diagnoses compared to others and are more likely to be aware of their condition. Policymakers need to identify strategies that can narrow the existing gap in quality and type of service between the private and public health sectors.

Private Health Insurance in the Post-Pandemic Era: Spatial Econometric Market Development Analysis

The post-COVID era has posed unprecedented challenges to healthcare systems worldwide, urging a reevaluation of healthcare financing mechanisms. This study investigates the evolving landscape of private health insurance markets in the aftermath of the pandemic while considering the influence of international sanctions. Employing a spatial lag model (SLM), data from Albania, Russia, and Malaysia were analyzed to uncover the intricate interplay of factors shaping private health insurance coverage rates. The findings reveal nuanced patterns and disparities across these countries. The significance of variables varies: while private insurance share and government health expenditure consistently exhibit positive and substantial impacts on coverage rates, the unemployment rate presents differential effects. COVID-19 deaths influence coverage in Russia, emphasizing the pandemic's specific impact. Moreover, hospital beds’ significance in Malaysia underscores healthcare infrastructure's varying importance. Importantly, the spatial lag effect is consistently significant, emphasizing regional interdependence. Collectively, our study highlights the multifaceted determinants of private health insurance coverage, revealing insights crucial for policymakers navigating post-pandemic healthcare financing challenges among international sanctions. Doi: 10.28991/ESJ-2023-07-06-013 Full Text: PDF

Abstract B092: Area-level socioeconomic influences on rates of cervical and colon cancer screenings

Abstract Introduction and Study Purpose: Cancer screening is one of the most important preventive modifiers of cancer outcome. The general correlation between negative socioeconomic influences (SEIs) and poorer cancer screening rates is known. However, variations on SEI correlation with cancer screening need to be confirmed at a smaller local level since there could be significant local variations. CDC PLACES is a high resolution dataset that provides data on cancer screening rates at a census tract level with coverage across the US. It is made up of small area estimates constructed with demographic data in CDC BRFSS, poverty data from ACS, and other sources. With CDC PLACES and SEI data readily available on a census tract level, it is possible to calculate associations between cancer screening compliance and SEIs on a local level to better identify communities potentially benefiting from increased cancer screening. We hypothesize that cancer screening rates will be positively correlated with economic resources, education, insurance coverage, and decreased minority population. Methodology: We performed a retrospective cross-sectional study of cervical and colon cancer screening rates at a census tract level using data from CDC PLACES. This study included 378 of the 443 census tracts in Cuyahoga County, Ohio. 65 census tracts were excluded due to missing data. SEI census tract-level variables including race, gender, age, income, education, and health insurance coverage were obtained from ACS. Cancer screening rates were obtained from CDC PLACES. Linkage across datasource was conducted at the census tract level. Pearson correlation coefficients were calculated to examine associations between the selected SEI variables and cancer screening rates across all 378 census tracts. Results: Within the 378 census tracts examined, cervical and colon cancer screening rates in Cuyahoga County were correlated with a similar set of SEI variables. Positive correlations were observed between cervical and colon cancer screening rates with greater percent White population (r=0.35, p&amp;lt;0.001; r=0.36, p&amp;lt;0.001; respectively), formal education achievement (r=0.75, p&amp;lt;0.001; r=0.79, p&amp;lt;0.001; respectively), and private health insurance coverage (r=0.75, p&amp;lt;0.001; r=0.81, p&amp;lt;0.001; respectively). Conversely, cervical and colon cancer screening rates were negatively correlated with greater percent of Black population (r=-0.24, p&amp;lt;0.001; r=-0.27, p&amp;lt;0.001; respectively), lower English language fluency (r=-0.47, p&amp;lt;0.001; r=-0.42, p&amp;lt;0.001; respectively), higher unemployment (r=-0.47, p&amp;lt;0.001; r=-0.51, p&amp;lt;0.001; respectively), and publicly insured healthcare coverage (r=-0.65, p&amp;lt;0.001; r=-0.67, p&amp;lt;0.001; respectively). Conclusion: Small area correlations between cancer screening rates and SEIs has the potential to inform local policy and research that more accurately serves the health needs of smaller community regions. Citation Format: Zherui Xuan, Jennifer Cullen. Area-level socioeconomic influences on rates of cervical and colon cancer screenings [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 B092.

Abstract A093: Implementation of a financial hardship screening among Native American patients with cancer

Abstract Introduction: Financial hardship and financial hardship screening are emerging concerns in oncology. Native American patients may be at increased risk of financial hardship due to factors including poverty, medical comorbidities, and lack of private health insurance coverage. Financial hardship for Native American patients with cancer has only rarely been studied, and implementation of screening for financial hardship for these patients has never been reported. Methods: Guided by input from a stakeholder advisory board consisting of patient, provider, and staff members at a single cancer center in Oklahoma, we implemented a financial hardship screening tool, the COmprehensive Score for financial Toxicity (COST) – Functional Assessment of Chronic Illness Therapy (FACIT) among 42 Native American patients with cancer. We conducted key informant interviews with ten of these patients and four clinical staff involved in the implementation process. Patient interviews included questions about current financial hardship, experiences in discussing financial hardship with the cancer care and primary care team, and acceptability of the COST-FACIT tool. Clinician interviews focused on their experience with the project, including implementation of the COST-FACIT tool, barriers to implementation, and sustainability. Recorded interviews were transcribed and thematically analyzed using MAXQDA® software. COST-FACIT tool data were analyzed using SAS v. 9.4 Results: Three-quarters (76%, n=32) of participants who completed the COST-FACIT tool reported moderate or severe financial hardship (Score &amp;lt;25 out of max 44, with lower scores indicating more hardship). A higher percentage of patients experiencing financial hardship were younger, covered by Medicaid, unemployed, not married/cohabiting, had lower income, and lower education compared to those with no/mild hardship (Scores ≥25). Among patients and clinicians, we identified themes of 1) financial hardship screening perception and intervention experiences, 2) screening efficacy and opportunities for improvement, and 3) systematic and patient related themes of Native American health systems and culture. Conclusions: Financial hardship was reported by the majority of Native American patients with cancer included in our study. Patients expressed a positive experience with the screening tool, including identification of financial challenges though timing of the tool in regards to their cancer diagnosis varied across patients. Clinicians experienced challenges in implementation of the COST-FACIT tool related to logistics, the COVID-19 pandemic, and concerns for sustainability. However, clinicians reported a positive experience with the tool and interactions with patients and referrals that resulted from the screening. Citation Format: Amanda E. Janitz, Amber S. Anderson-Buettner, Stefani D. Madison, Mark P. Doescher, Dorothy A. Rhoades. Implementation of a financial hardship screening among Native American patients with cancer [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 A093.

Individual and area level factors associated with the breast cancer diagnostic-treatment interval in Queensland, Australia.

Delays to breast cancer treatment can lead to more aggressive and extensive treatments, increased expenses, increased psychological distress, and poorer survival. We explored the individual and area level factors associated with the interval between diagnosis and first treatment in a population-based cohort in Queensland, Australia. Data from 3216 Queensland women aged 20 to 79, diagnosed with invasive breast cancer (ICD-O-3 C50) between March 2010 and June 2013 were analysed. Diagnostic dates were sourced from the Queensland Cancer Registry and treatment dates were collected via self-report. Diagnostics-treatment intervals were modelled using flexible parametric survival methods. The median interval between breast cancer diagnosis and first treatment was 15days, with an interquartile range of 9-26days. Longer diagnostic-treatment intervals were associated with a lack of private health coverage, lower pre-diagnostic income, first treatments other than breast conserving surgery, and residence outside a major city. The model explained a modest 13.7% of the variance in the diagnostic-treatment interval [Formula: see text]. Sauerbrei's D was 0.82, demonstrating low to moderate discrimination performance. Whilst this study identified several individual- and area-level factors associated with the time between breast cancer diagnosis and first treatment, much of the variation remained unexplained. Increased socioeconomic disadvantage appears to predict longer diagnostic-treatment intervals. Though some of the differences are small, many of the same factors have also been linked to screening and diagnostic delay. Given the potential for accumulation of delay at multiple stages along the diagnostic and treatment pathway, identifying and applying effective strategies address barriers to timely health care faced by socioeconomically disadvantaged women remains a priority.

How to Implement Universal Healthcare Coverage in the United States: Two Novel Pathways

Universal Health Coverage does not exist in the United States for two reasons: (1) there is a general unwillingness to dismantle the historically grown framework of the world’s most complex mix of public and private sector health coverage, and (2) mere cost considerations. The first concern can be alleviated by establishing a Universal Health Coverage system that retains much of the existing U.S. health infrastructure. The two proposed pathways presented herein comprise either (1) a leveled solution through Medicare expansion for the uninsured only, or (2) a more complex solution through a national, 2-tier healthcare system for all Americans. Both pathways are based on solid financing without major tax increases, utilizing existing and/or yet untapped funding sources. For the sake of forming a more perfect union, as stated in the Constitution, Universal Health Coverage in the United States must no longer be an illusion that continues to haunt our society in the 21st century.

Impact of declared wildfire disasters on survival of lung cancer patients undergoing radiation treatment.

302 Background: In recent years, the frequency and severity of climate-driven disasters, including wildfires, have posed significant challenges to the delivery of oncology care. Among various treatment modalities, radiotherapy stands is particularly vulnerable due to its reliance on consistent electrical power and daily treatment sessions. For patients receiving radiation treatment for locally advanced non-small cell lung cancer (NSCLC), even minor disruptions in treatment continuity have been shown to have a detrimental impact on overall survival. Methods: Patients undergoing definitive radiotherapy for nonoperative locally advanced NSCLC between 2004 and 2019 were selected from the hospital-based National Cancer Database, which captures approximately 70% of all cases in the United States. Disaster declarations were identified from the Federal Emergency Management Agency from 2004 to 2019. Exposed patients (n = 1,419) were defined as those who had a wildfire disaster declared in the county of the treatment facility during the exposure window (within 12 weeks of radiotherapy start date), while unexposed patients (n = 226,719) had no disasters declared within the same timeframe. Overall survival was defined as age when radiation therapy started and age of death, last contact, or study end. Cox proportional hazards was used for estimating hazard ratios (HRs) adjusted for sex, region, health insurance, comorbidities, facility type, lymph node involvement and concomitant chemotherapy. Survival estimates were weighted by the inverse of the probability of remaining uncensored at the end of the exposure window. Results: A total of 228,138 individuals were included in the study. Our preliminary data shows that exposed individuals were more likely to receive treatment in facilities located in western states, have no comorbidities, and have private health insurance coverage. Individuals whose facility had a wildfire disaster declared within 12 weeks of the radiation start date had worse overall survival (HR = 1.03; 95% Confidence Interval = 1.01, 1.06) compared to unexposed individuals with sensitivity analyses pending. Conclusions: Our study highlights the vulnerability of individuals undergoing radiotherapy for NSCLC to the hazards posed by wildfires. These findings underscore the urgent need for oncology institutions to prioritize the climate adaptation efforts aimed at safeguarding the needs of this vulnerable population.

Australian private health insurer attitudes towards osteopathy: A qualitative study

BackgroundAustralian osteopaths predominately work in private practice. The vast majority of patients who present to osteopaths fund their own care, with many receiving a rebate through their private health insurance cover. While there is little that describes the relationship between the Australian osteopathy profession and private health insurers, such information could provide an opportunity for insurers to improve coverage of osteopathy through enhanced benefits. ObjectivesTo identify the extent of private health insurance cover available for osteopathy and to explore the attitudes of private health insurers towards the Australian osteopathy profession. MethodsThis qualitative study used: 1) content analysis of Australian private health insurers offerings for osteopathy, and 2) the Theoretical Domains Framework (TDF) to inform interviews with representatives from Australian private health insurers. The interviews were transcribed and coded with respect to the TDF. ResultsOf the 35 private health insurers in Australia, 33 offered benefits for osteopathy. Four interviews were conducted with representatives from the 10 largest private health insurers who provide benefits. Osteopathy represents a very small proportion of their services. The inclusion of osteopathic services is market driven. Private health insurance representatives had limited knowledge and understanding of osteopathy, however, they acknowledged the value that some of their members saw in receiving osteopathic care. Osteopathy is bundled with complementary and allied health services by 91.4% of insurers. ConclusionOsteopathy is included in the majority of Australian private health insurers’ offerings because the service value-adds to their products. Further research into the efficacy and cost-effectiveness of osteopathy as well as an educational campaign that provides private health insurers with information about the scope of osteopathy are needed to secure its ongoing inclusion in private health insurance in Australia. Implications for practice•Benefits for osteopathic treatment are covered by most private health insurers in Australia.•Osteopathy is viewed favourably by these insurers.•The findings from this research will inform strategies to secure the ongoing inclusion of benefits for osteopathic treatment by private health insurers in Australia.

An Effective Health Care System through Health Technology Assessment and Evidence Based Payment System in India

The purpose of this research is to discuss the significance of health care insurance compensation for obtaining comprehensive medical treatment in India. Through a systematic review survey focusing on the keywords like out-of-pocket, Health Technology Assessment and Health care system was conducted by using the searches from Google Scholar, Science Direct, PubMed and ProQuest Database, it is observed that India ranks among the greatest out-of-pocket (OOP) healthcare expenditures in the globe. This seems to be notwithstanding the deployment of several public health plans and the provision of a significant variety of both private and public health coverage schemes. Decrease in the treatment quality across many healthcare institutions of government is a key cause causing the typical Indian individual to constantly rely on medical services provided by private firms, heading up OOP expenses. Among the most significant problems in implementing universal health care (UHC) in India is a poor acceptance of insurance products and awareness between many Indians. The burden of large OOP expenditures on people might be lessened by increasing medical insurance acceptance, which may be accomplished by enhancing India's medical claims system.

Accuracy of self-reported private health insurance coverage.

Studies on health insurance coverage often rely on measures self-reported by respondents, but the accuracy of such measures has not been thoroughly validated. This paper is the first to use linked Australian National Health Survey and administrative population tax data to explore the accuracy of self-reported private health insurance (PHI) coverage in survey data. We find that 11.86% of individuals misreport their PHI coverage status, with 11.57% of true PHI holders reporting that they are uninsured and 12.37% of true non-insured persons self-identifying as insured. Our results show reporting errors are systematically correlated with individual and household characteristics. Our evidence on the determinants of errors is supportive of common reasons for misreporting. We directly investigate biases in the determinants of PHI enrollment using survey data. We find that, as compared to administrative data, survey data depict a quantitatively different picture of PHI enrollment determinants, especially those capturing age, gender, language proficiency, labor force status, disability status, number of children in the household, or household income. We also show that PHI coverage misreporting is subsequently associated with misreporting of reasons for purchasing PHI, type of cover and length of cover.

Parent Ratings of Health Insurance Adequacy for Children with Emotional, Behavioral, or Developmental Problems.

Parents of children with special health care needs (CSHCN) report that private insurance is less adequate than public health coverage. Parents of CSHCN with emotional, behavioral, or developmental problems (EBDPs) may perceive private insurance to be especially inadequate due to higher need for a wider array of non-medical services and supports. This study's objective is to assess differences in parent ratings of insurance adequacy for public versus private health coverage between non-CSHCN, CSHCN, and CSHCN with EBDPs. This study pooled publicly available data from the 2016 through 2019 National Survey of Children's Health. Multivariable fixed effects logistic regression models estimated the association between insurance type, CSCHN and EBDP status, and parent ratings of their child's insurance adequacy. Marginal effects were calculated for insurance type, CSHCN and EBDP status, and their interactions to estimate the size of the association. Among all subgroups, consistently more parents with publicly insured children rated their insurance as adequate compared to those with private insurance. Parents of privately insured CSHCN with EBDPs rated their insurance as adequate at significantly lower rates than any other group of parents (55%)-including those with privately insured children without EBDPs (non-CSHCN= 67%; CSHCN=63%) and all other parents with publicly insured children (non-CSHCN=87%; CSHCN=83%; CSHCN with EBDPs=84%). Future research should investigate if perceptions of insurance adequacy among families whose CSHCN has an EBDP aligns with reports of service access and unmet health care needs.

Differences in Use of Fertility Treatment Between People With Medicaid and Private Health Insurance Coverage in the United States.

We aimed to compare differences in receipt of any and specific types of fertility services between people with Medicaid and private insurance. We used National Survey of Family Growth (2002-2019) data and linear probability regression models to examine the association between insurance type (Medicaid or private) and fertility service use. The primary outcome was use of fertility services in the past 12months, and secondary outcomes were use of specific types of fertility services at any time: 1) testing, 2) common medical treatment, and 3) use of any fertility treatment type (testing, medical treatment, or surgical treatment of infertility). We additionally calculated time-to-pregnancy using a method that estimates the unobserved total amount of time the respondent spent trying to become pregnant using their current duration of pregnancy attempt at the time of the survey. We calculated time-to-pregnancy ratios across respondent characteristics to examine if insurance type was associated with differential time-to-pregnancy. In adjusted models, Medicaid coverage was associated with an 11.2-percentage point (95% confidence interval: -22.3 to -0.0) lower use of fertility services in the past 12months compared with private coverage. Relative to private coverage, Medicaid insurance was also associated with large and statistically significantly lower rates of ever having used infertility testing or any fertility services. Insurance type was not associated with differences in time-to-pregnancy. People covered by Medicaid were less likely to have used fertility services compared with people with private insurance. Differences in coverage of fertility services between Medicaid and private payers may represent a barrier to fertility treatment for Medicaid recipients.

Stress and excessive alcohol consumption among insured and uninsured adults during the COVID-19 pandemic.

This study examined the relationships between stress, excessive drinking, including binge and heavy drinking, and health insurance status among a regionally representative sample of adults living in Northern Larimer County, Colorado, during the COVID-19 pandemic. Data from 551 adults aged 18 to 64 years (62.98% aged 45 to 65 years; 73.22% female; 92.98% non-Hispanic White) were used. The sample was weighted by age and binary sex. A series of logistic regressions were applied to examine bivariate associations among stress, drinking, and health insurance status, with and without accounting for the effects of sociodemographic and health-related covariates. Stratified analyses were applied to explore differential associations of stress and drinking among individuals with different health insurance coverage. A total of 23.23% of the adult sample reported binge drinking, and 16.15% reported heavy drinking; 10.53% of the sample reported both binge and heavy drinking. Individuals with higher levels of stress were more likely to report binge drinking (OR: 1.65; 95% CI: 1.65, 1.68) and heavy drinking (OR: 2.61; 95% CI: 2.54, 2.67), after adjusting for sociodemographic and health-related covariates. Relative to individuals with private health insurance coverage, adults enrolled in Medicaid and those without health insurance coverage were more susceptible to the effect of stress on binge and heavy drinking. Our results highlighted a need for continuing statewide and/or national efforts in closing the insurance coverage gap and providing affordable marketplace health insurance in the hope of preventing excessive drinking due to high levels of stress during a challenging time.

Inequality and private health insurance in Zimbabwe: history, politics and performance

IntroductionZimbabwe has one of the highest rates of private health insurance (PHI) expenditures as a share of total health expenditures in the world. The perfomamce of PHI, known as Medical Aid Societies in Zimbabwe, requires close monitoring since market failures and weaknesses in public policy and regulation can affect overall health system performance. Despite the considerable influence of politics (stakeholder interests) and history (past events) in shaping PHI design and implementation, these factors are frequently sidelined when analyzing PHI in Zimbabwe. This study considers the roles of history and politics in shaping PHI and determining its impact on health system performance in Zimbabwe.MethodsWe reviewed 50 sources of information using Arksey & O'Malley's (2005) methodological framework. To frame our analysis, we used a conceptual framework that integrates economic theory with political and historical aspects developed by Thomson et al. (2020) to analyze PHI in diverse contexts.ResultsWe present a timeline of the history and politics of PHI in Zimbabwe from the 1930s to present. Zimbabwe's current PHI coverage is segmented along socio-economic lines due to a long history of elitist and exclusionary politics in coverage patterns. While PHI was considered to perform relatively well up to the mid-1990s, the economic crisis of the 2000s eroded trust among insurers, providers, and patients. That culminated in agency problems which severely lessened PHI coverage quality with concurrent deterioration in efficiency and equity-related performance dimensions.ConclusionThe present design and performance of PHI in Zimbabwe is primarily a function of history and politics rather than informed choice. Currently, PHI in Zimbabwe does not meet the evaluative criteria of a well-performing health insurance system. Therefore, reform efforts to expand PHI coverage or improve PHI performance must explicitly consider the relevant historical, political and economic aspects for successful reformation.

The atlas of variation in healthcare Brazil: remarkable findings from a middle-income country

BackgroundBrazil’s Universal Health System is the world’s largest and covers every citizen without out-of-pocket costs. Nonetheless, healthcare inequities across regions have never been systematically evaluated.MethodsWe used government databases to compare healthcare resource utilization, outcomes, expenditure, and years of life lost between 2016 and 2019. The maps used patients’ residences as reference and adjusted for age and private health insurance coverage.ResultsThe Atlas shows that for several comparisons, there were no procedures in some regions, including primary coronary angioplasty, thrombolysis for stroke, bariatric surgery, and kidney transplant. Colonoscopy varied 1481.2-fold, asthma hospitalizations varied 257.5-fold, and mammograms varied 133.9-fold. Cesarean births ranged from 19.5% to 84.0%, and myocardial infarction and stroke case-fatalities were 1.1% to 33.7% and 5.0% to 39.0%, respectively. Higher private health insurance coverage in each region was associated with increased resource utilization in the public system in most comparisons.ConclusionThese findings demonstrate that the SUS does not fulfill the Brazilian constitutional rights due to underutilization, overutilization, and access disparities. The Atlas outlines multiple opportunities to generate value in the SUS.

Persistent inequalities in health care services utilisation in Brazil (1998–2019)

BackgroundOne of the primary objectives of the Brazilian health care system is to improve the health and well-being of all citizens. Since the establishment of the Unified Health System/Sistema Único de Saúde (SUS) in 1988, Brazil has made strides towards reducing inequalities in health care services utilisation. However, there are currently no comprehensive and up-to-date studies focused on inequalities in both curative and preventive health care services utilisation.MethodsWe evaluated data from the National Household Sample Survey and the Brazilian National Health Survey, which are two nationally representative studies that include findings from 1998, 2003, and 2008 and 2013 and 2019, respectively. We calculated Erreygers-corrected Concentration Indices (CInds) to evaluate the magnitude of socioeconomic-related inequalities associated with five indicators of health care services utilisation, including physician visits, hospital admissions, surgical procedures, Pap smears, and mammograms. The main factors associated with these inequalities were identified via a decomposition analysis of the calculated CInds.ResultsWhile the results of our analysis revealed persistent inequalities in health care services utilisation that favour the wealthy, we found that the overall magnitude of these inequalities decreased over time. The largest inequalities were observed in the utilisation of preventive care services (Pap smears and mammograms) and services available in the poorest regions of the country. Except for admissions for labour and delivery, our findings revealed that wealthier individuals were more likely to utilise hospital services; this represents a change from findings reported in previous years. Private health insurance coverage and individual socioeconomic status are significantly associated with inequalities in health care services utilisation throughout Brazil.ConclusionsCollectively, our findings suggest that we must continue to monitor potential inequalities in health care service utilisation to determine whether Brazilian policy objectives focused on improved health outcomes for all will ultimately be achieved.

Experiences of postnatal mothers with quality of care including water, sanitation and hygiene amenities during the outbreak of COVID - 19 in Ghana: An institutional cross-sectional study

ObjectiveTo investigate the experiences and perceptions of postnatal mothers with quality of healthcare including WASH amenities among postnatal mothers in Ghana during the COVID-19 outbreak. Study designThe study was an institutional cross-sectional. MethodsThe survey was conducted in six (6) regions across the northern, middle, and coastal belts of Ghana among postnatal mothers (n = 424). Eligible respondents accessed antenatal care (ANC) in 12 healthcare facilities (primary level and secondary level) during the outbreak of COVID-19 pandemic. Univariate ordered logistic regression analysis was conducted to predict determinants of overall perceived quality of healthcare and experiences with WASH amenities in healthcare facilities visited. FindingsPrivacy and confidentiality (mean score = 3.07) were the most highly rated quality indicator while the least rated indicator was dignity and respect of clients (mean score = 2.13). Approximately 50% of postnatal mothers reported paying out-of-pocket for essential ANC medications. Perceived quality of healthcare was positive among those who accessed care at a district/municipal hospital (Coef. = 1.29; 95%CI 0.45, 2.13, p = 0.003); co-habiting with a partner (Coef. = 1.64; 95%CI 0.64, 2.65, p = 0.001), and resident in an urban location (Coef. = 2.30; 95%CI 0.30, 3.30, p = 0.001). Mothers who accessed care at a district or municipal hospital (Coef. = 1.81; 95%CI 0.83, 2.78, p = 0.001); were co-habiting with a partner (Coef. = 1.92; 95%CI 0.76, 3.07, p = 0.001), and had a private health insurance cover (Coef. = 3.18; 95%CI 0.69, 5.67, p = 0.012) were more likely to rank WASH amenities better than their comparators. ConclusionOverall perception of postnatal mothers of healthcare quality including WASH amenities after outbreak of COVID-19 was good, but with significant concerns about dignity and respect accorded them during care and having to pay out-of-pocket for some ANC medications. Relevant managers, service providers and regulatory institutions are encouraged to initiate and sustain policy dialogues and stakeholder consultations on the healthcare quality care gaps established in this study. There is the need for more investments in WASH amenities in the health sector as a quality assurance strategy, especially for maternal and child health services.

Age of autism diagnosis in Latin American and Caribbean countries.

An earlier diagnosis of autism spectrum disorder might lead to earlier intervention. However, people living in Latin American and Caribbean countries do not have much knowledge about autism spectrum disorder symptoms. It has been suggested that the older a child is when diagnosed, the fewer opportunities he or she will have to receive services. We asked 2520 caregivers of autistic children in six different Latin America and Caribbean Countries, the child's age when they noticed some developmental delays and their child's age when they received their first autism spectrum disorder diagnosis. Results indicate that, on average, caregivers were concerned about their child's development by 22 months of age; however, the diagnosis was received when the child was 46 months of age. In addition, older children with better language abilities and public health coverage (opposed to private health coverage) were diagnosed later. On the contrary, children with other medical problems and more severe behaviors received an earlier diagnosis. In our study, children were diagnosed around the time they entered formal schooling, delaying the access to early intervention programs. In summary, the characteristics of the autistic person and the type of health coverage influence the age of diagnosis in children living in Latin America and Caribbean Countries.