Private Health Services Research Articles

Health-Seeking Behaviors and its Determinants: A Facility-Based Cross-Sectional Study in the Turkish Republic of Northern Cyprus.

Background: Understanding health-seeking behaviors and determining factors help governments to adequately allocate and manage existing health resources. The aim of the study was to examine the health-seeking behaviors of people in using public and private health facilities and to assess the factors that influence healthcare utilization in Northern Cyprus. Methods: A cross-sectional study was conducted in 2 polyclinics among 507 people using a structured intervieweradministered questionnaire. Health-seeking behaviors were measured using four indicators including routine medical check-ups, preferences of healthcare facilities, admission while having health problems, and refusal of health services while ill. Descriptive statistics and multivariable logistic regression analyses were done to explore factors influencing the use of health services. Results: About 77.3% of the participants reported to have visited health centers while they had any health problems. More than half (51.7%) of them had a routine medical check-up during the previous year, while 12.2% of them had refused to seek healthcare when they felt ill during the last five years. Of all, 39.1% of them reported preferring private health services. Current smokers (adjusted odds ratio [AOR]=1.92, 95% CI: 1.17-3.14), having chronic diseases (AOR=2.05, 95% CI: 1.95-2.16), having poor perceptions on health (AOR=2.33; 95% CI: 1.563.48), and spending less on health during the last three months (AOR=2.08, 95% CI: 1.43- 3.01) had about twice the odds of having routine checkups. Higher education (AOR=1.87, 95% CI: 1.38-2.55) was shown to be a positive predictor for the health-seeking behaviors, whereas having self-care problems (AOR=0.18, 95% CI: 0.08-0.40) and having a moderate-income (AOR=0.68, 95% CI: 0.57-0.81) were inversely associated with seeking healthcare. Conclusion: The utilization of public and private health sectors revealed evident disparities in the socio-economic characteristics of participants. The health-seeking behaviors were determined by need factors including chronic disease status and having poor health perception and also by enabling factors such as education, income, insurance status and ability to pay by oneself. These findings highlight the need for further nationwide studies and provide evidence for specific strategies to reduce the socioeconomic inequalities in the use of healthcare services.

PNS183 UNIVERSAL HEALTH INSURANCE COVERAGE FOR CHILDREN UNDER AGE 6: FACTORS ASSOCIATED WITH THE USE OF PRIVATE OVER PUBLIC HEALTH SERVICES IN VIETNAM

27% of children under age 6 were using private health services with full or partial fee for services although they have been granted health insurance coverage by the Vietnamese government if they go to public providers. Therefore, it is important to understand what makes these children go to private over public providers. This study aims to examine predisposing, enabling (income per capita by quintiles, education level of the household other than health insurance) and medical need factors associated with the choice of private over public healthcare services in Vietnamese children under age 6. Using Andersen Model of Health Services Utilization as a thematic framework, this study applied binary logistic regression models of private and public health service utilization, using nationally representative data from the Vietnam Household Living Standards Survey 2016. 2898 children under age 6 (50.2% male, 68% living in rural areas and 80.2% ethnic majority) were included in the study. Private healthcare services are more likely to be used by children who are living in urban areas while public healthcare services are preferred by children living in the Midland and Mountainous area. Income per capita does not correlate with the use of private over public health care services. However, children living in a household with education of university degree or higher are more likely to use public healthcare services. In terms of medical needs, the odds of using private over public services are 44 times higher for non-severe illness (95% CI: 25.9 - 74.6, p<0.001) than for vaccinations, followed by health check-ups with 22 times higher (95% CI: 12.3 - 39.7, p<0.001). The private health services are more likely to be used by children who live in urban area and who need non-severe treatment or health check-ups.

Cohort profile: Mental Health Living Longer: a population-wide data linkage to understand and reduce premature mortality in mental health service users in New South Wales, Australia

PurposeHealth systems must move from recognition to action if we are to address premature mortality in people with mental illness. Population data registers are an essential tool for planning and...

Utilization of health care services in public and private healthcare in India: Causes and determinants

ABSTRACT Objective: Despite several government initiatives aimed at improving public healthcare services, private-sector has been a dominant player in most of the Indian states. Limited evidence is available on the factors that influence the choice of using public or private health services, which assume significance in the present context, when the government is willing to purchase care from the private providers. This subject is further explored in the paper by using the 71st round of National Sample Survey, ‘Key Indicators of Social consumption in India Health’, 2014. Data sources/study setting: The analysis included 15 major states of India, dividing them into three groups: low-, middle- and high-income, using average GSDP per capita. We further used multi-variate regression to examine the factors explaining the utilization of either public or private facility. Findings and conclusion: The utilization of public facilities for outpatient and inpatient services was found to be very low, except Assam and Odisha, which attributed to the poor quality of care and long waiting hours. Caste, education and wealth quintiles were the main factors explaining the choice of either public or private facility and strength of association between socio-economic variables and their utilization that varied across 3-categories of states.

UTILIZACIÓN DE SERVICIOS DE SALUD BUCAL POR ESCOLARES CON DISCAPACIDAD INTELECTUAL DEL DISTRITO CAPITAL, COLOMBIA, 2015

Introduction: the use of oral health services is affected by aspects like age, sex, education, income, occupation, socioeconomic status, availability of services, geographic location, cultural aspects, attitudes towards health, values, lifestyles, previous health care experiences, presence or absence of symptoms, and disabilities. The aim of this study was to identify the determinants to oral health services use among a group of schoolchildren and adolescents with developmental disabilities in the city of Bogota (Colombia). Methods: a descriptive crosssectional study was conducted. A survey on determinants to the use of oral health services was applied to 102 parents of schoolchildren and adolescents with developmental disabilities in the city of Bogota (Colombia) during the first quarter of 2015 through probabilistic sampling. The inclusion criteria were as follows: parents in charge of schoolchildren and adolescents aged 4 to 18 years with an intellectual disability who were in cognitive, psychological and physical ability to respond. Bivariate and multivariate analysis were performed using the R software version 3.2.0. Results: there was a significant association between enabling factors like consulting for bleeding gums (p = 0.009), visiting a physician for dental problems (p = 0.081), knowledge of health rights (p = 0.001) or consulting the dentist for regular checkups (p = 0.006) and the use oral health services by schoolchildren and adolescents with developmental disabilities Conclusion: it is important to establish improvement strategies by articulating private or public health services providers with institutions devoted to the education of persons with disabilities, in order to reduce the access barriers in this minority group

Satisfacción y tiempo de espera de usuarios de establecimientos de salud peruanos: análisis secundario de ENSUSALUD 2014-2016

Introducción: Los sistemas de salud requieren contar con evaluaciones acerca de la calidad de la entrega de los servicios en el Perú. Objetivo: Estimar los niveles de satisfacción y tiempo de espera en usuarios de servicios de salud públicos y privados peruanos. Métodos: Análisis secundario del cuestionario 1 de la Encuesta Nacional de Satisfacción de Usuarios en Salud (ENSUSALUD) 2014, 2015 y 2016. El tiempo de espera fue definido como los minutos que tomó desde que el usuario llegó al establecimiento de salud hasta que ingresó al consultorio médico. La satisfacción fue evaluada con la percepción del usuario. Resultados: Los niveles de satisfacción fueron: 70,1% (IC 95% 69,7%-71,2%); 73,7% (IC 95% 72,5%-74,9%); y 73,9% (IC 95% 72,6%-75,1%) para el 2014, 2015 y 2016, respectivamente. Los usuarios afiliados al Seguro Integral de Salud (2014: 67,7% y 2016: 67,6%) y Seguro Social de Salud (EsSalud) (2015: 67,2%) fueron los que presentaron menores porcentajes. Las regiones que presentaron incremento en la satisfacción fueron Cajamarca (2016-2014: 26%), La Libertad (2016-2014: 26%). La mediana del tiempo de espera fue de 60 (q1-q3: 30-120), 75 (q1-q3: 30-150) y 75 (q1-q3: 35-140) minutos, para los años 2014, 2015 y 2016, respectivamente. La demora en la atención fue el problema más frecuente identificado por los usuarios. Conclusiones: En los años 2014, 2015 y 2016, el 70,1%, 73,7% y 73,9% de los usuarios de los servicios de salud peruanos estuvieron satisfechos con la atención. Se debe considerar la heterogeneidad por territorios y entidad financiera. La mediana de tiempo de espera para la atención fue de 60 minutos.

The influence of hospital location and ‘level of care’ on continuing professional development

Healthcare workers core skills are reinforced and knowledge of latest developments ensured by undertaking systematic continuing professional development. The current study explored the impact of health facility location and level of care provided on the continuing professional development offered to maternity services healthcare workers in Victoria, Australia. An online survey of middle to senior management staff of 71 public and private health services as well as 7 professional bodies was conducted, yielding 114 participants. Analysis was by location (metropolitan or regional/rural) and level of care provided. The findings revealed Australian Health Practitioner Regulation Agency registration is the predominant requirement to provide continuing professional development to staff. Dedicated education departments or educators are significantly underrepresented in Level 1&2 facilities, while Level 5&6 facilities are more likely to provide breastfeeding continuing professional development. Metropolitan locations provided more wide-ranging programmes compared with rural/regional locations. Key enablers are the capacity to share resources, have access to external courses and simulation equipment/centres, and the provision of relevant and timely continuing professional development programmes, indicating that ‘Educational hubs’ with credentialed staff working from better resourced regional facilities could deliver a complete array of CPD programmes to lower level facilities.

Selection bias and moral hazard in the Australian private health insurance market: Evidence from the Queensland skin cancer database

This study estimates the effects of moral hazard and selection bias in private insurance by exploiting the unique characteristics of private health insurance in Australia using a longitudinal data of about 37,000 individuals. We estimate determinants of private health insurance status and health service consumption together as a system to control for individual unobserved effects. We also take into account the evolution of the health production process by controlling for the lagged dependent variables. We found that risk-averse individuals were more likely to purchase private health insurance, suggesting an advantageous selection. There is also evidence of ex-post moral hazard as privately insured individuals consumed more health services. Controlling for the lagged health service consumption reduces the magnitude of moral hazard considerably. The presence of advantageous selection and moral hazard in private health insurance indicates that the Australian healthcare system can be more efficient by increasing coverage and monitoring consumption.

Arterial hypertension diagnostic and drug therapy failure among Brazilian elderly - FIBRA Study.

This study aimed to investigate the prevalence of failure in hypertension diagnosis, antihypertensive drug use and drug therapy efficacy and the association of these parameters with sociodemographic, health-related and access to health services variables in community-dwelling elderly. This is a descriptive cross-sectional study with 3,478 elderly from different Brazilian regions. We used Pearson's chi-square test to verify associations between outcomes and independent variables, and Poisson multiple regression to estimate crude and adjusted prevalence ratios. Of the total, 29.6% of the elderly evidenced failure in the diagnosis, 4.6% in the use of antihypertensives and 65.3% in drug efficacy. Diagnostic failure was associated with males, presence of morbidity, having a partner, white skin color/ethnicity, having access to the health covenant or private health service, with low/medium personal income and working. Antihypertensive use failure was associated with low/medium personal income and work. Hypertension management failures are prevalent in community-dwelling elderly. There is a need for actions that minimize the negative impact of these health shortcomings, in a country burdened by social, economic and ethnic differences.

HELICOBACTER PYLORI INFECTION AND GASTRIC CANCER PRECURSOR LESIONS: PREVALENCE AND ASSOCIATED FACTORS IN A REFERENCE LABORATORY IN SOUTHEASTERN BRAZIL

Helicobacter pylori infection is the most important risk factor for gastric atrophy and intestinal metaplasia, both considered gastric cancer precursor lesions. Therefore, the investigation of the occurrence of H. pylori infection, precursor lesions and associated factors guides the adoption of specific strategies for the control this type of cancer. To evaluate the prevalence of H. pylori infection in patients undergoing upper digestive endoscopy, as well as the prevalence of intestinal metaplasia, atrophy and chronic inflammation and their association with H. pylori infection. A retrospective study was performed based on reports of gastric endoscopic biopsies performed in a private laboratory affiliated to the Brazilian Public Health System (SUS). Patients were evaluated for age, gender and type of health service. The samples were evaluated for the presence of H. pylori, and also of chronic inflammation, intestinal metaplasia and glandular atrophy. Of a total of 4,604 patients (mean age 51±16.6), 63.9% were female and 63.1% coming from private health care service. The prevalence of H. pylori infection was 31.7% (n=1,459), and the percentage of infection was significantly higher in patients from public health service (42.0%) in relation to patients from private health service (25.6%). Among H. pylori (+) patients, a higher percentage of intestinal metaplasia (17.7% vs 13.3%) and glandular atrophy (17.6% vs 6.9%) were observed when compared to those H. pylori (-) (P<0.01). From the patients H. pylori (+) with at least one type of precursor lesion (n=418), 161 (38.5%) had metaplasia and chronic inflammation, 160 (38.3%) had atrophy and chronic inflammation and finally 97 (23.2%) presented metaplasia, atrophy and chronic inflammation simultaneously. The present study reinforces the association of H. pylori infection with gastric cancer precursor lesions in a Brazilian population, emphasizing the importance of infection prevention measures, as well as the treatment of infected patients, especially in regions with lower socioeconomic levels that show a higher prevalence of infection by H. pylori.

How is cervical cancer screening information communicated in UK websites? Cross-sectional analysis of content and quantitative presentation formats

ObjectivesTo investigate whether UK websites about cervical cancer screening targeted to the public include (1) information about benefits and risks of screening, possible screening results and cervical cancer statistics, (2)...

Access to primary care for persons with spinal cord injuries in the greater Gaborone area, Botswana.

BackgroundPeople with spinal cord injury (SCI) often have great need for healthcare services, but they report access challenges. Primary care access to people with SCI has not been explored in Botswana.ObjectiveThis study aimed to identify barriers and facilitators that users with spinal cord injuries experience in accessing primary care services in the greater Gaborone area, Botswana.MethodsA quantitative, cross-sectional, observational study was conducted. Data were collected with a structured questionnaire from 57 participants with traumatic and non-traumatic SCI. Descriptive and inferential analysis was performed.ResultsThe male to female ratio was 2.8:1. The mean age of participants was 40 years (standard deviation 9.59). Road traffic crashes caused 85% of the injuries. Most participants visited primary care facilities between 2 and 10 times in the 6 months before the study. Participants were satisfied with the services (63%) and felt that facilities were clean (95%) and well maintained (73.5%). Preferential treatment, respect, short waiting times and convenient hours facilitated satisfaction with services. Availability was hampered by insufficient provider knowledge on SCI as indicated by 71.9% of participants, and shortage of consumables (80.7%). Structural challenges (42.1% could not enter the facility by themselves and 56.5% could not use the bathroom) and lack of height-adjustable examining couches (66.7%) impeded accessibility. Cost was incurred when participants (64.9%) utilised private health services where public services failed to address their needs.ConclusionPrimary care services were mostly affordable and adequate. Availability, acceptability and accessibility aspects created barriers.

Good Life Project: Description Of The Impact Of Weight Loss Intervention At A Private Health Service In Manaus

Good Life Project: Description Of The Impact Of Weight Loss Intervention At A Private Health Service In Manaus

Health productivity in macroeconomic level in Turkey: A Multi-level Causality Test approach

Although private health services have been common, it is known that healthis a global public good, and it is related with global public expenditures.Recent studies shoved that productivity in health services is a main domainof government, nongovernmental organizations, and public sector. Thus,increase in productivity of health services provides efficient use of publicgoods. Moreover, public health services and productivity in health sector is apart of macroeconomic level. In this research, it is aimed to evaluate effects ofmacroeconomic indicators in health productivity. In the research, datacollected from Turkey Statistics Institute (TUIK) for 2001-2016 were used toenlighten macroeconomic indicators and health productivity outcomes.According to results of the study, health expenditures and % in GDP rates arecauses for fertility rate (p&lt;0.05). Moreover, health expenditures also causesfor number of health organizations and number of birth (p&lt;0.05). Number ofbirth causes price level indices (p&lt;0.05). All these causality results show thattheir correlations are positive, since both F statistic level and dataobservations support positive correlations.Key words: Health, macroeconomic, productivity

First choice for use of health services by the adult population of the Federal District, Brazil, 2015: a cross-sectional study.

to describe the first choice for use of health services and to analyze sociodemographic factors associated with seeking Primary Health Care (PHC) by the adult population of Brazil's Federal District in 2015. this was a population-based study, with 2,007 individuals, using a sample from the 2015 VIGITEL survey conducted by landline telephone, including questions on use of health services; we used logistic regression to identify factors associated with seeking PHC services. participants' first choice was predominantly for private health services (57.6%), respondents reported seeking public health services less (39.5%), particularly PHC services (primary health centers: 24.6%); multivariate analysis showed that educational level (postgraduate [OR=0.15 - 95% CI 0.04;0.59] and high school [OR=0.37 - 95%CI 0.18;0.75]), and not having private health insurance (OR=27.77 - 95%CI 10.61;72.70) were variables associated with seeking PHC services. individuals with low educational level and without private health insurance are those who mostly seek PHC services as their first choice in Brazil's Federal District.

\u201cMedical tourism will\u2026obligate physicians to elevate their level so that they can compete\u201d: a qualitative exploration of the anticipated impacts of inbound medical tourism on health human resources in Guatemala

BackgroundMedical tourism, which involves cross-border travel to access private, non-emergency medical interventions, is growing in many Latin American Caribbean countries. The commodification and export of private health services is often promoted due to perceived economic benefits. Research indicates growing concern for health inequities caused by medical tourism, which includes its impact on health human resources, yet little research addresses the impacts of medical tourism on health human resources in destination countries and the subsequent impacts for health equity. To address this gap, we use a case study approach to identify anticipated impacts of medical tourism sector development on health human resources and the implications for health equity in Guatemala.MethodsAfter undertaking an extensive review of media and policy discussions in Guatemala’s medical tourism sector and site visits observing first-hand the complex dynamics of this sector, in-depth key informant interviews were conducted with 50 purposefully selected medical tourism stakeholders in representing five key sectors: public health care, private health care, health human resources, civil society, and government. Participants were identified using multiple recruitment methods. Interviews were transcribed in English. Transcripts were reviewed to identify emerging themes and were coded accordingly. The coding scheme was tested for integrity and thematic analysis ensued. Data were analysed thematically.ResultsFindings revealed five areas of concern that relate to Guatemala’s nascent medical tourism sector development and its anticipated impacts on health human resources: the impetus to meet international training and practice standards; opportunities and demand for English language training and competency among health workers; health worker migration from public to private sector; job creation and labour market augmentation as a result of medical tourism; and the demand for specialist care. These thematic areas present opportunities and challenges for health workers and the health care system.ConclusionFrom a health equity perspective, the results question the responsibility of Guatemala’s medical education system for supporting an enhanced medical tourism sector, particularly with an increasing focus on the demand for private clinics, specific specialities, English-language training, and international standards. Further, significant health inequalities and barriers to care for Indigenous populations are unlikely to benefit from the impacts identified from participants, as is true for rural-urban and public-private health human resource migration.

The profiles of public and private patients in maternal healthcare: a longitudinal study to examine adverse selection

AbstractIn this article, we investigate differences in the profiles of patients within the Australian mixed public-private maternal health system to examine the extent of adverse selection. There are conflicting influences on adverse selection within the private health sector in Australia due to government regulations that incentivise lower risk segments of the population to purchase community-rated private health insurance. We use a two-phase modelling methodology that incorporates statistical learning and logistic regression on a dataset that links administrative and longitudinal survey data for a large cohort of women. We find that the key predictor of private patient status is having private health insurance, which itself is largely driven by sociodemographic factors rather than health-or pregnancy-related factors. Additionally, transitioning between the public-private systems for a subsequent pregnancy is uncommon; however, it is primarily driven by changes in private health insurance when it occurs. Other significant factors when transitioning to the private system for a second pregnancy are hypertension, increased access to specialists and stress related to previous motherhood experiences. Consequently, there is limited evidence of adverse selection in this market, with targeted financial incentives likely outweighing the impact of community rating even during childbearing years where private health service use increases.

Factors associated with the use of the health services by elderly men: a systematic review of the literature

A systematic review of the literature on analytical epidemiologic studies about factors associated with the use of health services by elderly men was conducted. Four databases were researched, namely PubMed, Scopus, Web of Science and Lilacs and the following key words "health services," "health services for the aged," "aged," "aged 80 and over," "men" and "men's health" and their corresponding expressions in Portuguese were used. After independent reading and selection of the abstracts and full texts of the 1782 articles located, only eight were included in this review. The Health Services Utilization model assisted in the presentation of the results. Predisposing factors associated with regard to the use of the healthcare services were identified: place of residence; lifestyle habits; age bracket; family history; education and marital status; training factors: private health services use and affiliation to a health insurance plan; effective factors of need; perception of health status; perceived susceptibility to stress; medical history; comorbidities; and functional status. The issue of aging among the male population is still poorly studied and deserves special attention to establish how elderly men express their needs and how they are being assisted by healthcare systems.

Evaluation of intensity standards of tungsten-halogen and led curing units.

Current evidence indicates that the minimum light intensity of photo curing units required to polymerize in a reliable way a composite resin, in increments of 2mm, is 300mW/cm2. The recent introduction of new generations of composite resin materials for large volume increments, partially contrasts with ISO 4049 (2009), calling for the use of light intensity of 1,000mW/cm2. Therefore, it is considered relevant to carry out periodic measurements of the emission intensity of light-curing units of clinical use. The aim of this study was to test the intensity [mW/cm2] of a representative sample of tungsten-halogen and LED photopolymerization units used in private and public health service in different areas of the Valparaiso Region in Chile. This was achieved through the use of dental radiometers, without considering the variables of intensity modification over time (either spontaneously, by undesirable inherent characteristics of the device, or by programs of intensity modification in time), or the density of accumulated power needed. This in vitro diagnostic test, evaluated a sample of 507 units, 107 halogen and 400 LED, for a period of around one month, using two radiometers as measuring instruments. For LED units the Bluephase Meter® radiometer, from Ivoclar-VivadentTM was used, and for halogen units we used the Coltolux® from ColteneTM. As a result, 85% of the LED and halogen units achieved the minimum requirements of intensity needed for the polymerization of conventional dental biomaterials. However, only 25% from the tested units achieved a power density of 1,000mW/cm2.

From medical tourism to regionalism from the bottom up: emerging transnational spaces of care between Libya and Tunisia

ABSTRACT This paper analyses the emergence of transnational care through the case study of Libyan patients seeking care in the Tunisian city of Sfax as a result of changes triggered by the 2011 Arab uprisings. Deconstructing categories of ‘medical tourist’ and ‘medical traveller’, we examine how the evolving geopolitical context produced specific migratory profiles (diasporic, traveller, cross-border, war-wounded and transnational patients) and spaces (cross-border, (intra)regional and transnational spaces of care) between Libya and Tunisia. Given a lack of data on the topic in North Africa, we developed a study on health mobilities and circulations from a South-South perspective. Based on a survey amongst Libyan patients (n = 205) in four private clinics and nine semi-structured interviews with health professionals in Sfax, we identified, how four key geopolitical periods shaped medical travel to this city: (1) initial diasporic exchanges facilitated by bilateral agreements; (2) an emerging medical tourism industry within private health services arising from the UN embargo on Libya; (3) the 2011 political crisis and arrival of war-wounded; and (4) therapeutic circulations and emerging transnational spaces of care resulting from the context of war.