Universal Health Care System Research Articles

Assessing Access to And Outcomes of Medical Oncology and Radiation Oncology Consultation in Non-Small Cell Lung Cancer Patients: A Population-Based Study Using Administrative Data

Background: Therapeutic advances in non-small cell lung cancer (NSCLC) have shifted treatment away from chemotherapy towards immunotherapy, monoclonal antibody, and tyrosine kinase inhibitor therapy. Most studies focusing on access to specialist care and lung cancer treatment were conducted before novel therapeutic strategies in NSCLC. This study aimed to better understand and inform referral practices for patients with NSCLC in Ontario. Methods: A retrospective population-based study using linked administrative healthcare data was conducted between 2010 and 2019. The study cohort was defined as patients, aged 18 years of age or older, with a stage I to IV NSCLC diagnosis in Ontario. Primary outcome: medical oncology or radiation oncology consultation within 120 days of diagnosis. Prognostic factors for consultation and receipt of treatment were identified using logistic regression. Results: 73,849 patients were diagnosed with NSCLC with 61.3% and 50.9% receiving a medical oncology or radiation oncology consultation respectively. The median time to consultation was 24 days (interquartile range [IQR] 13-49 days). As the stage increased, consultation was more likely (odds ratio [OR] 6.07, 95% CI 5.78-6.38). As the distance to the nearest cancer center increased consultation was less likely (OR 0.72, 95% CI 0.67-0.78). Stage III NSCLC and patients aged 40-44 years were more likely to receive treatment OR 4.09 (95%CI 3.82-4.38) and OR 3.28 (95% CI 2.51-4.28) respectively. Conclusion: Even in a universal health care system, socioeconomic factors impact a patient’s access to specialist care. Given newer, more effective therapeutic options for NSCLC, access to specialist care must be equitable.

The Impact of Censorship on Covid-19 Policy Formation in the United States

The dominant US response to Covid-19 has been shaped by the pharmaceutical industry. Doctors who proposed early treatments using vitamins and non-patented drugs were sanctioned, and their views were censored by corporate-liberal media. The new mRNA technology for vaccines was deployed with inconclusive testing results. Reports of vaccine-adverse events were marginalized. Underlying the population’s vulnerability to Covid-19 was a continuing increase in chronic illnesses, due to poor public health conditions, aggravated by the absence of universal healthcare. Dissident doctors whose response to Covid was censored found a platform with right-wing politicians and media. This gave enhanced political legitimacy, ironically, to the very forces that were most opposed to the kind of regulatory policies and system of universal healthcare that would have made the population less vulnerable.

Socioeconomic Status and Access to Care in a Universal Healthcare System: The Case of Acute Myocardial Infarction in Australia

Socioeconomic Status and Access to Care in a Universal Healthcare System: The Case of Acute Myocardial Infarction in Australia

Challenges and Progressions towards Universal Health System and Healthcare System in China: A Literature Review

Challenges and Progressions towards Universal Health System and Healthcare System in China: A Literature Review

Multimodal analysis and the oncology patient: Creating a hospital system for integrated diagnostics and discovery

We propose that an information technology and computational framework that would unify access to hospital digital information silos, and enable integration of this information using machine learning methods, would bring a new paradigm to patient management and research. This is the core principle of Integrated Diagnostics (ID): the amalgamation of multiple analytical modalities, with evolved information technology, applied to a defined patient cohort, and resulting in a synergistic effect in the clinical value of the individual diagnostic tools. This has the potential to transform the practice of personalized oncology at a time at which it is very much needed.In this article we present different models from the literature that contribute to the vision of ID and we provide published exemplars of ID tools. We briefly describe ongoing efforts within a universal healthcare system to create national clinical datasets. Following this, we argue the case to create “hospital units” to leverage this multi-modal analysis, data integration and holistic clinical decision-making. Finally, we describe the joint model created in our institutions.

Assessing the inequality in out-of-pocket health expenditure among the chronically and non-chronically ill in Saudi Arabia: a Blinder-Oaxaca decomposition analysis

BackgroundMany high-income countries have made significant progress towards achieving universal health coverage. Nevertheless, out-of-pocket (OOP) health expenditure continues to undermine the effectiveness of the universal healthcare system. In Saudi Arabia, due to the overburdened free public health services, many people opt for alternative healthcare services, risking high OOP payments. The presence of chronic illness further exacerbates this situation. However, there is limited evidence on the extent of the gap in OOP health expenditure between the chronically and non-chronically ill and the associated drivers contributing to this gap. The aim of this study was to assess inequalities in relative OOP health expenditure, estimated as the percentage of income spent on healthcare, between the chronically and non-chronically ill in Saudi Arabia and their associated drivers.MethodsData from 10,785 respondents were obtained from a national cross-sectional survey conducted in Saudi Arabia as part of the 2018 Family Health Survey. Inequalities in relative OOP health expenditure were measured using concentration indices and curves. A Blinder-Oaxaca decomposition analysis was used to assess the differences in relative OOP health expenditure between the chronically and non-chronically ill.ResultsThe results showed that the chronically ill experience a higher financial burden due to healthcare services in absolute costs and relative to their income compared to the non-chronically ill. In addition, there was higher pro-poor inequality (–0.1985) in relative OOP health expenditure among the chronically ill compared to that (–0.1195) among the non-chronically ill. There was a 2.6% gap in relative OOP health expenditure among the chronically and non-chronically ill, of which 53.8% was attributable to unexplained factors, with explained factors accounting for the 46.2% difference. Factors that significantly contributed to the overall gap (i.e. both explained and non-explained factors) included employment status, insurance status, self-rated health, and periodic check-ups.ConclusionThis study underscores the high financial burden due to OOP payments among the chronically ill and the existence of pro-poor inequalities. In addition, there is a significant gap in relative OOP health expenditure between the chronically and non-chronically ill, which is mainly attributable to differences in socio-economic characteristics. This indicates that the existing financial mechanisms have not been sufficient in cushioning the chronically ill and less well off in Saudi Arabia. This situation calls for health policymakers to integrate a social safety net into the health financing system and to prioritize the disadvantaged population, thereby ensuring access to health services without experiencing financial hardship.

The role of neighbourhood environments in hospitalization risk for diabetes and related conditions: A population-based cohort analysis by remoteness and deprivation indices.

Most socio-epidemiological studies on diabetes incidence, prevalence, or hospitalization focus on individual-level risk factors. This population-based cohort study sought to advance understanding on the associations of contextual characteristics and risk of diabetes-related avoidable hospitalization (DRAH) among at-risk Canadians. A national cohort was compiled from the 2013/2014 Canadian Community Health Survey, representing 5.1 million adults aged 35 years and older, reporting having been diagnosed with diabetes, hypertension, or heart disease. Their information was linked longitudinally to hospitalization data from the 2013/14 to 2017/18 Discharge Abstract Database as well as to measures of geographic variability from the Material and Social Deprivation Index and the Index of Remoteness. Cox regression models were used to examine associations between the contextual indices and first occurrence of a DRAH. Residents in the most rural and remote communities were 50% more likely (hazard ratio (HR): 1.51, 95% confidence interval (95% CI): 1.26 to 1.80) to experience a DRAH than those in the most urbanized and accessible communities, and residents in the most socially deprived areas were significantly more likely (HR: 1.44, 95% CI: 1.26 to 1.65) to be hospitalized than those in the most socially privileged areas, controlling for individuals' sociodemographic characteristics and health behaviours. Neighbourhood material deprivation did not exercise a statistically significant influence on hospitalization risk after adjusting for the other residential characteristics. There is a clear and significant gradient in diabetes-related hospitalization risk among Canadians with an underlying cardiometabolic condition by degree of residential remoteness and of neighbourhood social deprivation, independently of individual characteristics and despite Canada's universal healthcare system.

Patterns of care and outcomes in immigrants with non-small cell lung cancer. A population-based study (Sweden).

While studies have found lower cancer risks and better cancer survival in immigrant populations, it is debated whether cancer care is offered on equal terms to all residents regardless of background. Our aim was to study patterns of care and outcomes in immigrants in a country with a tax-financed universal health care system. We used a population-based database to compare clinical presentation, management and mortality between Swedish-born and immigrant patients with non-small cell lung cancer (NSCLC). Analyses were adjusted for potential confounders. We identified 40,075 patients diagnosed with NSCLC of which 84% were born in Sweden, 7% in Nordic and 9% in Non-Nordic countries. Non-Nordic immigrants were to a higher extent male, smokers, younger at diagnosis, had a better performance status and a higher educational level. No differences were seen regarding comorbidity burden or stage at diagnosis. Non-Nordic immigrants more often underwent positron emission tomography (PET) (aHR 1.32; 95% CI 1.19-1.45) and were more often discussed in a multidisciplinary team setting (aHR 1.30; 95% CI 1.17-1.44). There were no differences in treatment modalities following adjustment for age, with the exception of concurrent chemoradiotherapy in stage IIIA disease which was more common in Non-Nordic immigrants (aOR 1.34; 95% CI 1.03-1.74). Both overall and cause specific survival in non-metastatic disease were higher among Non-Nordic immigrants. Overall mortality in stage I-II: HR 0.81; 95% CI 0.73-0.90 and stage IIIA: HR 0.75; 95% CI 0.65-0.86. Following full adjustments, cause-specific mortality in stage I-II was aHR 0.86, 95% CI 0.75-0.98. Taken together, only minor differences in management and outcomes were observed between Swedish-born and immigrant patients. We conclude that lung cancer care is offered on equal terms. If anything, outcomes were better in Non-Nordic immigrants with early stage NSCLC.

Free Access to Direct-Acting Antivirals in Spain: More Favorable Impact on Hepatitis C Mortality Among Highly Educated People.

In 2015, hepatitis C treatment with direct-acting antivirals (DAAs) became free and widespread in Spain, significantly reducing hepatitis C-related mortality. However, health interventions can sometimes widen health inequalities. The objective of this study is to assess the impact of DAA treatment on hepatitis C-related mortality by educational level. We analyzed deaths from hepatitis C, unspecified liver cirrhosis, hepatocellular carcinoma, alcohol-related liver diseases, other liver diseases, and human immunodeficiency virus (HIV) disease among individuals living in Spain during 2012-2019 and aged ≥25 years. We calculated age-standardized mortality rates per million person-years by period, sex, and education. Using quasi-Poisson segmented regression models, we estimated the annual percent change in rates in pre- and postintervention periods by education level and the relative inequality index (RII). Hepatitis C mortality rates among low, middle, and highly educated people decreased from 25.2, 23.2, and 20.3/million person-years in the preintervention period to 15.8, 13.7, and 10.4 in the postintervention period. Mortality rates from other analyzed causes also decreased. Following the intervention, downward trends in hepatitis C mortality accelerated at all education levels, although more in highly educated people, and the RII increased from 2.1 to 2.7. For other analyzed causes of death, no favorable changes were observed in mortality trends, except for liver cirrhosis, hepatocellular carcinoma, HIV disease, and alcohol-related liver disease among higher educated people. Results suggest that DAA treatments had a very favorable impact on hepatitis C mortality at all education levels. However, even in a universal and free healthcare system, highly educated people seem to benefit more from DAA treatment than less educated people.

Access to cancer treatment: financial difficulties, system sustainability, methodological rigor. The role of scientific journals.

The growing national economic burden linked to cancer spending is certainly impacted by an aging population, yet it finds its greatest obstacle in the ever-increasing costs for diagnostics, therapies, and hospital care, putting a strain on patients' finances of the family and the health system. Even in a universal healthcare system like the Italian one, where much of the difficult decisions on healthcare spending are in the hands of government technicians, and shaped by political will, patients contribute to cancer costs out of their own pockets to a much greater extent than is perceived from common sense. The sustainability of the cancer care system cannot ignore the meticulous control of public spending, which is fundamental and essential for societies that aim to keep the standards of care extremely high and continuously improve access and reduce inequalities in cancer care. Clinical trials, healthcare professionals and patients are best placed to evaluate the costs and benefits of treatment choices and are among the most financially affected by such decisions. Can scientific journals in the sector have their contribution for improvement? How can journals potentially close this gap and inform doctors, taxpayers, and the general population? To address this problem effectively, attention needs to be paid to two fundamental issues: one is high-quality science, and another is the ability to inform decision-making.

More than health care

The Norwegian community health centres are one of the main providers of maternal and child health care services. They are often the primary, as well as a regular point of contact, for women during pregnancy and after childbirth. As such, they are a place where encounters between primary health care providers like public health nurses, midwives and immigrant women, are frequent. Midwives and public health nurses play an important role as state employees in the distribution of universal health provisions at the local level. This is especially important in meeting the diverse needs of service users in a universal health care system. This study investigates the implications of cultural diversity for health care practice in a universal system. It employs a qualitative approach, using data from nine semi-structured interviews with midwives and public health nurses across three Norwegian municipalities. It analyses their experiences in working with immigrant women during pregnancy, and after childbirth, through thematic analysis. The findings illustrate the practitioners’ different approaches to meeting with culturally diverse patients, the challenges they face in their work, and how they overcome them. The discussions address the practice of cross-cultural health care in the absence of national guidelines or formal training using street-level bureaucracy as an analytical concept. This article contributes to knowledge on the practice of cross-cultural health care at Norwegian community health centres in the absence of a culturally cognizant health policy. On a broader scale, this study illustrates the implications of diversity for policy and practice in a universal welfare state.  

Trajectories of Preventive Health Care Utilization Among Older Koreans: The Role of Social Relationships.

Receiving timely health screening is associated with important public health benefits among older adults. By focusing on the role of social relationships, the present study was aimed at examining longitudinal trajectories of health screening use among older adults in Korea, whose universal health care system provides free-of-charge health screening. A nationally representative sample of 3,575 individuals aged 65 or older from wave one of the Korean Longitudinal Study of Aging (2006) was followed for 10 years (up to Wave 6, 2016). Mixed-effect logit models were used to investigate how an older adult's social relationship characteristics (i.e., household composition, financial support from family, social group participation, and the frequency of contact with friends or relatives) were associated with their trajectories of participation in the national health screening program. Despite the low financial burden, only 49.7% of older adults in Korea reported receiving the recommended health screening at the baseline. Although the probability of receiving recommended health screening increased over the 10-year study period, the trajectories were significantly different by an older adult's social relationship characteristics. All four social relationship characteristics were significantly associated with receiving health screening. However, those with more frequent social contacts and those who participated in social groups showed steeper increases in the probability of receiving health screening (i.e., significant interaction with time). This study highlights the importance of social relationships and intervention approaches that accommodate socially isolated older adults to facilitate their timely receipt of recommended preventive care.

Health Need Factors Are the Key Drivers of Hospitalization among the Elderly Living Alone: An Analysis of Longitudinal Data.

Elderly people living alone are a large and growing proportion of the population of many developed economies. The elderly, particularly those living alone, are more likely to be hospitalized overnight, with consequent substantial health and financial costs. A widely used model of health service utilization is augmented with social issues that may specifically delineate some of the issues associated with living alone. A longitudinal survey of elderly (aged 65 and over) living alone in Australia with three time points over four years was analyzed using logistic regressions for overnight hospitalization. The main set of data (n = 672) had an average age of 75.91 years and was 70.2% female. The health need factors of self-rated general health and illness severity, along with comorbidity, were the key drivers of hospitalization. There were some individuals with prioritized access to hospitalization due to forms of health funding. The social issues did not independently stand out as drivers of overnight hospitalization, but the complexity of the inter-relationships between issues when studying the health of the elderly began to arise. The results enhance our understanding of health services utilization, within the context of a relatively universal health care system.

Cancer surgery cancellation: incidence, outcomes and recovery in a universal health care system.

Cancer surgery cancellation can have negative consequences for the patient, the surgeon and the health care system. There is a paucity of literature on cancer surgery cancellation and its association with wait times, perioperative outcomes, survival and costs of care. Therefore, the objective of this study was to determine the incidence of same-day cancer surgery cancellation in a universal health care context and its association with short and long-term outcomes. This was a population-based retrospective cancer cohort study in Ontario, Canada (2010-2016). There were 199 599 patients in the control cohort and 3539 patients in the cohort that experienced a cancellation. We assessed the cohorts for differences in survival, perioperative complications and costs of care. The overall cancellation rate was 1.74% and was predicted by cancer type (genitourinary), lower income quintile, and more central region of residence. Wait times in the cancelled cohort were longer than in the control cohort; however, this difference was not associated with worse survival outcomes. Patients in the cancelled cohort had higher complication rates while in hospital (7.3 %) than those in the control cohort (4.9%; p < 0.01). After adjusting for important confounders, the cancelled cohort was more costly ($1100). Same-day cancer surgery cancellation rates were low. They were associated with longer wait times, higher complication rates and increased costs of care. Survival was not worse in the cancelled cohort, suggesting that appropriate cancer urgency prioritization occurs. Preventable causes of cancellation should be targeted to improve outcomes in patients with cancer.

Healthcare Professionals in Kyrgyz Republic

The profession of healthcare involves a lot of specialization, aspects of exploration, a lot of effort hard work and determination. Healthcare becomes the most valuable profession al globally because it deals with the life and concerns of the livelihood, hence the hype is worth and has proved that a quality life with the healthy body requires a strong healthcare system that has the potential and a zeal to provide, reform and be active on social, economic, regional and global levels. It becomes a very crucial task to provide health Care to all in need with a proper communication with the health system norms rules and does keep a statistical data for research and to tackle the future needs, pandemics, endemics and creation of better preventions, treatments and management for patients from different regions, ages and of signified distress or commodities. Kyrgyzstan also has a healthcare system which is called as Kyrgyzstan Soviet system of free universal healthcare which provides a reasonable number of doctors assistance nurses with medical clinics hospitals to provide care and treatment to respective illness and maintain regional health in the regional population. As per the research is formed that is the compulsory social and medical insurance (CSSM) program which was established on January 2020 that lets an individual pay for certain medical expenses and regulate Health Care in the better quality has turned to be an interesting and a much better way for improvement of social economic status of the country and a step towards a better community Health. As per the capita gross, national income of Kyrgyzstan was 1,170 dollars in 2015 and human development in desk has classified it to a medium human development country shows lower-middle-income economy. So far, human immunodeficiency virus HIV virus had very low percentage of prevalence that is 830 cases were officially reported on 2006 of February but that but the real number was estimated to be 10 times more. One of the reasons for spread has been the prison population and narcotic trafficking, whereas cardiovascular and respiratory conditions stand first for the reason of morbidity in the society. However, the rate of maternal mortality was more than 15% in 2008, that signifies that gets done is under the ‘very bad’ category of right to reproductive health as the nation is fulfilling only 55% of expected. Therefore, adding up to the issues related to family and community illness and creating a challenge for the healthcare system.

The Risk of Bleeding in Pregnant Women with Acute Venous Thromboembolism Treated with Anticoagulants

Introduction Women are at an increased risk of venous thromboembolism (VTE) during pregnancy and the postpartum period. VTE, which includes pulmonary embolism (PE) and deep vein thrombosis (DVT), complicates 1 to 2 of 1000 pregnancies and is an important cause of maternal morbidity and mortality. The risk of VTE during pregnancy is increased five to ten-fold compared to the non-pregnant woman of comparable age. During pregnancy, subcutaneous weight-adjusted low-molecular-weight-heparin (LMWH) is the standard anticoagulation therapy for acute VTE. Women receive a minimum of 3 months of LMWH with treatment generally extended throughout pregnancy and for at least 6 weeks following delivery given the additional increased VTE risk during the postpartum period. Variable estimates are reported in the literature pertaining to the risk of bleeding in pregnant patients treated with therapeutic anticoagulation. The risk of major bleeding, as defined by the study, ranges between 2.9 and 30.0% according to a recent systematic review of the literature. The ability to make inference is limited by the small number of patients included in the studies and the substantial heterogeneity of bleeding definitions used. The paucity of data doesn't allow healthcare providers to accurately estimate the risk of bleeding in this population and prevents adequate patient counselling. As such, we conducted a population-based cohort study to evaluate the risk of bleeding events among pregnant women with acute VTE treated with LMWH anticoagulants. Methods We conducted a retrospective cohort study using data from electronic healthcare databases from the province of Quebec, Canada, including the Régie de l'assurance maladie du Québec (RAMQ), the Maintenance et Exploitation des Données pour l'Étude de la Clientèle Hospitalière (Med-Echo) and the Institut de la statistique du Québec (ISQ). From an inception cohort of Quebec residents with a diagnosis of incident VTE between January 1, 1998, and December 31, 2015, we created a study cohort of pregnant women diagnosed with VTE during pregnancy who received a prescription for LMWH within 15 days of the incident event. When the gestational age of pregnant women was not available in the database, a previously described algorithm was used to extrapolate the date of conception according to the delivery outcome. Women were followed until an inpatient diagnosis of bleeding within 30 days of delivery or censoring due to discontinuation of LMWH use, cessation of medication coverage eligibility, death, or the end of the study period. Major bleeding was defined as a hospitalization for bleeding within the study period. Results Of the 325,560 patients included in the inception VTE cohort, 259 pregnant patients remained after the exclusion criteria were applied. The mean age of patients was 29 years-old, 80.9% of patients had a DVT and 19.5% had a PE. 72.6% of patients received Dalteparin, while the other patients received Tinzaparin or Enoxaparin. In total, 20 patients (7.7%) experienced bleeding requiring hospitalization during the study period, 5 of which were antepartum bleeding events (1.9%). The incidence rate of major bleeding was 310.5 per 1,000 person-years (95% CI 189.6-479.5). There was no bleeding-related or all-cause related mortality in this cohort. Conclusion This study provides a population-derived estimate of bleeding in pregnant women treated with therapeutic anticoagulation for VTE during pregnancy. This study has some limitations. First, data is not available for women who do not use medical services during pregnancy, those who give birth outside a hospital setting. However, given the free universal healthcare system in the province of Quebec, the effect of this on our result is expected to be minimal. Second, the RAMQ database provides information on individuals adherent to the RAMQ drug plan and welfare recipients, but not on individuals who are covered by private insurance. This may affect the generalizability of our study findings if socioeconomic status is an effect modifier. Our results show that Dalteparin is the most used LMWH in pregnancy. This study provides an estimate of bleeding events that are clinically significant and require hospitalization. Further studies are needed to evaluate the factors associated with increased bleeding in this patient population.

'What price do you put on your health?': Medical cannabis, financial toxicityand patient perspectives on medication access in advanced cancer.

Following 2016 legislation permitting limited access to cannabis for research and medicinal purposes, the number of randomized clinical trials (RCTs) investigating the effectiveness of medicinal cannabis (MC) on symptom burden relief in cancer contexts has increased in Australia. This study aimed to understand the perceptions, hopes and concerns of people with advanced cancer regarding the future availability and regulation of MC in Australia. This qualitative study draws on semistructured interviews conducted between February 2019 and October 2020 in Brisbane, Australia, as part of an MC RCT substudy. Interviews were undertaken on48 patients with advanced cancer in palliative care eligible to participate in an MC trial (n = 26 participated in an RCT; n = 2 participated in a pilot study; n = 20 declined). Interviews included a discussion of patients' decision-making regarding trial participation, concerns about MC and perceptions of future availability, including cost. Transcribed interviews were analysed inductively and abductively, informed by constructivist thematic analysis conventions. Overall, participants supported making MC legally accessible as a prescription-only medication. Fear of financial toxicity, however, compromised this pathway. Steep posttrial costs of accessing MC prompted several people to decline trial participation, and others to predict-if found effective-that many would either access MC through alternative pathways or reduce their prescribed dosage to enable affordable access. These findings suggest that-despite a relatively robust universal healthcare system-Australians are potentially vulnerable to and fearful of financial toxicity. Prevalent in the United States, financial toxicity occurs when disadvantaged cancer patients access necessary but expensive medications with lasting consequences: bankruptcy, ongoing anxietyand cancer worry. Interview transcripts indicate that financial fears-and the systems sustaining them-may pose a threat to RCT completion and to equitable access to legal MC. Such findings support calls for embedding qualitative substudies and community partnerships within RCTs, while also suggesting the importance of subsidisation to overcoming injustices. A patient advisory committee informed RCT design. This qualitative substudy foregrounds patients' decision-making, perceptions and experiences.

Comprehensive Assessment of the Universal Healthcare System in Dentistry Japan: A Retrospective Observational Study.

Japan's universal healthcare insurance is facing economic challenges due to the advanced aging society, however, objective data of dental expenditure has never been introduced. This study aimed to identify the associated factors with dental expenditures using government-provided digitized insurance claims data and calculated the spending in the context of dental cost per person (DCPP). Seven associated factors analyzed were age, demographic, geographic, socioeconomic, regional wealth, the impact of the 8020-national campaign implementation (keep 20 teeth at age 80), and the effect of the home-visit dentistry for the elders. The average DCPP was high in older populations (75+) in all prefectures. The prefectures with the highest and lowest DCPP were significant compared to other states and retained their respective places in the cost hierarchy over the four years. The prefectures with more citizens participating in government assistance programs (GAP) had greater DCPPs. Dental costs were significantly related to geographic regions, age, per capita income, government assistance program prevalence, office complete denture frequency, and home visit care per patient. With a growing aging population, dental care costs will continue to increase, burdening its fiscal future. Associated factors identified should be considered to control the contentious increase of healthcare cost.

Progressivity of out-of-pocket costs under Australia's universal health care system: A national linked data study

BackgroundIn line with affordability and equity principles, Medicare—Australia's universal health care program—has measures to contain out-of-pocket (OOP) costs, particularly for lower income households. This study examined the distribution of OOP costs for Medicare-subsidised out-of-hospital services and prescription medicines in Australian households, according to their ability to pay. MethodsOOP costs for out-of-hospital services and medicines in 2017-18 were estimated for each household, using 2016 Australian Census data linked to Medicare Benefits Schedule (MBS) and Pharmaceutical Benefit Scheme (PBS) claims. We derived household disposable income by combining income information from the Census linked to income tax and social security data. We quantified OOP costs as a proportion of equivalised household disposable income and calculated Kakwani progressivity indices (K). ResultsUsing data from 82% (n = 6,830,365) of all Census private households, OOP costs as a percentage of equivalised household disposable income decreased from 1.16% in the poorest decile to 0.63% in the richest decile for MBS services, and from 1.35% to 0.35% for PBS medicines. The regressive trend was less pronounced for MBS services (K = -0.06), with percentage OOP cost relatively stable between the 2nd and 9th income deciles; while percentage OOP cost decreased with increasing income for PBS medicines (K = -0.24). ConclusionOOP costs for out-of-hospital Medicare services were mildly regressive while those for prescription medicines were distinctly regressive. Actions to reduce inequity in OOP costs, particularly for medicines, should be considered.

Use of virtual care in ophthalmology in Ontario, Canada in 2020 during the COVID-19 pandemic

ObjectifExaminer l'utilisation des soins virtuels en ophtalmologie et les tendances à cet égard tout en explorant les facteurs connexes au sein d'un système de soins de santé universel pendant la pandémie de COVID-19 en 2020. NatureÉtude transversale. ParticipantsOntariens admissibles à l'Assurance-santé de l'Ontario. MéthodesNous avons eu recours aux données de facturation des médecins pour la période de 2017 à 2020 afin de comparer les soins virtuels aux soins en personne. Une analyse de régression logistique a servi à examiner les facteurs en lien avec le recours aux soins virtuels. RésultatsLa hausse des visites virtuelles en ophtalmologie s'est produite immédiatement après l'adoption de la directive gouvernementale visant à réduire les activités en clinique et la mise en place d'un nouveau code de facturation pour les visites virtuelles (17,6 %). Les visites virtuelles ont atteint un sommet 2 semaines plus tard (55,8 %) pour diminuer immédiatement une fois la directive annulée (24,2 %). Entre mars et décembre 2020, les visites virtuelles étaient plus fréquentes chez les femmes (11,6 %) que chez les hommes (10,3 %), ainsi que chez les patients de < 20 ans (16,4 %) et de 20 à 39 ans (12,3 %) que chez ceux de 40 à 64 ans (10,8 %) et de ≥ 65 ans (10,6 %). Le recours aux visites virtuelles était similaire chez les patients des quartiers défavorisés (10,9 %) et des autres quartiers (11,1 %). Le taux de consultation virtuelle a été le plus élevé chez les porteurs d'une infection aiguë (14,2 %) ou d'un diagnostic sans caractère d'urgence (16,2 %), et le plus bas chez les patients qui présentaient une rétinopathie (4,2 %). Les ophtalmologistes de sexe féminin (15,4 %) ont prodigué des soins virtuels plus fréquemment que leurs collègues masculins (9,9 %). Ce sont les ophtalmologistes de 60 à 69 ans (13,1 %) qui ont prodigué le plus de soins virtuels (< 40 ans: 11,3 %; 40 à 49 ans : 11,0 %; 50 à 59 ans : 10,0 % et ≥ 70 ans : 7,7 %). Plusieurs modèles de régression logistique ont donné des résultats similaires. ConclusionAprès une hausse significative pendant la période initiale de la pandémie, l'utilisation des soins virtuels en ophtalmologie a ensuite diminué. Le recours aux soins virtuels variait significativement en fonction des caractéristiques des patients et des ophtalmologistes.