Health Service Utilization Research Articles

Baltimore community resident and collaborator perspectives on the influence of guaranteed income on health: a formative qualitative study

BackgroundGiven increased interest and investment in guaranteed income initiatives across North America, it is critical to understand the impact of guaranteed income on health, an understudied outcome. As part of Baltimore, Maryland’s guaranteed income pilot, we conducted formative research to understand the influence of increased income on health and develop concrete recommendations for implementation and evaluation of the pilot.MethodsWe conducted semi-structured in-depth interviews with Baltimore community residents (n = 8) and community collaborators (n = 8), probing on familiarity with guaranteed income; effect of guaranteed income on overall health and specific health outcomes (e.g., mental health, nutrition); and recommendations for program structure (e.g., eligibility, target population). Data were analyzed thematically using a framework analysis approach.ResultsRespondents agreed that guaranteed income could have beneficial effects on health though some were unsure of specific mechanisms. Respondents emphasized pathways through which guaranteed income could improve health: (1) reduced financial-related stress; (2) improved nutrition through purchase of healthier foods; (3) improved family well-being including child health and parent-child relationships; (4) increased utilization of health services; (5) improved community health through increased community cohesion and decreased violence. Respondents described decreased feelings of time scarcity as a social determinant of health. Most respondents reported that Baltimore’s guaranteed income program should prioritize young, low-income families with $1,000/month or more for at least one year.ConclusionsThis formative research on the potential health impacts of guaranteed income in Baltimore highlights important health outcomes and pathways, such as social cohesion and decreased feelings of time scarcity, to prioritize for evaluation.

Segmented assimilation trajectories of physician trust among internal migrants in Shanghai, China: A cross-sectional study

Physician trust is necessary for improving physician–patient relationships and maintaining an effective health-care system. Most studies on the theory of segmentation assimilation have mainly focused on comparing immigrants in different countries and few studies have applied segmented assimilation to clarify physician–patient relationships, especially physician trust among internal migrants in the context of Chinese megacities. A random sample of 1200 internal migrants was collected through an online questionnaire conducted in Shanghai from August to December 2021. An exploratory K-means cluster analysis and multivariate logistic regression models were employed to identify patterns of segmented assimilation and examine their relationships with physician trust, as well as the factors influencing physician trust among internal migrants in Shanghai. Results show four main patterns were revealed, namely first-generation classic assimilation, first-generation integrative assimilation, first-generation segmentation, and second-generation underclass assimilation, supporting the theory of segmented assimilation. Association between assimilation pattern and physician trust was observed. A relationship was found between assimilation patterns and trust in physicians. Migrants belonging to the first-generation classic and integrative assimilation groups exhibited a higher level of trust in doctors compared to those in the segmented assimilation groups. Additionally, undergraduate and postgraduate education attainment, an annual income of <400 000 yuan, visiting the physician ≥2 times in the past year, and self-rated health status before and after population floating were significant contributing factors for good physician trust. The government can implement corresponding measures to maintain physician trust, improve cultural adaptability instead of only at the economic level among internal migrants, achieving the facilitation of their understanding of the health system and health service utilization to increase physician trust.

Six-year (2016-2022) longitudinal patterns of mental health service utilization rates among children developmentally vulnerable in kindergarten and the COVID-19 pandemic disruption.

In the context of the COVID-19 pandemic, it becomes important to comprehend service utilization patterns and evaluate disparities in mental health-related service access among children. This study uses administrative health records to investigate the association between early developmental vulnerability and healthcare utilization among children in Alberta, Canada from 2016 to 2022. Children who participated in the 2016 Early Development Instrument (EDI) assessment and were covered by public Alberta health insurance were included (N = 23 494). Linear regression models were employed to investigate the association between service utilization and vulnerability and biological sex. Separate models were used to assess vulnerability specific to each developmental domain and vulnerability across multiple domains. The service utilization was compared between pre- and post-pandemic onset periods. The analysis reveals a significant decrease in all health services utilization from 2016 to 2019, followed by an increase until 2022. Vulnerable children had, on average, more events than non-vulnerable children. There was a consistent linear increase in mental health-related utilization from 2016 to 2022, with male children consistently experiencing higher utilization rates than females, particularly among vulnerable children. Specifically, there was a consistent linear increase in the utilization of anxiety-related services by children from 2016 to 2022, with females having, on average, 25 more events than males. The utilization of ADHD-related services showed different patterns for each group, with vulnerable male children having more utilization than their peers. Utilizing population-wide data, our study reveals sex specific developmental vulnerabilities and its impact on children's mental health service utilization during the COVID-19 pandemic, contributing to the existing literature. With data from kindergarten, we emphasize the need for early and targeted intervention strategies, especially for at-risk children, offering a path to reduce the burden of childhood mental health disorders.

Experience of sexual and reproductive health service utilization among Jimma University students: a qualitative study

BackgroundAmong the limits of the university spirit are potential sexual and reproductive health issues. Sexual and reproductive health services are essential for assisting students in overcoming such challenges. However, according to many facility reports and research, students prefer private services and do not use them. Despite the difficulties, a few studies have been conducted on the experiences of Ethiopian University students. Thus, this study explored the experiences of Jimma University students who used sexual and reproductive health services.MethodsA qualitative phenomenological approach was conducted from January 22nd to March 2nd, 2019, among Jimma university students. In-depth interviews were carried out to explore the lived experiences of sexual and reproductive health service use. Students were chosen by a purposive sampling method and recruited using gatekeepers until the needed sample size was obtained and the data was theoretically saturated. Key informants required to present decent information for study objectives were selected purposefully. The data were analyzed using the thematic analysis approach with the help of the ATLAS ti software package.ResultsEleven In-depth interviews and four key informant interviews were conducted. The study revealed seven overarching themes: sexual and reproductive health awareness and perception, problems, service delivery point preferences and practices, availability and accessibility, barriers to service utilization, handling mechanisms, and suggestions.ConclusionsOur study recognized positive and negative experiences of sexual health service use among Jimma University students. These findings suggested planning a comprehensive intervention that addresses the identified challenges and problems to improve students’ sexual and reproductive health services.

Seeking Dental Healthcare in the Context of COVID-19 Pandemic: A Study Examining the Health Belief Model

Abstract Background and Objectives The main purpose of the study was to examine the factors influencing older adults’ seeking dental care, in the context of coronavirus disease 2019 (COVID-19) pandemic, based on the Health Belief Model (HBM). Research Design and Methods Phone interviews were conducted using a structured questionnaire, among 200 older adults aged 65 and above, who are members of the Israeli largest sick fund Clalit Health Services, that were sampled through a systematic random sample. The data were collected between January 2022 and March 2022 and during September 2022. Results Our findings indicate that since the outbreak of COVID-19 in Israel, 61.5% and 55% of the participants reported visiting a dentist and a dental hygienist, respectively, and about a fifth of the participants have foregone care at both. Seeking dental care was associated with an increase in perceived threat, benefits, willingness to seek care, and with a decrease in perceived barriers. The HBM was found to be a suitable framework for illuminating older adults’ dental behavior, which explains 43% of the variance. Discussion and Implications The results of the study provided first-hand findings regarding seeking dental care during the COVID-19 pandemic. These findings emphasize the importance of providing dental services with clear recommendations about dental care and appropriate protective equipment, even under conditions of health concern, to enhance oral health services utilization.

Sexual and reproductive health service utilization and associated factors among youth workers at Kombolcha Industry Park, Kombolcha town, Northeast Ethiopia, 2023.

Youth is a decisive age that shapes the direction of their life and that of their family. However, due to the host of biological, social, and economic factors, youth Industry Park workers can be at high risk of adverse sexual and reproductive health outcomes. Therefore, assessing youth sexual and reproductive health service utilization and associated factors among youth workers is very crucial for timely intervention to their gaps. This study aimed to assess sexual and reproductive health service utilization and associated factors among youth workers working at Kombolcha Industry Park Kombolcha, Northeast Ethiopia, 2023. An institutional-based cross-sectional study was conducted at Kombolcha Industry Park, Kombolcha, among a total of 422 youth workers from 1 January to 30 January 2023. A simple random sampling technique was used to access a total of 422 youth workers in Kombolcha Industry Park. The data were collected using pre-test, structured, and interviewer-administered questionnaires. Data were entered into Epi Data version 3.1 and were exported to SPSS version 26 for analysis. Bi-variable and multivariable binary logistic regression analyses were performed. Adjusted odds ratio with 95% confidence interval was estimated to measure the strength of the association. The level of statistical significance was declared at a p value of less than 0.05. Overall utilization of reproductive health services was 45.50%. Being married [adjusted odds ratio (AOR) = 5.76, 95% CI (2.94, 11.25)], near distance of sexual and reproductive health (SRH) facility to home [AOR = 2.57, 95% CI (1.60, 4.14)], having good knowledge [AOR = 9.23 95%CI (4.88, 17.44)], and good attitude about SRH [AOR = 2.06 95% CI (1.29, 3.28)] were significantly associated with youth SRHs utilization. Youth sexual and reproductive health service utilization among youth workers of Kombolcha Industry Park was low. Ensuring SRHs availability and accessibility, empowering youth with knowledge of SRHs, and advocating sexual and reproductive health services to develop a good attitude might be important in improving reproductive health service utilization. Future researchers should address segments of the population other than Kombolcha Industry Park.

Implementing Effective School-Based Mental Health Services: A Guide for School Counselors

Across the United States, the number of children with mental health conditions has continued to rise. However, access and utilization of mental health services vary greatly. School-based mental health complements comprehensive school counseling and provides an opportunity for K–12 students to receive needed treatment they may not otherwise have access to. School counselors are well positioned to support the development, implementation, and sustainability of effective school-based mental health programming. We provide an overview of implementation science and case examples that detail the school counselor’s role in this work.

Demographic factors effect stroke-related healthcare utilisation among Australian stroke survivors

Health equity is a fast emerging priority for most healthcare systems around the world. Factors impacting health equity include education level, geographical location, age, gender, employment status and income. However, research examining the effect of these demographic variables on health service utilisation among mid-aged and older post-stroke adults is limited. Data was obtained from a sub-study of the Sax Institute’s 45 and Up Study, which is conducted in Australia. The sub-study survey collected demographic, health service utilisation and health status information from 576 participants who had a previous stroke diagnosis. Poisson regression was used to examine the association between demographic characteristics and number of consultations with a doctor and/or an allied health practitioner over a 12 month period. All demographic measures were significantly associated with the number of consultations with doctors and/or allied health practitioners. The number of doctor consultations increased for those who struggled to live on their available income (IRR = 1.41), but decreased for females (IRR = 0.81), those who reside in an inner regional area (IRR = 0.83), those who were separated, divorced or widowed (IRR = 0.61), and for those who completed a trade, apprenticeship or diploma (IRR = 0.83). The number of allied health practitioner consultations increased for those who completed a trade, apprenticeship or diploma (IRR = 1.27), and for those who struggled to live on their available income (IRR = 1.38), but decreased for increasing age (IRR = 0.87), females (IRR = 0.78), and for those who reside in an outer regional or remote area (IRR = 0.49). We identified several demographic factors associated with a lower frequency and type of health care services used by post-stroke adults. These possible barriers need to be explored further, as reduced use of healthcare services may lead to poorer stroke outcomes in these demographics. Specifically, researching strategies to best support individuals facing these additional challenges is necessary to ensure equitable healthcare for all Australians.

Racial and ethnic differences in the receipt of continuous positive airway pressure treatment for obstructive sleep apnea

ObjectiveTo examine the pattern of health services access and utilization that may contribute to racial/ethnic disparities in receiving continuous positive airway pressure (CPAP) treatment for obstructive sleep apnea (OSA). MethodsThis cross-sectional study used a national sample from the All of Us Research Program, which included over 80 % of participants from underrepresented populations in biomedical research. Study participants included adults aged 18 years and older diagnosed with OSA (N = 8518). Diagnosis of OSA and CPAP treatment were ascertained by diagnostic and procedural codes from the electronic health records. Sociodemographic characteristics and health service utilization factors were identified using self-reported survey data. ResultsWith this national survey, the overall diagnosed prevalence of OSA was 8.8 %, with rates of 8.12 % in non-Hispanic (NH) Black adults, 5.99 % in Hispanic adults, and 10.35 % in NH White adults. When comparing to NH White adults, Hispanic adults were less likely to receive CPAP treatment for OSA after adjusting for socioeconomic and demographic characteristics, access to and utilization of health services, and comorbidities such as obesity and having multiple chronic conditions (OR = 0.73, 95 % CI = 0.59,0.90), p < 0.01. ConclusionsThe rates of CPAP treatment among OSA patients are not consistent across racial and ethnic groups. Unequal access to health services based on residence may contribute to these differences. Interventions that target disparities in OSA diagnosis, access to treatment, and barriers in insurance coverage could potentially help reduce racial and ethnic differences in OSA diagnosis and management.

Pre- and Post-admission Care for Children Hospitalized With Skin and Soft Tissue Infections.

Although skin and soft tissue infections (SSTIs) are among the most common indications for pediatric hospitalization, little is known about outpatient care received for SSTI before and after hospitalization. We assessed peri-hospitalization care for SSTI, including antibiotic exposures and their impact on hospital length of stay (LOS). This is a retrospective cohort study of 1229 SSTI hospitalizations in 2019 from children aged 1-to-18 years enrolled in Medicaid from 10 US states included in the Merative Marketscan Medicaid database. We characterized health service utilization (outpatient visits, laboratory and diagnostic tests, antibiotic exposures) 14 days before and 30 days after hospitalization and evaluated the effects of pre-hospitalization care on hospital LOS with linear regression. Only 43.1% of children hospitalized with SSTI had a preceding outpatient visit with a SSTI diagnosis, 69.8% of which also filled prescription for an antibiotic. Median LOS for SSTI admission was 2 days (interquartile range 1-3). Pre-hospitalization visits with a diagnosis of SSTI were associated with a 0.7 day reduction (95% confidence interval: 0.6-0.81) in LOS (P < .001), but pre-hospital antibiotic exposure alone had no effect on LOS. Most children (81.7%) filled antibiotic prescriptions after hospital discharge and 74.5% had post-discharge ambulatory visits. Although most children did not receive pre-admission care for SSTI, those that did had a shorter hospitalization. Further investigation is necessary on how to optimize access and use of outpatient care for SSTI.

Screening for psychological distress in childhood and mental health-related hospital attendance among young adults

ObjectivesThe prevalence of mental disorders is high and increasing among children and young people. Investigating the relationship between self-reported poor mental health and mental health service utilisation can provide evidence on the benefits of universal screening, but longitudinal data is rare. ApproachData from a nationally representative English cohort (Next Steps) were linked to NHS Hospital Episode Statistics. GHQ-12 assessed psychological distress in Next Steps at age 15; participants were followed until their first mental health-related hospital presentations or were censored at the end of the study (age 27). Cox proportionate hazard models with survey weights estimated associations. ResultsOut of 4058 young people included in the analyses, 19% reported high levels of distress at age 15. During the 12-year follow-up, 5.3%, 2.9% and 2.7% of the participants had at least one mental disorder, drug/alcohol misuse and self-harm presentation, respectively, and 4.2% had a mental health treatment. Higher GHQ-12 scores were associated with mental disorder presentations (HR=1.10, 95% CI:1.04-1.16), and mental health treatments (HR=1.14, 95% CI:1.08-1.20). Associations were weaker for young people living in deprived areas, or if their main parent had lower education. ConclusionsAdolescent psychological distress predicts subsequent hospital attendance in young adulthood, but there are treatment gaps in service utilisation among more disadvantaged individuals. Detecting youth with mental health difficulties through universal screening, may facilitate early intervention, improve life-course outcomes, and reduce secondary healthcare use. ImplicationsLinked cohort and administrative data can improve our understanding on long-term healthcare utilisation and treatment needs.

Utilization of Outpatient Mental Health Services During and After The COVID-19 Pandemic

Objective and ApproachThis study examines the impact of COVID-19 on outpatient mental health (OP-MH) service use and assesses the role of telehealth on OP-MH service patterns. Using the 5% national sample of Medicare beneficiaries, the intervention group was defined as those newly diagnosed with a MH condition in 2019 (no MH diagnosis 2 years prior) with a 2-year study period of 2020-2021. The comparison group included non-overlapping individuals newly diagnosed in 2017 with a study period of 2018-2019. The OP utilization patterns were examined over the 2 years post-diagnosis and compared across MH diagnostic categories, including schizophrenia, bipolar, depression, anxiety, trauma-related, and substance-use disorders. ResultsThe intervention group observed a significant reduction in MH utilization in March-April 2020 compared to the matched sample. While patients with schizophrenia and bipolar disorders saw a return to normal patterns by May 2020, those with depression, anxiety, trauma-related, and substance-use disorders continued to exhibit significant reductions in MH utilization post-COVID-19. The intervention group demonstrated a significant increase in telehealth usage, transitioning from 1% pre-COVID-19 to a peak of ~60% during the pandemic. This trend gradually decreased, reaching an average of 30% by the end of 2021 across all conditions. Conclusions and ImplicationsThis study underscores the impact of the pandemic on OP-MH utilization and emphasizes the potential of telehealth in improving access to care to meet OP-MH needs. Further, the results highlight the differences in OP-MH utilization across diagnostic categories and the relative benefit of telehealth options for these conditions.

A population-based repeated cross-sectional study using administrative health data to examine the impact of the COVID-19 pandemic on mental wellness in citizens of the Métis Nation of Ontario

Objective and ApproachThe COVID-19 pandemic led to unprecedented levels of mental unwellness and yet there are no reports to date that share Métis-specific data. Our study examined changes in patterns of mental and addictions-related (MHA) outpatient health service utilization using population-based data on Métis Nation of Ontario (MNO) citizens before and during the COVID-19 pandemic. Administrative health data in Ontario, Canada between 2017 and 2022 was linked with the MNO's Citizenship Registry (2022) under an existing Data Governance and Sharing Agreement. Monthly rates of MHA outpatient visits were compared between the pre-COVID-19 period (March 2017 to February 2020) and post-COVID-19 onset (March 2020 to December 2022), and rate ratios comparing observed and expected rates were derived using Poisson generalized estimating equations. Stratifications by age and sex were examined. Results and ConclusionAmong 28,400 MNO citizens (50.3% male; median age 44 years; 28.3% living rurally), the average monthly rate of MHA outpatient visits was 47.4 per 1000 population pre-COVID-19. During the COVID-19 pandemic, the observed MHA outpatient visit rates were 13% higher than expected (RR=1.13; 95% CI: 1.02-1.26). MHA outpatient visits were higher in females compared to males and MNO citizens aged 30 to 64 years versus older or younger citizens. Implications This study is the first to use population-level study to examine MHA health service use in Métis people. High-quality, contemporary data on the mental health outcomes of MNO citizens is crucial to inform MNO’s Mental Health and Addictions programming, resource allocation and emergency preparedness.

RELEASE: Preliminary results from a novel data-linkage study into mental health and substance use service utilisation by people released from Scottish prisons

ObjectivesPeople released from prison are at increased risk of dying by suicide, drug overdose, and illnesses related to drugs and alcohol. International literature demonstrates patterns in health service access that imply service accessibility may be insufficient to meet the mental health and substance use needs of this population. This study aims to compare the use of health services for mental health and substance use between people released from Scottish prisons and the general population, using national Scottish data for the first time. ApproachRetrospective observational cohort study, comparing all individuals released from Scottish Prison in 2015 (n=8,917), and a random general population sample (n=42,455), matched on age, sex, postcode and Scottish Index of Multiple Deprivation (SIMD) deciles. Scottish Prison Service data were linked with community prescriptions, death registrations, inpatient admissions to general and psychiatric hospitals, outpatient contacts, and emergency care. ResultsDescriptive summaries of the demographic characteristics of the cohort and bivariate comparisons of service use across different services will be presented, alongside planned approaches using Poisson regression models of service contacts. ConclusionsThis study advances our understanding of the feasibility of conducting research using national linked data from health and justice services and provides insight into differences in access to mental health and substance use support. ImplicationsThis research expands applications of public health approaches and administrative data research in Scotland. It provides crucial evidence to inform interventions that optimise access to appropriate services, to improve the lives of people released from Scottish prisons and to reduce inequalities.

Understanding Patterns of Care for Older Adults: Data to Action

ObjectiveOlder adult population is growing rapidly, the current system is not adequately designed to meet the needs of individuals to live safely and independently in the place of their choice. To understand the variations in care and identify where to intervene, we examined the transitions in care of community-dwelling older adults (COA) leading up to 24-hour assisted living at special care homes (SCH). ApproachWe conducted a retrospective-cohort study using health administrative data from a Canadian province with a long history of comprehensive, longitudinal data. Using process mining techniques, health service utilization of COA, 65 and older, was mapped as a journey rather than independent care events. We examined the common patterns experienced leading up to SCH admission by sequencing transitions between care settings. Consideration was given to geography that the individual resides in and their health status to understand variations. ResultsOverall health utilization patterns revealed predominant reliance on acute care and SCH admissions. However, geographic variations were identified (regions and urban/rural). More than 2000 transition patterns between emergency department, hospital, community, and SCH were observed. ConclusionThe ability for COA to age in place is dependent on the individual, where they live, and the availability of and access to services to meet their needs. To minimize undesirable and early admissions to SCH, a multifaceted, collaborative approach to align community-based supports for COA is required. The results of these analyses will help inform areas in which to focus interventions and serve as a baseline while evaluating impact.

Creating a population-wide Desirable Health Service Utilisation Indicator using linked health and administrative data

Background and ObjectiveHealthcare research faces challenges in developing metrics that resonate with the general public or policymakers. We created a Desirable Health Service Utilisation Indicator (DHSUI) to address this gap, centred around New Year’s wishes for survival and non-occurrence of undesired events in the following year, for the population of Wales, UK, following discussions with policy-makers. MethodsWe accessed and linked individual electronic healthcare records from primary and secondary care sources within the Secure Anonymised Information Linkage (SAIL) Databank. The study used data for all Welsh General Practice registered individuals on the 1st January 2015 with follow-up until residency break, death, or 31st December 2022. The DHSUI was calculated per person per year and quantified the distribution of the population who survive calendar years and do not use selected health services (not admitted to hospital; no emergency department attendance; and not prescribed antibiotics, analgesics, or mental health drugs). We linked area level demographic data to measure socio-economic differences in DHSUI distribution. ResultsFocussing on 2022, a population of 2,668,977 people were included, with 1,150,347 (43%) identified as meeting the indicator. The proportion of desirable health decreased significantly with age and with increasing socio-economic deprivation. A higher proportion of males (50%) had desirable health compared to females (37%). The most prevalent sub-indicator among those with undesirable health was antibiotic prescriptions accounting for 52% of cases. ConclusionThis DHSUI indicator is easy to interpret and will assist policymakers and the public in understanding the magnitude and distribution of desirable healthcare utilisation.

Prediction model for composite adverse pregnancy outcomes: Indonesia demographic health survey analysis

Adverse Pregnancy Outcome (APO) is the leading cause of infant mortality, particularly in low and middle-income countries. Despite no significant change in neonatal mortality rates in Indonesia over the past fifteen years, identifying the risk factors for APO can help healthcare professionals provide personalized interventions and support. This study aims to determine the determinants of APO risk in Indonesia. The cross-sectional study utilized the 2017 Indonesian Health Demographic Survey (IDHS), which included 9,752 women of reproductive age. APO, including low birth weight, early birth, and stillbirth, was the outcome of the study. The demographic characteristics and other risk factors were evaluated. To identify APO-risk-associated factors, we performed multiple logistic regression analysis. The results showed that low economic status (Adj. OR= 1.407; 1.153-1.716; p= 0.001)), living in rural areas (Adj. OR= 0.804; 0.663-0.976; p= 0.027), having a history of pregnancy or childbirth complications (Adj. OR= 4.563; 3.617-5.756; p= 0.0001), premature rupture of the membrane during pregnancy or after giving birth (Adj. OR= 1.351; 1.069-1.708; p= 0.012), antenatal visits &lt;4 times (Adj. OR= 1.603; 1.123-2.288; p= 0.009), consumption of iron supplement tablets &lt;90 days (Adj. OR= 1.275; 1.063-1.529; p= 0.009), and twin pregnancy (Adj. OR= 33.715; 18.587-61.153; p= 0.0001) significantly influenced the APO prevalence. The study concluded that APO risk is significantly impacted by poor obstetric history features, multiple births, low health service utilization, and sociodemographic factors. Early detection of these risk factors is essential for reducing neonatal death caused by APO.

Wealth disparities in maternal health service utilization among women of reproductive age in Ethiopia: findings from the mini-EDHS 2019

BackgroundEthiopia has made strides in reducing maternal mortality, but significant discrepancies in maternal health service utilization exist across socioeconomic levels. According to studies, women from higher-income households are far more likely to use essential services such as antenatal care, delivery care, and postnatal care than poorer women. This wealth disparity is a primary contributor to persistently high maternal mortality, particularly among poor populations. The study’s goal was to assess wealth disparities in maternal health service uptake and identify contributing factors.Methods and materialsWe used the Ethiopian Mini Demographic Health Survey (EMDHS), conducted in 2019 on women aged 15–49 living in selected census areas, with a weighted sample size of 3,909. The Erreygers Concentration Index (ECI) was used to measure wealth inequalities in maternal health care, and the ECI decomposition was used to identify factors contributing to inequality in maternal health services.ResultsMaternal health service utilization was pro-rich among women in Ethiopia. The prevalence of antenatal care service (ANC), delivery, and postnatal care (PNC) service utilization showed a pro-rich distribution among Ethiopian women, with ECI = 0.115 (95% CI: 0.091–0.137), ECI = 0.223 (95% CI: 0.191–0.276), and ECI = 0.121 (95% CI: 0.041-0.200), respectively. The ECI indices were decomposed to examine the contributing factors to disparities in maternal service utilization in Ethiopia. Mother’s current age, household family size, region, birth order, and parity were contributors to maternal health service utilization.ConclusionThe ANC service, delivery service and PNC service utilization showed a pro-rich distribution among Ethiopian women. Mother’s current age, household family size, region, birth order, and parity are important contributors of maternal health service inequality. To improve access and usage among low-income women, policymakers can develop programs including increasing the number of free or subsidized services and providing transportation.

Health service utilization, economic burden and quality of life of patients with mucopolysaccharidosis in China

BackgroundPatients with mucopolysaccharidosis (MPS) often face delayed diagnoses, limited treatment options and high healthcare costs, that may significantly affect patients' quality of life. The objective of this study was to understand medical service utilization related to diagnosis and treatment, economic burden during diagnosis period, and health-related quality of life among MPS patients in China.MethodsA series of patients diagnosed with MPS registered in the national patient organization were recruited for a cross-sectional survey from May to July 2019. Information were collected from patients or their parents via phone interview, including demographic data, utilization of services related to diagnosis and treatment, total cost during the period of MPS diagnosis and health-related quality of life (HRQoL). HRQoL was assessed by PedsQL 4.0 Generic Core Scale (PedsQL) and 36-item short-form health survey (SF-36) depending on the age of patients with MPS and compared with the general Chinese population.ResultsA total of 180 MPS patients (50, 67, 15, 46, 1 and 1 for type I, II, III, IV, VI and VII), with a mean age of 9.54 years and 137 (76.11%) males, were included in analysis. The mean age at first visit to a medical doctor for MPS related symptoms was 3.65 ± 2.58 years old, while only 12 patients (6.67%) were diagnosed on their first visit. The mean diagnostic delay, which is defined as the time between the first visit to a medical doctor for MPS related symptoms and the final diagnosis, was 9.42 months, with no significant difference between types. The average number of misdiagnosis was 4.56. Before the confirmed diagnosis, the patients made an average of 6.31 visits and visited 4.3 hospitals. During diagnosis period, the mean of ¥81,086.72 direct medical costs accounted for 63.75% of the total cost. Only 32.78% of the patients had ever received specific treatments. The mean scores of PedsQL and SF-36 of patients were significantly lower than the Chinese norms. Household annual income per person, specific treatment use and MPS subtype were significantly associated HRQoL of patients.ConclusionThe results highlight challenges faced by MPS patients in terms of diagnosis, access to specific treatments, economic burden and low HRQoL. There is an urgent need to improve early detection and diagnosis, create fair and consistent mechanisms to increase access to specialized treatment and reduce the economic burden of MPS patients in China.

Gender differences in cost-related unmet healthcare needs: a national study in Turkiye

BackgroundUnmet healthcare needs are a complex and multifaceted issue, influenced by individual, socioeconomic, and healthcare system factors. This study aimed to investigate the determinants influencing cost-related unmet healthcare needs within the Turkish population, emphasizing a comprehensive analysis of gender disparities in accessing healthcare services.MethodsThis secondary analysis scrutinizes the 2019 Turkiye Health Survey data of 16,976 individuals aged 15 and older. The dependent variables included cost-related unmet medical, dental, and prescribed medication, and mental services. The independent variables were considered under a three-domain approach for the determination of health service utilization, developed by Andersen. Logistic regression models with predisposing, enabling, and need factors were run for any self-perceived cost-related unmet need for each sex and overall population. Another six regression models for both sexes were run for each subgroup of indivuals with unmet healthcare needs.ResultsThe study revealed that 15.4% of individuals cannot access healthcare due to financial constraints, with 16.8% for women and 13.5% for men. The highest level of unmet needs is associated with accessing dental care services for both sexes. According to multivariate analyses, the unmet need for both sexes decreases with older age and higher education level, and it is greater for those who have difficulties communicating in Turkish. By adding enabling and needs factors, the odds ratios of education decreased for men, while education became nonsignificant for women. Having chronic disease impacts unmet needs for both sexes. However, the inability to perform daily activities due to health problems was not a significant factor for men. Poorer household income increases overall unmet needs. Education is a determinant of both medical and mental care needs.ConclusionsThis pioneering study illuminates the multifaceted gender disparities in cost-related unmet healthcare needs across Turkiye, reflecting the intertwined issues of access influenced by a complex interplay of factors. Our findings underscore the significance of adopting an intersectional approach to address health inequalities.