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Service Utilisation (service + utilisation)
Selected AbstractsCosts and determinants of privately financed home-based health care in Ontario, CanadaHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2008Denise N. Guerriere PhD Abstract The Canadian context in which home-based healthcare services are delivered is characterised by limited resources and escalating healthcare costs. As a result, a financing shift has occurred, whereby care recipients receive a mixture of publicly and privately financed home-based services. Although ensuring that care recipients receive efficient and equitable care is crucial, a limited understanding of the economic outcomes and determinants of privately financed services exists. The purposes of this study were (i) to determine costs incurred by families and the healthcare system; (ii) to assess the determinants of privately financed home-based care; and (iii) to identify whether public and private expenditures are complements or substitutes. Two hundred and fifty-eight short-term clients (< 90 days of service utilisation) and 256 continuing care clients (> 90 days of utilisation) were recruited from six regions across the province of Ontario, Canada, from November 2003 to August 2004. Participants were interviewed by telephone once a week for 4 weeks and asked to provide information about time and monetary costs of care, activities of daily living (ADL), and chronic conditions. The mean total cost of care for a 4-week period was $7670.67 (in 2004 Canadian dollars), with the overwhelming majority of these costs (75%) associated with private expenditures. Higher age, ADL impairment, being female, and a having four or more chronic conditions predicted higher private expenditures. While private and public expenditures were complementary, private expenditures were somewhat inelastic to changes in public expenditures. A 10% increase in public expenditures was associated with a 6% increase in private expenditures. A greater appreciation of the financing of home-based care is necessary for practitioners, health managers and policy decision-makers to ensure that critical issues such as inequalities in access to care and financial burden on care recipients and families are addressed. [source] Intellectual disability, challenging behaviour and cost in care accommodation: what are the links?HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2005Martin Knapp PhD Abstract The paper examines the links between degree of intellectual disability, challenging behaviour, service utilisation and cost for a group of people with intellectual disabilities living in care accommodation in England. A cross-sectional survey was conducted of people with intellectual disabilities, identified via provider organisations, with supplementary collection of costs data. Multivariate analyses of cost variations were carried out for 930 adults with intellectual disabilities. There were strong, nonlinear, interdependent links between degree of intellectual disability, behaviour, service use and costs. Higher costs were associated with more severe intellectual disabilities and more challenging behaviour. Sector and scale of residence also influenced cost in quite complex ways. Access to and use of services by people with intellectual disabilities were not always appropriately linked to perceived or actual needs. Policy makers and local commissioning agencies need to explore the sources of cost variation between individuals, sectors and types of accommodation in order to achieve national policy objectives on quality, choice, independence and inclusion. [source] More than technology and access: primary care patients' views on the use and non-use of health information in the Internet ageHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2004Anne Rogers MSc(Econ) PhD Abstract Over the past decade, there has been considerable interest in the transmission of health information made available though the Internet with increasing confidence being placed in the potential power of the Internet to transform communication, clinical practice and relationships with patients. Subsequent to the failure of a primary-care-based initiative designed to provide free assistance and access to health information via the Internet, a survey was conducted. Findings from this survey suggested that facilitating access to e-information is necessary, but not in itself sufficient, to encourage current non-users to start exploring the Internet. The qualitative study reported here was aimed at exploring the way in which people use and perceive the utility of Internet information for managing health and illness and engaging with the health service system. Data was gathered from two sources. Interviews and observations of a sample who had used a free primary-care-based Internet service (n = 5) and interviews with a sample drawn from a survey of patient attitudes to using the Internet for health information (n = 12). The less-considered aspects of access and the use of e-information for health matters related to the varied existing relationships respondents had to computers, health information and health professionals. One of the main reasons why some respondents do not use the Internet to access health information is related to a lack of perceived utility and pertinence of such information for managing their healthcare. The optimal and equitable use of the Internet as a means of complimenting health-service utilisation will not emerge merely from increasing access to e-information. The potential for narrowing or increasing inequality between the information rich and poor needs to be viewed in a broader psychosocial context. The latter includes the nature of existing relationships which people have with the health service and the value that people place on their own capacity to make use of information in managing their healthcare. [source] Deliberate self-harm in older adults: a review of the literature from 1995 to 2004INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2007Jenifer Chan Abstract Background The prevention of suicide is a national and international policy priority. Old age is an important predictor of completed suicide. Suicide rates in old age differ markedly from country to country but there is a general trend towards increasing rates with increasing age. In 1996 Draper reviewed critically the evidence on attempted suicide in old age in the 10 years between 1985 and 1994. The review highlighted a need for prospective controlled studies in older people with more representative samples as well as studies examining the interaction of risk factors, precipitants, motivations, psychopathology and response to treatment. The aim of this paper is to update this review and to summarise the advances in our understanding of DSH in later life. Method We have critically reviewed relevant studies published between 1995 and 2004 to summarise the advances in our understanding of factors associated with deliberate self-harm in later life. Results The main advances in understanding have been to clarify the effect of personality and cultural factors, service utilisation pre and post attempt, and the (lesser) impact of socio-economic status and physical illness. Methodological weaknesses continue to include inadequate sample sizes performed on highly selected populations, inconsistent age criteria and lack of informant data on studies relating to role of personality. Conclusions Future studies should include prospective, cross-cultural research with adequate sample sizes and which are population-based. Such approaches might confirm or refute the results generated to date and improve knowledge on factors such as the biological correlates of deliberate self-harm, service utilisation, costs and barriers to health care, and the interaction of these factors. Intervention studies to elucidate the impact of modifying these factors and of specific treatment packages are also needed. Copyright © 2007 John Wiley & Sons, Ltd. [source] Factors influencing parental decision to consult for children with upper respiratory tract infectionJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2008Chirk-Jenn Ng Aim: This study aimed to determine which factors could influence (i) parents' decision to seek medical consultatin and (ii) their preference for either public or private medical service in children with upper respiratory tract infection. Methods: This cross-sectional study was conducted at the Gombak district, which is an urban area in Malaysia. We randomly selected parents of kindergarten children aged 4,5 years to participate in this questionnaire survey. The main outcome measures were predictors of early medical consultation and type of service utilisation (public versus private). Results: We achieved a response rate of 84.5% (n = 1033/1223). 64.1% sought early medical consultation and 70.9% preferred to consult a private doctor. Early consultation was predicated by the parent gender being male (OR 1.50; 95% CI 1.09, 2.05), non-Chinese (OR 1.75%; 95% CI 1.10, 2.79), and those who preferred child specialists (OR 2.02; 95% CI 1.27, 3.23). Lower income group (OR 4.28; 95% CI 2.30, 7.95) and not having a regular doctor (OR 4.99%; 95% CI 3.19, 7.80) were predictors of using the public health services. Conclusions: Parent's gender, ethnicity and income influenced their decision to seek early medical consultation for their children's respiratory illness while income and having a regular doctor could predict their choice of healthcare services. [source] HEALTH ISSUES AMONG FILIPINO WOMEN IN REMOTE QUEENSLANDAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 4 2001Margaret Kelaher ABSTRACT: This paper discusses health issues among Filipinas (women born in the Philippines) living in remote and rural environments in Queensland. The sample was recruited as part of the University of Queensland component of the Australian Longitudinal Study of Women's Health (ALSWH). Most of the women lived in an urban or semi-urban area (391), whereas 90 lived in rural or remote areas. Community perceptions had a much greater impact on health service utilisation in rural and remote areas than in urban areas. The transition between newcomer and old-timer is more difficult for Filipinas than for other rural women because they are visibly different from other members of the community and suffer from stigmatisation associated with perceptions of Filipinas as mail order brides. For these women, concerns about confidentiality and a reluctance to ask for support are major barriers to health service utilisation. The area of greatest concern is mental health, particularly in relation to parenting issues. Improving access may involve providing a greater awareness of what services are available and allowing women to access services in a way that does not require them to label themselves or be labelled by others. [source] | ||||||||||