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Services Use (services + use)
Kinds of Services Use Selected AbstractsProgressive segmented health insurance: Colombian health reform and access to health servicesHEALTH ECONOMICS, Issue 1 2007Fernando Ruiz Abstract Equal access for poor populations to health services is a comprehensive objective for any health reform. The Colombian health reform addressed this issue through a segmented progressive social health insurance approach. The strategy was to assure universal coverage expanding the population covered through payroll linked insurance, and implementing a subsidized insurance program for the poorest populations, those not affiliated through formal employment. A prospective study was performed to follow-up health service utilization and out-of-pocket expenses using a cohort design. It was representative of four Colombian cities (Cendex Health Services Use and Expenditure Study, 2001). A four part econometric model was applied. The model related medical service utilization and medication with different socioeconomic, geographic, and risk associated variables. Results showed that subsidized health insurance improves health service utilization and reduces the financial burden for the poorest, as compared to those non-insured. Other social health insurance schemes preserved high utilization with variable out-of-pocket expenditures. Family and age conditions have significant effect on medical service utilization. Geographic variables play a significant role in hospital inpatient service utilization. Both, geographic and income variables also have significant impact on out-of-pocket expenses. Projected utilization rates and a simulation favor a dual policy for two-stage income segmented insurance to progress towards the universal insurance goal. Copyright © 2006 John Wiley & Sons, Ltd. [source] The Impact of HIV on Oral Health and Subsequent Use of Dental ServicesJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 2 2003Aram Dobalian PhD Abstract Objective: This study examined differences in health and access to dental services among a nationally representative sample of patients with HIV using Andersen's Behavioral Model of Health Services Use. Methods: This investigation is a longitudinal study that used structural equation modeling to analyze data from the HIV Cost and Services Utilization Study, a probability sample of 2,864 adults under treatment for HIV infection. Key predisposing variables included sex, drug use, race/ethnicity, education, and age. Enabling factors included income, insurance, and regular source of care. Need factors included mental, physical, and oral health. Dependent variables included whether a respondent utilized dental services and number of visits. Results: More education, dental insurance, usual source of dental care, and poor oral health predicted a higher probability of having a dental visit. African Americans, Hispanics, those exposed to HIV through drug use or heterosexual contact, and those in poor physical health were less likely to have a dental visit. Of those who visited dental professionals, older persons, those with dental insurance, and those in worse oral health had more visits. African Americans and persons in poor mental health had fewer visits. Conclusions: Persons with more HIV-related symptoms and a diagnosis of AIDS have a greater need for dental care than those with fewer symptoms and without AIDS, but more pressing needs for physical and mental health services limit their access to dental services. Providers should better attend to the oral health needs of persons with HIV who are in poor physical and mental health. [source] Health Care Services Use by Adolescents with Intakes into an Outpatient Alcohol and Drug Treatment ProgramTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 2006Sujaya Parthasarathy PhD We examined utilization and cost in the 1 year pre- and post-intake among a sample of adolescents (N,419) entering chemical dependency (CD) treatment. Multivariate analyses showed that these youth used significantly more medical services than a demographically matched sample of members without substance use (SU) problems. Their utilization and costs were higher than matched members, and they did not show the same reductions in post-treatment costs that adults do. This is of concern since it would appear that the medical and mental health problems of adolescents entering CD treatment may be so severe that there are no short-term reductions in post-treatment cost, including ER and hospitalizations. [source] The Epidemiology of Emergency Medical Services Use by Older Adults: An Analysis of the National Hospital Ambulatory Medical Care SurveyACADEMIC EMERGENCY MEDICINE, Issue 5 2007Manish N. Shah MD ObjectivesTo characterize older adult emergency department (ED) visits arriving by emergency medical services (EMS) and to identify factors associated with those patient visits. MethodsA secondary analysis of the ED component of the 1997,2000 National Hospital Ambulatory Medical Care Survey using logistic regression analyses was conducted. The dependent variable was the modes of arrival (EMS vs. not EMS) to the ED. Independent variables were grouped into four domains: demographic, clinical, system, and service characteristics. ResultsBetween 1997 and 2000, 38% of EMS responses were for patients aged 65 years and older. During that period, 62.2 million older adult ED patient visits occurred; 38% arrived via EMS. The average rate of EMS utilization by older adults was 167/1,000 population per year, more than four times the rate for younger patients (39/1,000 population). Fifty-three percent of EMS responses with transport to an ED for older adults resulted in hospital admission. Factors found to be associated with EMS mode of arrival included demographic (older age and urban residence), clinical (need for more rapid care and circulatory system illnesses), and service (need for procedures). ConclusionsOlder adults account for a large proportion of EMS responses and use EMS at a disproportionately high rate. As the older adult population grows, EMS systems must prepare for the increased volume of older adults by making changes in training, operations, and equipment. [source] Pain interference impacts response to treatment for anxiety disordersDEPRESSION AND ANXIETY, Issue 3 2009Carrie Farmer Teh PhD Abstract Background: Anxiety disorders and pain are commonly comorbid, though little is known about the effect of pain on the course and treatment of anxiety. Methods: This is a secondary analysis of a randomized controlled trial for anxiety treatment in primary care. Participants with panic disorder (PD) and/or generalized anxiety disorder (GAD) (N=191; 81% female, mean age 44) were randomized to either their primary-care physician's usual care or a 12-month course of telephone-based collaborative care. Anxiety severity, pain interference, health-related quality of life, health services use, and employment status were assessed at baseline, and at 2-, 4-, 8-, and 12-month follow-up. We defined response to anxiety treatment as a 40% or greater improvement from baseline on anxiety severity scales at 12-month follow-up. Results: The 39% who reported high pain interference at baseline had more severe anxiety (mean SIGH-A score: 21.8 versus 18.0, P<.001), greater limitations in activities of daily living, and more work days missed in the previous month (5.8 versus 4.0 days, P=.01) than those with low pain interference. At 12-month follow-up, high pain interference was associated with a lower likelihood of responding to anxiety treatment (OR=.28; 95% CI=.12,.63) and higher health services use (26.1% with ,1 hospitalization versus 12.0%, P<.001). Conclusions: Pain that interferes with daily activities is prevalent among primary care patients with PD/GAD and associated with more severe anxiety, worse daily functioning, higher health services use, and a lower likelihood of responding to treatment for PD/GAD. Depression and Anxiety, 2009. © 2009 Wiley-Liss, Inc. [source] America's Health Care Safety Net Intact or Unraveling?ACADEMIC EMERGENCY MEDICINE, Issue 11 2001Lynne D. Richardson MD Abstract In virtually every community in this nation, the emergency department (ED) is an integral part of the health care safety net, often serving as the only available point of access to the health care system for many vulnerable and disenfranchised individuals. The authors present a brief overview of the March 2000 report released by the Institute of Medicine that described and assessed the current status of the nation's health care safety net. The authors discuss the role of the ED as a safety net provider and as a window onto the status of the rest of the health care system. The authors describe the Andersen behavioral model of health services use and suggest it as a useful theoretical framework for emergency medicine researchers who are interested in studying these issues. [source] Expanding the Andersen Model: The Role of Psychosocial Factors in Long-Term Care UseHEALTH SERVICES RESEARCH, Issue 5 2002Elizabeth H Bradley Objective. To examine a prevailing conceptual model of health services use (Andersen 1995) and to suggest modifications that may enhance its explanatory power when applied to empirical studies of race/ethnicity and long-term care. Study Setting. Twelve focus groups of African-American (five groups) and white (seven groups) individuals, aged 65 and older, residing in Connecticut during 2000. Study Design. Using qualitative analysis, data were coded and analyzed in NUD-IST 4 software to facilitate the reporting of recurrent themes, supporting quotations, and links among the themes for developing the conceptual framework. Specific analysis was conducted to assess distinctions in common themes between African-American and white focus groups. Data Collection. Data were collected using a standardized discussion guide, augmented by prompts for clarification. Audio taped sessions were transcribed and independently coded by investigators and crosschecked to enhance coding validity. An audit trail was maintained to document analytic decisions during data analysis and interpretation. Principal Findings. Psychosocial factors (e.g., attitudes and knowledge, social norms, and perceived control) are identified as determinants of service use, thereby expanding the Andersen model (1995). African-American and white focus group members differed in their reported accessibility of information about long-term care, social norms concerning caregiving expectations and burden, and concerns of privacy and self-determination. Conclusions. More comprehensive identification of psychosocial factors may enhance our understanding of the complex role of race/ethnicity in long-term care use as well as the effectiveness of policies and programs designed to address disparities in long-term care service use among minority and nonminority groups. [source] Health services use in women with a history of bulimia nervosa or binge eating disorderINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 1 2005Ruth H. Striegel-Moore PhD Abstract Objective The current study examined health services use during the past 12 months in a sample of young women with a history of an adolescent eating disorder (bulimia nervosa [BN] or binge eating disorder [BED]). Method A community sample of 1,582 young women (mean age = 21.5 years) was classified, based on a screening interview (and, for eating disorder diagnosis, confirmatory diagnostic interview), into one of three groups: BN or BED (n = 67), other psychiatric disorder (n = 443), and no adolescent psychiatric disorder (n = 1,072). Results A history of BN/BED in adolescence was associated with elevated health services use, but this was a general effect associated with having a psychiatric disorder, not an effect specific to the diagnosis of an eating disorder. Total service days, outpatient psychotherapy visits, and emergency department visits were elevated in the combined group of BN/BED and other psychiatric disorder participants relative to the healthy comparison group. The women with BN/BED did not differ significantly from the women with a non,eating-related psychiatric disorder in the use of these services. Discussion The similarity of health services use in young women with BN or BED and those with other psychiatric disorders underscores the clinical and economic impact of these eating disorders. © 2004 by Wiley Periodicals, Inc. [source] Considering context, place and culture: the National Latino and Asian American StudyINTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH, Issue 4 2004Margarita Alegria Abstract This paper provides a rationale for, and overview of, procedures used to develop the National Latino and Asian American Study (NLAAS). The NLAAS is nationally representative community household survey that estimates the prevalence of mental disorders and rates of mental health service utilization by Latinos and Asian Americans in the US. The central aims of the NLAAS are to: 1) describe the lifetime and 12-month prevalence of psychiatric disorders and the rates of mental health services use for Latino and Asian American populations using nationwide representative samples of Latinos and Asian Americans, 2) assess the associations among social position, environmental context, and psychosocial factors with the prevalence of psychiatric disorders and utilization rates of mental health services, and 3) compare the lifetime and 12-month prevalence of psychiatric disorders, and utilization of mental health services of Latinos and Asian Americans with national representative samples of non-Latino whites (from the National Comorbidity Study-Replication) (NCS-R) and African Americans (from the National Survey of American Life) (NSAL). This paper presents new concepts and methods utilized in the development of the NLAAS to capture and investigate ethnic, cultural and environmental considerations that are often ignored in mental health research. Copyright © 2004 Whurr Publishers Ltd. [source] Health care utilization and expenditures for privately and publicly insured children with sickle cell disease in the United States,,PEDIATRIC BLOOD & CANCER, Issue 4 2009Mercy Mvundura PhD Abstract Background There are no current national estimates on health care utilization and expenditures for US children with sickle cell disease (SCD). Procedure We used the MarketScan® Medicaid Database and the MarketScan® Commercial Claims and Encounters Database for 2005 to estimate health services use and expenditures. The final samples consisted of 2,428 Medicaid-enrolled and 621 privately insured children with SCD. Results The percentage of children with SCD enrolled in Medicaid with an inpatient admission was higher compared to those privately insured (43% vs. 38%), yet mean expenditures per admission were 35% lower ($6,469 vs. $10,013). The mean number of emergency department (ED) visits was 49% higher for Medicaid-enrolled children compared to those with private insurance (1.36 vs. 0.91), but mean expenditures per ED visit were 28% lower. The mean number of non-ED outpatient visits was similar (12.6 vs. 11.5) but mean expenditures were 40% lower for the Medicaid-enrolled children ($3,557 vs. $5,908). The mean expenditures on drug claims were higher among those with Medicaid than private insurance ($1,049 vs. $531). Mean total expenditures for children with SCD enrolled in Medicaid were 25% lower than for privately insured children ($11,075 vs. $14,722). The samples were comparable with respect to SCD-related inpatient discharge diagnoses and use of outpatient blood transfusions. Conclusions Children with SCD enrolled in Medicaid had lower expenditures than privately insured children, despite higher utilization of medical care, which indicates lower average reimbursements. Research is needed to assess the quality of care delivered to Medicaid-enrolled children with SCD and its relation to health outcomes. Pediatr Blood Cancer 2009;53:642,646. Published 2009 Wiley-Liss, Inc. [source] The Gudaga Study: establishing an Aboriginal birth cohort in an urban communityAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 2010Elizabeth Comino Abstract Objective: This paper describes the establishment of the Gudaga Study, an Aboriginal birth cohort in south-west Sydney, and our approach to follow-up of participants. The Study describes the health, development, and services use of Aboriginal infants and their mothers. The research team works closely with the local Aboriginal community to implement the research. Methods: All mothers in the maternity ward of an urban hospital were surveyed to identify mothers with an Aboriginal infant. These and some additional mothers identified through other networks were recruited to the study. Results: The number of mothers were surveyed was 2,108. Mothers of Aboriginal infants were younger (25.3 years compared to 28.4 years, p<0.001), less likely to be married (16.1% cf. 58.4%, p<0.001) and to have completed school (63.2% cf. 77.8%, p=0.002) than mothers of non-Aboriginal infants. Of 155 identified mothers of Aboriginal infants, 136 were recruited and 23 through other networks. At 12 months, 85.5% of infants were followed up. Conclusions: This study, to our knowledge, is the first cohort study of this kind on the eastern seaboard of Australia. The study has strong community support and follow-up, contrary to views that Aboriginal people are reluctant to participate in research. These data have national and regional significance. [source] The comparison of health status and health services utilisation between Indigenous and non-Indigenous infants in AustraliaAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2010Lixin Ou Abstract Objective: To examine the differences in health services utilisation and the associated risk factors between Indigenous and non-Indigenous infants at a national level in Australia. Methods: We analysed data from a national representative longitudinal study, the Longitudinal Study for Australian Children (LSAC) starting in 2004. We used survey logistic regression and survey multiple linear regression to examine the factors associated with health services utilisation. Results: Health status of Indigenous infants was poorer than that of non-Indigenous. In comparison to non-Indigenous infants, in the previous 12-month period, the Indigenous infants were significantly less likely to use the following health services: maternal and child health centre or help lines (OR=0.35, 95%CI: 0.24-0.49); maternal and child health nurse visits (OR=0.45, 95%CI: 0.32-0.63); general practitioners (GPs) (OR=0.45, 95%CI: 0.31-0.64); and paediatrician (OR=0.52, 95%CI: 0.35-0.77). In contrast, they were more likely to visit a hospital outpatient clinic (OR=1.82, 95%CI: 1.16-2.85). Mothers' age, education and marital status were associated with certain health services use. Financial status and residential location were the important predictors of the use of health services. Conclusion: The rates of health services utilisation by Indigenous infants were lower and were associated with mothers' characteristics and socio-economic status. Implications: The gaps in health services utilisation between Indigenous and non-Indigenous infant requires immediate policy initiatives. Further research is needed to explore the causal pathways between health status, health services utilisation and multiple risk factors at different levels. [source] Employer burden of mild, moderate, and severe major depressive disorder: mental health services utilization and costs, and work performance,DEPRESSION AND ANXIETY, Issue 1 2010Howard G. Birnbaum Ph.D. Abstract Background: Treatment utilization/costs and work performance for persons with major depressive disorder (MDD) by severity of illness is not well documented. Methods: Using National Comorbidity Survey-Replication (2001,2002) data, US workforce respondents (n=4,465) were classified by clinical severity (not clinically depressed, mild, moderate, severe) using a standard self-rating scale [Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR)]. Outcomes included 12-month prevalence of medical services/medications use/costs and workplace performance. Treatment costs (employer's perspective) were estimated by weighing utilization measures by unit costs obtained for similar services used by MDD patients in claims data. Descriptive analysis across three severity groups generated ,2 results. Results: Using a sample of 539 US workforce respondents with MDD, 13.8% were classified mild, 38.5% moderate, and 47.7% severe cases. Mental health services usage, including antidepressants, increased significantly with severity, with average treatment costs substantially higher for severe than for mild cases both regarding mental health services ($697 vs. $388, ,2=4.4, P=.019) and antidepressants ($256 vs. $88, ,2=9.0, P=.001). Prevalence rates of unemployment/disability increased significantly (,2=11.7, P=.003) with MDD severity (15.7, 23.3, and 31.3% for mild, moderate, and severe cases). Severely and moderately depressed workers missed more work than nondepressed workers; the monthly salary-equivalent lost performance of $199 (severely depressed) and $188 (moderately depressed) was significantly higher than for nondepressed workers (,2=10.3, P<.001). Projected to the US workforce, monthly depression-related worker productivity losses had human capital costs of nearly $2 billion. Conclusions: MDD severity is significantly associated with increased treatment usage/costs, treatment adequacy, unemployment, and disability and with reduced work performance. Depression and Anxiety, 2010. © 2009 Wiley-Liss, Inc. [source] | ||||||||||