Trends in Alcohol Services Utilization from 1991–1992 to 2001–2002: Ethnic Group Differences in the U.S. Population

Background:  During the early 1990s in the United States, changes to the provision and financing of alcohol treatment services included reductions in inpatient treatment services and in private sector spending for treatment. We investigated trends in alcohol services utilization over the 10‐year period from 1991–1992 to 2001–2002 among U.S. whites, blacks, and Hispanics. Methods:  Data come from 2 household surveys of the U.S. adult population. The 1991 to 1992 National Longitudinal Alcohol Epidemiologic Survey and the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions conducted face‐to‐face interviews with a multistage cluster sample of individuals 18 years of age and older in the continental United States. Treatment utilization represented both total utilization and the use of alcohol services. Data analyses were prevalence rates and multivariate logistic regressions for lifetime utilization with drinkers and individuals with alcohol use disorders (AUDs). Results:  From 1991–1992 to 2001–2002, drinking‐related emergency room and human services use increased for drinkers, while total utilization and the use of private health professional services and mutual aid decreased for individuals with AUDs. In drinkers and individuals with AUDs, blacks and Hispanics were less likely than whites to use private health professional care. Hispanics with AUDs were less likely than whites with AUDs to use alcohol or drug programs. Ethnicity interacted with alcohol severity to predict alcohol services utilization. At higher levels of alcohol severity, blacks and Hispanics were less likely than whites to ever use treatment and to use alcohol services (i.e., human services for Hispanic drinkers, mental health services for blacks with AUDs, and mutual aid for Hispanics with AUDs). Conclusions:  Our findings showed increases from 1991–1992 to 2001–2002 in alcohol services utilization for drinkers, but reductions in utilization for individuals with AUDs. Blacks and Hispanics, particularly those at higher levels of alcohol severity, underutilized treatment services compared to whites. These utilization trends for blacks and Hispanics may reflect underlying disparities in healthcare access for minority groups, and language and logistical barriers to utilizing services

Maternal health in Jamaica : health needs, services, and utilization

The main health issues for Jamaican women are nutrition, fertility, infection, chronic diseases, and stress and social problems. The two leading causes of adult health for women are cerebro-vascular accidents and coronary heart disease - of which high blood pressure is a major component among black women. The main factors causing stress for Jamaican women include unemployment, economic inadequacy, separation of partners, male promiscuity, limited availability of schooling for children, and violence. The Jamaican health care system needs more family planning services for those who want them; good community-based prenatal education and screening and hospital delivery for high-risk pregnancies, better community education and better transportation so that women and midwifes can visit more often. There is also a great need for health education to overcome broad misperceptions, which may block demand for family planning services.Reproductive Health,Health Monitoring&Evaluation,Adolescent Health,Early Child and Children's Health,Gender and Health

The effects of a fee-waiver program on health care utilization among the poor : evidence from Armenia

This study examines the impact of a fee-waiver program for basic medical services on health care utilization in Armenia. Because of the reduction in public financing of health services and decentralization and increased privatization of health care provision, private out-of-pocket contributions are increasingly becoming a significant component of health costs in Armenia. To help poor families cope with this constraint, the Armenian government provided a free-of-charge basic package service to eligible individuals in vulnerable groups, such as the disabled and children from single parent households. Drawing on the 1996 and 1998-99 Armenia Integrated Survey of Living Standards (AISLS), which allows the identification of eligible individuals under this program, the authors estimate the impact of the fee-waiver program on utilization of health services, particularly among the poor. Across the two survey rounds utilization rates have indeed declined despite comparable levels of income, and this decline has occurred among both the poor and the rich, with average utilization falling by 12 percent between the two surveys. But families with four or more children, the largest beneficiary group under the"vulnerable population"program, have decreased their use of health care services in a disproportionate manner-21 percent reduction in use between the two survey rounds. This precipitous drop in health care use by this vulnerable group, despite being eligible for free medical services, suggests that the program was inadequate in stemming the decline in the use of health services. The authors further present evidence to suggest that the free-of-charge eligibility program acts more like an income transfer mechanism, particularly to disabled individuals.Health Systems Development&Reform,Health Monitoring&Evaluation,Public Health Promotion,Early Child and Children's Health,Health Economics&Finance,Health Systems Development&Reform,Health Economics&Finance,Gender and Health,Regional Rural Development,Health Monitoring&Evaluation

Focus on vulnerable populations and promoting equity in health service utilization ––an analysis of visitor characteristics and service utilization of the Chinese community health service

Background Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents. Methods Multistage sampling method was applied to select 35 cities in China. Four CHIs were randomly chosen in every district of the 35 cities. A total of 88,482 visitors to the selected CHIs were investigated by using intercept survey method at the exit of the CHIs in 2008, 2009, 2010, and 2011. Descriptive analyses were used to analyze the main characteristics (gender, age, and income) of the CHI visitors, and the results were compared with that from the National Health Services Survey (NHSS, including CHIs and higher levels of hospitals). We also analyzed the service utilization and the satisfactions of the CHI visitors. Results The proportions of the children (2.4%) and the elderly (about 22.7%) were lower in our survey than those in NHSS (9.8% and 38.8% respectively). The proportion of the low-income group (26.4%) was apparently higher than that in NHSS (12.5%). The children group had the lowest satisfaction with the CHIs than other age groups. The satisfaction of the low-income visitors was slightly higher than that of the higher-income visitors. The utilization rate of public health services was low in CHIs. Conclusions The CHIs in China appears to fulfill the public health target of uptake by vulnerable populations, and may play an important role in promoting equity in health service utilization. However, services for children and the elderly should be strengthened

Prevalence of Mental Health Disorder Symptoms and Rates of Help-seeking Among University-Enrolled, Black Men

Background. Black men in college represent a subgroup of emerging adults who are at increased risk of developing mental health disorders (MHDs), such as anxiety and depression. Such risk has been attributed to disproportionate experiences with everyday racial discrimination and high levels of psychological distress. Despite being at higher risk, university-enrolled, Black men are not utilizing mental health or health resources at optimal rates. The current evidence base describing prevalence of MHDs and health services utilization among Black men in college is limited. The present study addresses this by examining mental health prevalence among university-enrolled, Black men and their rates of health services utilization. Methods. We analyzed data (N ~ 2500) from a student survey, Spit for Science, a longitudinal, ongoing, research study at a mid-Atlantic, public university. Participants are given surveys in their freshman year and follow-up surveys every spring thereafter. Measures included: mental health disorders (depression and anxiety, as measured by the Symptom Checklist 90) and campus health service utilization (counseling center, health services, wellness center, and recreational sports). We conducted descriptive analyses to determine MHD symptom prevalence and utilization rates; Mann Whitney U tests to compare prevalence rates to White men and Black women; and, Chi-squared tests to compare rates of utilization among groups. Results. During their Freshman year, greater than 60% of students from each ethnic group reported at least one anxiety symptom and greater than 80% reported at least one depressive symptom. By senior year, reporting rates decreased significantly for Black men (49.6%) but remained high for White men (69.1%) and Black women (63%); p \u3c0.000. For depression, results were similar; however, only significant differences between Black men (72.7%) and Black women (87.1%); p\u3c0.000. Black men (20.4%), though reporting high levels of symptoms, still utilized counseling services at lower rates compared to White men (37.76%); p = 0.024. Conclusion. Findings suggest that Black men underutilize available campus health resources despite reporting one or more symptoms associated with anxiety and depression. Further research and prevention efforts are needed to improve help-seeking among this vulnerable population.https://scholarscompass.vcu.edu/gradposters/1077/thumbnail.jp

Does mobile phone ownership predict better utilization of maternal and newborn health services? a cross-sectional study in Timor-Leste.

BackgroundIncreasingly popular mobile health (mHealth) programs have been proposed to promote better utilization of maternal, newborn and child health services. However, women who lack access to a mobile phone are often left out of both mHealth programs and research. In this study, we determine whether household mobile phone ownership is an independent predictor of utilization of maternal and newborn health services in Timor-Leste.MethodsThe study included 581 women aged 15-49 years with a child under the age of two years from the districts of Manufahi and Ainaro in Timor-Leste. Participants were interviewed via a structured survey of knowledge, practices, and coverage of maternal and child health services, with additional questions related to ownership and utilization of mobile phones. Mobile phone ownership was the exposure variable, and the dependent variables included having at least four antenatal care visits, skilled birth attendance, health facility delivery, a postnatal checkup within 24 h, and a neonatal checkup within 24 h for their youngest child. Logistic regression models were applied to assess for associations.ResultsSixty-seven percent of women reported having at least one mobile phone in the family. Women who had a mobile phone were significantly more likely to be of higher socioeconomic status and to utilize maternal and newborn health services. However, after adjusting socioeconomic factors, household mobile phone ownership was not independently associated with any of the dependent variables.ConclusionEvaluations of the effects of mHealth programs on health in a population need to consider the likelihood of socioeconomic differentials indicated by mobile phone ownership

Beyond Socioeconomic Status: Some Implications for Planned Health Intervention Among the Poor

This paper discusses the insights derived and the lessons learned from two research studies that have been recently conducted among families in rural Leyte, “Determinants of Maternal Health Care Utilization among Rural Women: The Case of Three Barangays in Leyte” and the urban poor of Metro Manila, “Health Seeking Behavior among Families in High Risk Urban Communities.” The discussion, however, is limited to the utilization of health care services among rural and urban poor families, specifically the use of public and private health facilities and the services of the health functionaries.urban management, health sector, urbanization, health care, rural sector

Public health services and health care utilization in Viet Nam

The main objectives of this paper are to review policies on health services and to provide an assessment of public health facilities and the access of people to health care services in Vietnam. Medical facilities and staffs in public establishments have been increasing. Health insurance has been expanded rapidly in the recent years. It is very encouraging that the poor and ethnic minority are more likely to be enrolled in health insurance than other people. In addition, we find that health insurance helps the insured increase health care utilization and reduce out-of-pocket spending. The density of medical staffs is also positively correlated with outpatient health care utilization. However, the quality of health care services and the access to health care services remain limited in poor, remote and mountainous areas.Health policy, health insurance, health care, Vietnam

Oral Health: Successes and Opportunities for Children's Health Initiatives

Examines the relationship between dental insurance and oral health improvement, including access to oral health care. Looks at utilization of dental services by children in the Children's Health Initiatives as well as other programs

The relevance of satisfaction with coverage for health care utilization: evidence from Catalonia

This paper discloses satisfaction with medical coverage as a key determinant factor of heath care utilization in Catalonia (Spain). We use data from the 2002 Catalan Health Interview Survey for exploring its relevance either for the event of the visit or the number of visits. In the two cases we account for endogeneity derived from the availability of duplicate coverage and underreporting bias in health self-reported status. We evidence that those who are more satisfied will take more use of the health care services like it succeeds in other consumer events.consumer satisfaction; health care services utilization; duplicate coverage.