Microfinance investments in quality at private clinics in Uganda: a case-control study

Background: Small private-sector health care providers can play an important role in meeting the developing country health care needs, but a lack of credit can prove major constraint to small-provider expansion. This study examines the potential of small, microfinance loans to strengthen the private health sector and improve access to quality preventive and curative health services in Uganda. Methods: This study estimates logistic regressions using 2,387 client exit interviews to assess the impact of microfinance loans on perceived quality and the viability and sustainability of small, private clinics. Results: The study finds perceived quality improved with loan recipients' clients being more likely to choose clinics on the basis of drug availability, fair charges, cleanliness, and confidentiality. In addition, the assessment found evidence of increased client flows, but the changes produced mixed results for sustainability with respondents being only half as likely to "always" visit a particular clinic. Conclusion: The results indicate that the microfinance program improved perceived quality at loan recipient clinics, especially as reliable drug outlets

The Design and Methodology of the Ohio COVID-19 Survey

Background: Governments worldwide are balancing contrasting needs to curtail the toll that coronavirus disease 2019 (COVID-19) takes on lives and health care systems and to preserve their economies. To support decisions, data that simultaneously measure the health status of the population and the economic impact of COVID-19 mitigation strategies are needed. In the United States, prior to the onset of COVID-19, surveys or tracking systems usually focused on public health or economic indicators, but not both. However, tracking public health and economic measures together allow policy makers and epidemiologists to understand how policy and program decisions are associated. The Ohio COVID-19 Survey (OCS) attempts to track both measures in Ohio as one of the first statewide population surveys on COVID-19. To achieve this there are several methodological challenges which need to be overcome. Methods: The OCS utilizes a representative panel offering both cross-sectional and longitudinal analyses. It targets 700 to 1000 respondents per week for a total of 12 600 to 18 000 respondents over an 18-week period. Leveraging a sample of 24 000 adult Ohioans developed from a statewide population health survey conducted in fall 2019, the OCS produces weekly economic and health measures that can be compared to baseline measures obtained before the COVID-19 pandemic began. Results: The OCS was able to quickly launch and achieve high participation (45.2%) and retention across waves. Conclusion: The OCS demonstrates how it is possible to leverage an existing health-based survey in Ohio to generate a panel which can be used to quickly track fast-breaking health issues like COVID-19

A Comparison of Benefit Limits in Mental Health

This study provides insight to policy makers and stakeholders on how three types of benefits limits on Medicaid-covered mental health services might affect access for consumers diagnosed with severe mental illness. The study used a retrospective cohort design with data for Medicaid-covered, community-based mental health services provided in Ohio during fiscal year 2010. Log-binomial regression was used for the analysis. Results indicate that limits compared have significant, varying consequences based on Medicaid coverage and diagnoses. When constraining Medicaid costs, policy makers should consider how limits will disrupt care and include clinicians in discussions prior to implementatio

Maternal and child health and family planning service utilization in Guatemala: implications for service integration

Does the utilization of modern maternal and child health (MCH) services influence subsequent contraceptive use? The answer to this question holds important implications for proposals which advocate MCH and family planning service integration. This study uses data from the 1995/6 Guatemalan Demographic Health Survey and its 1997 Providers Census to test the influence of MCH service utilization on individual contraceptive use decisions. We use a full-information maximum likelihood regression model to control for unobserved heterogeneity. This model produces estimates of the MCH effect, independent of individual women's underlying receptiveness to MCH and contraceptive messages. The results of the analysis indicate that the intensity of MCH service use is indeed positively associated with subsequent contraceptive use among Guatemalan women, even after controlling for observed and unobserved individual- , household- , and community-level factors. Importantly, this finding holds even after controlling for the unobserved factors that 'predispose' some women to use both types of services. Simulations reveal that, for these Guatemalan women, key determinants such as age and primary schooling work indirectly through MCH service use to increase contraceptive utilization.Contraceptives MCH Guatemala Family planning

Medicaid Payment Mechanisms: Impact on Medication Adherence and Health Care Service Utilization in Type 2 Diabetes Enrollees

Abstract The purpose of this retrospective cohort study was to examine the impact of the type of health plan (capitated vs. fee for service [FFS]) on outcomes (medication adherence and health care service utilization) in type 2 diabetes Medicaid enrollees. Subjects were 8581 Medicaid enrollees with type 2 diabetes who newly started oral pharmacotherapy and were followed for 6 months before and 12 months after the index antidiabetic medication to collect data on medication adherence and health care service utilization. Multiple log-linear regression analysis was used to predict medication adherence while negative binomial regressions were used to examine health care service utilization. Medication adherence was found to be significantly lower for patients in capitated plans (5%, P?<?0.05). Moreover, patients in capitated plans were associated with 14% more hospitalizations and 16% increased odds of emergency room visits, but 27% fewer outpatient visits compared to those in FFS plans (all P?<?0.05). Although Medicaid programs use capitated managed care plans primarily as a cost-containment strategy, these plans may not be cost-effective for the long-term management of chronic conditions such as diabetes. (Population Health Management 2010;13:209?218)Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/85126/1/pop_2009_0046.pd

Studies in Family Planning

Texto completo: acesso restrito. p. 230-243An impact evaluation of an integrated school-and health-clinic-based adolescent reproductive health initiative was undertaken by the Sate Secretariats of Health and Education in Bahia, Brazil during 1997-99.The project was initiated in response to continued high pregnancy rates among adolescents and growing numbers of new HIV infections among young adults. It sought top romote responsible sexual and health-seeking behaviors among public secondary-school students, including the use of public health clinics. The study design included a matched control group used to measure project impact. The findings indicate that the project was successful in increasing the flow of sexual and reproductive health information to secondary-school students and that it had an impact on adolescents' intentions to use public health clinics in the future. No effects on sexual or contraceptive-use behaviors or on use of public clinics were observed, however. Client exit-interview data from a subset of project clinics indicate that adolescents who use clinic-based services are overwhelmingly female and considerably older on average and much more likely ever to have been pregnant than are adolescents in the target population fort the project