Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients - a systematic review

BACKGROUND: In all OECD countries, there is a trend to increasing patients' copayments in order to balance rising overall health-care costs. This systematic review focuses on inequalities concerning the amount of out-of-pocket payments (OOPP) associated with income, education or gender in the Elderly aged 65+. METHODS: Based on an online search (PubMed), 29 studies providing information on OOPP of 65+ beneficiaries in relation to income, education and gender were reviewed. RESULTS: Low-income individuals pay the highest OOPP in relation to their earnings. Prescription drugs account for the biggest share. A lower educational level is associated with higher OOPP for prescription drugs and a higher probability of insufficient insurance protection. Generally, women face higher OOPP due to their lower income and lower labour participation rate, as well as less employer-sponsored health-care. CONCLUSIONS: While most studies found educational and gender inequalities to be associated with income, there might also be effects induced solely by education; for example, an unhealthy lifestyle leading to higher payments for lower-educated people, or exclusively gender-induced effects, like sex-specific illnesses. Based on the considered studies, an explanation for inequalities in OOPP by these factors remains ambiguous

Die Prävention psychischer Erkrankungen bei Kindern und Jugendlichen - Evaluation schulbasierter Interventionen

Die vorliegende Arbeit befasst sich mit der Prävention psychischer Erkrankungen bei Kindern und Jugendlichen. Sie verbindet fünf Publikationen. Wird zunächst die besondere Eignung von Schule als Setting zur Förderung psychischer Gesundheit erörtert, verdeutlicht eine systematische Übersichtsarbeit den Bedarf in diesem Bereich, und stellt die Bedeutung einer Kombination von Informationsvermittlung und direktem Kontakt mit Betroffenen heraus. Im zweiten Teil der Arbeit werden sowohl qualitative wie auch quantitative Evaluationen von Interventionen des Leipziger Vereins \"Irrsinnig Menschlich e.V.\" vorgestellt. Zum einen wurden Schüler, Lehrer und Eltern der Projektschulen des \"Schulcoach\"-Projekts in Fokusgruppen und mittels Fragebögen befragt, welche Entwicklungen diese spezielle Form der systemischen Betreuung angestoßen hat und welchen Einfluss die Schulcoaches auf die Rolle der psychischen Gesundheit im Schulalltag nahmen. Des Weiteren werden Schüler mittels einer qualitativen Fokusgruppen-Erhebung gezielt nach der äußeren Gestaltung, der thematischen Ausrichtung und dem Nutzungsverhalten von eigens gestalteten Informationsmaterialien, den \"Info-Pocket-Guides\", befragt. Die Ergebnisse dieser Evaluationen werden schließlich vor dem Hintergrund des Eingangs dargestellten Bedarfs diskutiert.:1. Bibliographische Beschreibung 2. Einführung 2.1. Die Prävalenz psychischer Störungen und ihre Auswirkungen 2.2. Psychische Gesundheit bei Kindern und Jugendlichen 2.3. Die Rolle der Schule als Setting für präventive Maßnahmen 2.4. Ziele dieser Arbeit 3. Schule als Setting zur Prävention psychischer Störungen: Chancen, Perspektiven und Beispiele guter Praxis 4. School-based prevention programs for depression and anxiety in adolescence: a systematic review 5. Übergang 6. Die Förderung psychischer Gesundheit in der Schule durch Schulcoaches: Evaluation eines Modellprojekts in Sachsen 7. Do \"School Coaches\" make a difference in school-based mental health promotion? – Results from a large focus group study 8. Info-Pocket-Guides als Beitrag zur Prävention psychischer Erkrankungen: Wie bewerten SchülerInnen Inhalt, Design und Nutzen? 9. Diskussion 10. Zusammenfassung 11. Literaturverzeichnis I. Danksagung II. Erklärung über die eigenständige Abfassung der Arbeit III. Curriculum Vitae IV. Publikatione

DO ‘SCHOOL COACHES’ MAKE A DIFFERENCE IN SCHOOL-BASED MENTAL HEALTH PROMOTION?

Background: Mental disorders in children and adolescents are common and have serious consequences. Schools present a key opportunity to promote mental health and implement prevention measures. Four school coaches in five German schools were enlisted to engage students, teachers and parents in building a sustainably healthy school and classroom climate. Subjects and methods: Altogether, 58 focus groups with students (N=244), parents (N=54) and teachers (N=62) were conducted longitudinally. Topics included: (1) the development of the school and classroom climate, (2) the role of mental health in the regular curriculum, and (3) the role of school coaches in influencing these aspects. Results: Over time, school coaches became trusted reference persons for an increasing number of school system members. They were able to positively influence the school and classroom climate by increasing the awareness of students, teachers and parents of mental health in daily routines. Nevertheless, topics like bullying and student inclusion remained an issue at follow-up. Conclusions: Overall, the school coach intervention is a good model for establishing the topic of mental health in everyday school life and increasing its importance. Future efforts will focus on building self-supporting structures and networks in order to make these efforts sustainable

Income-, education- and gender-related inequalities in out-of-pocket health-care payments for 65+ patients - a systematic review

Abstract Background In all OECD countries, there is a trend to increasing patients' copayments in order to balance rising overall health-care costs. This systematic review focuses on inequalities concerning the amount of out-of-pocket payments (OOPP) associated with income, education or gender in the Elderly aged 65+. Methods Based on an online search (PubMed), 29 studies providing information on OOPP of 65+ beneficiaries in relation to income, education and gender were reviewed. Results Low-income individuals pay the highest OOPP in relation to their earnings. Prescription drugs account for the biggest share. A lower educational level is associated with higher OOPP for prescription drugs and a higher probability of insufficient insurance protection. Generally, women face higher OOPP due to their lower income and lower labour participation rate, as well as less employer-sponsored health-care. Conclusions While most studies found educational and gender inequalities to be associated with income, there might also be effects induced solely by education; for example, an unhealthy lifestyle leading to higher payments for lower-educated people, or exclusively gender-induced effects, like sex-specific illnesses. Based on the considered studies, an explanation for inequalities in OOPP by these factors remains ambiguous.</p