222 research outputs found
Equity in health care financing: The case of Malaysia
Background: Equitable financing is a key objective of health care systems. Its importance is
evidenced in policy documents, policy statements, the work of health economists and policy
analysts. The conventional categorisations of finance sources for health care are taxation, social
health insurance, private health insurance and out-of-pocket payments. There are nonetheless
increasing variations in the finance sources used to fund health care. An understanding of the equity
implications would help policy makers in achieving equitable financing.
Objective: The primary purpose of this paper was to comprehensively assess the equity of health
care financing in Malaysia, which represents a new country context for the quantitative techniques
used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes,
contributions to Employee Provident Fund and Social Security Organization, private insurance and
out-of-pocket payments) independently, and subsequently by combined the financing sources to
evaluate the whole financing system.
Methods: Cross-sectional analyses were performed on the Household Expenditure Survey
Malaysia 1998/99, using Stata statistical software package. In order to assess inequality,
progressivity of each finance sources and the whole financing system was measured by Kakwani's
progressivity index.
Results: Results showed that Malaysia's predominantly tax-financed system was slightly
progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced
by four progressive finance sources (in the decreasing order of direct taxes, private insurance
premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance
source (indirect taxes).
Conclusion: Malaysia's two tier health system, of a heavily subsidised public sector and a user
charged private sector, has produced a progressive health financing system. The case of Malaysia
exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to
help shape health financing strategies for the nation
Transitional âhospital to homeâ care of older patients: healthcare professionalsâ perspectives
Author's accepted version (postprint).This is an Accepted Manuscript of an article published by Wiley in Scandinavian Journal of Caring Sciences on 27/08/2020.Available online: https://onlinelibrary.wiley.com/doi/epdf/10.1111/scs.12904acceptedVersio
A critical analysis of the cycles of physical activity policy in England
BACKGROUND: There has been increasing focus on the importance of national policy to address population levels of physical inactivity. Components of a comprehensive national physical activity policy framework include: 1) national recommendations on physical activity levels; 2) setting population goals and targets; 3) surveillance or health monitoring systems; and 4) public education. The aim of the current paper was to analyse the policy actions which have addressed each of these elements in England and to identify areas of progress and remaining challenges. METHODS: A literature search was undertaken to identify past and present documents relevant to physical activity policy in England. Each document was analysed to identify content relevant to the four key elements of policy which formed the focus of the current research. RESULTS: Physical activity recommendations are an area where England has demonstrated a robust scientific approach and good practice; however, the physical activity campaigns in England have not been sufficiently sustained to achieve changes in social norms and behaviour. The setting of physical activity targets has been unrealistic and continuous changes to national surveillance measures have presented challenges for monitoring trends over time. CONCLUSIONS: Overall, physical activity policy in England has fluctuated over the past two decades. The variations and cycles in policy reflect some of the challenges in implementing and sustaining physical activity policy in the face of political changes, changes in government direction, and changing opportunities to profile active lifestyles
Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services
Background: Emergency department (ED) data have the potential to provide critical intelligence on when violence
is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national
experimental ED monitoring system to examine how it could target violence prevention interventions towards at
risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in
nighttime assaults.
Methods: A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172) over a
three-year period (31st March 2008 to 30th March 2011) to English EDs analysing changes by weekday, month,
holidays, major sporting events, and demographics of those presenting.
Results: Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals
[CIs] 3.11-3.16; P < 0.001); with male:female ratios increasing on more violent nights. Risks peak at age 18 years. Deprived individuals have greater risks of presenting across all ages (AOR 3.87, 95% CIs 3.82-3.92; P < 0.001). Proportions of assaults from deprived communities increase midweek. Female presentations in affluent areas peak aged 20 years. By age 13, females from deprived communities exceed this peak. Presentations peak on Friday and Saturday nights and the eves of public holidays; the largest peak is on New Yearâs Eve. Assaults increase over
summer with a nadir in January. Impacts of annual celebrations without holidays vary. Some (Halloween, Guy
Fawkes and St Patrickâs nights) see increased assaults while others (St Georgeâs and Valentineâs Day nights) do not. Home nation World Cup football matches are associated with nearly a three times increase in midweek assault
presentation. Other football and rugby events examined show no impact. The 2008 Olympics saw assaults fall. The
overall calendar model strongly predicts observed presentations (R2 = 0.918; P < 0.001).
Conclusions: To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and
optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence
The influence of demographic characteristics, living conditions, and trauma exposure on the overall health of a conflict-affected population in Southern Sudan
BACKGROUND: There remains limited evidence on how armed conflict affects overall physical and mental well-being rather than specific physical or mental health conditions. The aim of this study was to investigate the influence of demographic characteristics, living conditions, and violent and traumatic events on general physical and mental health in Southern Sudan which is emerging from 20 years of armed conflict. METHODS: A cross-sectional survey of 1228 adults was conducted in November 2007 in the town of Juba, the capital of Southern Sudan. Multivariate linear regression analysis was used to investigate the associations and relative influence of variables in three models of demographic characteristics, living conditions, and trauma exposure, on general physical and mental health status. These models were run separately and also as a combined model. Data quality and the internal consistency of the health status instrument (SF-8) were assessed. RESULTS: The variables in the multivariate analysis (combined model) with negative coefficients of association with general physical health and mental health (i.e. worse health), respectively, were being female (coef. -2.47; -2.63), higher age (coef.-0.16; -0.17), absence of soap in the household (physical health coef. -2.24), and experiencing within the past 12 months a lack of food and/or water (coef. -1.46; -2.27) and lack of medical care (coef.-3.51; -3.17). A number of trauma variables and cumulative exposure to trauma showed an association with physical and mental health (see main text for data). There was limited variance in results when each of the three models were run separately and when they were combined, suggesting the pervasive influence of these variables. The SF-8 showed good data quality and internal consistency. CONCLUSIONS: This study provides evidence on the pervasive influence of demographic characteristics, living conditions, and violent and traumatic events on the general physical and mental health of a conflict-affected population in Southern Sudan, and highlights the importance of addressing all these influences on overall health
Payments and quality of care in private for-profit and public hospitals in Greece
<p>Abstract</p> <p>Background</p> <p>Empirical evidence on how ownership type affects the quality and cost of medical care is growing, and debate on these topics is ongoing. Despite the fact that the private sector is a major provider of hospital services in Greece, little comparative information on private versus public sector hospitals is available. The aim of the present study was to describe and compare the operation and performance of private for-profit (PFP) and public hospitals in Greece, focusing on differences in nurse staffing rates, average lengths of stay (ALoS), and Social Health Insurance (SHI) payments for hospital care per patient discharged.</p> <p>Methods</p> <p>Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003.</p> <p>Results</p> <p>PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities.</p> <p>Conclusions</p> <p>In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision.</p
Direct costs of dementia in nursing homes
Dementia represents an economical burden to societies nowadays. Total dementia
expenses are calculated by the sum of direct and indirect costs. Through the stages
of the diseases, as the patients may require institutionalization or a formal caregiver, the
direct costs tend to increase. This study aims to analyze the direct costs of dementia in
Portuguese nursing homes in 2012, compare the spending between seniors with and
without dementia, and propose a predictive costs model. The expenses analysis was
based on (1) the use of emergency rooms and doctorâs appointments, either in public
or private institutions; (2) days of hospitalization; (3) medication; (4) social services use;
(5) the need for technical support; and (6) the utilization of rehabilitation services. The
sample was composed of 72 people, half with dementia and half without. The average
annual expense of a patient with dementia was e15,287 thousand, while the cost of a
patient without dementia was about e12,289 thousand. The variables âability to make
yourself understood,â âself-performance: getting dressedâ and âthyroid disordersâ were
found to be statistically significant in predicting the expensesâ increase. In nursing homes,
in 2012, the costs per patient with dementia were 1, 2 times higher than per patient
without dementia
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