Using microfinance to facilitate household investment in sanitation in rural Cambodia

Improved sanitation access is extremely low in rural Cambodia. Non-governmental organizations have helped build local supply side latrine markets to promote household latrine purchase and use, but households cite inability to pay as a key barrier to purchase. To examine the extent to which microfinance can be used to facilitate household investment in sanitation, we applied a two-pronged assessment: (1) to address the gap between interest in and use of microfinance, we conducted a pilot study to assess microfinance demand and feasibility of integration with a sanitation marketing program and (2) using a household survey ( n = 935) at latrine sales events in two rural provinces, we assessed attitudes about microfinance and financing for sanitation. We found substantial stated intent to use a microfinance institution (MFI) loan to purchase a latrine (27%). Five percent of current owners used an MFI loan for latrine purchase. Credit officers attended 159 events, with 4761 individuals attending. Actual loan applications were low, with 4% of sales events attendees applying for a loan immediately following the event (mean = 1.7 loans per event). Ongoing coordination was challenging, requiring management commitment from the sanitation marketing program and commitment to social responsibility from the MFI. Given the importance of improving sanitation coverage and concomitant health impacts, linking functional sanitation markets to already operational finance markets has the potential to give individuals and households more financial flexibility. Further product research and better integration of private vendors and financing modalities are necessary to create a scalable microfinance option for sanitation markets

The effect of crime in Mexico on healthcare access and utilization in the United States-Mexico border region

The United States (US)-Mexico border region is an important and understudied area for research on disparities in healthcare access, quality, and cost. There is a long history of crossing the border for healthcare, in which many US citizens and legal residents from the border region cross into Mexico for medical treatment and/or to purchase pharmaceuticals. Border crossing is common due to a low supply of healthcare services on the US side of the border, cultural preferences, dissatisfaction with care in the US, looser prescription requirements, and more affordable provider options. With increased violence in northern Mexico beginning in late 2006, it was not known whether patterns of border crossing had changed. No prior studies had addressed the impact of crime in Mexico on border crossing for healthcare, and it was not known whether people would continue crossing into Mexico for medical care, substitute care from Mexico with care from a US provider, or forego care altogether. I used several data sources to measure the impact of the homicide rate in the nearest Mexican municipality on healthcare access for US residents. For each study, I used a difference-in-difference empirical approach, comparing high crime areas to low crime areas and border to non-border counties. In Study 1, I examined rates of total border crossing as measured by legal US entries from Mexico and found evidence that an increase in homicide rates was negatively associated with US entries. I did not find an association between homicide rates and self-reported healthcare access in the four border states (Arizona, California, New Mexico, and Texas) as measured by self-reports of having a regular healthcare provider, needing medical care but not being able to access due to cost, and cervical/breast cancer screening. In Study 2, I examined the association between homicide rates and hospitalization for ambulatory care sensitive conditions in Arizona, California, and Texas. I found a positive relationship in border counties, indicating that individuals may be suffering from reduced access to ambulatory care in border counties with high crime rates in nearby Mexican municipalities. In Study 3, I examined the association between homicide rates and potentially avoidable emergency department encounters and did not find a statistically significant association. Taken together, these studies indicate that although there may be some effect of crime in northern Mexico on healthcare access, the effect is likely small and difficult to measure using available secondary data sources.Doctor of Philosoph

The relationship between violence in Northern Mexico and potentially avoidable hospitalizations in the USA–Mexico border region

BACKGROUND: Substantial proportions of US residents in the USA-Mexico border region cross into Mexico for health care; increases in violence in northern Mexico may have affected this access. We quantified associations between violence in Mexico and decreases in access to care for border county residents. We also examined associations between border county residence and access. METHODS: We used hospital inpatient data for Arizona, California and Texas (2005-10) to estimate associations between homicide rates and the probability of hospitalization for ambulatory care sensitive (ACS) conditions. Hospitalizations for ACS conditions were compared with homicide rates in Mexican municipalities matched by patient residence. RESULTS: A 1 SD increase in the homicide rate of the nearest Mexican municipality was associated with a 2.2 percentage point increase in the probability of being hospitalized for an ACS condition for border county patients. Residence in a border county was associated with a 1.3 percentage point decrease in the probability of being hospitalized for an ACS condition. CONCLUSIONS: Increased homicide rates in Mexico were associated with increased hospitalizations for ACS conditions in the USA, although residence in a border county was associated with decreased probability of being hospitalized for an ACS condition. Expanding access in the border region may mitigate these effects by providing alternative sources of care

Team formation and performance: evidence from healthcare referral networks

We examine the teams that emerge when a primary care physician (PCP) refers patients to specialists. When PCPs concentrate their specialist referrals — for instance, sending their cardiology patients to fewer distinct cardiologists — this encourages repeat interactions between PCPs and specialists. Repeated interactions provide more opportunities and incentives to develop productive team relationships. Using data from the Massachusetts All Payer Claims Database, we construct a new measure of PCP team referral concentration and document that it varies widely across PCPs, even among PCPs in the same organization. Chronically ill patients treated by PCPs with 1 standard deviation higher team referral concentration have 4% lower health care utilization on average, with no discernible reduction in quality. We corroborate this finding using a national sample of Medicare claims, and show that it holds under various identification strategies that account for observed and unobserved patient and physician characteristics. The results suggest that repeated PCP-specialist interactions improve team performance.P01 AG005842 - NIA NIH HHSPublished versio

Dental Fluoride Varnish Application During Medical Visits Among Children Who Are Privately Insured

This cross-sectional study examines fluoride varnish application rates during well-child medical visits and identify characteristics associated with fluoride varnish receipt

Exploring the Association of Homicides in Northern Mexico and Healthcare Access for US Residents

Many legal residents in the United States (US)-Mexico border region cross from the US into Mexico for medical treatment and pharmaceuticals. We analyzed whether recent increases in homicides in Mexico are associated with reduced healthcare access for US border residents

Disappearing and Reappearing Differences in Drug-Eluting Stent Use by Race

Drug-eluting coronary stents (DES) rapidly dominated the marketplace in the United States after approval by the Food and Drug Administration in April 2003, but utilization rates were initially lower among African-American patients. We assess whether racial differences persisted as DES diffused into practice

Resource Use Trajectories for Aged Medicare Beneficiaries with Complex Coronary Conditions

To use coronary revascularization choice to illustrate the application of a method simulating a treatment's effect on subsequent resource use

Barriers and Facilitators to Optimal Fluoride Varnish Application

Objective: National guidelines recommend that all children under age six receive fluoride varnish (FV) in medical settings. However, application rates remain low. This study aimed to update understanding of barriers and facilitators to guideline concordant FV application. Methods: We conducted virtual semi-structured interviews with a purposive sample (e.g., FV application rates, geographic location, practice size and type) of pediatric primary care clinicians and medical assistants in Massachusetts between February 1 and June 30, 2022. The Consolidated Framework for Implementation Research served as the study\u27s theoretical framework and data were analyzed using a modified grounded theory approach. Results: Of the 31 participants, 90% identified as White and 81% as female. Major themes, which linked to four CFIR domains, included: Variation in perceived adequacy of reimbursement; Differences in FV application across practice types; Variation in processes, protocols, and priorities; External accountability for quality of care; and Potential levers for change. Important subthemes included challenges for small practices; role of quality measures in delivering guideline-concordant preventive oral healthcare; and desire for preventive care coordination with dentists. Conclusions: This study suggests that potential barriers and facilitators to guideline concordant FV application exist at multiple levels that may warrant further study. Examples include testing the effectiveness of quality measures for FV application and testing strategies for implementing consistent processes and protocols for improving FV application rates. Keywords: fluoride varnish; pediatric primary care; policy; preventive oral health; qualitative

Association of Postpartum Mental Illness Diagnoses with Severe Maternal Morbidity

Background: This study aimed to determine whether birthing people who experience severe maternal morbidity (SMM) are more likely to be diagnosed with a postpartum mental illness. Materials and Methods: Using the Massachusetts All Payer Claims Database, this study used modified Poisson regression analysis to assess the association of SMM with mental illness diagnosis during the postpartum year, accounting for prenatal mental illness diagnoses and other patient characteristics. Results: There were 128,161 deliveries identified, with 55.0% covered by Medicaid. Of these, 3.1% experienced SMM during pregnancy and/or delivery hospitalization, and 20.1% had a mental illness diagnosis within 1 year postpartum. In adjusted regression analyses, individuals with SMM had a 10.6% increased risk of having any mental illness diagnosis compared to individuals without SMM, primarily due to an increased risk of a depression or post-traumatic stress disorder diagnosis among people with SMM than those without SMM. Conclusions: Individuals who experienced SMM had a higher risk of a mental illness diagnosis in the postpartum year. Given increases in SMM in the United States in recent decades, policies to mitigate mental health sequelae of SMM are urgently needed. Keywords: health insurance; maternal morbidity; mental health; perinatal; post-traumatic stress disorder; postpartum