International Journal for Equity in Health最新文献

{"title":"Mental health stigma and health-seeking behaviors amongst pregnant women in Vietnam: a mixed-method realist study.","authors":"Le Minh Thi, Ana Manzano, Bui Thi Thu Ha, Le Thi Vui, Nguyen Thai Quynh-Chi, Doan Thi Thuy Duong, Kimberly Lakin, Sumit Kane, Tolib Mirzoev, Do Thi Hanh Trang","doi":"10.1186/s12939-024-02250-z","DOIUrl":"10.1186/s12939-024-02250-z","url":null,"abstract":"<p><strong>Background: </strong>Approximately 15% of women in low-and middle-income countries experience common perinatal mental disorders. Yet, many women, even if diagnosed with mental health conditions, are untreated due to poor quality care, limited accessibility, limited knowledge, and stigma. This paper describes how mental health-related stigma influences pregnant women's decisions not to disclose their conditions and to seek treatment in Vietnam, all of which exacerbate inequitable access to maternal mental healthcare.</p><p><strong>Methods: </strong>A mixed-method realist study was conducted, comprising 22 in-depth interviews, four focus group discussions (total participants n = 44), and a self-administered questionnaire completed by 639 pregnant women. A parallel convergent model for mixed methods analysis was employed. Data were analyzed using the realist logic of analysis, an iterative process aimed at refining identified theories. Survey data underwent analysis using SPSS 22 and descriptive analysis. Qualitative data were analyzed using configurations of context, mechanisms, and outcomes to elucidate causal links and provide explanations for complexity.</p><p><strong>Results: </strong>Nearly half of pregnant women (43.5%) would try to hide their mental health issues and 38.3% avoid having help from a mental health professional, highlighting the substantial extent of stigma affecting health-seeking and accessing care. Four key areas highlight the role of stigma in maternal mental health: fear and stigmatizing language contribute to the concealment of mental illness, rendering it unnoticed; unconsciousness, normalization, and low literacy of maternal mental health; shame, household structure and gender roles during pregnancy; and the interplay of regulations, referral pathways, and access to mental health support services further compounds the challenges.</p><p><strong>Conclusion: </strong>Addressing mental health-related stigma could influence the decision of disclosure and health-seeking behaviors, which could in turn improve responsiveness of the local health system to the needs of pregnant women with mental health needs, by offering prompt attention, a wide range of choices, and improved communication. Potential interventions to decrease stigma and improve access to mental healthcare for pregnant women in Vietnam should target structural and organizational levels and may include improvements in screening and referrals for perinatal mental care screening, thus preventing complications.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"163"},"PeriodicalIF":4.5,"publicationDate":"2024-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11328496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141995706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020.","authors":"Luis Gabriel Cuervo, Carmen Juliana Villamizar, Daniel Cuervo, Pablo Zapata, Maria B Ospina, Sara Marcela Valencia, Alfredo Polo, Ángela Suárez, Maria O Bula, J Jaime Miranda, Gynna Millan, Diana Elizabeth Cuervo, Nancy J Owens, Felipe Piquero, Janet Hatcher-Roberts, Gabriel Dario Paredes, María Fernanda Navarro, Ingrid Liliana Minotta, Carmen Palta, Eliana Martínez-Herrera, Ciro Jaramillo","doi":"10.1186/s12939-024-02211-6","DOIUrl":"10.1186/s12939-024-02211-6","url":null,"abstract":"&lt;p&gt;&lt;p&gt;In this study, we evaluated and forecasted the cumulative opportunities for residents to access radiotherapy services in Cali, Colombia, while accounting for traffic congestion, using a new people-centred methodology with an equity focus. Furthermore, we identified 1-2 optimal locations where new services would maximise accessibility. We utilised open data and publicly available big data. Cali is one of South America's cities most impacted by traffic congestion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methodology: &lt;/strong&gt;Using a people-centred approach, we tested a web-based digital platform developed through an iterative participatory design. The platform integrates open data, including the location of radiotherapy services, the disaggregated sociodemographic microdata for the population and places of residence, and big data for travel times from Google Distance Matrix API. We used genetic algorithms to identify optimal locations for new services. We predicted accessibility cumulative opportunities (ACO) for traffic ranging from peak congestion to free-flow conditions with hourly assessments for 6-12 July 2020 and 23-29 November 2020. The interactive digital platform is openly available.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Primary and secondary outcomes: &lt;/strong&gt;We present descriptive statistics and population distribution heatmaps based on 20-min accessibility cumulative opportunities (ACO) isochrones for car journeys. There is no set national or international standard for these travel time thresholds. Most key informants found the 20-min threshold reasonable. These isochrones connect the population-weighted centroid of the traffic analysis zone at the place of residence to the corresponding zone of the radiotherapy service with the shortest travel time under varying traffic conditions ranging from free-flow to peak-traffic congestion levels. Additionally, we conducted a time-series bivariate analysis to assess geographical accessibility based on economic stratum. We identify 1-2 optimal locations where new services would maximize the 20-min ACO during peak-traffic congestion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Traffic congestion significantly diminished accessibility to radiotherapy services, particularly affecting vulnerable populations. For instance, urban 20-min ACO by car dropped from 91% of Cali's urban population within a 20-min journey to the service during free-flow traffic to 31% during peak traffic for the week of 6-12 July 2020. Percentages represent the population within a 20-min journey by car from their residence to a radiotherapy service. Specific ethnic groups, individuals with lower educational attainment, and residents on the outskirts of Cali experienced disproportionate effects, with accessibility decreasing to 11% during peak traffic compared to 81% during free-flow traffic for low-income households. We predict that strategically adding sufficient services in 1-2 locations in eastern Cali would notably enhance accessibility and reduce inequities. The recommended l","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"161"},"PeriodicalIF":4.5,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11325712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pakistan's path to universal health coverage: national and regional insights.","authors":"Di Yang, Zlatko Nikoloski, Ghazna Khalid, Elias Mossialos","doi":"10.1186/s12939-024-02232-1","DOIUrl":"10.1186/s12939-024-02232-1","url":null,"abstract":"<p><strong>Background: </strong>Universal Health Coverage (UHC) is a common health policy objective outlined in the Sustainable Development Goals. With provincial governments taking the initiative, Pakistan has implemented and extended UHC program amid a complex public health landscape. In this context, we assess Pakistan's progress toward achieving UHC at the national and subnational level.</p><p><strong>Methods: </strong>We use data from the Demographic and Health Surveys and the Household Integrated Economic Survey to construct a UHC index at the national and subnational level for 2007, 2013, and 2018. Furthermore, we use Concentration Index (CI) and CI decomposition methodologies to assess the primary drivers of inequality in accessing medical services. Logistic regression and Sartori's two-step model are applied to examine the key determinants of catastrophic health expenditure (CHE).</p><p><strong>Results: </strong>Our analysis underscores Pakistan's steady progress toward UHC, while revealing significant provincial disparities in UHC progress. Provinces with lower poverty rate achieve higher UHC index, which highlights the synergy of poverty alleviation and UHC expansion. Among the examined indicators, child immunization remains a key weakness that one third of the children are not fully vaccinated and one sixth of these not-fully-vaccinated children have never received any vaccination. Socioeconomic status emerges as a main contributor to disparities in accessing medical services, albeit with a declining trend over time. Household socioeconomic status is negatively correlated with CHE incidence, indicating that wealthier households are less susceptible to CHE. For individuals experiencing CHE, medicine expenditure takes the highest share of their health spending, registering a staggering 70% in 2018.</p><p><strong>Conclusion: </strong>Pakistan's progress toward UHC aligns closely with its economic development trajectory and policy efforts in expanding UHC program. However, economic underdevelopment and provincial disparities persist as significant hurdles on Pakistan's journey toward UHC. We suggest continued efforts in UHC program expansion with a focus on policy consistency and fiscal support, combined with targeted interventions to alleviate poverty in the underdeveloped provinces.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"162"},"PeriodicalIF":4.5,"publicationDate":"2024-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11325752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141987902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A new model to understand the complexity of inequalities in dementia.","authors":"Clarissa Giebel","doi":"10.1186/s12939-024-02245-w","DOIUrl":"10.1186/s12939-024-02245-w","url":null,"abstract":"<p><p>Many people living with dementia and unpaid carers experience inequalities in care related to challenges in receiving a correct diagnosis, care and support. Whilst complexities of the evidence are well recognised including barriers in receiving a diagnosis or post-diagnostic care, no coherent model has captured the far-reaching types and levels of inequalities to date. Building on the established Dahlgren & Whitehead Rainbow model of health determinants, this paper introduces the new Dementia Inequalities model. The Dementia Inequalities model, similar to the original general rainbow model, categorises determinants of health and well-being in dementia into three layers: (1) Individual; (2) Social and community networks; and (3) Society and infrastructure. Each layer comprises of general determinants, which have been identified in the original model but also may be different in dementia, such as age (specifically referring to young- versus late-onset dementia) and ethnicity, as well as new dementia-specific determinants, such as rare dementia subtype, having an unpaid carer, and knowledge about dementia in the health and social care workforce. Each layer and its individual determinants are discussed referring to existing research and evidence syntheses in the field, arguing for the need of this new model. A total of 48 people with lived, caring, and professional experiences of dementia have been consulted in the process of the development of this model. The Dementia Inequalities model provides a coherent, evidence-based overview of inequalities in dementia diagnosis and care and can be used in health and social care, as well as in commissioning of care services, to support people living with dementia and their unpaid carers better and try and create more equity in diagnosis and care.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"160"},"PeriodicalIF":4.5,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11323611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of an innovative payment method on inpatient volume and bed resources and their regional distribution: the case of a central province in China.","authors":"Kunhe Lin, Yifan Yao, Yingbei Xiong, Li Xiang","doi":"10.1186/s12939-024-02243-y","DOIUrl":"10.1186/s12939-024-02243-y","url":null,"abstract":"<p><strong>Background: </strong>Since 2020, China has piloted an innovative payment method known as the Diagnosis-Intervention Packet (DIP). This study aimed to assess the impact of the DIP on inpatient volume and bed allocation and their regional distribution. This study investigated whether the DIP affects the efficiency of regional health resource utilization and contributes to disparities in health equity among regions.</p><p><strong>Methods: </strong>We collected data from a central province in China from 2019 to 2022. The treatment group included 508 hospitals in the pilot area (Region A, where the DIP was implemented in 2021), whereas the control group consisted of 3,728 hospitals from non-pilot areas within the same province. We employed the difference-in-differences method to analyze inpatient volume and bed resources. Additionally, we conducted a stratified analysis to examine whether the effects of DIP implementation varied across urban and rural areas or hospitals of different levels.</p><p><strong>Results: </strong>Compared with the non-pilot regions, Region A experienced a statistically significant reduction in inpatient volume of 14.3% (95% CI 0.061-0.224) and a notable decrease of 9.1% in actual available bed days (95% CI 0.041-0.141) after DIP implementation. The study revealed no evidence of patient consultations shifting from inpatient to outpatient services due to the reduction in hospital admissions in Region A after DIP implementation. Stratified analysis revealed that inpatient volume decreased by 12.4% (95% CI 0.006-0.243) in the urban areas and 14.7% in the rural areas of Region A (95% CI 0.051-0.243). At the hospital level, primary hospitals experienced the greatest impact, with a 19.0% (95% CI 0.093-0.287) decline in inpatient volume. Furthermore, primary and tertiary hospitals experienced significant reductions of 11.0% (95% CI 0.052-0.169) and 8.2% (95% CI 0.002-0.161), respectively, in actual available bed days.</p><p><strong>Conclusions: </strong>Despite efforts to curb excessive medical service expansion in the region following DIP implementation, large hospitals continue to attract a large number of patients from primary hospitals. This weakening of primary hospitals and the subsequent influx of patients to urban areas may further limit rural patients' access to medical services. The implementation of the DIP may raise concerns about its impact on health care equality and accessibility, particularly for underserved rural populations.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"159"},"PeriodicalIF":4.5,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11320847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141975633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of health disparities on peripheral vascular access outcomes in hospitalized patients: an observational study","authors":"Nicholas Mielke, Charlotte O’Sullivan, Yuying Xing, Amit Bahl","doi":"10.1186/s12939-024-02213-4","DOIUrl":"https://doi.org/10.1186/s12939-024-02213-4","url":null,"abstract":"Placement of peripheral intravenous catheters (PIVC) is a routine procedure in hospital settings. The primary objective is to explore the relationship between healthcare inequities and PIVC outcomes. This study was a multicenter, observational analysis of adults with PIVC access established in the emergency department requiring inpatient admission between January 1st, 2021, and January 31st, 2023, in metro Detroit, Michigan, United States. Epidemiological, demographic, therapeutic, clinical, and outcomes data were collected. Health disparities were defined by the National Institute on Minority Health and Health Disparities. The primary outcome was the proportion of PIVC dwell time to hospitalization length of stay, expressed as the proportion of dwell time (hours) to hospital stay (hours) x 100%. Multivariable linear regression and a machine learning model were used for variable selection. Subsequently, a multivariate linear regression analysis was utilized to adjust for confounders and best estimate the true effect of each variable. Between January 1st, 2021, and January 31st, 2023, our study analyzed 144,524 ED encounters, with an average patient age of 65.7 years and 53.4% female. Racial demographics showed 67.2% White, and 27.0% Black, with the remaining identifying as Asian, American Indian Alaska Native, or other races. The median proportion of PIVC dwell time to hospital length of stay was 0.88, with individuals identifying as Asian having the highest ratio (0.94) and Black individuals the lowest (0.82). Black females had a median dwell time to stay ratio of 0.76, significantly lower than White males at 0.93 (p < 0.001). After controlling for confounder variables, a multivariable linear regression demonstrated that Black males and White males had a 10.0% and 19.6% greater proportion of dwell to stay, respectively, compared to Black females (p < 0.001). Black females face the highest risk of compromised PIVC functionality, resulting in approximately one full day of less reliable PIVC access than White males. To comprehensively address and rectify these disparities, further research is imperative to improve understanding of the clinical impact of healthcare inequities on PIVC access. Moreover, it is essential to formulate effective strategies to mitigate these disparities and ensure equitable healthcare outcomes for all individuals.","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"9 1","pages":""},"PeriodicalIF":4.8,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141944521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the road to public healthcare accessibility: a qualitative study to understand healthcare utilization among hard-to-reach groups in Kerala, India.","authors":"Surya Surendran, Jaison Joseph, Hari Sankar, Gloria Benny, Devaki Nambiar","doi":"10.1186/s12939-024-02191-7","DOIUrl":"10.1186/s12939-024-02191-7","url":null,"abstract":"<p><strong>Background: </strong>Kerala, a southern state in India, is known to be atypical due to its high literacy rate and advanced social development indicators. Facing competition from a dominant private healthcare system, recent government health system reforms have focused on providing free, high-quality universal healthcare in the public sector. We carried out an analysis to ascertain the initial impacts of these measures among 'hard to reach groups' as part of a larger health policy and systems research study, with a focus on public sector health service utilisation.</p><p><strong>Methods: </strong>We conducted Focus Group Discussions (FGDs) among identified vulnerable groups across four districts of Kerala between March and August of 2022. The FGDs explored community perspectives on the use of public healthcare facilities including enablers and barriers to healthcare access. Transliterated English transcripts were coded using ATLAS.ti software and thematically analyzed using the AAAQ framework, supplemented with inductive code generation.</p><p><strong>Results: </strong>A total of 34 FGDs were conducted. Availability and cost-effectiveness were major reasons for choosing public healthcare, with the availability of public insurance in inpatient facilities influencing this preference. However, accessibility of public sector facilities posed challenges due to long journeys and queues. Uneven roads and the non-availability of public transport further restricted access. Gaps in acceptability were also observed: participants noted the need for the availability of special treatments available, reduced waiting times for special groups like those from tribal communities or the elderly mindful of their relatively greater travel and need for prompt care. Although quality improvements resulting from health reform measures were acknowledged, participants articulated the need for further enhancements in the availability and accessibility of services so as to make public healthcare systems truly acceptable.</p><p><strong>Conclusion: </strong>The 'Kerala Model of Development' has been applauded internationally for its success in recent years. However, this has not inured the state from the typical barriers to public sector health care use articulated by participants in the study, which match global evidence. In order to deepen the impact of public sector reforms, the state must try to meet service user expectations- especially among those left behind. This requires attention to quality, timeliness, outreach and physical access. Longer term impacts of these reforms - as we move to a post-COVID scenario - should also be evaluated.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"157"},"PeriodicalIF":4.5,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11312678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141906581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myanmar immigrant women's perceptions, beliefs, and information-seeking behaviors with nutrition and food practices during pregnancy in Thailand: a qualitative study.","authors":"Sasitara Nuampa, Pornnapa Tangsuksan, Kwanchit Sasiwongsaroj, Rudee Pungbangkadee, Somsiri Rungamornrat, Nuntiya Doungphummes, Sittiporn Netniyom, Crystal L Patil","doi":"10.1186/s12939-024-02240-1","DOIUrl":"10.1186/s12939-024-02240-1","url":null,"abstract":"<p><strong>Background: </strong>Although nutrition is an essential contributor to the quality of pregnancy outcomes, little is known about the experiences and influences affecting dietary behaviors during pregnancy among migrant women, particularly those from Myanmar, the largest immigrant population in Thailand. To fill this gap, we conducted a descriptive qualitative study to explore Myanmar immigrant women's perceptions, beliefs, and information-seeking behaviors concerning nutrition and food practices during pregnancy.</p><p><strong>Methods: </strong>We conducted focus group discussions (FGDs) with fifty Myanmar immigrant pregnant women aged 18-45 years across all trimesters, who were recruited using purposive sampling from a public tertiary hospital. The FGDs were conducted in Thai or Myanmar using semi-structured guides that probed women's pregnancy perceptions and experiences about nutrition and food patterns during pregnancy. The FGDs were audio-recorded, translated, and transcribed. Direct content analysis was used to guide the analysis through an ecological perspective framework.</p><p><strong>Results: </strong>The seven FGDs with fifty women revealed four major themes involving perceptions, beliefs, and information-seeking behaviors. The qualitative results consisted of (1) a positive attitude toward better changes under difficult conditions (setting goals for infant health; uncertainty about changes); (2) beliefs about eating patterns and dietary practices during pregnancy (taboos aimed at protecting women's health and ensuring safe childbirth; taboos aimed at guaranteeing infant safety); (3) limited access to appropriate information about nutrition (unclear dietary information from healthcare providers; ease of learning from experiences in informal social networks); and (4) difficult living conditions in a non-native setting (work-related influences on dietary behaviors; lack of comprehensible language to gain food literacy). In addition, the results were highlighted across four levels of ecological perspectives.</p><p><strong>Conclusions: </strong>Immigrant pregnant women are a vulnerable population that should be treated with equity to ensure quality of life through optimal nutrition throughout pregnancy. Respectful care requires that healthcare providers develop culturally sensitive nutrition interventions to increase nutrition literacy, accessibility, and pregnancy outcomes.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"156"},"PeriodicalIF":4.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11308142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Composition and influencing factors of hospitalization expenses for epilepsy patients based on path analysis.","authors":"Jing Gong, Nian Li, Ying Wang, Wanzhen Xie, Leiyu Shi, Shengwu Liao, Oudong Xia, Gang Sun","doi":"10.1186/s12939-024-02242-z","DOIUrl":"10.1186/s12939-024-02242-z","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to understand the composition and influencing factors of epilepsy patients' hospitalization expenses, thus providing a reference for reducing the disease burden of epilepsy patients in low- and middle-income developing countries.</p><p><strong>Methods: </strong>A total of 4206 hospitalized cases of epilepsy from 2018 to 2020 were collected. Descriptive statistics were used to understand the patient cost composition, path analysis was used to understand the direct and indirect factors of hospitalization expenses.</p><p><strong>Results: </strong>From 2018 to 2020, the average hospitalization expenses for epilepsy patients was 4,299.93 RMB yuan, and the average length of stay was 2.47 days. The highest proportion of hospitalization expenses was diagnosis costs (> 50%), followed by comprehensive medical service costs and drug costs. In terms of the total effect coefficient, the major factors affecting the hospitalization expenses were length of stay (0.880), emergency admission(0.463), and the comorbidities and complications(> 0.250). Hospital length of stay, discharge mode(death) and number of hospitalizations(2 times) affect hospitalization expenses through direct effect. Long-term hospitalization (> 30 days), admission routes(emergency), the comorbidities and complications, presence of drug allergy, and age also affect hospitalization expenses through indirect effects.</p><p><strong>Conclusion: </strong>Diagnosis costs and length of stay are important factors affecting the medical expenses of epilepsy inpatients. In general, the quality control of the hospital is good, but it still needs to standardize the diagnosis and treatment behavior of medical staff through the clinical path.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"155"},"PeriodicalIF":4.5,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11304936/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141901650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multilevel medical insurance mitigate health cost inequality due to air pollution: Evidence from China.","authors":"Ennan Wang, Minglai Zhu, Yisha Lin, Xiaoyu Xi","doi":"10.1186/s12939-024-02238-9","DOIUrl":"10.1186/s12939-024-02238-9","url":null,"abstract":"<p><strong>Background: </strong>Air pollution affects residents' health to varying extents according to differences in socioeconomic status. However, there has been a lack of research on whether air pollution contributes to unfair health costs.</p><p><strong>Methods: </strong>In this research, data from the China Labour Force Dynamics Survey are matched with data on PM2.5 average concentration and precipitation, and the influence of air pollution on the health expenditures of residents is analysed with econometric methods involving a two-part model, instrument variables and moderating effects.</p><p><strong>Results: </strong>The findings reveal that air pollution significantly impacts Chinese residents' health costs and leads to low-income people face health inequality. Specifcally, the empirical evidence shows that air pollution has no significant influence on the probability of residents' health costs (β = 0.021, p = 0.770) but that it increases the amount of residents' total outpatient costs (β = 0.379, p < 0.006), reimbursed outpatient cost (β = 0.453, p < 0.044) and out-of-pocket outpatient cost (β = 0.362, p < 0.048). The heterogeneity analysis of income indicates that low-income people face inequality due to health cost inflation caused by air pollution, their total and out-of-pocket outpatient cost significantly increase with PM2.5 (β = 0.417, p = 0.013; β = 0.491, p = 0.020). Further analysis reveals that social basic medical insurance does not have a remarkable positive moderating effect on the influence of air pollution on individual health inflation (β = 0.021, p = 0.292), but supplementary medical insurance for employees could reduce the effect of air pollution on low-income residents' reimbursed and out-of-pocket outpatient cost (β=-1.331, p = 0.096; β=-2.211, p = 0.014).</p><p><strong>Conclusion: </strong>The study concludes that air pollution increases the amount of Chinese residents' outpatient cost and has no significant effect on the incidence of outpatient cost. However, air pollution has more significant impact on the low-income residents than the high-income residents, which indicates that air pollution leads to the inequity of medical cost. Additionally, the supplementary medical insurance reduces the inequity of medical cost caused by air pollution for the low-income employees.</p>","PeriodicalId":13745,"journal":{"name":"International Journal for Equity in Health","volume":"23 1","pages":"153"},"PeriodicalIF":4.5,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11301995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141893400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}