Predictors of patients' choice of hospitals under universal health coverage: a case study of the Nicaraguan capital.

BACKGROUND: This study looks at the factors that can shape patients' choice of healthcare providers. Understanding this process can help with making high quality healthcare more accessible for all. We focus on distance, patient's health status, (perceived) quality of healthcare facility, and referrals to investigate how these factors compete in shaping patients' choice of hospitals. METHODS: This study was carried out in Managua, the capital of Nicaragua. Utilizing an exit-survey, patients were interviewed across five public hospitals in 2017 and then six in 2019 when a new highly-equipped hospital was added to the system. We used a multinomial logit model to investigate patients' preference of a specific hospital over the rest within each wave. RESULTS: Our results show that being referred to a hospital is the strongest predictor and in some cases, it can increase the relative risk ratio of choosing a facility by a factor of 49 (p < 0.01; 95% CI: 27.39-87.17). For the remaining factors, the hierarchy of importance was less clear-cut yet all these factors remained significantly important at various levels. CONCLUSIONS: Overall, our results highlight the importance of referral systems in making quality healthcare more equitable. Moreover, with distance also being a key predictor and in the absence of an organized referral system, those with low-income would either be further deprived by having to settle with locally available healthcare (regardless of its quality) or face high amounts of out-of-pocket expenditure when seeking help from the private sector.

Mothers' experiences of quality of care and potential benefits of implementing the WHO safe childbirth checklist: a case study of Aceh Indonesia.

BACKGROUND: In an effort to mitigate missed opportunities to provide high-quality care, the World Health Organization (WHO) has developed the Safe Childbirth Checklist (SCC) to support health providers perform essential tasks. Our qualitative study is a baseline assessment of quality of care (QoC) perceived by mothers who gave birth at health facilities aiming to highlight areas where implementing the SCC can potentially improve the QoC as well as areas that are not part of the SCC yet require improvement. METHODS: Assessing the overall experience of care, our qualitative study focuses on 8 out of 29 items in the checklist that are related to the personal interactions between healthcare provider and mothers. Using a set of semi-structured questions, we interviewed 26 new mothers who gave institutional births in Aceh province in Indonesia. RESULTS: Our findings revealed some gaps where implementing the SCC can potentially improve safety and QoC. They include communicating danger signs at critical points during birth and after discharge, encouraging breastfeeding, and providing mothers with information on family planning. Moreover, taking a qualitative approach allowed us to identify additional aspects such as need for clarity at the point of admission, maintaining dignity, and protecting mothers' rights in the decision-making process to be also essential for better QoC. CONCLUSIONS: Our study highlights the need to actively listen to and engage with the experiences of women in the adaptation and implementation of the checklist. While our findings indicate that implementing the SCC has the potential to improve the quality of maternal care and overall birth experience, a more holistic understanding of the lived experiences of women and the dynamics of their interactions with health facilities, care providers, and their birth companions can complement the implementation of the checklist.

The connection between COVID-19 vaccine abundance, vaccination coverage, and public trust in government across the globe.

This study investigates that how the number of COVID-19 vaccines secured correlates with the vaccination coverage (full and booster) depending on whether or not there is trust in national government across 47 countries. The data are based on global figures as of Nov. 2021 and Feb. 2022 while measures for confidence in government is according to Gallup World Poll, Oct. 2021. The model includes an interaction term of these two predictors, also controls for a range of socio-economic factors and country specific variables. The results indicate a non-linear and mixed relationship between the numbers secured, the public trust, and the vaccination rate. In Feb. 2022, with confidence in government, securing number of vaccines to cover 200% of the population (or more) increased the full vaccination rate by 12.26% (95% CI: 11.70-12.81); where number secured was 300% (or more), the coverage increased by 7.46% (95% CI: 6.95-7.97). Under similar scenarios, rate of booster shots increased by 13.16% (95% CI: 12.62-13.70; p < 0.01) and 14.36% (95% CI: 13.86-14.85; p < 0.01), respectively. Where the number secured fell below 200%, confidence in government had a revers relationship with the rate of full vaccination (-2.65; 95% CI: -3.32 to -1.99), yet positive with the rate of booster shots (1.65; 95% CI: 1.18-2.12). These results indicate that better success can be achieved by a combination of factors including securing sufficient number of vaccines as well as improving the public trust. Vaccine abundance, however, cannot be translated into greater success in vaccination coverage. This study highlights the importance of efficiency in acquiring vaccine resources and need for improvement in public belief in immunization programmes rather than stock piling.

Public opinion on global distribution of COVID-19 vaccines: Evidence from two nationally representative surveys in Germany and the United States.

Despite ongoing calls for a more even global distribution of COVID-19 vaccines, there remains a great disparity between high- and low-income countries. We conducted representative surveys among the adult populations in the United States (N = 1,000) and Germany (N = 1,003) in June 2021 to assess public opinion in these countries on the distributive justice of COVID-19 vaccines. We conducted two instances of analytic hierarchy processes (AHP) to elicit how the public weighs different principles and criteria for vaccine allocation. In further discrete choice experiments, respondents were asked to split a limited supply of vaccine doses between a hypothetical high-income and a hypothetical low-income country. AHP weights in the United States and Germany were 37.4% (37.2-37.5) and 49.4% (49.2-49.5) for "medical urgency", 32.7% (32.6-32.8) and 25.4% (25.2-25.5) for "equal access for all", 13.7% (13.6-13.8) and 13.3% (13.2-13.4) for "production contribution", and 16.3% (16.2-16.4) and 12.0% (11.9-12.1) for "free market rules", respectively, with 95% CI shown in parentheses. In the discrete choice experiment, respondents in the United States and Germany split available vaccine doses such that the low-income country, which was three times more populous than the high-income country, on average received 53.9% (95% CI: 52.6-55.1) and 57.5% (95% CI: 56.3-58.7) of available doses, respectively. When faced with a dilemma where a vulnerable family member was waiting for a vaccine, 20.7% (95% CI: 18.2-23.3) of respondents in the United States and 18.2% (95% CI: 15.8-20.6) in Germany reduced the amount they allocated to the low-income country sufficiently to secure a vaccine for their family member. Our results indicate that the public in the United States and Germany favours utilitarian and egalitarian distribution principles of vaccines for COVID-19 over libertarian or meritocratic principles. This implies that political decisions favouring higher levels of redistribution would be supported by public opinion in these two countries.

Public opinion towards global distribution of COVID-19 vaccines - Data from Germany and the United States.

This study gathered evidence from Germany and the United States on public opinion towards fair distribution of COVID-19 vaccines across the world. Analytical Hierarchy Process and discrete choice experiments were used for this purpose. The sample is nationally representative of adults (aged 18 and above) for both countries using quotas on age, gender, education, state, and COVID-19 vaccination rates at the time of the fieldwork (25 May 2021 to 26 June 2021). Overall 1,003 responses in Germany and 1,000 in the United States were collected.

Individual and social predictors of smoking and obesity: A panel study in Germany.

This is a longitudinal study of changes in smoking behaviour as well as becoming overweight/obese (OW/OB) and the strength of their association with personal factors such as self-control, mental health, and socioeconomic status (SES) versus their connection with the behaviour of other household members. Furthermore, we investigate that in terms of roles within a household, who is more vulnerable towards the behaviour of others. We used a hybrid model that followed individual adults (person-level fixed-effect) who participated in a national representative panel survey in Germany, SOEP, between 2008 and 2016 and answered all SF-12 items (N = 6874). The count of members in a household showing the associated adverse health behaviour was the nested random-effect. Compared with other predictors, the likelihood of a person becoming OW/OB had the strongest association with the number of cohabits who were also OW/OB and it became worse as this number increased (OR 7.18, 95% CI: 2.10-24.54 and 12.44, 95% CI: 1.53-100.85, for men and women respectively, e.g. compared with being married 2.83, 95% CI: 2.28-3.53 and 1.82, 95% CI: 1.42-2.34). However, for smoking the same rapid trend was not observed. Particularly, becoming OW/OB in female (adult) children was strongly associated with the behaviour of others (compared with household head or partner). For smoking the strongest link with others was among women who were head of the household. For both behaviours, we found neither mental health nor self-control to be strong predictors. Our findings indicate that various factors do not play equal roles in changes in health behaviour and particularly for women, becoming OW/OB is strongly connected with the behaviour of others. We further discuss the potential importance of social norms that might be helpful in developing more effective policies incorporating social connections as well as norms.