A Multicenter Curricular Intervention to Address Resident Knowledge and Perceptions of Personal Finance.

OBJECTIVES: We evaluated internal medicine residents' confidence and knowledge of personal finance, perceptions of burnout, and relations between these issues before and after an educational intervention. METHODS: We surveyed internal medicine residents at two university-based training programs in 2018. We developed and implemented a curriculum at both sites, covering topics of budgeting, saving for retirement, investment options, and the costs of investing. Each site used the same content but different strategies for dissemination. One used a condensed-form lecture series (two 1-hour sessions) and the other used a microlecture series (four 30-minute sessions) series. Residents were resurveyed following the intervention for comparison. RESULTS: The preintervention survey response rate was 41.2% (122/296) and the postintervention response rate was 44.3% (120/271). Postintervention mean scores for personal finance knowledge improved for basic concepts (52.6% vs 39.4%, P < 0.001), mutual fund elements (30.8% vs 19.7%, P < 0.001), investment plans (68.5% vs. 49.2%, P < 0.001), and overall knowledge (50.1% vs 36.1%, P < 0.001). A significantly smaller proportion of residents reported feelings of burnout following the intervention (23.3% vs 36.9%, P = 0.022). CONCLUSIONS: Our findings show that residents want to learn about finances. Our brief educational intervention is a practical way to improve overall knowledge. Our intervention suggests that improving knowledge of finance may be associated with decreased feelings of burnout.

Psychological, sociocultural and economic coping strategies of mothers or female caregivers of children with a disability in Belu district, Indonesia.

Caring for children with a disability can cause a range of psychological and socioeconomic challenges for parents and caregivers, such as anxiety, depression, inability to find affordable and appropriate childcare, loss of income and expenses related to disability specific treatment. As part of a study exploring the impacts of childhood disability on mothers or female caregivers and families, and the copy strategies they used, this paper describes strategies employed by mothers or female caregivers to cope with challenges associated with childhood disability within their family in Belu district, Indonesia. A qualitative approach using one-on-one in-depth interviews was used to collect data from participants (n = 22) who were recruited using a combination of purposive and snowball sampling techniques. Interviews were recorded, transcribed verbatim and imported to NVivo 12 for analysis. A qualitative framework analysis was used to guide data analysis. The conceptual framework of coping strategies guided the conceptualisation and discussion of the findings. The findings showed that active psychological coping strategies, including cognitive or acceptance strategies, knowledge of both health condition and socio-academic related development of children with a disability, and family relationship and support, were used by the participants to cope with psychological challenges facing them. Self-reliance and religious/spiritual coping strategies were also utilised. Sociocultural strategies, such as social withdrawal or disengagement, professional support and culture-based support, were used by the participants to cope with social impacts, stigma, and discrimination associated with childhood disability. Participants also reported using financial strategies such as selling of family assets to cope with the economic challenges. The findings indicate the need for programs and interventions that address the needs of mothers and female caregivers and their families, to assist with effectively managing the significant challenges they face when caring for a child with a disability. Further studies are needed, with a larger number of participants and the inclusion of fathers or male caregivers, in order to better understand the broader coping experience of childhood disability impacts within families.

Association of Neighborhood Deprivation Index With Success in Cancer Care Crowdfunding.

Importance: Financial toxicity resulting from cancer care poses a substantial public health concern, leading some patients to turn to online crowdfunding. However, the practice may exacerbate existing socioeconomic cancer disparities by privileging those with access to interpersonal wealth and digital media literacy. Objective: To test the hypotheses that higher county-level socioeconomic status and the presence (vs absence) of text indicators of beneficiary worth in campaign descriptions are associated with amount raised from cancer crowdfunding. Design, Setting, and Participants: This cross-sectional analysis examined US cancer crowdfunding campaigns conducted between 2010 and 2019 and data from the American Community Survey (2013-2017). Data analysis was performed from December 2019 to March 2020. Exposures: Neighborhood deprivation index of campaign location and campaign text features indicating the beneficiary's worth. Main Outcomes and Measures: Amount of money raised. Results: This study analyzed 144 061 US cancer crowdfunding campaigns. Campaigns in counties with higher neighborhood deprivation raised less (-26.07%; 95% CI, -27.46% to -24.65%; P < .001) than those in counties with less neighborhood deprivation. Campaigns raised more funds when legitimizing details were provided, including clinical details about the cancer type (9.58%; 95% CI, 8.00% to 11.18%; P < .001) and treatment type (6.58%; 95% CI, 5.44% to 7.79%; P < .001) and financial details, such as insurance status (1.39%; 95% CI, 0.20% to 2.63%; P = .02) and out-of-pocket costs (7.36%; 95% CI, 6.18% to 8.55%; P < .001). Campaigns raised more money when beneficiaries were described as warm (13.80%; 95% CI, 12.30% to 15.26%; P < .001), brave (15.40%; 95% CI, 14.11% to 16.65%; P < .001), or self-reliant (5.23%; 95% CI, 3.77% to 6.72%; P < .001). Conclusions and Relevance: These findings suggest that cancer crowdfunding success ay disproportionately benefit those in high-socioeconomic status areas and those with the internet literacy necessary to portray beneficiaries as worthy. By rewarding those with existing socioeconomic advantage, cancer crowdfunding may perpetuate socioeconomic disparities in cancer care access. The findings also underscore the widespread nature of financial toxicity resulting from cancer care.

Review of evolution of the public long-term care insurance (LTCI) system in different countries: influence and challenge.

BACKGROUND: The growing demand for LTC (Long-term care) services for disabled elderly has become a daunting task for countries worldwide, especially China, where population aging is particularly severe. According to CSY (China Statistical Yearbook,2019), the elderly aged 65 or above has reached 167 million in 2018, and the number of disabled elderly is as high as 54%. Germany and other countries have alleviated the crisis by promoting the public LTCI (Long-Term Care Insurance) system since the 1990s, while China's public LTCI system formal pilot only started in 2016. Therefore, the development of the public LTCI system has gradually become a hot topic for scholars in various countries, including China. METHODS: This review has been systematically sorted the existing related literature to discuss the development of public LTCI (Long-Term Care Insurance)system form four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, challenge of public LTCI, and the relationship between public LTCI and private LTCI. We searched some databases including Web of Science Core Collection, Medline, SCOPUS, EBSCO, EMBASE, ProQuest and PubMed from January 2008 to September 2020. The quality of 38 quantitative and 21 qualitative articles was evaluated using the CASP(Critical Appraisal Skills Programme) critical evaluation checklist. RESULTS: The review systematically examines the development of public LTCI system from four aspects, namely, the comparison of public LTCI systems in different countries, the influence of public LTCI, the challenge of public LTCI, and the relationship between public LTCI and private LTCI. For example, LTCI has a positive effect on the health and life quality of the disabled elderly. However, the role of LTCI in alleviating the financial burden on families with the disabled elderly may be limited. CONCLUSION: Some policy implications on the future development of China's LTCI system can be obtained. For example, the government should fully consider the constraints such as price rise, the elderly disability rate, and the substantial economic burden. It also can strengthen the effective combination of public LTCI and private LTCI. It does not only help to expand the space for its theoretical research but also to learn the experiences in the practice of the LTCI system in various countries around the world. It will significantly help the smooth development and further promote the in-depth reform of the LTCI system in China.

A Contingent Valuation Study for Eliciting a Monetary Value of a Quality-Adjusted Life-Year in the General Greek Population.

OBJECTIVES: To elicit a willingness-to-pay (WTP) per quality-adjusted life-year (QALY) estimate for the general Greek population and assess the impact of individuals' socio-demographic characteristics and motives on this estimate. METHODS: A telephone-based survey was carried out employing a representative sample of the general Greek population (n = 1342). A computer-assisted telephone-interview method was adopted to ensure random sampling. A total of 528 participants reported a WTP value for a utility improvement from their current health to perfect health. Those individuals' motives were assessed through predefined statements. Test-retest reliability was assessed using intraclass correlation coefficient (ICC). Multiple linear regression (MLR) and one-way analysis of variance (ANOVA) tests were conducted to assess the effect of socioeconomic/demographic determinants and motive statements, respectively, on WTP/QALY. MLR was re-estimated considering as dependent variable the WTP/QALY estimate calculated for participants: (1) stating a WTP value ≤ their household income and (2) presenting higher certainty regarding stated WTP value (sensitivity analysis). RESULTS: Analysis revealed good reliability for WTP/QALY estimates and motive statements (ICC values > 0.8). Mean WTP/QALY was €26 280. The respective 5% trimmed value was €14 862. Being a student and household income affected WTP/QALY. Sensitivity analysis did not produce markedly different WTP/QALY predictors, implying the robustness of results, irrespective of the participant group considered. Individuals who indicated the inability to cover basic family needs or pay tax claims as motives reported lower WTP/QALY values compared with those not viewing these aspects as motives. CONCLUSIONS: Findings confirm that the World Health Organization's criterion used currently in Greek cost-effectiveness studies is not unreasonable. Additional research is essential to further explore WTP/QALY estimates in the Greek setting and facilitate informed decision making.

The Other Student Debt Crisis: How Borrowing to Pay for a Child's College Education Relates to Parents' Mental Health at Midlife.

OBJECTIVES: More parents are borrowing to help their children pay for college. These loans may be a source of financial stress and worry, which could influence parents' mental health. We determine whether child-related educational debt is associated with worse mental health among parents and if fathers are more sensitive to this debt than mothers, given potential gender differences in financial decision-making and relationships with adult children. METHOD: Data come from the National Longitudinal Survey of Youth 1979, a nationally representative sample of persons born between 1957 and 1964. We used the Center for Epidemiologic Studies Depression Scale and the Short Form-12 Mental Health Component Score to assess mental health. We restricted our sample to parents who had at least one biological child attend college and who were interviewed at age 50, when mental health was assessed (n = 3,545). RESULTS: Among fathers, having any child-related educational debt versus none was associated with fewer depressive symptoms, but having greater amounts of child-related educational debt was associated with more depressive symptoms and worse mental health. No relationship was found for mothers. DISCUSSION: Our findings indicate that the student debt crisis may also have mental health implications for aging parents, particularly for fathers.

Mobile money use and social health insurance enrolment among rural dwellers outside the formal employment sector: Evidence from Kenya.

BACKGROUND: The study set out to explore whether mobile money use (mobile phone-based financial services) increased the probability of rural dwellers outside the formal employment sector of being enrolled in Kenya's social health insurance, the National Hospital Insurance Fund (NHIF). METHODS: We used data from the 2015 FinAccess Household Survey and analysed responses of 4282 rural individuals outside the formal employment sector. Probit and bivariate probit models were used and adjusted for mobile phone ownership, sex, age, age-squared, education, wealth quintile, bank account use, informal group membership, occupation, and health shocks. RESULTS: We found that 16.26% (95% CI, 14.58% to 18.10%) of mobile money users had NHIF cover as compared with 2.44% (95% CI, 1.83% to 3.23%) of nonusers. Importantly, mobile money use increased the probability of being enrolled in NHIF by 4.6% (95% CI, 2.1% to 7.1%) after controlling for confounders. Access to mobile money was associated with reduced travel time and lower transport costs, which are likely to be key mechanisms for increasing NHIF enrolment. CONCLUSION: By lowering transport costs and saving travel time, mobile money provides an easy means to pay social health insurance premiums thus incentivising its uptake among rural people outside of formal employment.

Developing a Financial Literacy Program with Survivors of Intimate Partner Violence: The Voices of Survivors.

As the social work field increasingly recognizes economic abuse within intimate partner relationships, the field has developed financial empowerment programs to empower survivors for their financial future. Although research has demonstrated the effectiveness of financial literacy programs, there are barriers to their implementation in the field. Studies have explored, from the perspective of advocates, best practices in incorporating financial literacy into services; however, no studies have explored implementation approaches from the perspective of survivors. This study explores, from the perspective of 34 survivors, approaches for implementing financial literacy programming. Participants described their understanding of financial empowerment as being in charge of finances, having financial power, and not having to endure the struggle. To counter financial disempowerment, participants identified the need for financial confidence, knowledge, and tools. Participants shared their strategies for saving money, though many participants reported barriers to using banks as savings tools. Almost all participants stressed the importance of financial literacy services for survivors, especially around banking, credit, and debt. Finally, participants shared recommendations for job readiness and training programming. Findings have implications for domestic violence and broader social work organizations implementing financial empowerment services. Social workers can support financial empowerment efforts through program development and research efforts.

Microfinance Interventions and HIV Treatment Outcomes: A Synthesizing Conceptual Framework and Systematic Review.

BACKGROUND: Microfinance interventions have the potential to improve HIV treatment outcomes, but the mechanisms through which they operate are not entirely clear. OBJECTIVES: To construct a synthesizing conceptual framework for the impact of microfinance interventions on HIV treatment outcomes using evidence from our systematic review. METHODS: We conducted a systematic review by searching electronic databases and journals from 1996 to 2018 to assess the effects of microfinance interventions on HIV treatment outcomes, including adherence, retention, viral suppression, and CD4 cell count. RESULTS: All studies in the review showed improved adherence, retention, and viral suppression, but varied in CD4 cell count following participation in microfinance interventions-overall supporting microfinance's positive role in improving HIV treatment outcomes. Our synthesizing conceptual framework identifies potential mechanisms through which microfinance impacts HIV treatment outcomes through hypothesized intermediate outcomes. CONCLUSION: Greater emphasis should be placed on assessing the effect mechanisms and intermediate behaviors to generate a sound theoretical basis for microfinance interventions.

Is microfinance associated with changes in women's well-being and children's nutrition? A systematic review and meta-analysis.

BACKGROUND: Microfinance is the provision of savings and small loans services, with no physical collateral. Most recipients are disadvantaged women. The social and health impacts of microfinance have not been comprehensively evaluated. OBJECTIVE: To explore the impact of microfinance on contraceptive use, female empowerment and children's nutrition in South Asia, Sub-Saharan Africa and Latin America and the Caribbean. DESIGN: We conducted a systematic search of published and grey literature (1990-2018), with no language restrictions. We conducted meta-analysis, where possible, to calculate pooled ORs. Where studies could not be combined, we described these qualitatively. DATA SOURCES: EMBASE, MEDLINE, LILACS, CENTRAL and ECONLIT were searched (1990-June 2018). ELIGIBILITY CRITERIA: We included controlled trials, observational studies and panel data analyses investigating microfinance involving women and children. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias. The methodological quality of included studies was assessed using the Cochrane risk-of-bias tool for controlled trials and quasi-experimental studies and a modified Newcastle Ottawa Scale for cross-sectional surveys and analyses of panel data. Meta-analyses were conducted using STATA V.15 (StataCorp). RESULTS: We included 27 studies. Microfinance was associated with a 64% increase in the number of women using contraceptives (OR 1.64, 95% CI 1.45 to 1.86). We found mixed results for the association between microfinance and intimate partner violence. Some positive changes were noted in female empowerment. Improvements in children's nutrition were noted in three studies. CONCLUSION: Microfinance has the potential to generate changes in contraceptive use, female empowerment and children's nutrition. It was not possible to compare microfinance models due to the small numbers of studies. More rigorous evidence is needed to evaluate the association between microfinance and social and health outcomes. PROSPERO REGISTRATION NUMBER: CRD42015026018.

Strategies to reduce informal payments in health systems: a systematic review.

BACKGROUND: Informal payment is a major barrier to universal health coverage, particularly in low and middle-income countries. AIMS: The aim of this study was to determine appropriate methods to reduce informal payments in health care via a systematic review. METHODS: For this systematic review, we searched the Cochrane Library, PubMed and SCOPUS covering the period 2000-2014: 10 papers which considered reduction strategies for IP were finally included in the review. Three of the authors independently extracted data and assessed the papers against inclusion and exclusion criteria. RESULTS: Improving public awareness and measures towards changing the culture were the main policies to combat informal payment. In addition, providing additional financial support to motivate physicians and other health service providers, appropriate monitoring of legislation, and converting informal to formal payment through tailored new policies were other solutions mentioned towards reducing or removing informal payments. CONCLUSIONS: No unique strategy exists for reducing informal payments in any health system. Choosing an appropriate strategy depends on the context and financing structure of the health system in any particular setting.

Sources of finance for hospitalized treatment in India: Evidence for policy.

A study of sources of finance which the household resorts to, in order to meet the hospitalization expense can be of use to policy makers who may want to work in the direction of providing financial security against hospitalization expenses to the masses. In this view, an attempt has been made to study the sources of finance for hospitalized treatment at an individual level based on criteria such as level of living, socio-economic background, level of care in India, as well as at state level through unit level data of the survey on "Social Consumption related to Health", conducted by National Sample Survey (NSS) during January, 2014 to June, 2014. It has been found that the household's income or saving is not sufficient to meet the expenditure for hospitalized treatment and people have to borrow or arrange finance by other means for hospitalized treatment across the country. The results thereby suggest inputs to policy makers and re-establish the necessity of appropriate policy in order to provide financial security against escalating medical expenses.

Investing: the case for recognition as an independent capacity.

In this article, we provide support for the need to recognize investing as an independent capacity. A comparison of the definitions and models of financial and investing capacities revealed significant differences between them. A review of the status of investing capacity assessment revealed that there are currently no investing capacity specific assessment instruments (ICSAIs). Implications for researchers and clinicians resulting from the lack of recognition of investing as an independent capacity are discussed and used as a rational for the need to develop ICSAIs. The benefits of ICSAI development for financial, legal, and clinical professionals as well as for investors are discussed, and a direction for future investing capacity research is proposed.

Drivers behind widespread informal payments in the Romanian public health care system: From tolerance to corruption to socio-economic and spatial patterns.

In order to explain informal payments in public health care services in Romania, this paper evaluates the relationship between extra payments or valuable gifts (apart from official fees) and the level of tolerance to corruption, as well as the socio-economic and spatial patterns across those individuals offering informal payments. To evaluate this, a survey undertaken in 2013 is reported. Using logistic regression analysis, the findings are that patients with a high tolerance to corruption, high socio-economic risk (those divorced, separated, or with other form of marital status, and those not working), and located in rural or less affluent areas are more likely to offer (apart from official fees) extra payments or valuable gifts for health care services. The paper concludes by discussing the health policy implications.

A systematic review of empirical studies on methodology and burden of informal patient payments in health systems.

INTRODUCTION: Informal patients' payments (IPPs) is a sensitive subject. The aim of current study was to assess the trends in informal payment studies and explore methods of IPPs measurement, prevalence, and features (payment type, volume, and receiver) in various contexts. METHODS: A search strategy was developed to identify peer-reviewed articles addressing informal payments on PubMed, Science Direct, Web of Science, Scopus, and CINAHL. A total of 1252 studies were identified initially. After screening process, 38 studies were included in the systematic review. The selected studies were appraised, and findings were synthesized. RESULT: Among selected studies, quantitative approaches were mostly used for measuring IPPs from general public and patients' perspective, and qualitative methods mainly targeted health care providers. Reported IPP prevalence in selected articles ranges between 2% and 80%, more prevalent in the inpatient sector than in outpatient. CONCLUSION: There are a number of strategies for the measurement of IPPs with different strengths and weaknesses. Most applied strategies for general public were quantitative surveys recruiting more than 1000 participants using a face-to-face structured interview, and then qualitative studies on less than 150 health care providers, with focus group discussion. This review provides a comprehensive picture of current informal patients' payments measurement tools, which helps researchers in future investigations.

Demand for Long-Term Care Insurance in China.

The aim of this study was to estimate willingness to pay (WTP) for long-term care insurance (LTCI) and to explore the determinants of demand for LTCI in China. We collected data from a household survey conducted in Qinghai and Zhejiang on a sample of 1842 households. We relied on contingent valuation methods to elicit the demand for LTCI and random effects logistic regression to analyze the factors associated with the demand for LTCI. Complementarily, we used document analysis to compare the LTCI designed in this study and the current LTCI policies in the pilot cities. More than 90% of the respondents expressed their willingness to buy LTCI. The median WTP for LTCI was estimated at 370.14 RMB/year, accounting for 2.29% of average annual per capita disposable income. Price, age, education status, and income were significantly associated with demand for LTCI. Most pilot cities were found to mainly rely on Urban Employees Basic Medical Insurance funds as the financing source for LTCI. Considering that financing is one of the greatest challenges in the development of China's LTCI, we suggest that policy makers consider individual contribution as an important and possible option as a source of financing for LTCI.

Informal Patient Payments and Bought and Brought Goods in the Western Balkans - A Scoping Review.

BACKGROUND: Informal patient payments for healthcare are common in the Western Balkans, negatively affecting public health and healthcare. AIM: To identify literature from the Western Balkans on what is known about informal patient payments and bought and brought goods, to examine their effects on healthcare and to determine what actions can be taken to tackle these payments. METHODS: After conducting a scoping review that involved searching websites and databases and filtering with eligibility criteria and quality assessment tools, 24 relevant studies were revealed. The data were synthesized using a narrative approach that identified key concepts, types of evidence, and research gaps. RESULTS: The number of studies of informal patient payments increased between 2002 and 2015, but evidence regarding the issues of concern is scattered across various countries. Research has reported incidents of informal patient payments on a wide scale and has described various patterns and characteristics of these payments. Although these payments have typically been small - particularly to providers in common areas of specialized medicine - evidence regarding bought and brought goods remains limited, indicating that such practices are likely even more common, of greater magnitude and perhaps more problematic than informal patient payments. Only scant research has examined the measures that are used to tackle informal patient payments. The evidence indicates that legalizing informal patient payments, introducing performance-based payment systems, strengthening reporting, changing mentalities and involving the media and the European Union (EU) or religious organizations in anti-corruption campaigns are understood as some of the possible remedies that might help reduce informal patient payments. CONCLUSION: Despite comprehensive evidence regarding informal patient payments, data remain scattered and contradictory, implying that informal patient payments are a complex phenomenon. Additionally, the data on bought and brought goods illustrate that not much is known about this matter. Although informal patient payments have been studied and described in several settings, there is still little research on the effectiveness of such strategies in the Western Balkans context.

A decision support model for investment on P2P lending platform.

Peer-to-peer (P2P) lending, as a novel economic lending model, has triggered new challenges on making effective investment decisions. In a P2P lending platform, one lender can invest N loans and a loan may be accepted by M investors, thus forming a bipartite graph. Basing on the bipartite graph model, we built an iteration computation model to evaluate the unknown loans. To validate the proposed model, we perform extensive experiments on real-world data from the largest American P2P lending marketplace-Prosper. By comparing our experimental results with those obtained by Bayes and Logistic Regression, we show that our computation model can help borrowers select good loans and help lenders make good investment decisions. Experimental results also show that the Logistic classification model is a good complement to our iterative computation model, which motivates us to integrate the two classification models. The experimental results of the hybrid classification model demonstrate that the logistic classification model and our iteration computation model are complementary to each other. We conclude that the hybrid model (i.e., the integration of iterative computation model and Logistic classification model) is more efficient and stable than the individual model alone.

[What do family medicine trainees think about gratitude payment?] / Mit gondolnak a családorvos-rezidensek a hálapénzrol?

INTRODUCTION: The issue of gratuity is one of the most important health policy issues in Hungary. AIM: The authors' aim is to investigate the attitude of Hungarian family medicine trainees towards gratitude payment. METHOD: Quantitative, paper-based survey among trainees from four Departments of Family Medicine in Hungary (n = 152). RESULTS: More than 50 percent of the residents do not approve of accepting gratitude money. Men (p<0.026), and graduating residents accept it significantly more often (p<0.036) while doctors with children tend to accept it more frequently (p<0.051). They think that the reason for this phenomenon is the lack of proper care (65%), vulnerability and the sense of real gratitude patients feel (52%). According to the participants, the least influencing factor was the low salary of physicians (14.4%). They believe that accepting gratuity is a corruption, and it's humiliating for doctors (80-80%). CONCLUSION: Family medicine residents approve of gratitude money even less as compared to the results of previous studies, but related to other gratitude payment issues we have found similar opinions. Orv Hetil. 2017; 158(26): 1028-1035.