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1.
West Afr J Med ; 37(3): 237-247, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32476117

RESUMO

BACKGROUND: Type 2 diabetes mellitus can be a major drain on resources due to lifelong treatment and risk of catastrophic expenditure from treatment of complications. The prevalence has been projected to rise to alarming levels in developing countries. This study aimed to assess the levels of, and associations between good glycaemic control among patients with type 2 diabetes and their modes of financing healthcare. METHODS: In this hospital based descriptive cross-sectional study, 260 patients being managed for type 2 diabetes at the outpatient clinics of Lagos University Teaching Hospital, Lagos were recruited by systematic random sampling method. All participants received a HBA1C test to assess glycaemic control and a composite interviewer administered questionnaire adapted from the MMAS-8 and diabetes care profile to assess medication adherence, modes of financing and other factors related to disease management. RESULTS: Of the 260 study participants, 34.62% (90) had good glycaemic control. In the mode of health care financing only 15% (39) paid by health insurance (NHIS), while 85% of the respondents' payment was by out-of-pocket (OOP) payment. About half of these OOP payments were made by family, friends and others (in this study, a proxy for informal means of pooling finances). Significant associations were found between glycaemic control and adherence (2 13.93, p=0.001), glycaemic control and mode of payment (2 15.30, p=0.0000) and also adherence and mode of payment (2 16.59, p =0.002). CONCLUSION: In this study, only about a third of patients with type 2 diabetes achieved good glycaemic control, most patients used OOP financing and patients with OOP financing had poorer adherence and poorer glycaemic control. There is a need to scale up health insurance to improve health outcomes in diabetes management and protect people in developing countries from the burden of health care costs of chronic diseases like type 2 diabetes.


Assuntos
Glicemia/metabolismo , Diabetes Mellitus Tipo 2/tratamento farmacológico , Financiamento Pessoal/economia , Gastos em Saúde/estatística & dados numéricos , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/economia , Feminino , Financiamento Pessoal/estatística & dados numéricos , Hemoglobina A Glicada/análise , Hospitais de Ensino , Humanos , Hipoglicemiantes/economia , Insulina/economia , Masculino , Pessoa de Meia-Idade , Nigéria , Fatores Socioeconômicos
2.
J Clin Ethics ; 31(2): 178-183, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32585663

RESUMO

An ethically sound discharge from the hospital can be impeded by a number of factors, including a lack of payor for a patient's care, a lack of appropriate discharge options, and a lack of authority to sign a patient into a long-term facility. In some cases, the primary barrier involves the patient's lack of financial decision-making capacity. When a patient's income comes primarily from government assistance, financial decision making is connected to both the individual's well-being and to fair allocation of resources. Taking away another person's financial independence is a substantial intrusion on autonomy and should not be considered lightly. However, poor management of funds can lead to homelessness, medical noncompliance, vulnerability to financial exploitation, and other threats to human flourishing. As with medical decision-making capacity, poor decisions alone do not invalidate an individual's right to self-determination. And as with medical decision-making capacity, such determinations should not be made ad hoc or be capricious, but should rely on sound assessment criteria. When there are justified concerns that a patient may be vulnerable due to limited financial decision-making capacity, an evaluation should be completed and a surrogate payee be sought, when appropriate.


Assuntos
Tomada de Decisões , Financiamento Pessoal , Competência Mental , Alta do Paciente , Assistência Centrada no Paciente , Tomada de Decisão Clínica , Humanos , Assistência Centrada no Paciente/economia , Autonomia Pessoal
3.
PLoS One ; 15(5): e0233749, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469973

RESUMO

INTRODUCTION: Smoking is hazardous to health and places a heavy economic burden on individuals and their families. Clearly, smoking in China is prevalent since China is the largest consumer of tobacco in the world. Chinese smoking and nonsmoking households were compared in terms of the incidence and intensity of Catastrophic Health Expenditures (CHEs). The factors associated with catastrophic health expenditures were analyzed. METHODS: Data for this study were collected from two waves of panel data in 2011 and 2013 from the national China Health and Retirement Longitudinal Study (CHARLS). A total of 8073 households with at least one member aged above 45 were identified each year. Catastrophic health expenditure was measured by the ratio of a household's out-of-pocket healthcare payments (OOP) to the household's Capacity to Pay (CTP). A panel logit random-effects model was used to examine correlates with catastrophic health expenditure. RESULTS: The incidence of catastrophic health expenditures for Chinese households with members aged 45 and above in 2011 and 2013 were 12.99% and 15.56%, respectively. The mean gaps (MGs) were 3.16% and 4.88%, respectively, and the mean positive gaps (MPGs) were 24.36% and 31.40%, respectively. The incidences of catastrophic health expenditures were 17.41% and 20.03% in former smoking households, 12.10% and 15.09% in current smoking households, and 12.72% and 13.64% in nonsmoking households. In the panel logit regression model analysis, former smoking households (OR = 1.444, P<0.001) were more prone to catastrophic health expenditures than nonsmoking households. Risk factors for catastrophic health expenditures included members with chronic diseases (OR = 4.359, P<0.001), hospitalized patients (OR = 8.60, P<0.001), elderly people aged above 65 (OR = 1.577, P<0.001), or persons with disabilities (OR = 1.275, P<0.001). Protective factors for catastrophic health expenditures included being in an urban household, having a larger family size, and having a higher household income. CONCLUSIONS: The incidence of catastrophic health expenditures in Chinese households is relatively high. Smoking is one of the primary risk factors for catastrophic health expenditures. Stronger interventions against smoking should be made in time to reduce the occurrence of health issues caused by smoking and the financial losses for individuals, families and society.


Assuntos
Doença Catastrófica/economia , Financiamento Pessoal/economia , Gastos em Saúde/estatística & dados numéricos , Fumar Tabaco , Idoso , China , Características da Família , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , não Fumantes , Fatores de Risco , Fumantes , Fumar Tabaco/efeitos adversos , Fumar Tabaco/economia
4.
Med Care ; 58 Suppl 6 Suppl 1: S4-S13, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32412948

RESUMO

BACKGROUND: High deductible health plans linked to Health Savings Accounts (HSA-HDHPs) must include all care under the deductible except for select preventive services. Some employers and insurers have adopted Preventive Drug Lists (PDLs) that exempt specific classes of medications from deductibles. OBJECTIVE: The objective of this study was to examine the association between shifts to PDL coverage and medication utilization among patients with diabetes in HSA-HDHPs. RESEARCH DESIGN: A natural experiment comparing pre-post changes in monthly and annual outcomes in matched study groups. SUBJECTS: The intervention group included 1744 commercially-insured HSA-HDHP patients with diabetes age 12-64 years switched by employers to PDL coverage; the control group included 3349 propensity-matched HSA-HDHP patients whose employers offered no PDL. MEASURES: Outcomes were out-of-pocket (OOP) costs for medications and the number of pharmacy fills converted to 30-day equivalents. RESULTS: Transition to the PDL was associated with a relative pre-post decrease of $612 (-35%, P<0.001) per member OOP medication expenditures; OOP reductions were higher for key classes of antidiabetic and cardiovascular medicines listed on the PDL; the policy did not affect unlisted classes. The PDL group experienced relative increases in medication use of 6.0 30-day fills per person during the year (+11.2%, P<0.001); the increase was more than twice as large for lower-income (+6.6 fills, +12.6%, P<0.001) than higher-income (+3.0 fills, +5.1%, P=0.024) patients. CONCLUSION: Transition to a PDL which covers important classes of medication to manage diabetes and cardiovascular conditions is associated with substantial annual OOP cost savings for patients with diabetes and increased utilization of important classes of medications, especially for lower-income patients.


Assuntos
Custo Compartilhado de Seguro/métodos , Dedutíveis e Cosseguros , Hipoglicemiantes/economia , Poupança para Cobertura de Despesas Médicas , Pobreza/estatística & dados numéricos , Adolescente , Adulto , Criança , Diabetes Mellitus/economia , Diabetes Mellitus/prevenção & controle , Feminino , Financiamento Pessoal/economia , Financiamento Pessoal/estatística & dados numéricos , Humanos , Hipoglicemiantes/uso terapêutico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pobreza/economia , Adulto Jovem
5.
PLoS One ; 15(4): e0232600, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353086

RESUMO

INTRODUCTION: Cholera is a highly infectious disease and remains a serious public health burden in Bangladesh. The objective of the study was to measure the private demand for oral cholera vaccines (OCV) in Bangladesh and to investigate the key determinants of this demand, reflected in the household's willingness to pay (WTP) for oral cholera vaccine. METHODS: A contingent valuation method was employed in an urban setting of Bangladesh during December 2015 to January 2016. All respondents (N = 1051) received a description of World Health Organization (WHO) prequalified OCV, Shanchol™. Interviews were conducted with either the head of households or their spouse or a major economic contributor of the households. Respondents were asked about how much at maximum they were willing to pay for OCV for their own and their household members' protection. Results are presented as the average and median of the reported maximum WTP of the respondents with standard deviations and 95% confidence interval. Natural log-linear regression model was employed to examine the factors influencing participants' WTP for OCV. RESULTS: About 99% of the respondents expressed WTP for OCV with a maximum mean and median WTP per vaccination (2 doses) of US$ 2.23 and US$ 1.92 respectively. On the household level with an average number of 4.62 members, the estimated mean WTP was US$ 10 (median: US$ 7.69) which represents the perceived demand for OCV of a household to vaccinate against cholera. CONCLUSIONS: The demand of vaccination further indicates that there is a potential scope for recovering a certain portion of the expenditure of immunization program by introducing direct user fees for future cholera vaccination in Bangladesh. Findings from this study will be useful for the policy-makers to make decision on cost-recovery in future oral cholera vaccination programs in Bangladesh and in similar countries.


Assuntos
Vacinas contra Cólera/economia , Cólera/prevenção & controle , Financiamento Pessoal , População Urbana/estatística & dados numéricos , Vacinação/economia , Administração Oral , Adulto , Bangladesh , Vacinas contra Cólera/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários/estatística & dados numéricos , Vacinação/métodos
6.
PLoS One ; 15(5): e0232882, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32433652

RESUMO

BACKGROUND: Pre-payment and risk pooling schemes, central to the idea of universal health coverage, should protect households from catastrophic health expenditure and impoverishment; particularly when emergency care is required. Inadequate financial protection consequent on surgical emergencies occurs despite the existence of risk-pooling schemes. This study documented the experiences and coping strategies of slum and non-slum dwellers in a southwestern metropolis of Nigeria who had undergone emergency surgery. METHODS: In-depth interviews were conducted with 31 participants (13 slums dwellers, 18 non-slum dwellers) who had recently paid for emergency surgical care in Ibadan. Patients who had experienced catastrophic health expenditure from the use of emergency surgical care were identified and people who paid for the care were purposively selected for the interviews. Using an in-depth interview guide, information on the experiences and overall coping strategies during and after the hospitalization was collected. Data were analyzed inductively using the thematic approach. RESULTS: The mean age of the 31 participants (consisting of 7 men and 24 women) was 31 ± 5.6years. Apathy to savings limited the preparation for unplanned healthcare needs. Choice of hospital was determined by word of mouth, perceptions of good quality or prompt care and availability of staff. Social networks were relied on widely as a coping mechanism before and during the admission. Patients that were unable to pay experienced poor and humiliating treatment (in severe cases, incarceration). Inability to afford care was exacerbated by double billing and extraneous charges. It was opined that health care should be more affordable for all and that the current National Health Insurance Scheme, that was operating sub-optimally, should be strengthened appropriately for all to benefit. CONCLUSION: The study highlights households' poor attitude to health-related savings and pre-payment into a social solidarity fund to cover the costs of emergency surgical care. It also highlights the factors influencing costs of emergency surgical care and the role of social networks in mitigating the high costs of care. Improving financial protection from emergency surgical care would entail promoting a positive attitude to health-related savings, social solidarity and extending the benefits of social health insurance.


Assuntos
Tratamento de Emergência/economia , Cirurgia Geral/economia , Gastos em Saúde , Adulto , Atitude Frente a Saúde , Feminino , Financiamento Pessoal , Hospitalização/economia , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Nigéria , Pesquisa Qualitativa , Apoio Social , Fatores Socioeconômicos , População Urbana , Adulto Jovem
10.
Postgrad Med ; 132(4): 320-327, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32306819

RESUMO

AIMS: This survey aimed to explore real-world physician experiences and treatment satisfaction with fast-acting insulin aspart (faster aspart) in clinical practice across Europe and Canada. MATERIALS AND METHODS: An online web-based survey was used for physicians treating people with type 1 or type 2 diabetes. General practitioners and specialists, with experience using faster aspart, were interviewed. RESULTS: A total of 191 physicians participated in the survey. Most of their patients (68% of those with T1D and 63% of those with T2D) were previously treated with another mealtime insulin before switching to faster aspart. At the time of initiating faster aspart, nearly half of patients had an HbA1c level between 7.5% (59 mmol/mol) and 8.5% (69 mmol/mol). The main prescription drivers for faster aspart, versus other mealtime insulins, were faster onset of action, improved postprandial glucose (PPG) control, and dosing flexibility. Most physicians were more satisfied with faster aspart than other mealtime insulins regarding at-meal (66%) and post-meal (71%) dosing flexibility, improved PPG levels (66%), and onset of action (61%). Main reasons for not prescribing faster aspart included a good response to current treatment (76%) or patient reluctance to switch (57%). Overall, 12% of patients discontinued faster aspart, for reasons including concerns of hypoglycemia (17%), poor adherence (17%), and level of patient co-pay (17%). More than half of physicians had fewer concerns regarding postprandial hyperglycemia, and were more confident in their patients reaching their HbA1c target with faster aspart than with other mealtime insulins. LIMITATIONS: The findings of this survey are based heavily on physicians' experiences, and could therefore be subject to recall bias. CONCLUSIONS: Reported physician and patient experiences of using faster aspart have been positive, and better PPG control and increased dosing flexibility are expected to improve glycemic management.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina Aspart/uso terapêutico , Médicos/psicologia , Glicemia , Relação Dose-Resposta a Droga , Feminino , Financiamento Pessoal , Hemoglobina A Glicada/análise , Humanos , Hipoglicemia , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/economia , Insulina Aspart/administração & dosagem , Insulina Aspart/economia , Masculino , Adesão à Medicação , Período Pós-Prandial , Fatores de Tempo
11.
BMC Public Health ; 20(1): 539, 2020 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-32312238

RESUMO

BACKGROUND: In 2014, a revision of the national medical tariffs for inpatient health care services took place in Iran, and a new hotline was set up to report informal payments. It was expected that such measures would eliminate or decrease informal payments prevalence. This study estimates the prevalence of informal payments for inpatient health care services in the post-reform period, explores factors associated with informal payments and examines patients' and healthcare providers' views regarding the causes of informal payments and possible practical solutions for their reduction. METHODS: We surveyed by phone patients who used inpatient health care services in seven Iranian hospitals in 2016. Descriptive and regression analyses were used to estimate the prevalence and determine factors associated with informal payments. We conducted a qualitative analysis through thematic analyses based on focus group discussions and in-depth interviews. RESULTS: Of 2696 respondents, 14% reported paying informally for inpatient services. Informal payments were reported more frequently among private hospital users, given more frequently to physicians in public teaching hospitals and 'other staff' in private hospitals, in the form of cash and voluntary. Being an adult, hospital or treatment type, being insured, and household head's education influenced the probability of paying informally. The amount paid informally was associated with being insured, the educational status of the household's head, household size, service, and hospital types. Based on qualitative findings, the leading causes of informal payments reported by patients and healthcare providers can be categorized into four groups - financing challenges; governance challenges; service delivery challenges; and actors and stakeholders. Modifying, adjusting and applying policy interventions; supervision, monitoring and evaluation; and actors and stakeholders were identified as possible solutions for tackling informal payment in the inpatient health care services. CONCLUSION: The prevalence of informal patient payments for inpatient services in the post-reform period seems to have reduced; however, they remain to be common. Regular monitoring, reviewing of payment policies to the physicians, informing patients, changing the behaviour of healthcare providers and patients, and developing ethical guidelines to prevent informal payments were suggested for reduction and elimination of informal payments in the Iranian healthcare sector.


Assuntos
Financiamento Pessoal , Gastos em Saúde/estatística & dados numéricos , Hospitalização/economia , Pacientes Internados , Adulto , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
12.
Medwave ; 20(2): e7833, 2020 Mar 19.
Artigo em Espanhol | MEDLINE | ID: mdl-32225131

RESUMO

Background: Out-of-pocket spending on medicines and supplies can lead to a heavy financial burden in households. Objective: To determine the out-of-pocket spending on medicines and supplies in Peru and the population groups with the highest out-of-pocket spending on medicines and supplies in 2007 and 2016. Methods: We conducted an analytical cross-sectional study of the Peruvian National Household Survey on Living and Poverty Conditions for the years 2007 and 2016. Mean and median out-of-pocket spending on medicines and supplies are reported in USD for the general population, and according to the presence or not of factors described in the literature as associated with out-of-pocket spending on medicines and supplies. Results: 92 148 and 130 296 participants from 2007 and 2016 were included. In 2007, a median of 3.19 (interquartile range: 0.96 to 7.99) and an average of 8.14 (95% confidence interval: 7.80 to 8.49) were found for the out-of-pocket spending on medicines and supplies. In 2016, the median and mean out-of-pocket spending on medicines and supplies were 3.55 (interquartile range: 1.48 to 8.88) and 9.68 (95% confidence interval: 9.37 to 9.99), respectively. For 2016, higher out-of-pocket spending on medicines and supplies was found in women, children under five and over 60 years of age, people of higher educational level, having private or armed forces insurance, living in the coastal region, and being in one of the highest per capita quintile of expenditure. Between 2007 and 2016, the out-of-pocket spending on medicines and supplies was significantly increased in children under five (p < 0.001), uninsured persons (p < 0.001), insured to the Seguro Integral de Salud (p < 0.001) or the Armed Forces (p = 0.035), for the urban and rural area (both p < 0.001), and in people without chronic diseases (p < 0.001). Conclusions: An increase in out-of-pocket spending on medicines and supplies was found in the study period. There were population groups with significant increases in out-of-pocket spending on medicines and supplies. It is necessary to explore further the factors associated with out-of-pocket spending on medicines and supplies in groups of greater economic vulnerability regarding direct health spending in Peru.


Assuntos
Custos de Medicamentos , Financiamento Pessoal , Gastos em Saúde , Adolescente , Adulto , Criança , Estudos Transversais , Características da Família , Feminino , Financiamento Pessoal/economia , Gastos em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Pobreza , Adulto Jovem
13.
BMC Public Health ; 20(1): 480, 2020 Apr 10.
Artigo em Inglês | MEDLINE | ID: mdl-32276624

RESUMO

BACKGROUND: Screening for sexually transmitted infection (STI) especially HIV as early detection and treatment have been financially supported under the Thai Universal Coverage (UC) scheme since 2009 (THB140 for HIV). However, the implementation has not been evidence-based, strategic risk-based, nor economically evaluated whereas husbands who accompanied the pregnant women are likely to have a lower risk than those who did not come along. This study is aimed to determine the husband's willingness-to-pay (WTP) for his HIV and syphilis screening tests and potential factors affecting STI screenings at the antenatal care (ANC) clinic of a tertiary hospital in Thailand. METHODS: A pilot open-ended interview was conducted among 50 participants to estimate the mean and standard deviation of WTP prices for HIV and syphilis screening tests. A questionnaire was developed to obtain demographics, STI knowledge and screening history, as well as two contingent valuation methods (bidding and payment scale), using the mean WTP prices identified from the pilot study as a starting WTP with »SD step-up/down. The survey of 200 randomly selected husbands of pregnant women was conducted at King Chulalongkorn Memorial Hospital from April to June 2018. Descriptive statistics and logistic regression were used for data analysis. RESULTS: During the study period, 597 pregnant women received their first ANC. Of 368 accompanying husbands, 200 were enrolled in the study. Their median age was 31 (IQR 27-36) years old and 67% had a first child. Eighty-eight percent of the participants were willing to test for the STIs. Based on the bidding method, WTP prices for HIV and syphilis screening tests were US$14.5 (IQR 12.4-14.5) and US$9.7 (IQR 10-12), respectively. The payment scale method suggested approximately three-quarters of the WTP prices from the bidding method. CONCLUSIONS: The husbands who accompanied their pregnant wives to the ANC clinic showed positive behaviors according to the propitious selection theory. They tend to cooperate well with STI testing and are willing to pay at least two times the price of the STI screening tests. The financial support to promote STI screenings should be reconsidered to cover other groups with higher sexual behavior risks and less WTP.


Assuntos
Financiamento Pessoal , Infecções por HIV/prevenção & controle , Programas de Rastreamento/economia , Cônjuges/psicologia , Sífilis/prevenção & controle , Adulto , Instituições de Assistência Ambulatorial , Feminino , Humanos , Masculino , Projetos Piloto , Gravidez , Cuidado Pré-Natal , Cônjuges/estatística & dados numéricos , Inquéritos e Questionários , Tailândia , Cobertura Universal do Seguro de Saúde
15.
Lancet ; 395(10227): 912-920, 2020 03 14.
Artigo em Inglês | MEDLINE | ID: covidwho-2354

RESUMO

The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena , Estresse Psicológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Financiamento Pessoal , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Saúde Pública , Quarentena/economia , Quarentena/psicologia , Condições Sociais , Estigma Social , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle
16.
BMC Public Health ; 20(1): 337, 2020 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-32178657

RESUMO

BACKGROUND: Pre-exposure prophylaxis (PrEP) is recommended as an HIV prevention strategy for key populations, in particular men who have sex with men (MSM). However, the willingness to pay market rate for PrEP is largely unknown. This study aimed to investigate the willingness to pay for PrEP and its associated factors among MSM living in Mainland China. METHODS: A cross-sectional survey was conducted among 689 MSM who were recruited through a gay-friendly health consulting service center in Chengdu, China during 2018-2019. We collected information on participants' willingness to pay for PrEP and its potential correlates (e.g., PrEP awareness and acceptability, perceived risk of HIV infection) using a structured questionnaire. Univariate and multivariate logistic regression were used for data analyses. RESULTS: Only 14.1% of respondents indicated they would not pay any money for PrEP, around half (49.3%) would like to pay $14-84 per month, and very few (6.8%) would like to pay ≥283 per month (market rate). We found that PrEP awareness (unadjusted odds ratio (ORu) = 1.41; 95% CI: 1.01-1.97), acceptability (ORu =1.20; 95% CI: 1.07-1.34), perceived PrEP adherence (ORu =1.23; 95% CI: 1.08-1.41), and perceived PrEP benefit in reducing condom use (ORu =1.29; 95% CI: 1.07-1.55) were all associated with participants' willingness to pay the market rate for PrEP. Other facilitators of PrEP pay willingness included full disclosure of sexual orientation to health professionals, high HIV literacy, and a high degree of HIV disclosure with sex partners. CONCLUSIONS: The overall willingness to pay for the market rate of PrEP was low among this urban sample of Chinese MSM. Programs aiming to promote PrEP pay willingness should provide enhanced counseling to improve PrEP-related cognition, deliver accurate HIV/PrEP information to increase health literacy, and decrease stigma towards sexual minorities to develop trust with health professionals.


Assuntos
Financiamento Pessoal/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Profilaxia Pré-Exposição/economia , Adolescente , Adulto , China , Estudos Transversais , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Adulto Jovem
17.
Am J Surg ; 219(4): 571-577, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32147020

RESUMO

INTRODUCTION: Bariatric surgery is an effective treatment for obesity resulting in both sustained weight loss and reduction in obesity-related comorbidities. It is uncertain how sociodemographic factors affect postoperative outcomes. METHODS: The National Inpatient Sample was queried for patients undergoing Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) from 2005 to 2014. Factors associated with selection of SG over RYGB, increased postoperative length of stay (LOS) greater than 3 days, and inpatient mortality were compared by race, insurance status, and other clinical and hospital factors. RESULTS: The database captured 781,413 patients, of which 525,986 had a RYGB and 255,428 had SG. There was an increase in the incidence of SG over RYGB over time. Among the self-pay/uninsured, the increased incidence began several years earlier than other groups. Black patients had greater odds of increased postoperative LOS (OR 1.40) and in-hospital mortality (OR 2.11). CONCLUSION: Sociodemographic factors are associated with differences in temporal trends in the adoption of SG versus RYGB for surgical weight loss.


Assuntos
Gastrectomia/tendências , Derivação Gástrica/tendências , Mortalidade Hospitalar , Tempo de Internação/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Comorbidade , Grupos de Populações Continentais/estatística & dados numéricos , Conjuntos de Dados como Assunto , Feminino , Financiamento Pessoal/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Setor Privado , Fatores Raciais , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto Jovem
18.
Lancet ; 395(10227): 912-920, 2020 03 14.
Artigo em Inglês | MEDLINE | ID: mdl-32112714

RESUMO

The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena , Estresse Psicológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Financiamento Pessoal , Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Saúde Pública , Quarentena/economia , Quarentena/psicologia , Condições Sociais , Estigma Social , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/prevenção & controle
19.
Public Health ; 181: 141-150, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32032922

RESUMO

OBJECTIVES: To provide an evaluation of medical expenditures induced by depression and depressive symptoms among rural elderly in China. STUDY DESIGN: The panel dataset used for this study is taken from the China Family Panel Studies (CFPS) data for the years 2012 and 2016. We examined the case of rural elderly who were 60 years old or older at the time of the 2012 survey and 64 years old or older at the time of the 2016 survey and then created a panel dataset that includes 2938 rural elderly for both years to estimate the influence of depressive symptoms/depression on medical cost. METHODS: Both two part model and four part model were used to estimate the influence of depressive symptoms and depression on medical expenditure. Then a counter-factual method was used to calculate the cost of depressive symptoms and depression among rural elderly in China. RESULTS: Mental health status has significant effects on individual medical expenses, and they aggregately contribute to 47.26% of total personal expected medical expenditures. Specifically, the rural group, the female group, the widowed group, and the poorly educated group have higher medical expenditures because of depressive status than the other groups. CONCLUSIONS: Mental health status significantly increased both the chance of undergoing medical care and the degree of medical expenditure among rural elderly in China. This situation is more serious in some vulnerable groups. Therefore, the Chinese government needs to reform its mental health of rural elderly and insurance institutions to eliminate the policy-caused barriers to mental health resources, especially for vulnerable groups.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Assistência à Saúde/economia , Depressão/economia , Transtorno Depressivo/economia , Financiamento Pessoal/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Idoso , China/epidemiologia , Depressão/tratamento farmacológico , Depressão/epidemiologia , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/epidemiologia , Feminino , Financiamento Pessoal/economia , Serviços de Saúde/economia , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Inquéritos e Questionários
20.
JAMA ; 323(6): 538-547, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-32044941

RESUMO

Importance: Privately insured patients who receive care from in-network physicians may receive unexpected out-of-network bills ("surprise bills") from out-of-network clinicians they did not choose. In elective surgery, this can occur if patients choose in-network surgeons and hospitals but receive out-of-network bills from other involved clinicians. Objective: To evaluate out-of-network billing across common elective operations performed with in-network primary surgeons and facilities. Design, Setting, and Participants: Retrospective analysis of claims data from a large US commercial insurer, representing 347 356 patients who had undergone 1 of 7 common elective operations (arthroscopic meniscal repair [116 749]; laparoscopic cholecystectomy [82 372]; hysterectomy [67 452]; total knee replacement [42 313]; breast lumpectomy [18 018]; colectomy [14 074]; coronary artery bypass graft surgery [6378]) by an in-network primary surgeon at an in-network facility between January 1, 2012, and September 30, 2017. Follow-up ended November 8, 2017. Exposure: Patient, clinician, and insurance factors potentially related to out-of-network bills. Main Outcomes and Measures: The primary outcome was the proportion of episodes with out-of-network bills. The secondary outcome was the estimated potential balance bill associated with out-of-network bills from each surgical procedure, calculated as total out-of-network charges less the typical in-network price for the same service. Results: Among 347 356 patients (mean age, 48 [SD, 11] years; 66% women) who underwent surgery with in-network primary surgeons and facilities, 20.5% of episodes (95% CI, 19.4%-21.7%) had an out-of-network bill. In these episodes, the mean potential balance bill per episode was $2011 (95% CI, $1866-$2157) when present. Out-of-network bills were associated with surgical assistants in 37% of these episodes; when present, the mean potential balance bill was $3633 (95% CI, $3384-$3883). Out-of-network bills were associated with anesthesiologists in 37% of episodes; when present, the mean potential balance bill was $1219 (95% CI, $1049-$1388). Membership in health insurance exchange plans, compared with nonexchange plans, was associated with a significantly higher risk of out-of-network bills (27% vs 20%, respectively; risk difference, 6% [95% CI, 3.9%-8.9%]; P < .001). Surgical complications were associated with a significantly higher risk of out-of-network bills, compared with episodes with no complications (28% vs 20%, respectively; risk difference, 7% [95% CI, 5.8%-8.8%]; P < .001). Among 83 021 procedures performed at ambulatory surgery centers with in-network primary surgeons, 6.7% (95% CI, 5.8%-7.7%) included an out-of-network facility bill and 17.2% (95% CI, 15.7%-18.8%) included an out-of-network professional bill. Conclusions and Relevance: In this retrospective analysis of commercially insured patients who had undergone elective surgery at in-network facilities with in-network primary surgeons, a substantial proportion of operations were associated with out-of-network bills.


Assuntos
Procedimentos Cirúrgicos Eletivos/economia , Honorários Médicos , Financiamento Pessoal/economia , Cobertura do Seguro/economia , Seguro Saúde/economia , Anestesiologistas/economia , Dedutíveis e Cosseguros , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Assistentes Médicos/economia , Estudos Retrospectivos , Cirurgiões/economia , Estados Unidos
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