Health services utilization by fibromyalgia patients from two ethnic groups.

AIM: The cost to the healthcare system of management and treatment for fibromyalgia patients is high. The aims of the study were to identify and compare factors associated with the use of healthcare services among fibromyalgia patients in southern Israel from two ethnic groups. METHODS: A cross-sectional study of patients insured in the southern district of the Clalit Healthcare Services in Israel in 2019-2020. The data were collected from the central computerized system. Multivariable regression models were developed for healthcare services utilization. RESULTS: During the study period, 7686 members were diagnosed with fibromyalgia. The median for specialist consultations was 47 and for imaging tests was eight. About 47% made emergency room visits and 25% were hospitalized. The median of imaging tests was significantly higher in Jewish patients than in Arab patients (8 vs. 6; p = .000). In contrast, a significantly higher rate of Arab patients visited the Emergency Room at least once (51.6% vs. 46.75%; p = .000) and they had a higher median number or Emergency Room visits (2 vs. 1; p = .003), compared with Jewish patients. In the Arab group there was a strong effect coefficient for another localized pain syndrome with specialist consultations (odds ratio [OR] 1.699; 95% confidence interval [CI] 1.266-2.241) and imaging tests (OR 2.511; 95% CI 1.496-4.146). CONCLUSIONS: The utilization rate of healthcare services is high among fibromyalgia patients. The factors associated with high healthcare utilization are different in the two ethnic groups. Future studies could show if interventions designed to address modifiable factors could reduce the overutilization of healthcare services.

Does universal health insurance coverage reduce unmet healthcare needs in China? Evidence from the National Health Service Survey.

BACKGROUND: China has nearly achieved universal health insurance coverage, but considerable unmet healthcare needs still exist. Although this topic has attracted great attention, there have been few studies examining the relationship between universal health insurance coverage and unmet healthcare needs. This study aimed to clarify the impact of universal health insurance coverage and other associated factors on Chinese residents' unmet healthcare needs. METHODS: Data was derived from the fourth, fifth, and sixth National Health Service Survey of Jiangsu Province, which were conducted in 2008, 2013, and 2018, respectively. Descriptive statistics were used to analyze the prevalence of unmet healthcare needs. Binary multivariate logistic regression was used to estimate the association between unmet healthcare needs and universal health insurance coverage, along with other socioeconomic factors. RESULTS: 8.99%, 1.37%, 53.37%, and 13.16% of the respondents in Jiangsu Province reported non-use of outpatient services, inpatient services, physical examinations, and early discharge from hospital, respectively. The trend in the prevalence of unmet healthcare needs showed a decline from 2008 to 2018. Health insurance had a significant reducing effect on non-use of outpatient services, inpatient services, or early discharge from hospital. People having health insurance in 2013 and 2018 were significantly less likely to report unmet healthcare needs compared to those in 2008. The effect of health insurance and its universal coverage on reducing unmet healthcare needs was greater in rural than in urban areas. Other socioeconomic factors, such as age, marital status, educational level, income level, or health status, also significantly affected unmet healthcare needs. CONCLUSIONS: Universal health insurance coverage has significantly reduced Chinese residents' unmet healthcare needs. Policy efforts should pay more attention to the benefits of health insurances in rural areas and optimize urban-rural health resources to promote effective utilization of healthcare.

User fees exemptions alone are not enough to increase indigent use of healthcare services.

The aim of this study was to assess whether user fees exemptions increased healthcare services use among indigents in the Ouargaye district in Burkina Faso. In this pre-post study, we surveyed 1224 indigents in 2010 about their healthcare services use over the preceding 6 months. Of these, 540 subsequently received a user fees exemption card. A follow-up survey was conducted 1 year later with a 55.3% retention rate. Analyses were performed in accordance with Andersen and Newman's model (Societal and individual determinants of medical care utilization in the United States. Milbank Q 1973;51:95-124) to explain healthcare services use by considering predisposing and facilitating factors and health needs indicators. Logistic regression analyses were performed.Among indigents exempted from user fees, 46.2% increased their healthcare services use in 2011, as opposed to 42.1% among the non-exempted. Being exempted was not associated with increased use of services (odds ratio, OR = 1.1, 95% confidence interval, CI [0.80-1.51]). Regardless of whether they were exempted or not, the indigents most likely to have increased their healthcare services use were older than 69 years of age (OR = 1.66, 95% CI [1.05-2.64]), male (OR = 1.44, 95% CI [0.99-2.08]), in low-income households (OR = 1.71, 95% CI [1.15-2.54]), and had received financial support from their families to obtain healthcare (OR = 1.59, 95% CI [1.1-2.28]). The indigents' increased healthcare services use was not attributable to user fees exemptions. Some contamination of the intervention is conceivable. Interventions combining user fees exemptions with actions targeting other obstacles to healthcare access would probably be more effective in increasing indigents' use of healthcare centres.

Husbands' experiences and perceptions regarding the use of maternity waiting homes in rural Zambia.

OBJECTIVE: To explore men's experience and beliefs regarding the use of maternity waiting homes (MWHs) in Kalomo District, Zambia. METHODS: As part of a qualitative study, in-depth interviews with the husbands/partners of women attending the under-five clinic at a health center with a MWH were conducted between April 1 and May 31, 2014. Men aged 18-50 years whose partner/wife was of reproductive age and who had lived in the area for more than 6 months were eligible for inclusion. RESULTS: Overall, 24 husbands/partners were interviewed in seven rural health centers. Men perceived many potential benefits of MWHs, including improved access to facility-based skilled delivery services and treatment in case of labor complications. Their many roles included decision making and securing funds for transport, food, cleaning materials, and clothes for the mother and the neonate to use during and after labor. However, limited financial resources made it difficult for them to provide for their wives and newborns, and usually led to delays in their decisions about MWH use. Poor conditions in MWHs and the lack of basic social and healthcare needs meant some men had forbidden their wives/partners from using the facilities. CONCLUSION: Important intervention targets for improving access to MWHs and skilled birth attendance have been identified.

Influência de um programa de exercícios físicos no uso de serviços de saúde na Atenção Básica de Saúde do município de Rio Claro, SP / Influence of a physical activity program on the use of Primary Care services in the city of Rio Claro, SP

A prevenção e o controle das doenças crônicas não transmissíveis adquiridos com a prática regular de atividade física podem contribuir na melhoria da saúde dos indivíduos, o que pode reduzir o uso dos serviços de saúde e os gastos do governo. O objetivo do estudo foi verificar a influência da prática de exercícios físicos no uso dos serviços de saúde na Atenção Básica de Saúde (ABS). Participaram do estudo 26 mulheres de um programa de exercícios físicos em unidades de saúde da ABS do município de Rio Claro- SP. Foi aplicado um questionário com as participantes do programa de 2009 a 2011, contendo questões referentes à participação no programa, condições de saúde, percepção dos participantes em relação ao uso dos serviços de saúde sobre consultas médicas, medicamentos, doenças/queixas e internações, no momento anterior e posterior ao ingresso no programa. Foi realizada análise descritiva e de comparação, na qual foi utilizada a análise por intervalo de confiança para médias e frequências, sendo este de 95%. Após iniciar no programa, houve melhora da percepção de saúde das participantes, bem como relatos de diminuição do número de visitas à unidade de saúde, do número de medidas da pressão arterial, do descontrole da pressão arterial e da glicemia. Houve também manutenção do número e da dose de medicamentos, do número de doenças/queixas e do número de medidas da glicemia. A prática de exercícios físicos oferecida pelo programa contribuiu para melhora nos níveis de saúde percebida e para diminuição do uso dos serviços de saúde.

The prevention and control of chronic non-communicable diseases, promoted by the regular practice of physical activity, can improve the health status of individuals, and this can reduce government spending and the use of healthcare services. The aim of this study was to investigate the influence of physical activity practice on the use of Primary Care services. Twenty-six women enrolled in a physical activity program held in Primary Care units located in the city of Rio Claro, state of São Paulo, participated in this study. A questionnaire was administered to the women who participated in the program from 2009 to 2011, containing questions regarding participation in the program, health conditions, and participants? perceptions concerning the use of healthcare services related to medical appointments, medications, diseases/complaints and hospitalizations, in the moments before and after the enrolment in the program. A descriptive and comparative analysis was carried out, in which confidence interval analysis for means and frequencies was used, with 95% confidence intervals. After starting the program, there was an improvement in the participants? health perception, as well as reports of decrease in the number of visits to the healthcare unit, in the number of blood pressure measurements, in uncontrolled blood pressure and blood glucose. On the other hand, the number and dose of drugs remained the same, as well as the number of diseases/complaints and the number of blood glucose measurements. The practice of physical exercises offered by the program contributed to improve the levels of perceived health and to reduce the use of the healthcare services.

Situação no mercado de trabalho e utilização de serviços de saúde no Brasil / Labor market status and the use of healthcare services in Brazil

Este estudo compara a utilização de serviços de saúde segundo a situação no mercado de trabalho em três anos e investiga se estão associados após ajuste por características sócio-demográficas e presença de doença crônica. Foram estudados homens de 15 a 64 anos, incluídos na PNAD de 1998, 2003 e 2008 de acordo com a utilização de consulta médica e internação nos últimos 12 meses e visita ao dentista há menos de três anos. A associação entre a situação no mercado de trabalho e o uso de serviços de saúde em 2008 foi estimada pela regressão de Poisson. Foram estudados 33.726 homens. As prevalências de consulta médica e odontológica aumentaram ao longo do período, mas mantiveram-se mais elevadas entre os trabalhadores com proteção social. Desemprego e trabalho sem proteção social foram independente e negativamente associados à menor prevalência de consulta médica e odontológica em 2008. Conhecer as barreiras e aumentar a oferta de serviços com perfil de funcionamento adequado para quem trabalha é fundamental para tentar reduzir as iniquidades observadas. Por outro lado, promover a inserção no trabalho com garantias dos direitos sociais pode contribuir para a melhoria dos indicadores de saúde pública.

This study compares the use of health services among economically active men according to labor market status in the years 1998, 2003, 2008 and investigates whether both are associated after adjustment for socio-demographic characteristics and health indicators. All males aged 15 to 64, participating in the National Household Survey 1998, 2003 and 2008 were included. The association between labor market status and use of services in 2008 was estimated by Poisson regression. 33,726 males were surveyed and the prevalence of medical and dental care use was found to be higher among workers with social protection. The frequency of health care use increased over the period, but remained significantly higher among formally employed workers. Unemployment and work without social protection were negatively associated with medical and dental care visits. The socio-economic structure that establishes different social groups with unequal health conditions also affects the use of health services. Further investigation into the social and physical barriers to health care use by the unemployed and informal workers is required in order to reduce perceived health inequities.