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1.
Nutrients ; 13(7)2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34371967

RESUMO

Interventions that address binge eating and food insecurity are needed. Engaging people with lived experience to understand their needs and preferences could yield important design considerations for such interventions. In this study, people with food insecurity, recurrent binge eating, and obesity completed an interview-based needs assessment to learn facilitators and barriers that they perceive would impact their engagement with a digital intervention for managing binge eating and weight. Twenty adults completed semi-structured interviews. Responses were analyzed using thematic analysis. Three themes emerged. Participants shared considerations that impact their ability to access the intervention (e.g., cost of intervention, cost of technology, accessibility across devices), ability to complete intervention recommendations (e.g., affordable healthy meals, education to help stretch groceries, food vouchers, rides to grocery stores, personalized to budget), and preferred intervention features for education, self-monitoring, personalization, support, and motivation/rewards. Engaging people with lived experiences via user-centered design methods revealed important design considerations for a digital intervention to meet this population's needs. Future research is needed to test whether a digital intervention that incorporates these recommendations is engaging and effective for people with binge eating and food insecurity. Findings may have relevance to designing digital interventions for other health problems as well.


Assuntos
Bulimia/psicologia , Bulimia/terapia , Insegurança Alimentar , Obesidade/psicologia , Obesidade/terapia , Design Centrado no Usuário , Adulto , Idoso , Custos e Análise de Custo , Dieta Saudável , Feminino , Acesso aos Serviços de Saúde/economia , Humanos , Masculino , Refeições , Pessoa de Meia-Idade , Motivação , Determinação de Necessidades de Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Autocuidado/métodos
3.
PLoS Negl Trop Dis ; 15(8): e0009702, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34398889

RESUMO

BACKGROUND: Annually, about 2.7 million snakebite envenomings occur globally. Alongside antivenom, patients usually require additional care to treat envenoming symptoms and antivenom side effects. Efforts are underway to improve snakebite care, but evidence from the ground to inform this is scarce. This study, therefore, investigated the availability, affordability, and stock-outs of antivenom and commodities for supportive snakebite care in health facilities across Kenya. METHODOLOGY/PRINCIPAL FINDINGS: This study used an adaptation of the standardised World Health Organization (WHO)/Health Action International methodology. Data on commodity availability, prices and stock-outs were collected in July-August 2020 from public (n = 85), private (n = 36), and private not-for-profit (n = 12) facilities in Kenya. Stock-outs were measured retrospectively for a twelve-month period, enabling a comparison of a pre-COVID-19 period to stock-outs during COVID-19. Affordability was calculated using the wage of a lowest-paid government worker (LPGW) and the impoverishment approach. Accessibility was assessed combining the WHO availability target (≥80%) and LPGW affordability (<1 day's wage) measures. Overall availability of snakebite commodities was low (43.0%). Antivenom was available at 44.7% of public- and 19.4% of private facilities. Stock-outs of any snakebite commodity were common in the public- (18.6%) and private (11.7%) sectors, and had worsened during COVID-19 (10.6% versus 17.0% public sector, 8.4% versus 11.7% private sector). Affordability was not an issue in the public sector, while in the private sector the median cost of one vial of antivenom was 14.4 days' wage for an LPGW. Five commodities in the public sector and two in the private sector were deemed accessible. CONCLUSIONS: Access to snakebite care is problematic in Kenya and seemed to have worsened during COVID-19. To improve access, efforts should focus on ensuring availability at both lower- and higher-level facilities, and improving the supply chain to reduce stock-outs. Including antivenom into Universal Health Coverage benefits packages would further facilitate accessibility.


Assuntos
Antivenenos/uso terapêutico , Equipamentos e Provisões Hospitalares/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mordeduras de Serpentes/tratamento farmacológico , Antivenenos/economia , COVID-19/epidemiologia , Custos e Análise de Custo , Equipamentos e Provisões Hospitalares/economia , Acesso aos Serviços de Saúde/economia , Humanos , Quênia/epidemiologia , Setor Privado/economia , Setor Privado/estatística & dados numéricos , Setor Público/economia , Setor Público/estatística & dados numéricos , Mordeduras de Serpentes/economia , Mordeduras de Serpentes/epidemiologia
5.
Am J Public Health ; 111(8): 1523-1529, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34213978

RESUMO

Objectives. To identify the association between Medicaid eligibility expansion and medical debt. Methods. We used difference-in-differences design to compare changes in medical debt for those gaining coverage through Louisiana's Medicaid expansion with those in nonexpansion states. We matched individuals gaining Medicaid coverage because of Louisiana's Medicaid expansion (n = 196 556) to credit report data on medical debt and compared them with randomly selected credit reports of those living in Southern nonexpansion state zip codes with high rates of uninsurance (n = 973 674). The study spanned July 2014 through July 2019. Results. One year after Louisiana Medicaid expansion, medical collections briefly rose before declining by 8.1 percentage points (95% confidence interval [CI] = -0.107, -0.055; P ≤ .001), or 13.5%, by the third postexpansion year. Balances also briefly rose before falling by 0.621 log points (95% CI = -0.817, -0.426; P ≤ .001), or 46.3%. Conclusions. Louisiana's Medicaid expansion was associated with a reduction in the medical debt load for those gaining coverage. These results suggest that future Medicaid eligibility expansions may be associated with similar improvements in the financial well-being of enrollees.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Medicaid , Adulto , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Louisiana , Masculino , Medicaid/economia , Medicaid/estatística & dados numéricos , Pessoa de Meia-Idade , Pobreza , Estados Unidos
6.
BMJ Open ; 11(7): e045441, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34244254

RESUMO

INTRODUCTION: People living in slums face several challenges to access healthcare. Scarce and low-quality public health facilities are common problems in these communities. Costs and prevalence of catastrophic health expenditures (CHE) have also been reported as high in studies conducted in slums in developing countries and those suffering from chronic conditions and the poorest households seem to be more vulnerable to financial hardship. The COVID-19 pandemic may be aggravating the economic impact on the extremely vulnerable population living in slums due to the long-term consequences of the disease. The objective of this review is to report the economic impact of seeking healthcare on slum-dwellers in terms of costs and CHE. We will compare the economic impact on slum-dwellers with other city residents. METHODS AND ANALYSIS: This scoping review adopts the framework suggested by Arksey and O'Malley. The review is part of the accountability and responsiveness of slum-dwellers (ARISE) research consortium, which aims to enhance accountability to improve the health and well-being of marginalised populations living in slums in India, Bangladesh, Sierra Leone and Kenya. Costs of accessing healthcare will be updated to 2020 prices using the inflation rates reported by the International Monetary Fund. Costs will be presented in International Dollars by using purchase power parity. The prevalence of CHE will also be reported. ETHICS AND DISSEMINATION: Ethical approval is not required for scoping reviews. We will disseminate our results alongside the events organised by the ARISE consortium and international conferences. The final manuscript will be submitted to an open-access international journal. Registration number at the Research Registry: reviewregistry947.


Assuntos
COVID-19 , Acesso aos Serviços de Saúde/economia , Áreas de Pobreza , Bangladesh , Países em Desenvolvimento , Feminino , Instalações de Saúde , Humanos , Índia , Quênia , Masculino , Pandemias , Literatura de Revisão como Assunto , SARS-CoV-2 , Serra Leoa
9.
Hastings Cent Rep ; 51(4): 7-8, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34255366

RESUMO

One of the biggest policy interventions during the last year of the COVID-19 pandemic was the Coronavirus Aid, Relief, and Economic Securities Act, instituting a novel form of economic relief similar to a universal basic income. The economic impact payments, colloquially known as "stimulus checks," were distributed based on the socioeconomic status of American citizens and legal residents and provided much-needed financial aid. However, the distribution of these payments paid little attention to other important factors that might determine the economic security of said individuals, such as race and gender. This article calls for policy-makers to pay particular attention to how structural inequity and discrimination based on identity could affect the efficacy of proposed policies and demonstrate an ethic of care informed by an understanding of intersectionality.


Assuntos
COVID-19/economia , COVID-19/epidemiologia , Efeitos Psicossociais da Doença , Economia Comportamental/estatística & dados numéricos , Financiamento da Assistência à Saúde/ética , Comportamentos Relacionados com a Saúde/ética , Acesso aos Serviços de Saúde/economia , Humanos , Nações Unidas , Estados Unidos
11.
Fertil Steril ; 116(1): 54-63, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34148590
14.
Pharmacogenomics ; 22(9): 515-517, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34032472

RESUMO

The Pharmacogenomics Access & Reimbursement Symposium, a landmark event presented by the Golden Helix Foundation and the Pharmacogenomics Access & Reimbursement Coalition, was a 1-day interactive meeting comprised of plenary keynotes from thought leaders across healthcare that focused on value-based strategies to improve patient access to personalized medicine. Stakeholders including patients, healthcare providers, industry, government agencies, payer organizations, health systems and health policy organizations convened to define opportunities to improve patient access to personalized medicine through best practices, successful reimbursement models, high quality economic evaluations and strategic alignment. Session topics included health technology assessment, health economics, health policy and value-based payment models and innovation.


Assuntos
Congressos como Assunto/tendências , Acesso aos Serviços de Saúde/tendências , Reembolso de Seguro de Saúde/tendências , Assistência Médica/tendências , Farmacogenética/tendências , District of Columbia , Pessoal de Saúde/economia , Pessoal de Saúde/tendências , Acesso aos Serviços de Saúde/economia , Humanos , Reembolso de Seguro de Saúde/economia , Assistência Médica/economia , Farmacogenética/economia , Medicina de Precisão/economia , Medicina de Precisão/tendências , Avaliação da Tecnologia Biomédica/economia , Avaliação da Tecnologia Biomédica/tendências
15.
Int J Surg ; 90: 105956, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33940199

RESUMO

BACKGROUND: Surgical disease in Low Income Countries (LIC) is common, and overall provision of surgical care is poor. A key component of surgical health systems as part of universal health coverage (UHC) is financial risk protection (FRP) - the need to protect individuals from financial hardship due to accessing healthcare. We performed a systematic review to amalgamate current understanding of the economic impact of surgery on the individual and household. Our study was registered on Research registry (www.researchregistry.com). METHODS: We searched Pubmed and Medline for articles addressing economic aspects of surgical disease/care in low income countries. Data analysis was descriptive in light of a wide range of methodologies and reporting measures. Quality assessment and risk of bias analysis was performed using study design specific Joanna-Briggs Institute checklists. This study has been reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (Assessing the methodological quality of systematic reviews) Guidelines. RESULTS: 31 full text papers were identified for inclusion; 22 descriptive cross-sectional studies, 4 qualitative studies and 5 economic analysis studies of varying quality. Direct medical, direct non-medical and indirect costs were variably reported but were substantial, resulting in catastrophic expenditure. Costs had far reaching economic impacts on individuals and households, who used entire savings, took out loans, reduced essential expenditure and removed children from school to meet costs. CONCLUSION: Seeking healthcare for surgical disease is economically devastating for individuals and households in LICs. Policies directed at strengthening surgical health systems must seek ways to reduce financial hardship on individuals and households from both direct and indirect costs and these should be monitored and measured using defined instruments from the patient perspective.


Assuntos
Países em Desenvolvimento/economia , Acesso aos Serviços de Saúde/economia , Pobreza , Procedimentos Cirúrgicos Operatórios/economia , Criança , Estudos Transversais , Fatores Econômicos , Humanos , Cobertura Universal do Seguro de Saúde
17.
Pediatr Clin North Am ; 68(3): 651-658, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34044991

RESUMO

The integrated behavioral health care model in primary care has the potential to reduce barriers to care experienced by children and families from ethnic minorities and low socioeconomic status. Limited access to pediatric behavioral health care is a significant problem, with up to 40% of children and adolescents with identified mental disorders and only 30% of them receiving care. Barriers include transportation, insurance, and shortage of specialists. Primary care provider bias, decreased knowledge and feelings of competence, and cultural beliefs and stigma also affect earlier diagnosis and treatment, particularly for Hispanic families with low English proficiency and African Americans.


Assuntos
Assistência Integral à Saúde , Acesso aos Serviços de Saúde , Serviços de Saúde Mental , Pediatria , Adolescente , Afro-Americanos , Criança , Assistência Integral à Saúde/economia , Assistência Integral à Saúde/normas , Competência Cultural , Grupos Étnicos , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/normas , Disparidades em Assistência à Saúde , Hispano-Americanos , Humanos , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/normas , Pediatria/economia , Pediatria/normas , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Racismo , Classe Social , Fatores Socioeconômicos
18.
Med Care ; 59(6): 487-494, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33973937

RESUMO

BACKGROUND: Physicians often receive lower payments for dual-eligible Medicare-Medicaid beneficiaries versus nondual Medicare beneficiaries because of state reimbursement caps. The Affordable Care Act (ACA) primary care fee bump temporarily eliminated this differential in 2013-2014. OBJECTIVE: To examine how dual payment policy impacts primary care physicians' (PCP) acceptance of duals. RESEARCH DESIGN: We assessed differences in the likelihood that PCPs had dual caseloads of ≥10% or 20% in states with lower versus full dual reimbursement using linear probability models adjusted for physician and area-level traits. Using a triple-difference approach, we examined changes in dual caseloads for PCPs versus a control group of specialists in states with fee bumps versus no change during years postbump versus prebump. SUBJECTS: PCPs and specialists (cardiologists, orthopedic surgeons, general surgeons) that billed fee-for-service Medicare. MEASURES: State dual payment policies and physicians' dual caseloads as a percentage of their Medicare patients. RESULTS: In 2012, 81% of PCPs had dual caseloads of ≥10% and this was less likely among PCPs in states with lower versus full dual reimbursement (eg, difference=-4.52 percentage points; 95% confidence interval, -6.80 to -2.25). The proportion of PCPs with dual caseloads of ≥10% or 20% decreased significantly between 2012 and 2017 and the fee bump was not consistently associated with increases in dual caseloads. CONCLUSIONS: Pre-ACA, PCPs' participation in the dual program appeared to be lower in states with lower reimbursement for duals. Despite the ACA fee bump, dual caseloads declined over time, raising concerns of worsening access to care.


Assuntos
Acesso aos Serviços de Saúde/economia , Medicaid/economia , Medicare/economia , Patient Protection and Affordable Care Act , Médicos de Atenção Primária/economia , Planos de Pagamento por Serviço Prestado , Feminino , Humanos , Masculino , Médicos de Atenção Primária/estatística & dados numéricos , Estados Unidos
20.
Anesth Analg ; 132(6): 1727-1737, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-33844659

RESUMO

BACKGROUND: The health system of Liberia, a low-income country in West Africa, was devastated by a civil war lasting from 1989 to 2003. Gains made in the post-war period were compromised by the 2014-2016 Ebola epidemic. The already fragile health system experienced worsening of health indicators, including an estimated 111% increase in the country's maternal mortality rate post-Ebola. Access to safe surgery is necessary for improvement of these metrics, yet data on surgical and anesthesia capacity in Liberia post-Ebola are sparse. The aim of this study was to describe anesthesia capacity in Liberia post-Ebola as part of the development of a National Surgical, Obstetric, and Anesthesia Plan (NSOAP). METHODS: Using the World Federation of Societies of Anaesthesiologists (WFSA) Anaesthesia Facility Assessment Tool (AFAT), we conducted a cross-sectional survey of 26 of 32 Ministry of Health recognized hospitals that provide surgical care in Liberia. The surveyed hospitals served approximately 90% of the Liberian population. This assessment surveyed infrastructure, workforce, service delivery, information management, medications, and equipment and was performed between July and September 2019. Researchers obtained data from interviews with anesthesia department heads, medical directors and through direct site visits where possible. RESULTS: Anesthesiologist and nurse anesthetist workforce densities were 0.02 and 1.56 per 100,000 population, respectively, compared to 0.63 surgeons per 100,000 population and 0.52 obstetricians/gynecologists per 100,000 population. On average, there were 2 functioning operating rooms (ORs; OR in working condition that can be used for patient care) per hospital (standard deviation [SD] = 0.79; range, 1-3). Half of the hospitals surveyed had a postanesthesia care unit (PACU) and intensive care unit (ICU); however, only 1 hospital had mechanical ventilation capacity in the ICU. Ketamine and lidocaine were widely available. Intravenous (IV) morphine was always available in only 6 hospitals. None of the hospitals surveyed completely met the minimum World Health Organization (WHO)-WFSA standards for health care facilities where surgery and anesthesia are provided. CONCLUSIONS: Overall, we noted several critical gaps in anesthesia and surgical capacity in Liberia, in spite of the massive global response post-Ebola directed toward health system development. Further investment across all domains is necessary to attain minimum international standards and to facilitate the provision of safe surgery and anesthesia in Liberia. The study results will be considered in development of an NSOAP for Liberia.


Assuntos
Anestesia/tendências , Atenção à Saúde/tendências , Acesso aos Serviços de Saúde/tendências , Doença pelo Vírus Ebola/epidemiologia , Doença pelo Vírus Ebola/terapia , Número de Leitos em Hospital , Anestesia/economia , Atenção à Saúde/economia , Acesso aos Serviços de Saúde/economia , Número de Leitos em Hospital/economia , Humanos , Libéria/epidemiologia , Inquéritos e Questionários
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