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2.
Pan Afr Med J ; 33: 152, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558949

RESUMO

Introduction: Access to free diagnoses and treatments has been shown to be a major determinant in malaria control. The Cameroon government launched in 2011 and 2014 the exemption of the under-fives' simple and severe malaria treatment policy to increase access to health care and reduce inequality, so as to reduce the mortality related to malaria among the under-fives. This study assessed the effect of providing free malaria treatment in the Buea health district. Methods: This retrospective and cross sectional study was carried out in the Buea health district. Aggregated monthly data from (2008-2010) before and (2012-2014) after the implementation of free malaria treatment was compared, to assess the attributable outcomes of free treatment. A semi-structure questionnaire was also used to assess barriers faced in providing free malaria treatment services by health care workers. Data was collected using a semi-structure questionnaire and a data review summary sheet. The data was analysed using Epi-Info 7, Excel and SPSS (Statistical Package for the Social Sciences) version 20.0 for Windows. All statistical tests were performed at 95% confidence interval (significance level of 0.05). Results: Increase utilisation of health care; as general and malaria related consultations (by 5.7% (p=0.001) witnessed an increase after the implementation of free malaria treatment services. Severe malaria hospitalisation also increased, indicating that most caregivers used the health facility when complications had already set in, which could have led to no significant reduction in mortality due to malaria among under-five children (4.4%, p=0.533). Conclusion: Utilisation of health care increased; as consultation and morbidity rate increased after the implementation of free malaria treatment services. Communication strategy should therefore be strengthened so as to better disseminate information, so as to enhance the effectiveness of the program. There is the need to make a large-scale study to assess the impact of subsidized malaria treatment.


Assuntos
Antimaláricos/administração & dosagem , Política de Saúde , Acesso aos Serviços de Saúde/economia , Malária/tratamento farmacológico , Antimaláricos/economia , Camarões , Cuidadores/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Financiamento Governamental/economia , Hospitalização/estatística & dados numéricos , Humanos , Malária/economia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Inquéritos e Questionários
4.
Inquiry ; 56: 46958019852873, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31208262

RESUMO

Facing projected growth in federal deficits, policymakers may increasingly look to Medicare for opportunities to slow spending. Medicare Advantage, which has grown to over one-third of the Medicare population, now costs the federal government over $230 billion a year. Competition in the program is weak in many parts of the country and federal subsidies are distributed unevenly to beneficiaries who are enrolled. This article offers a potential approach toward reforming the Medicare Advantage payment system, which could lower federal costs and enhance equity in the program. It builds a simple framework containing policy options and uses 2015 Centers for Medicare and Medicaid Services data to estimate the stylized impact on federal spending and enrollee benefits.


Assuntos
Equidade em Saúde , Gastos em Saúde/estatística & dados numéricos , Medicare Part C/economia , Medicare Part C/estatística & dados numéricos , Financiamento Governamental/economia , Humanos , Estados Unidos
5.
Inquiry ; 56: 46958019856977, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31189382

RESUMO

Population health improvements can be achieved through work made possible by government spending on health care, public health, and social services. The extent to which spending allocations across these sectors is synergistic with or trade-off against one another is unknown. Achieving a balanced portfolio with multi-sector contributions is key to improving health outcomes. This study tested competing hypotheses regarding achievement of balanced multi-sector resources for health. County-level U.S. Census Bureau data on all local governmental spending measured each county's average per capita local government spending for public hospitals, public health, social services, and education. American Hospital Association (AHA) Annual Survey data on hospital community health service provision were used to calculate an index of hospital community service provision aggregated to county level by year. County Health Rankings data measured each county's health outcomes and health factors. Longitudinal mixed-effects regression models (n = 1877 counties) predicted changes in spending for each government spending category based on two sets of predictors (government spending vs community health services and needs) from current and prior year. Models account for average spending in each category and county-, state-, and time-trends. Models showed that spending increases in each of the four spending categories examined (public hospitals, public health, social services, and education) were not associated with changes in spending across other categories in current or prior years. For all categories, an increase from baseline spending levels in Year 1 was always significantly associated with an increase from baseline spending level in that same category in Year 2 (ie, spending stayed above baseline in Year 2). Multi-sector initiatives to health outcomes require funding across sectors, yet there was little evidence to suggest that communities that invest in public hospitals, public health, or other social services see commensurate increases in other areas. Underlying funding decisions may reflect strategic decisions within a community to scale up single sectors, constrained resources for multi-sector scale up, or a host of additional factors not measured here.


Assuntos
Financiamento Governamental/economia , Gastos em Saúde/estatística & dados numéricos , Saúde da População , Seguridade Social , Serviço Social/economia , Humanos , Saúde Pública , Inquéritos e Questionários
6.
J Aging Soc Policy ; 31(4): 291-297, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31154942

RESUMO

Aging around the world poses a global challenge in eldercare. This challenge is particularly felt in low- and middle-income countries (LMICs), where population aging outpaces the development of aged care policies and services. This Perspective highlights the phenomenon of global convergence in several unsettling trends and challenges shared across LMICs. These include the weakening of informal family care systems for the elderly, growing need for formal long-term care of the frail and disabled who can no longer be adequately supported by family members, and mounting pressures for policy responses to tackle these societal challenges. It is argued that policymakers should take a proactive stance. That is, when family care for the elderly falls short and family caregivers are increasingly under strain, the government should step in and step up support to fill in the gap by developing appropriate policies and a continuum of long-term care services that are accessible and affordable for the majority of older people in need. Three general principles are then suggested with regard to long-term care provision, financing, and quality assurance, which transcend national borders and can be used to guide long-term care policymaking across LMICs.


Assuntos
Envelhecimento , Países em Desenvolvimento , Financiamento Governamental , Política de Saúde , Assistência de Longa Duração , Formulação de Políticas , Cuidadores/tendências , Países em Desenvolvimento/economia , Financiamento Governamental/economia , Humanos , Pobreza
7.
Rev Saude Publica ; 53: 39, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31066817

RESUMO

OBJECTIVE: To analyze the allocation of financial resources in the Brazilian Unified Health System (SUS) in the state of São Paulo by level of care, health region, source of funds and level of government. METHODS: This is an exploratory study based on 2014 data extracted from the Public Health Budget Database, presented in absolute terms, relative terms and per capita . RESULTS: In 2014, R$52.1 bi were spent on public health, 58.0% having corresponded to the expenditures of the municipalities and 42.0% to those of the state government. Regional per capita spending varied from R$561.75 to R$824.85. As for the per capita spending on primary health care, which represented 37.5% of the municipalities' total expenditure, the lowest value was found in the city of São Paulo and the highest, in Araçatuba. Campinas had the highest per capita expenditure on medium and high complexity care, while Presidente Prudente had the lowest. The highest regional percentage of the current net revenue spent on health was verified in Registro, and the lowest, in the city of São Paulo. CONCLUSIONS: The paradigm of the health sector's financing in São Paulo revealed that the expenditure on primary health care, level elected by health policy as strategic because it depends on coordination and integral health care in the attention networks, was not considered a priority in relation to the expenditure with the medium and high complexity, exposing the iniquities in the state's regions.


Assuntos
Alocação de Recursos para a Atenção à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Política de Saúde , Financiamento da Assistência à Saúde , Programas Nacionais de Saúde/economia , Brasil , Orçamentos/estatística & dados numéricos , Cidades , Financiamento Governamental/economia , Financiamento Governamental/estatística & dados numéricos , Humanos , Valores de Referência
8.
BMC Psychol ; 7(1): 13, 2019 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-30836984

RESUMO

BACKGROUND: There is sufficient evidence that psychosocial stimulation (PS) benefits children's neurocognitive behavior, however, there is no information on how it works when delivered through an Unconditional Cash Transfer (UCT) platform for poor rural population in developing countries. The objective of this study is to measure effects of adding PS for children of lactating mothers enrolled to receive UCT with health education (HE) on neurocognitive behavior of children in rural Bangladesh. METHODS: The study will be conducted at 11 unions of Ullapara sub-district in Bangladesh. The study is a cluster randomized controlled trial with three-arms; (i) PS and UCT with HE (ii) UCT with HE and iii) Comparison arm. The cluster will be considered as an old Ward of a Union, the lowest tier of local government system in rural Bangladesh. There are three old Wards in a union. These three clusters will be randomized to one of the three arms. Similarly, randomization will be done for each 11 Unions and then 11 clusters will be assigned to an arm. Eighteen participants will be recruited from each cluster randomly (n = 196 in each arm). The intervention designed for one year includes UCT with HE for the poor as a safety net program in rural Bangladesh with or without PS. An age-based curriculum of PS is already available for Bangladeshi children and this will be administered by trained local women; play leaders (PL) in intervention clusters. The government of Bangladesh is providing UCT of taka 500 ($6.25) as maternity allowance per month with HE. The primary outcomes will be cognitive, motor and language composite scores measured by Bayley-III and behavior using Wolke's behavior rating scale. The secondary outcomes will be children and mothers' growth, family food security status, health seeking behavior, mothers' depressive symptoms and self-esteem and violence against mothers. DISCUSSION: The study will provide a unique opportunity to assess an integrated early childhood development intervention using UCT platform to mitigate developmental delays in poor vulnerable children of rural Bangladesh. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT03281980, registered on September 13, 2017.


Assuntos
Desenvolvimento Infantil , Financiamento Governamental , Educação em Saúde , Comportamento do Lactente , Serviços de Saúde Materno-Infantil , Mães , Poder Familiar , Adulto , Bangladesh , Aleitamento Materno , Protocolos Clínicos , Países em Desenvolvimento , Feminino , Financiamento Governamental/economia , Financiamento Governamental/métodos , Financiamento Governamental/organização & administração , Educação em Saúde/economia , Educação em Saúde/métodos , Educação em Saúde/organização & administração , Humanos , Lactente , Masculino , Serviços de Saúde Materno-Infantil/economia , Serviços de Saúde Materno-Infantil/organização & administração , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , População Rural
9.
J Dent Educ ; 83(5): 497-503, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30858275

RESUMO

The high cost of dental education and consequent loan burdens contribute to the shortage of pediatric dental providers in rural areas (RAs). Economic incentives are meant to recruit practitioners to RAs. The aim of this study was to assess the ability of government subsidized loan repayment programs (GSLRPs) to recruit pediatric specialists to practice in RAs. A 26-item questionnaire was emailed to all 921 pediatric dental residents across the U.S. in 2015 for a cross-sectional study of factors influencing their choice of practice location. The instrument included information about GSLRPs, enabling the study to serve as a quasi-experiment on the level of funding needed to make GSLRPs effective. A total of 169 residents responded, for an 18% response rate; 74% of respondents were women and 86% had student loan debt. Among the respondents, 40.6% said they would like to practice in RAs, but only 4.1% actually intended to do so. Over one-third initially reported interest in GSLRPs for practicing in RAs. However, after being informed that the average GSLRP is $30,000 annually, one-third of those lost interest. Although 14.2% said no amount would convince them to consider practice in an RA, over half (53.3%) indicated willingness to consider it if the GSLRP were $40,000-$60,000. These results suggest that current GSLRP levels are insufficient to induce pediatric dentists to practice in RAs.


Assuntos
Financiamento Governamental , Internato e Residência , Odontopediatria/estatística & dados numéricos , Área de Atuação Profissional , Apoio ao Desenvolvimento de Recursos Humanos , Adulto , Estudos Transversais , Financiamento Governamental/economia , Financiamento Governamental/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Odontopediatria/economia , Odontopediatria/educação , Área de Atuação Profissional/economia , Área de Atuação Profissional/estatística & dados numéricos , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Apoio ao Desenvolvimento de Recursos Humanos/economia , Apoio ao Desenvolvimento de Recursos Humanos/organização & administração , Apoio ao Desenvolvimento de Recursos Humanos/estatística & dados numéricos , Estados Unidos
11.
South Med J ; 112(2): 91-97, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30708373

RESUMO

OBJECTIVES: Public health and social services spending have been shown to improve health outcomes at the county level, although there are significant state and regional variations in such spending. Texas offers an important opportunity for examining nuances in the patterns of association between local government health and social services spending and population health outcomes. The primary objectives of this study were to describe local investments in education, health, and social services at the county-area level for all of Texas from 2002 through 2012 and to examine how changes in local investment over time were associated with changes in health outcomes. METHODS: We used two large secondary data sources for this study. First, US Census Bureau data were used to measure annual spending by all local governments on public hospitals, community health care and public health, and >1 dozen social services. Second, County Health Rankings & Roadmaps data measured county health outcomes. We performed regression models to examine the association between increases in local government spending and a county's health outcomes ranking 4 years later. Multilevel mixed-effects linear regression models accounted for mean spending in each category, county health factors ranking, and county and state random effects. RESULTS: Local governments in Texas spent an average of $4717 per capita across all health and social services. Although spending was relatively consistent across 2002-2012, there was notable variation in spending across counties and services. Regression models found that changes in four spending categories were associated with significant improvements in health outcomes: fire and ambulance, community health care and public health, housing and community development, and libraries. For each, an additional one-time investment of $15 per capita was associated with a 1-spot improvement in statewide county health rankings within 4 years. CONCLUSIONS: Existing evidence regarding the association between social services spending and health outcomes may not yield sufficiently granular data for policy makers within a single state. Investments in certain social services in Texas were associated with improvements in health outcomes, as measured by improvements in the County Health Rankings, in the years subsequent to spending increases. Similar analyses in other states and regions may yield actionable avenues for policy makers to improve population health.


Assuntos
Serviços de Saúde Comunitária/economia , Financiamento Governamental/economia , Gastos em Saúde/estatística & dados numéricos , Governo Local , Saúde Pública , Serviço Social/economia , Humanos , Estudos Retrospectivos , Texas
12.
PLoS One ; 14(2): e0211199, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30730913

RESUMO

Consumer spending on organic food products has grown rapidly. Some claim that organics have ecological, equity, and health advantages over conventional food and therefore should be subsidized. Here we explore the distributive impacts of an organic fruit subsidy that reduces the retail price of organic fruit in the US by 10 percent. We estimate the impact of the subsidy on organic fruit demand in a representative poor, middle income, and rich US household using three analytical methods; including two econometric and one machine learning. We do not find strong evidence of regressive redistribution due to our simulated organic fruit subsidy; the poor household's relative reaction to the subsidy is not much different than the reaction at the other two households. However, the infra-marginal savings from the subsidy tend to be larger in richer households.


Assuntos
Alimentos Orgânicos/economia , Frutas/economia , Agricultura Orgânica/economia , Comércio/economia , Comércio/estatística & dados numéricos , Comércio/tendências , Simulação por Computador , Comportamento do Consumidor/economia , Comportamento do Consumidor/estatística & dados numéricos , Financiamento Governamental/economia , Financiamento Governamental/estatística & dados numéricos , Alimentos Orgânicos/estatística & dados numéricos , Humanos , Renda/estatística & dados numéricos , Aprendizado de Máquina , Agricultura Orgânica/estatística & dados numéricos , Agricultura Orgânica/tendências , Estados Unidos
13.
AIDS Educ Prev ; 31(1): 82-94, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30742479

RESUMO

We surveyed U.S. HIV/AIDS directors or designees in states and non-state regions, regarding factors influencing HIV viral suppression: (1) non-federal prevention funding; (2) contacting newly reported patients and providers, for care linkage and partner services; (3) follow-up of non-received viral load reports, to identify untreated patients; and (4) genotype/phenotype surveillance, to monitor drug resistance. The survey was conducted April-July 2015; 50 (87.7%) participated. Eighty percent of jurisdictions contacted all newly reported patients; 60% contacted all providers. HIV resistance tests were reportable in 38%; 66% contacted providers and/or patients about missed viral loads. Non-federal funding was significantly associated with annual diagnoses (p = .0001) and population (p = .0002), but not with other factors studied. Many jurisdictions lacked non-federal funding (28%), or experienced unrestored reductions since 2008 (33%). Jurisdictions' funding and preventive practices varied greatly. HIV viral suppression could be enhanced by restoring (or establishing) non-federal prevention funding, and by more standardized surveillance/outreach practices.


Assuntos
Sorodiagnóstico da AIDS/economia , Financiamento Governamental/economia , Infecções por HIV/prevenção & controle , Diretores Médicos , Administração em Saúde Pública , Síndrome de Imunodeficiência Adquirida , Adulto , Feminino , Financiamento Governamental/tendências , Humanos , Programas de Rastreamento , Inquéritos e Questionários , Estados Unidos , Carga Viral
14.
Int J Health Plann Manage ; 34(2): 619-635, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30615218

RESUMO

OBJECTIVE: To assess the relationship between government expenditure on maternal health (GE) and maternal mortality (MM) in Mexican poor population between 2000 and 2015 in the 2457 Mexican municipalities. METHODS: Using administrative data, we performed the analysis in three stages: First, we tested the presence of selection bias in MM. Next, we assessed the presence of spatial dependence in the incidence and severity of MM. Finally, we estimated a spatial error model considering the correction of estimates for the spatial dependence and selection bias assessed before. RESULTS: MM and GE were not randomly distributed throughout the Mexican territory; the most socially vulnerable municipalities exhibited the highest levels of MM severity but the lowest levels of GE and available human and physical resources for maternal health; the incidence of MM was independent of GE; elasticity of GE-severity in MM was -4% (P < 0.01). CONCLUSIONS: Resource allocation for maternal health must move towards a more comprehensive vision, and efforts to achieve an effective delivery of universal health services must improve, particularly regarding the most vulnerable municipalities.


Assuntos
Financiamento Governamental/estatística & dados numéricos , Gastos em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mortalidade Materna , Adulto , Financiamento Governamental/economia , Acesso aos Serviços de Saúde/economia , Humanos , Incidência , Saúde Materna/economia , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/estatística & dados numéricos , México/epidemiologia , Modelos Econométricos , Modelos Estatísticos , Alocação de Recursos , Fatores Socioeconômicos , Análise Espacial , Adulto Jovem
16.
Eval Program Plann ; 73: 146-155, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30639832

RESUMO

Public support of training in firms corresponds to the long-term importance of the quality of human capital in the competitiveness of firms and nations. Thus, the EU supports such training via the European Social Fund (ESF). The evaluation community evaluates the support by using either qualitative or quantitative methods. The simultaneous application of these two approaches is rare. The purpose of this paper is to combine quantitative (counterfactual impact evaluation) and qualitative (qualitative comparative analysis) methods in order to fill the methodological gap. Based on the combination of both approaches, it explores their strengths, complementarity and disadvantages to evaluate public support for employee training in the Czech Republic. The combination of methods makes it possible to identify not only the impacts but also their causes. Linking the ESF support to corporate competitiveness is crucial for demonstrating the effectiveness of public spending.


Assuntos
Financiamento Governamental/organização & administração , Capacitação em Serviço/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Projetos de Pesquisa , Causalidade , República Tcheca , Emprego/organização & administração , Financiamento Governamental/economia , Humanos , Estudos de Casos Organizacionais
17.
Int J Health Serv ; 49(2): 237-259, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30678522

RESUMO

Portugal has faced an economic and financial crisis that began circa FY2009 and whose effects are still ongoing. In FY2011, the Portuguese state and the European triumvirate - composed of the European Commission, the International Monetary Fund, and the European Central Bank - signed the Memoranda of Understanding. This troika agreement aimed to improve the operational efficiency of public services. This crisis had a considerable impact on the Portuguese citizens' life and productivity, as well as on the public health care system. Cuts over public expenditures have been made to reduce the risk of noncompliance with budgetary targets, despite their potential impact on quality and access to health care services. We analyzed the main policies and measures undertaken by the Portuguese Ministry of Health with respect to the bailout program associated with the troika agreement. Then, we focused on the budgetary cuts-related risks over the social performance of the care system. Evidence suggests that structural reforms in the health care sector in the troika period had positive effects in terms of drugs administration and consumption, on the one hand, and secondary care expenditures reduction, on the other hand. Nonetheless, we observed some divestitures on infrastructures and the worsening of access to health care services.


Assuntos
Recessão Econômica , Setor de Assistência à Saúde/economia , Financiamento Governamental/economia , Financiamento Governamental/organização & administração , Setor de Assistência à Saúde/organização & administração , Gastos em Saúde , Política de Saúde , Humanos , Modelos Econométricos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/organização & administração , Portugal
18.
Health Policy ; 123(1): 96-103, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30482387

RESUMO

Scholars have raised concerns that cutbacks on government health expenditure (GHE) during recessions may jeopardise population health. The present research investigates the extent to which population health outcomes are affected by responses of GHE to business cycles, i.e., cyclicality of GHE. We estimate GHE cyclicality by regressing detrended GHE on detrended gross domestic product (GDP). Our analysis of data for 1995 through 2014 from 135 developing countries shows that mean cyclicality is 0.61, or that a one percent deviation from the GDP trend is positively correlated with a 0.61 percent deviation from the GHE trend. Further, countries in which GHE is less procyclical appear to have shorter life expectancies and higher adult mortality rates. These results suggest that reducing procyclicality of GHE by protecting GHE in bad times may generate substantial health gains. Importantly, our results show that increasing the weight of social security funds in health budgets, and improving institutional quality, can be critical to breaking the procyclical pattern of GHE.


Assuntos
Financiamento Governamental/economia , Gastos em Saúde/estatística & dados numéricos , Saúde da População , Países em Desenvolvimento , Recessão Econômica , Produto Interno Bruto , Humanos , Modelos Estatísticos
19.
Med Law Rev ; 27(2): 267-294, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30272190

RESUMO

This article explores the relationship between obligation and publicly funded healthcare. Taking the National Health Service (NHS) as the focal point of discussion, the article presents a historical analysis of the shifting nature and function of obligation as it relates to this institution. Specifically, and drawing inspiration from recent literature that takes seriously the notion of the tie or bond at the core of obligation, the article explores how the forms of social relation and bonds underpinning a system like the NHS have shifted across time. This is undertaken via an analysis of Aneurin Bevan's vision of the NHS at its foundation, the importance today of the patient (and the individual generally) within publicly funded healthcare, and the role of contract as a contemporary governance mechanism within the NHS. A core feature of the article is its emphasis on the impact that a variety of economic factors-including privatisation, marketisation, and the role of debt and finance capital-are having on previously settled understandings of obligation and the forms of social relation underpinning them associated with the NHS. It is therefore argued that an adequate analysis of obligation in healthcare law and related fields must extend beyond the doctor-patient relationship and that of state-citizen of the classical welfare state in order to incorporate new forms of relation, such as that between creditor and debtor, and new actors, including private healthcare providers and financial institutions.


Assuntos
Assistência à Saúde/economia , Assistência à Saúde/ética , Assistência à Saúde/tendências , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/ética , Programas Nacionais de Saúde/tendências , Responsabilidade Social , Contratos , Assistência à Saúde/história , Economia/tendências , Ética nos Negócios , Ética Institucional , Financiamento Governamental/economia , Financiamento Governamental/ética , Financiamento Governamental/história , Financiamento Governamental/tendências , História do Século XX , Humanos , Relações Interprofissionais/ética , Programas Nacionais de Saúde/história , Privatização , Reino Unido
20.
AIDS Care ; 31(4): 505-512, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30189747

RESUMO

Depression is common among women with HIV and untreated depression can result in poor quality of life and worsen HIV outcomes. Women with HIV who are dually enrolled in Medicaid and Medicare faced a potential disruption in medication access when Medicare Part D was implemented in 2006. The goal of this study was to estimate the effects of Medicare Part D implementation on antidepressant use, depressive symptoms, and hospitalization in Medicaid-Medicare dual eligible women with HIV. This study used 2003-2008 data from the Women's Interagency HIV Study. The effects of Medicare Part D were estimated using a difference-in-differences approach, adjusting for temporal trends using a matched control group of Medicaid-only enrollees. Before Medicare Part D implementation, dual eligibles differed from Medicaid-only enrollees in antidepressant use and hospitalization, despite having identical prescription drug coverage through Medicaid. For dual enrollees, the transition to Medicare Part D was not associated with changes in antidepressant use, depressive symptoms, or hospitalization. We did not find disruptive effects on antidepressant use and related outcomes among dual eligibles in this study. Stable antidepressant use may be due to better access to medical care for dual eligibles through Medicare both before and after Medicare Part D implementation, which may have eclipsed any effects of the transition. It may also signal that classification of antidepressants as a protected drug class under Medicare Part D was effective in preventing psychiatric medication disruption.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Medicaid/estatística & dados numéricos , Medicare Part D/estatística & dados numéricos , Medicamentos sob Prescrição/uso terapêutico , Adulto , Idoso , Fármacos Anti-HIV/economia , Antidepressivos/uso terapêutico , Custos de Medicamentos , Definição da Elegibilidade , Feminino , Financiamento Governamental/economia , Infecções por HIV/psicologia , Hospitalização , Humanos , Cobertura do Seguro/economia , Seguro de Serviços Farmacêuticos/economia , Masculino , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/economia , Transtornos Mentais/epidemiologia , Saúde Mental , Medicamentos sob Prescrição/economia , Qualidade de Vida , Resultado do Tratamento , Estados Unidos
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