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3.
Tidsskr Nor Laegeforen ; 139(15)2019 10 22.
Artigo em Norueguês | MEDLINE | ID: mdl-31642631

RESUMO

BACKGROUND: The aim of the public health survey in the Norwegian counties is to obtain information that is useful for public health work. In 2018, two parallel data collection processes were undertaken in Hordaland county. Both samples were drawn randomly from the National Population Register, but one of these was limited to users of the helsenorge.no website. The purpose of this article is to investigate the degree to which limiting users to the helsenorge.no website leads to selection bias beyond the selection that occurs through ordinary non-participation. MATERIAL AND METHOD: Services for Sensitive Data (TSD) was used in the data collection for the sample drawn from the National Population Register (n = 36 000), and the helsenorge.no platform was used in the data collection for the sample limited to users of helsenorge.no (n = 30 000). The response rate was 40.8 % and 41.5 %, respectively. RESULTS: For some outcome measures, the differences between the two datasets were modest (gender distribution, age, education and health habits). For variables that were more directly related to health, the differences were greater. In the helsenorge.no sample a higher proportion reported generally poorer health (29.4 vs. 24.0 %), mental health problems (13.6 vs. 11.6 %), disability pension (10.5 vs. 7.8 %) and long-term illness (13.3 vs. 9.3 %). Analyses of subgroups showed more pronounced differences in the proportion with generally poorer health and mental health problems between those with low education in the helsenorge.no sample and the corresponding group in the sample from the National Population Register. INTERPRETATION: Systematic and pronounced differences between the samples show that limiting recruitment to users of helsenorge.no's services results in further selection problems.


Assuntos
Inquéritos Epidemiológicos , Seleção de Pacientes , Adolescente , Adulto , Idoso , Doença Crônica/epidemiologia , Coleta de Dados/métodos , Escolaridade , Feminino , Nível de Saúde , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/normas , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Noruega/epidemiologia , Satisfação Pessoal , Saúde Pública , Sistema de Registros , Viés de Seleção , Autorrelato , Previdência Social/estatística & dados numéricos , Apoio Social , Uso de Tabaco/epidemiologia , Adulto Jovem
4.
Artigo em Chinês | MEDLINE | ID: mdl-31594119

RESUMO

Objective: To study the main factors that influencing Pneumoconiosis patients' healthcare seeking behaviors. Methods: Conducting a descriptive analysis to analyze the relationship between the annual hospitalization rate and social security status (medical insurance, location of medical insurance, proportion of insurance used for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, whether to apply for compensation after diagnosing pneumoconiosis, whether they receive social assistance and a minimum allowance) , social relationship status of patients (whether there is pneumoconiosis in the family or relatives, whether there is a pneumoconiosis in a friend or a colleague, and whether or not he/she has received financial assistance) , life quality of patients (subjective feelings) and living standard of patients (dietary level) based on data acquired from 120 pneumoconiosis patients. Results: The results of single factor analysis reveal that the location of medical insurance, the proportion of insurance for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, whether to apply for compensation after diagnosing pneumoconiosis are statistically significant in pneumoconiosis patients' hospital utilization ratio (P<0.05) . The place where medical insurance is located is the current place of residence, the reimbursement ratio of medical insurance for pneumoconiosis is listed as 50%-70%, the work unit has medical insurance, those who have not applied for compensation for pneumoconiosis have a higher utilization rate of hospitalization services. The annual hospitalization rate was 73.3%, 80.0%, 60.6%, 63.0%, respectively. Conclusion: The location of patient medical insurance, the proportion of insurance used for reimbursement of pneumoconiosis, whether there is employment injury insurance at work, and whether to apply for compensation after pneumoconiosis are the influencing factors of the patients' annual hospitalization rate.


Assuntos
Hospitalização/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pneumoconiose , Humanos , Reembolso de Seguro de Saúde , Previdência Social
5.
Artigo em Chinês | MEDLINE | ID: mdl-31594121

RESUMO

Objective: To analyze the social insurance guarantee of pneumoconiosis patients in Kaizhou from 2006 to 2018, and to provide basis for the prevention and treatment of pneumoconiosis in the future. Methods: The social security situation of pneumoconiosis patients in Kai Zhou District in 2006-2018 years was analyzed. Results: There were 3357 cases of pneumoconiosis in Kaizhou District, with a social security rate of 99%; 79.4% of the coal mine pneumoconiosis patients, 87.5% of whom enjoy industrial injury insurance; the majority of the Xiangyu Railway pneumoconiosis patients were over 60 years old, accounting for 3.4%, all enjoy special treatment of Xiangyu Railway; the former township enterprises restructure pneumoconiosis patients, mainly under 60 years old, accounting for 3.4%. Among them, 79% enjoy work-related injury insurance, and 15.2% were rural poverty victims. Conclusion: Kaizhou district provides better social security for pneumoconiosis patients in this area, which can provide basis for formulating social security policies for pneumoconiosis patients in other areas.


Assuntos
Minas de Carvão , Doenças Profissionais , Pneumoconiose , Previdência Social , Humanos , Pessoa de Meia-Idade
6.
Artigo em Chinês | MEDLINE | ID: mdl-31594128

RESUMO

Objective: To investigate the living conditions, insurance coverage, and assistance of pneumoconiosis patients diagnosed in Chongqing from May 2006 to May 2018. Methods: A cross-sectional survey was conducted in July 2018, and 40 890 pneumoconiosis patients from occupational diseases report management agency were obtained. 34 625 cases meeting the inclusion criteria were investigated, and descriptive statistical analysis was performed on the data. Results: There were 34 625 cases of pneumoconiosis patients alive in Chongqing, and 22730 (65.6%) had participated in work-related injury insurance, 6 308 (18.2%) had participated in basic medical insurance for urban employees which were still effective. 27 056 (78.1%) had participated in cooperative insurance for urban and rural residents which were still effective. 4 393 (12.7%) received assistance for the residents in need in urban and rural areas. 5827 (16.8%) benefited the policy of "Xiangyu Railway". There were 7 961 cases (2.4%) whose work-related injury insurance had expired did not get one-off compensation, and did not receive any assistance. Conclusion: Most of the patients with pneumoconiosis in Chongqing obtained protection in terms of work-related injury insurance, medical insurance, civil assistance and poverty alleviation to a certain extent, but the strength of the guarantee is not enough. Patients with pneumoconiosis might suffer from poverty caused by illness. It is recommended to improve the system of work-related injury insurance benefits, establish special funds for pneumoconiosis patients, strengthen health education and health promotion for pneumoconiosis patients, and strengthen the management of pneumoconiosis patients.


Assuntos
Cobertura do Seguro , Pneumoconiose , Previdência Social , China , Estudos Transversais , Humanos , População Rural
7.
Artigo em Chinês | MEDLINE | ID: mdl-31594130

RESUMO

Objective: To investigate the current status of social security among pneumoconiosis patients from two areas of Chongqing, China with different economic levels from 2006 to 2018, and to provide a reference for the development of security policy for pneumoconiosis patients. Methods: The current status of social security was analyzed for pneumoconiosis patients from A and B counties of Chongqing who were diagnosed from 2006 to 2018, and a comparative analysis was performed. Results: From 2006 to 2017, there was a significant increase in the number of newly diagnosed pneumoconiosis patients in A county, while the number of newly diagnosed pneumoconiosis patients remained relatively stable in B county. As of May 2018, there were 5738 pneumoconiosis patients in A county and 4155 pneumoconiosis patients in B county. Among the 5738 pneumoconiosis patients in A county, 5335 (93%) had employers, and among these patients, 2729 (47.6%) received one-time compensation from occupational injury insurance, and currently 1884 (32.8%) were covered by the insurance. Among the 4155 pneumoconiosis patients in B county, 2482 (59.7%) received one-time compensation from occupational injury insurance, and currently 3062 (73.7%) were covered by the insurance. The social security rate of pneumoconiosis patients was 71.0% in A county and 81.4% in B county, and there was a significant difference in the distribution of social security among pneumoconiosis patients between the two counties (χ(2)=4704.9, P<0.01) . Conclusion: Strict implementation of social security policies for pneumoconiosis patients by local governments is the key to solving social assistance for pneumoconiosis patients and improving their quality of life and social security level.


Assuntos
Pneumoconiose , Previdência Social , China , Humanos , Qualidade de Vida
8.
BMC Health Serv Res ; 19(1): 633, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488152

RESUMO

BACKGROUND: Faced with growing budget pressure, policymakers worldwide recognize the necessity of strategic disinvestment from ineffective, inefficient or harmful medical practices. However, disinvestment programs face substantial social, political and cultural challenges: mistrust, struggles for clinical autonomy or stakeholders' reluctance to engage in what can be perceived as 'rationing'. Academic literature says little about effective strategies to address these challenges. This paper provides insights on this matter. We analyzed the epistemic work of a group of policymakers at the National Health Care Institute on what was initially a disinvestment initiative within the context of the Dutch basic benefits package: the 'Appropriate Care' program. The Institute developed a strategy using national administrative data to identify and tackle low-value care covered from public funds as well as potential underuse, and achieve savings through improved organization of efficiency and quality in health care delivery. How did the Institute deal with the socio-political sensitivities associated with disinvestment by means of their epistemic work? METHOD: We conducted ethnographic research into the National Health Care Institute's epistemic practices. Research entailed document analysis, non-participant observation, in-depth conversations, and interviews with key-informants. RESULTS: The Institute dealt with the socio-political sensitivities associated with disinvestment by democratizing the epistemic practices to identify low-value care, by warranting data analysis by clinical experts, by creating an epistemic safe space for health care professionals who were the object of research into low-value care, and by de-emphasizing the economization measure. Ultimately, this epistemic work facilitated a collaborative construction of problems relating to low-value care practices and their solutions. CONCLUSIONS: This case shows that - apart from the right data and adequate expertise - disinvestment requires clinical leadership and political will on the part of stakeholders. Our analysis of the Institute's Appropriate Care program shows how the epistemic effort to identify low-value care became a co-construction between policymakers, care providers, patients and insurers of problems of 'waste' in Dutch social health insurance. This collective epistemic work gave cognitive, moral and political standing to the idea of 'waste' in public health expenditure.


Assuntos
Assistência à Saúde/economia , Seguro Saúde/economia , Avaliação de Programas e Projetos de Saúde/economia , Antropologia Cultural , Orçamentos , Humanos , Países Baixos , Previdência Social/economia
9.
Cien Saude Colet ; 24(7): 2583-2592, 2019 Jul 22.
Artigo em Espanhol | MEDLINE | ID: mdl-31340275

RESUMO

In light of the labor conditions defined within the framework of neoliberalism implemented in Mexico, labor dynamics are problematized, the main problems of access to the health and social security system are identified and the systematic violation of rights - especially the right to work, to social security and to health - are discussed. The objective of this article is to contribute with proposals for the construction of a comprehensive, inclusive, healthcare and social security system that contributes to the improvement of the lives of workers.


Assuntos
Assistência à Saúde/organização & administração , Emprego/normas , Política , Direito à Saúde , Acesso aos Serviços de Saúde , Humanos , México , Previdência Social
10.
Med Pr ; 70(4): 459-473, 2019 Jul 16.
Artigo em Polonês | MEDLINE | ID: mdl-31293279

RESUMO

BACKGROUND: The increasing number of people receiving benefits due to incapacity for work is a heavy burden for the state budget. In order to reduce the scale of this phenomenon, the Social Insurance Institution (ZUS) carries out a rehabilitation program as part of disability pension prevention. MATERIAL AND METHODS: The study was based on the analysis of medical documentation of 607 patients rehabilitated at the Saint Queen Jadwiga's Regional Clinical Hospital No. 2 in Rzeszow, as part of the ZUS prevention of disability pension program in 2011-2013. Medical documentation included the medical history and results of the Functional Test recommended by ZUS. Two years after the completion of rehabilitation, a telephone check was conducted among 118 rehabilitated patients to assess their occupational status. RESULTS: The analysis of the Functional Test documentation showed that in all groups of wykorzystujapatients included in the rehabilitation program, as well as those among whom the control was carried out, the majority were people with post-exercise pain, full physical fitness, slight mobility limitation, full efficiency in everyday activities, correct strength of muscles and moving abilities, as well as normal psychosocial efficiency. The vast majority of them received a recommendation regarding work in a properly-adjusted position. It was shown that in the 2-year observation period, the percentage of professionally active people increased from 56% to 61.02%. CONCLUSIONS: The most important factors determining the return to work include psychosocial efficiency and the level of pain. Med Pr. 2019;70(4):459-73.


Assuntos
Emprego , Doenças Musculoesqueléticas/reabilitação , Retorno ao Trabalho , Avaliação da Capacidade de Trabalho , Adulto , Idoso , Doença Crônica/reabilitação , Pessoas com Deficiência/reabilitação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Previdência Social
11.
Salud Publica Mex ; 61(3): 257-264, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31276341

RESUMO

OBJECTIVE: To describe temporal trends in lung cancer incidence, mortality and associated health care costs in the Mexican Institute of Social Security. MATERIALS AND METHODS: . Incident cases were estimated from hospital discharges in 276 IMSS hospitals between 2006 and 2016. Crude and adjusted mortality rates were calculated. The costs of outpatient and inpatient treatment were calculated based on the medical-technical costs of reference o standard cost. RESULTS: Both incidence and mortality had a decreased time trend. The cost of medical care for the 2 539 patients in 2017 was 42 million US dollars, with an average cost per patient of 16 537 US dollars. The cost per annum of disability pensions is 97.2 million pesos. CONCLUSIONS: It is likely that the reduction of the risk of getting sick and dying from lung cancer in IMSS affiliates is due to the control measures of tobacco smoke. It is still necessary to establish strategies to diagnose and treat patients in early stages.


Assuntos
Custos de Cuidados de Saúde , Neoplasias Pulmonares/economia , Neoplasias Pulmonares/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/terapia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Previdência Social , Fatores de Tempo , Adulto Jovem
12.
Neurology ; 93(4): e404-e413, 2019 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-31213498

RESUMO

OBJECTIVE: To estimate the prevalence of cluster headache in working-aged people, compare sickness absence rates and disability pension in cluster headache patients to rates in a matched comparison group, and explore associations of sociodemographic factors with such rates. METHODS: Through population-based registers, we identified 3,240 people aged 16-64, living in Sweden in 2010, who at least once during 2001-2010 received inpatient or specialized outpatient health care with cluster headache (ICD-10 code G44.0) as main diagnosis. A comparison group (n = 16,200), matched for age, sex, type of living area, and educational level, from the total population aged 16-64 (n = 5,945,895) was used. Outcomes were sickness absence (>14 days) and disability pension during 2010. Crude and adjusted prevalence rates and odds ratios with 95% confidence intervals were computed. RESULTS: The prevalence of cluster headache in working-aged people was 0.054%. In 2010, 17.30% of the cluster headache group and 9.16% of the comparison group had been on sickness absence. In the cluster headache group, female patients had higher sickness absence rates (25.31%) and full-time disability pension (13.17%) than male patients (13.38% and 8.79%). Cluster headache patients older than 35 had higher rates than those of the same age in the comparison group. Further, cluster headache patients born outside Sweden were more likely to have full-time disability pension than patients born in Sweden. CONCLUSIONS: Much higher rates of the patients had sickness absence or disability pension than in the comparison group. Further shown differences related to sex, age, and other sociodemographic factors need to be addressed.


Assuntos
Cefaleia Histamínica/epidemiologia , Pensões/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Previdência Social/estatística & dados numéricos , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Suécia/epidemiologia , Adulto Jovem
17.
BMC Public Health ; 19(1): 598, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101035

RESUMO

BACKGROUND: There is a growing interest in the costs of informal care; however, the results of previous studies mostly rely on self-reported data, which is subject to numerous biases. The aim of this study is to contribute to the topic by estimating the indirect costs of short-term absenteeism associated with informal caregiving in Poland with the use of social insurance data on care absence incidence. METHODS: The human capital method was used to estimate the indirect costs of caregiving from a societal perspective. The incidence of caregiving was identified based on the Social Insurance Institution's data on absence days attributable to care provided to children and other family members. Gross domestic product (GDP) per worker was used as a proxy of labour productivity. Deterministic one-way sensitivity analysis was performed. RESULTS: The indirect costs of short-term caregivers' absenteeism in Poland was €306.2 million (0.116% of GDP) in 2006 and increased to €824.0 million in 2016 (0.180% of GDP). The number of care absence days grew from 5.9 million (0.45 days per worker) in 2006 to 10.6 million (0.70 days per worker) in 2016. Approximately 85% of the total costs were attributable to child care. The results of the sensitivity analysis show that the indirect costs varied from the base scenario by - 30.8 to + 15.8%. CONCLUSION: Informal short-term caregiving leads to substantial productivity losses in the Polish economy, and the dynamic upward trend of care absence incidence suggests that the costs of caregiving are expected to rise in the future.


Assuntos
Absenteísmo , Cuidadores/economia , Cuidado da Criança/economia , Efeitos Psicossociais da Doença , Gastos em Saúde/estatística & dados numéricos , Adulto , Criança , Eficiência , Feminino , Produto Interno Bruto , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Polônia/epidemiologia , Previdência Social/economia , Fatores de Tempo
18.
Asian Pac J Cancer Prev ; 20(5): 1547-1554, 2019 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-31128061

RESUMO

Background: Cervical Cancer (CC) is an important public health problem worldwide. In 2015, CC was the sixth leading cause of death for women aged 30-59 years in Mexico. Despite the importance of having high-quality and accurate estimates of CC treatment costs that can be used to effectively evaluate the impact of preventive programs, there is scarce information on this topic in Mexico. Objective: To estimate the treatment costs by stage diagnosis in patients with CC at a Mexican Social Security Institute (IMSS) oncology hospital in Mexico City. Methods: An observational retrospective study of the resources used to treat 346 women with CC was conducted. Medical charts were reviewed and relevant resource use information was extracted using a data collection instrument that was created based on treatment guidelines. Data were classified into nine cost categories to estimate the total cost per patient. Results: The mean age of patients in the study sample was 54.3 years (range: 41-67), and the average body mass index (BMI) was >26 kg/m2. Among the participants, 37% were smokers, 39% had diabetes, and 56% had hypertension. The medical cost for stages I-IV ranged from $4,738 to $6,058 USD, with an estimated average cost of $5,114 USD. Conclusion: Total treatment costs per patient are high, especially since they were estimated considering only 7.5 months of treatment. This is the first study to estimate the annual cost to treat CC in Mexico and to additionally document the resource pattern use, cost by stage of cancer, and the distribution by cost categories.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Oncologia/economia , Previdência Social/economia , Neoplasias do Colo do Útero/economia , Feminino , Hospitais/estatística & dados numéricos , Humanos , México , Pessoa de Meia-Idade , Estudos Retrospectivos
19.
BMC Health Serv Res ; 19(1): 258, 2019 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-31029112

RESUMO

BACKGROUND: As a consequence of the low government expenditure and limited access to health insurance offered by the Social Security Scheme (SSS), out-of-pocket payments (OOPPs) have become the main source of payment for health care in Myanmar. This study aims to provide evidence on the patterns of health care use and OOPPs by the general population and SSS beneficiaries in Myanmar. METHOD: Face-to-face interviews were conducted among two samples drawn independently of each other. The first sample, the general population sample of persons not insured by SSS, was drawn from the general population in the Yangon Region. The second sample, the SSS sample, was drawn from those possessing SSS insurance. The data were analyzed per sample. Mann-Whitney U tests were applied to compare ordinal variables and independent sample t-tests were applied to compare continuous variables between the two samples. Two-step cluster analysis was applied to identify clusters of respondents with similar patterns of health care use and OOPPs. After the clustering procedure, we used regression analysis to examine the association between socio-demographic characteristics and cluster membership (patterns of health care use and OOPPs) for the two samples separately. RESULTS: Only 23% of those who belonged to the SSS sample and sought health care during the past 12 months, report receiving health care from a SSS clinic during the last episode of illness. Close distance is the main reason for choosing a specific health facility in both samples. OOPPs for health care and pharmaceuticals, used during the last episode of illness are significantly higher in the general population sample. The regression analysis shows that the pattern of health care use is significantly associated with household income. In addition, respondents in the general population sample with a higher income pay higher amounts for their last health care used and were significantly more likely to have to borrow money or sell assets as a coping strategy to cover the payments. CONCLUSION: Significantly higher OOPPs in the general population sample highlight the need of financial protection among this group. Myanmar needs to extend social protection for both coverage breadths and coverage depth.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Análise por Conglomerados , Feminino , Financiamento Pessoal , Humanos , Masculino , Pessoa de Meia-Idade , Mianmar , Projetos Piloto , Previdência Social , Inquéritos e Questionários
20.
G Ital Nefrol ; 36(2)2019 Apr.
Artigo em Italiano | MEDLINE | ID: mdl-30983182

RESUMO

After a quick description of the anatomopathology and physiopathology of renal failure, the Authors delve into the problem of assessing its medicolegal aspects in the fields of civil invalidity and social security. In Italy, civil invalidity involves protecting the psychological and physical welfare of the disabled, as sanctioned by law 118 of 1971; this law protects all citizens with a debilitating condition, including those who do not work or are not of working age. A disabled person is someone who, if of working age (between 18 and retirement) has a reduction of more than ⅓ (34%) of their general work capacity; if under or over the retirement age, they have a persistent difficulty in carrying out age-appropriate functions and tasks. In support of an application for being awarded civil invalidity, people can also refer to law no. 104 of 1992, which assesses social, relational and work disadvantages of a disabled person. INPS (Italian Social Security Institute) protection, on the other hand, is a social security protection based on health requirements (having a capacity for work which is reduced by more than ⅓, as established by law no. 222 of 1984), as well as on the following administrative requirement: having paid, as a worker, at least 260 weekly contributions, equivalent to five years of contribution and insurance, of which 156, equal to three years of contribution and insurance, were made in the five-year period preceding the date of submitting the application. If this is the case, the protected person, thus insured, can enjoy protection for their illness by virtue of the stipulations for social security.


Assuntos
Avaliação da Deficiência , Pessoas com Deficiência/legislação & jurisprudência , Insuficiência Renal/diagnóstico , Previdência Social , Fatores Etários , Peso Corporal , Creatinina/sangue , Feminino , Taxa de Filtração Glomerular , Humanos , Medicina Interna , Itália , Masculino , Nefrologia , Insuficiência Renal/etiologia , Insuficiência Renal/patologia , Insuficiência Renal/fisiopatologia , Fatores Sexuais , Avaliação da Capacidade de Trabalho
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