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8.
Nat Hum Behav ; 4(3): 255-264, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31959926

RESUMO

Health and social scientists have documented the hospital revolving-door problem, the concentration of crime, and long-term welfare dependence. Have these distinct fields identified the same citizens? Using administrative databases linked to 1.7 million New Zealanders, we quantified and monetized inequality in distributions of health and social problems and tested whether they aggregate within individuals. Marked inequality was observed: Gini coefficients equalled 0.96 for criminal convictions, 0.91 for public-hospital nights, 0.86 for welfare benefits, 0.74 for prescription-drug fills and 0.54 for injury-insurance claims. Marked aggregation was uncovered: a small population segment accounted for a disproportionate share of use-events and costs across multiple sectors. These findings were replicated in 2.3 million Danes. We then integrated the New Zealand databases with the four-decade-long Dunedin Study. The high-need/high-cost population segment experienced early-life factors that reduce workforce readiness, including low education and poor mental health. In midlife they reported low life satisfaction. Investing in young people's education and training potential could reduce health and social inequalities and enhance population wellbeing.


Assuntos
Crime/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Seguridade Social/estatística & dados numéricos , Fatores Socioeconômicos , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Análise por Conglomerados , Crime/economia , Bases de Dados Factuais , Dinamarca/epidemiologia , Prescrições de Medicamentos/economia , Escolaridade , Feminino , Hospitalização/economia , Hospitais Públicos/economia , Humanos , Lactente , Seguro Saúde/economia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Satisfação Pessoal , Seguridade Social/economia , Ferimentos e Lesões/economia , Adulto Jovem
9.
Gac Sanit ; 34(1): 21-25, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-30482407

RESUMO

OBJECTIVE: In this paper we address whether the System for Personal Autonomy and Care of Dependent Persons contributes to increasing the volume of resources of the public social services system (displacement effect) or, on the contrary, whether this development has taken place at the expense of other social services (substitution effect). METHOD: Panel data analysis is used to explain how per capita expenditure on social services evolves in the Spanish Regions under the common regime in the period 2002-2016. RESULTS: The implementation of the Dependency Act is associated with a 14% increase in the level of per capita expenditure on social services. This effect raises 25% when the variable explained is expenditure on current transfers of a social nature. On the other hand, law changes introduced in 2012 and 2013 were associated with a reduction in per capita expenditure on current transfers of around 10%. CONCLUSIONS: This evidence would refute the hypothesis that the System for Personal Autonomy and Care of Dependent Persons had merely a "substitution" effect on autonomous spending on social services.


Assuntos
Orçamentos/legislação & jurisprudência , Gastos em Saúde/legislação & jurisprudência , Assistência de Longa Duração/economia , Seguridade Social/economia , Recursos em Saúde/economia , Recursos em Saúde/legislação & jurisprudência , Humanos , Assistência de Longa Duração/legislação & jurisprudência , Modelos Econométricos , Seguridade Social/legislação & jurisprudência , Fatores Socioeconômicos , Espanha
10.
Pan Afr Med J ; 35(Suppl 2): 64, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33623588

RESUMO

The emergence of COVID-19 in December 2019 has highlighted several lessons about Public health emergencies. One important lesson is on the role of social welfare benefits and protection in the overall management of public health emergencies. The absence of a functional and digitalized social welfare system in Africa may render ineffective public health measures to mitigate the spread of COVID-19. The social determinant of disease illustrates the nexus between poverty and health outcomes. Therefore, COVID-19 is an opportunity for African governments to rethink their stance on social welfare benefits and protection; and adopt mechanisms that protect the most vulnerable.


Assuntos
/prevenção & controle , Pobreza , Saúde Pública , Seguridade Social/economia , África , Humanos , Determinantes Sociais da Saúde , Populações Vulneráveis
11.
J Nutr ; 149(Suppl 1): 2332S-2340S, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31793643

RESUMO

This commentary on the Integrated Strategy for Attention to Nutrition (EsIAN) journal supplement begins with a discussion about the challenges that implementation researchers confront with respect to analyzing complex impact pathways. We note that the research on the implementation of the EsIAN component of Mexico's conditional cash transfer program was based implicitly or explicitly on a program impact pathway approach, which used both quantitative and qualitative methods to examine bottlenecks in program implementation. We then identify 5 categories of contexts that affect the impact, implementation, and survival of intervention programs: 1) biological, 2) social-cultural, 3) delivery modalities and platforms, 4) bureaucratic, and 5) political. Each of these contexts presents theoretical and methodological challenges for investigators. In this commentary, we focus primarily on biological and social-cultural contexts, discussing the theoretical and methodological challenges the investigators faced and the research strategies they used to address them, which have produced a unique compilation of "learning by doing" studies. We also touch briefly on the political context in which the Prospera program research was conducted. We conclude with statements that highlight the exceptional value of the journal supplement, not only with respect to the analysis of the interventions the studies cover and the sustained examination of a long-term program but also as a major contribution to the literature in implementation science in nutrition.


Assuntos
Suplementos Nutricionais/economia , Alimentos Fortificados , Seguridade Social/economia , Comunicação , Cultura , Humanos , Lactente , México , Pesquisa Qualitativa , Normas Sociais
12.
J Nutr ; 149(Suppl 1): 2290S-2301S, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31793644

RESUMO

BACKGROUND: The impact of the Conditional Cash Transfer Program in Mexico was significant but smaller than expected. Several bottlenecks related to program design and implementation have been identified that may have limited its impact; population and other contextual factors may be equally important to analyze. OBJECTIVES: We aimed to explore how sociocultural context contributes to poor nutrition in Mexico and how it shaped the acceptability, fidelity, and penetration of the fortified food and of education sessions provided by the program. METHODS: We carried out qualitative research studies in the central and southern states in urban, rural, and indigenous settings between 2001 and 2014 with different informants and by using interviews, focus group discussions, and nonparticipatory observation. We explored 4 dimensions of the sociocultural context: objective dimension (e.g., food availability and family organization), social norms and symbolic meaning related to child feeding, literacy and communication with the biomedical culture, and knowledge related to child care generally and child feeding. We generated information about the experience of the beneficiaries with fortified food and education sessions. RESULTS: Several sociocultural factors, including patriarchal family organization, high availability of nonnutritious food, social norms promoting the consumption of food in liquid form for young children, sharing of food among family members, traditional knowledge, and communication barriers with the biomedical culture, participated in shaping the poor nutrition situation, the inadequate utilization of fortified foods, and the inappropriateness of the education sessions. CONCLUSIONS: Our studies revealed the importance of local context and culture to understand the acceptance, utilization, and impact of a nutrition program and shed light on infant and child feeding practices. This knowledge is critical to strengthen program designs and ensure adequacy with the diversity of cultural and social contexts in which programs are implemented.


Assuntos
Fenômenos Fisiológicos da Nutrição Infantil , Suplementos Nutricionais , Alimentos Fortificados , Normas Sociais , Seguridade Social/economia , Pré-Escolar , Cultura , Educação em Saúde , Humanos , Lactente , México , Estado Nutricional , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
13.
J Nutr ; 149(Suppl 1): 2281S-2289S, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31793648

RESUMO

BACKGROUND: Mexico's Prospera-Oportunidades-Progresa Conditional Cash Transfer Program (CCT-POP) included the distribution of fortified food supplements (FFS) for pregnant and lactating women and young children. Rigorous evaluations showed significant impacts on nutrition outcomes but also substantial gaps in addressing nutrition problems. OBJECTIVES: To highlight the program design-related and implementation-related gaps and challenges that motivated further research and the eventual design and roll-out of a modified nutrition component for CCT-POP. METHODS: We used a program impact pathway approach to highlight the extent and quality of implementation of CCT-POP, and its impact on nutrition outcomes. We drew on previously published and new primary data, organized into 3 sources: impact evaluations, studies to inform reformulation of the FFS, and a longitudinal follow-up study using qualitative and quantitative methods to document FFS use and the dietary intake of women and children. RESULTS: Despite positive impacts, a high prevalence of malnutrition persisted in the population. Coverage and use of health services improved, but quality of care was lacking. Consumption of FFS among lactating women was irregular. Micronutrient intake improved among children who consumed FFS, but the pattern of use limited frequency and quantity consumed. Substantial diversity in the prevalence of undernutrition was documented, as was an increased risk of overweight and obesity among women. CONCLUSIONS: Three key design and implementation challenges were identified. FFS, although well accepted for children, had limited potential to substantially modify the quality of children's diets because of the pattern of use in the home. The communications strategy was ineffective and ill-suited to its objective of motivating FFS use. Finally, the program with its common design across all regions of Mexico was not well adapted to the special needs of some subgroups, particularly indigenous populations. The studies reviewed in this paper motivated additional research and the eventual redesign of the nutrition component.


Assuntos
Suplementos Nutricionais , Alimentos Fortificados , Motivação , Seguridade Social/economia , Criança , Fenômenos Fisiológicos da Nutrição Infantil , Dieta , Feminino , Humanos , Lactação , Desnutrição/epidemiologia , México , Micronutrientes/administração & dosagem , Gravidez , Projetos de Pesquisa
15.
Age Ageing ; 49(1): 82-87, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31732735

RESUMO

BACKGROUND: care in the final year of life accounts for 10% of inpatient hospital costs in UK. However, there has been little analysis of costs in other care settings. We investigated the publicly funded costs associated with the end of life across different health and social care settings. METHOD: we performed cross-sectional analysis of linked electronic health records of residents aged over 50 in a locality in East London, UK, between 2011 and 2017. Those who died during the study period were matched to survivors on age group, sex, deprivation, number of long-term conditions and time period. Mean costs were calculated by care setting, age and months to death. RESULTS: across 8,720 matched patients, the final year of life was associated with £7,450 (95% confidence interval £7,086-£7,842, P < 0.001) of additional health and care costs, 57% of which related to unplanned hospital care. Whilst costs increased sharply over the final few months of life in emergency and inpatient hospital care, in non-acute settings costs were less concentrated in this period. Patients who died at older ages had higher social care costs and lower healthcare costs than younger patients in their final year of life. CONCLUSIONS: the large proportion of costs relating to unplanned hospital care suggests that end-of-life planning could direct care towards more appropriate settings and lead to system efficiencies. Death at older ages results in an increasing proportion of care costs relating to social care than to healthcare, which has implications for an ageing society.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Assistência Terminal/economia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização/economia , Humanos , Londres , Masculino , Registro Médico Coordenado , Pessoa de Meia-Idade , Seguridade Social/economia , Seguridade Social/estatística & dados numéricos , Assistência Terminal/estatística & dados numéricos , Fatores de Tempo
16.
Soc Work ; 64(4): 321-328, 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31566240

RESUMO

Modern technology threatens to dramatically alter the U.S. labor economy, but the crumbling social safety net may be insufficient for affected workers. Some advocates propose to address these converging problems through universal basic income (UBI). Authors conducted a preliminary review of social work perspectives on the topic of UBI. They found very little relevant literature, especially among American scholars. Existent social work literature frames UBI as an alternative to the neoliberal welfare state and mass unemployment. Social workers also contribute a critical social justice orientation to UBI scholarship in other disciplines. Grounded in the NASW Code of Ethics, authors argue that it is imperative for American social workers to seriously consider UBI as an answer to growing inequality and the unique expertise that social workers offer as allies of marginalized populations.


Assuntos
Renda , Pobreza/ética , Política Pública , Justiça Social/ética , Assistentes Sociais/psicologia , Humanos , Princípios Morais , Pobreza/economia , Pobreza/prevenção & controle , Seguridade Social/economia , Seguridade Social/ética , Serviço Social/ética , Estados Unidos , Design Universal
17.
Int J Health Policy Manag ; 8(8): 462-466, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31441285

RESUMO

Long-term care (LTC) must be carefully delineated when expenditures are compared across countries because how LTC services are defined and delivered differ in each country. LTC's objectives are to compensate for functional decline and mitigate the care burden of the family. Governments have tended to focus on the poor but Germany opted to make LTC universally available in 1995/1996. The applicant's level of dependence is assessed by the medical team of the social insurance plan. Japan basically followed this model but, unlike Germany where those eligible may opt for cash benefits, they are limited to services. Benefits are set more generously in Japan because, prior to its implementation in 2000, health insurance had covered long-stays in hospitals and there had been major expansions of social services. These service levels had to be maintained and be made universally available for all those meeting the eligibility criteria. As a result, efforts to contain costs after the implementation of the LTC Insurance have had only marginal effects. This indicates it would be more efficient and equitable to introduce public LTC Insurance at an early stage before benefits have expanded as a result of ad hoc policy decisions.


Assuntos
Seguro de Assistência de Longo Prazo/economia , Assistência de Longa Duração/economia , Seguridade Social/economia , Idoso , Serviços de Saúde Comunitária/economia , Humanos , Seguro Saúde/economia , Japão , Assistência de Longa Duração/organização & administração , Dinâmica Populacional/tendências
18.
BMJ Open ; 9(8): e029789, 2019 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-31446413

RESUMO

OBJECTIVES: To identify how social return on investment (SROI) analysis-traditionally used by business consultants-has been interpreted, used and innovated by academics in the health and social care sector and to assess the quality of peer-reviewed SROI studies in this sector. DESIGN: Systematic review. SETTINGS: Community and residential settings. PARTICIPANTS: A wide range of demographic groups and age groups. RESULTS: The following databases were searched: Web of Science, Scopus, CINAHL, Econlit, Medline, PsychINFO, Embase, Emerald, Social Care Online and the National Institute for Health and Care Excellence. Limited uptake of SROI methodology by academics was found in the health and social care sector. From 868 papers screened, 8 studies met the criteria for inclusion in this systematic review. Study quality was found to be highly variable, ranging from 38% to 90% based on scores from a purpose-designed quality assessment tool. In general, relatively high consistency and clarity was observed in the reporting of the research question, reasons for using this methodology and justifying the need for the study. However, weaknesses were observed in other areas including justifying stakeholders, reporting sample sizes, undertaking sensitivity analysis and reporting unexpected or negative outcomes. Most papers cited links to additional materials to aid in reporting. There was little evidence that academics had innovated or advanced the methodology beyond that outlined in a much-cited SROI guide. CONCLUSION: Academics have thus far been slow to adopt SROI methodology in the evaluation of health and social care interventions, and there is little evidence of innovation and development of the methodology. The word count requirements of peer-reviewed journals may make it difficult for authors to be fully transparent about the details of their studies, potentially impacting the quality of reporting in those studies published in these journals. PROSPERO REGISTRATION NUMBER: CRD42018080195.


Assuntos
Assistência à Saúde/economia , Reabilitação Vocacional/economia , Seguridade Social/economia , Análise Custo-Benefício , Humanos , Avaliação de Programas e Projetos de Saúde , Participação Social
19.
Epilepsy Behav ; 98(Pt A): 59-65, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31299534

RESUMO

OBJECTIVE: We aimed to evaluate the excess direct and indirect costs associated with nonepileptic seizures. METHODS: From the Danish National Patient Registry (2011-2016), we identified 1057 people of any age with a diagnosis of psychogenic nonepileptic seizures (PNESs) and matched them with 2113 control individuals. Additionally, 239 partners of patients with PNES aged ≥18 years were identified and compared with 471 control partners. Direct costs included frequencies and costs of hospitalizations and outpatient use weighted by diagnosis-related group, and specific outpatient costs based on data from the Danish Ministry of Health. The use and costs of drugs were based on data from the Danish Medicines Agency. The frequencies of visits and hospitalizations and costs of general practice were derived from National Health Security data. Indirect costs included labor supply-based income data, and all social transfer payments were obtained from Coherent Social Statistics. RESULTS: A higher percentage of people with PNES and their partners compared with respective control subjects received welfare benefits (sick pay, disability pension, home care). Those with PNES had a lower employment rate than did controls for equivalent periods up to three years before the diagnosis was made. The additional direct and indirect annual costs for those aged ≥18 years, including transfers to patients with PNES, compared with controls, were €33,697 for people with PNES and €15,121 for their partners. SIGNIFICANCE: Psychogenic nonepileptic seizures have substantial socioeconomic consequences for individual patients, their partners, and society.


Assuntos
Emprego/economia , Custos de Cuidados de Saúde , Convulsões/diagnóstico , Convulsões/economia , Seguridade Social/economia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Assistência Ambulatorial/economia , Assistência Ambulatorial/tendências , Criança , Pré-Escolar , Dinamarca/epidemiologia , Emprego/tendências , Feminino , Custos de Cuidados de Saúde/tendências , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/tendências , Hospitalização/economia , Hospitalização/tendências , Humanos , Renda/tendências , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Convulsões/epidemiologia , Seguridade Social/tendências , Adulto Jovem
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