Preferences of Hungarian consumers for quality, access and price attributes of health care services — result of a discrete choice experiment

In 2010, a household survey was carried out in Hungary among 1037 respondents to study consumer preferences and willingness to pay for health care services. In this paper, we use the data from the discrete choice experiments included in the survey, to elicit the preferences of health care consumers about the choice of health care providers. Regression analysis is used to estimate the effect of the improvement of service attributes (quality, access, and price) on patients’ choice, as well as the differences among the socio-demographic groups. We also estimate the marginal willingness to pay for the improvement in attribute levels by calculating marginal rates of substitution. The results show that respondents from a village or the capital, with low education and bad health status are more driven by the changes in the price attribute when choosing between health care providers. Respondents value the good skills and reputation of the physician and the attitude of the personnel most, followed by modern equipment and maintenance of the office/hospital. Access attributes (travelling and waiting time) are less important. The method of discrete choice experiment is useful to reveal patients’ preferences, and might support the development of an evidence-based and sustainable health policy on patient payments.

The health and nutritional status of multiethnic perimenopausal women

An integrated, dual-phase study design assessed the health and nutritional status and practices of African-American (A-A), Caribbean (A-C), and white non-Hispanic (W-A) women during perimenopause (40–55 years). During Phase I, four focus groups (n = 37) of male and female participants discussed the health and social implications of perimenopause. A conceptual framework for the main study (Phase II) was developed from the focus groups' findings, in concert with the main study's specific aims and objectives. ^ The main study, a cross-sectional survey, quantitatively assessed the health and nutritional status of a convenience sample of 109 women (25 A-A, 31 A-C and 53 W-A), who met specific eligibility criteria. Using seven instruments, sociodemographic, dietary, medical, reproductive health, health practice and anthropometric data were collected. ^ The groups were of comparable age, education, and socioeconomic status (SES). Despite these similarities, statistically significant interethnic nutritional status differences were found. Significantly more total energy and energy from fat were consumed by A-A than W-A and A-C women. Also, significantly more A-A and A-C than W-A women were overweight or obese with android-type weight patterning. ^ Overall, iron and calcium Recommended Dietary Allowances (RDA's) were not met by 35% and 68% of participants, respectively. Iron deficiency anemia was reported by 29% of participants while 33% reported heavier menstrual bleeding. Coupled with suboptimal iron intakes, this is likely to present a serious public health problem. Similarly, increased bone demineralization characteristic of perimenopause, coupled with suboptimal calcium intakes could precipitate another public health problem, osteoporosis. ^ Participants had different expectations about the role of medical care during perimenopause. Significantly more white (57%) than black (38% [A-A and AC]) women sought medical attention for symptoms. Whereas Hormone Replacement Therapy (HRT) was prescribed for 25% of them, only 13% were compliant at enrollment. ^ The trends and statistically significant findings of this study have huge public health policy implications. It is imperative that appropriate policies are formulated to ensure that America's ethnically diverse perimenopausal women have ready access to culturally appropriate care. This would optimize their health outcomes, and enhance their quality of life and productive capacities at this critical juncture of their lives. ^

Eliciting Preferences for Social Health Insurance in Ethiopia : A Discrete Choice Experiment

Peer reviewed

The Policy Dystopia Model:an interpretive analysis of tobacco industry political activity

BACKGROUND: Tobacco industry interference has been identified as the greatest obstacle to the implementation of evidence-based measures to reduce tobacco use. Understanding and addressing industry interference in public health policy-making is therefore crucial. Existing conceptualisations of corporate political activity (CPA) are embedded in a business perspective and do not attend to CPA's social and public health costs; most have not drawn on the unique resource represented by internal tobacco industry documents. Building on this literature, including systematic reviews, we develop a critically informed conceptual model of tobacco industry political activity. METHODS AND FINDINGS: We thematically analysed published papers included in two systematic reviews examining tobacco industry influence on taxation and marketing of tobacco; we included 45 of 46 papers in the former category and 20 of 48 papers in the latter (n = 65). We used a grounded theory approach to build taxonomies of "discursive" (argument-based) and "instrumental" (action-based) industry strategies and from these devised the Policy Dystopia Model, which shows that the industry, working through different constituencies, constructs a metanarrative to argue that proposed policies will lead to a dysfunctional future of policy failure and widely dispersed adverse social and economic consequences. Simultaneously, it uses diverse, interlocking insider and outsider instrumental strategies to disseminate this narrative and enhance its persuasiveness in order to secure its preferred policy outcomes. Limitations are that many papers were historical (some dating back to the 1970s) and focused on high-income regions. CONCLUSIONS: The model provides an evidence-based, accessible way of understanding diverse corporate political strategies. It should enable public health actors and officials to preempt these strategies and develop realistic assessments of the industry's claims.

Putting Adequate Financial and Human Resources in Healthcare for Effective Universal Health Coverage in Kenya: Lessons and Experiences from China

In recent years, most low and middle-income countries, have adopted different approaches to universal health coverage (UHC), to ensure equity and financial risk protection in accessing essential healthcare services. UHC-related policies and delivery strategies are largely based on existing healthcare systems, a result of gradual development (based on local factors and priorities). Most countries have emphasized on health financing, and human resources for health (HRH) reform policies, based on good practices of several healthcare plans to deliver UHC for their population.

Health financing and labor market frameworks were used, to understand health financing, HRH dynamics, and to analyze key health policies implemented over the past decade in Kenya’s effort to achieve UHC. Through the understanding, policy options are proposed to Kenya; analyzing, and generating lessons from health financing, and HRH reforms experiences in China. Data was collected using mixed methods approach, utilizing both quantitative (documents and literature review), and qualitative (in-depth interviews) data collection techniques.

The problems in Kenya are substantial: high levels of out-of-pocket health expenditure, slow progress in expanding health insurance among informal sector workers, inefficiencies in pulling of health are revenues, inadequate deployed HRH, maldistribution of HRH, and inadequate quality measures in training health worker. The government has identified the critical role of strengthening primary health care and the National Hospital Insurance Fund (NHIF) in Kenya’s move towards UHC. Strengthening primary health care requires; re-defining the role of hospitals, and health insurance schemes, and training, deploying and retaining primary care professionals according to the health needs of the population; concepts not emphasized in Kenya’s healthcare reforms or programs design. Kenya’s top leadership commitment is urgently needed for tougher reforms implementation, and important lessons from China’s extensive health reforms in the past decade are beneficial. Key lessons from China include health insurance expansion through rigorous research, monitoring, and evaluation, substantially increasing government health expenditure, innovative primary healthcare strengthening, designing, and implementing health policy reforms that are responsive to the population, and regional approaches to strengthening HRH.

Health Literacy and Medicare Recipient's Knowledge of Health Insurance Options

Health literacy is a major problem for the aging population (Parker, Ratzan, & Lurie, 2003). The significance of this study was to access the relationship between health literacy and knowledge of Medicare to determine ways in which seniors can effectively navigate their healthcare insurance.

THE EPIDEMIOLOGY AND HEALTH ECONOMICS OF ANKLE INJURIES

The thesis focuses on a central theme of the epidemiology and health economics of ankle sprains to inform health policy and the provision of health services. It describes the burden, prognosis, resource utilization, and costs attributed to these injuries. The first manuscript systematically reviewed 34 studies on the direct and indirect costs of treating ankle and foot injuries. The overall costs per patient ranged from $2,075- $3,799 (2014 USD) for ankle sprains; $290-$20,132 for ankle fractures; and $6,345-$45,731 for foot fractures, reflecting differences in injury severity, treatment methods, and study characteristics. The second manuscript provided an epidemiological and economic profile of non-fracture ankle and foot injuries in Ontario using linked databases from the Institute for Clinical Evaluative Sciences. The incidence rate of ankle sprains was 16.9/1,000 person-years. Annually, ankle and foot injuries cost $21,685,876 (2015 CAD). The mean expenses per case were $99.98 (95% CI, $99.70-100.26) for any injury. Costs ranged from $133.78-$210.75 for ankle sprains and $1,497.12-$1,755.69 for dislocations. The third manuscript explored the impact of body mass index on recovery from medically attended grade 1 and 2 ankle sprains using the Foot and Ankle Outcome Score. Data came from a randomized controlled trial of a physiotherapy intervention in Kingston, Ontario. At six months, the odds ratio of recovery for participants with obesity was 0.60 (0.37-0.97) before adjustment and 0.74 (0.43-1.29) after adjustment compared to non-overweight participants. The fourth manuscript used trial data to examine the health-related quality of life among ankle sprain patients using the Health Utilities Index version 3 (HUI-3). The greatest improvements in scores were seen at one month post-injury (HUI-3: 0.88, 95% CI: 0.86-0.90). Individuals with grade 2 sprains had significantly lower ambulation scores than those with grade 1 sprains (0.70 vs. 0.84; p<0.05). The final manuscript used trial data to describe the financial burden (direct and indirect costs) of ankle sprains. The overall mean costs were $1,508 (SD: $1,452) at one month and increased to $2,206 (SD: $3,419) at six months. Individuals with more severe injuries at baseline had significantly higher (p<0.001) costs compared to individuals with less severe injuries, after controlling for confounders.

The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

Market reforms and privatisation in the English National Health Service

The article examines developments in the marketisation and privatisation of the English National Health Service, primarily since 1997. It explores the use of competition and contracting out in ancillary services and the levering into public services of private finance for capital developments through the Private Finance Initiative. A substantial part of the article examines the repeated restructuring of the health service as a market in clinical services, initially as an internal market but subsequently as a market increasing opened up to private sector involvement. Some of the implications of market processes for NHS staff and for increased privatisation are discussed. The article examines one episode of popular resistance to these developments, namely the movement of opposition to the 2011 health and social care legislative proposals. The article concludes with a discussion of the implications of these system reforms for the founding principles of the NHS and the sustainability of the service.

Health reforms in Latin America: processes and results

Two types of health reforms in Latin America are analysed: one based on insurance and service commodification and the one referred to the unified public systems of progressive governments. Health insurance with explicit service packages has not fulfilled their purposes of universal coverage, equal access to necessary health services and improvement of health conditions but has opened health as a field of profit making for insurance companies and private health providers. The national health services as a state obligation have developed territorialized health services and widened substantially timely access to the majority of the population. The adoption of an integrated and wide social policy has an impact on population well fare. It faces some problems derived from the old health systems and the power of the insurance and medical complex.

Economic crisis and national health system

The text analyzes the impact of the economic crisis in some critical aspects of the National Health System: outcomes, health expenditure, remuneration policy and privatization through Private Public Partnership models. Some health outcomes related to social inequalities are worrying. Reducing public health spending has increased the fragility of the health system, reduced wage income of workers in the sector and increased heterogeneity between regions. Finally, the evidence indicates that privatization does not mean more efficiency and better governance. Deep reforms are needed to strengthen the National Health System.

The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews

Background
First generation migrants are reportedly at higher risk of mental ill-health compared to the settled population. This paper systematically reviews and synthesizes all reviews on the mental health of first generation migrants in order to appraise the risk factors for, and explain differences in, the mental health of this population.
Methods
Scientific databases were searched for systematic reviews (inception-November 2015) which provided quantitative data on the mental ill-health of first generation migrants and associated risk factors. Two reviewers screened titles, abstracts and full text papers for their suitability against pre-specified criteria, methodological quality was assessed.
Results
One thousand eight hundred twenty articles were identified, eight met inclusion criteria, which were all moderate or low quality. Depression was mostly higher in first generation migrants in general, and in refugees/asylum seekers when analysed separately. However, for both groups there was wide variation in prevalence rates, from 5 to 44 % compared with prevalence rates of 8–12 % in the general population. Post-Traumatic Stress Disorder prevalence was higher for both first generation migrants in general and for refugees/asylum seekers compared with the settled majority. Post-Traumatic Stress Disorder prevalence in first generation migrants in general and refugees/ asylum seekers ranged from 9 to 36 % compared with reported prevalence rates of 1–2 % in the general population. Few studies presented anxiety prevalence rates in first generation migrants and there was wide variation in those that did. Prevalence ranged from 4 to 40 % compared with reported prevalence of 5 % in the general population. Two reviews assessed the psychotic disorder risk, reporting this was two to three times more likely in adult first generation migrants. However, one review on the risk of schizophrenia in refugees reported similar prevalence rates (2 %) to estimates of prevalence among the settled majority (3 %). Risk factors for mental ill-health included low Gross National Product in the host country, downward social mobility, country of origin, and host country.
Conclusion
First generation migrants may be at increased risk of mental illness and public health policy must account for this and influencing factors. High quality research in the area is urgently needed as is the use of culturally specific validated measurement tools for assessing migrant mental health.

Paradigms that guide the models of attention to the health in Brazil: an analytic essay

SILVA, Flávio César Bezerra da ; COSTA, Francisca Marta de Lima; ANDRADE, Hamilton Leandro Pinto de; FREIRE, Lúcia de Fátima; MACIEL, Patrícia Suerda de Oliveira; ENDERS, Bertha Cruz ; MENEZES, Rejane Maria Paiva de. Paradigms that guide the models of attention to the health in Brazil: an analytic essay. Revista de Enfermagem UFPE On Line., Recife, v.3,n.4, p.460-65. out/dez. 2009. Disponível em < http://www.ufpe.br/revistaenfermagem/index.php/revista/search/results >.

Cornell Institute for Healthy Futures Takes Holistic View of Health

To address modern health care challenges, the College of Human Ecology and the School of Hotel Administration (SHA) have formed the Cornell Institute for Healthy Futures (CIHF), believed to be the world’s first academic center to combine hospitality, design, health policy and management. Led by Rohit Verma, the institute aims to improve service in health care, wellness and senior living through academia and industry partnerships.

Paradigms that guide the models of attention to the health in Brazil: an analytic essay

SILVA, Flávio César Bezerra da ; COSTA, Francisca Marta de Lima; ANDRADE, Hamilton Leandro Pinto de; FREIRE, Lúcia de Fátima; MACIEL, Patrícia Suerda de Oliveira; ENDERS, Bertha Cruz ; MENEZES, Rejane Maria Paiva de. Paradigms that guide the models of attention to the health in Brazil: an analytic essay. Revista de Enfermagem UFPE On Line., Recife, v.3,n.4, p.460-65. out/dez. 2009. Disponível em < http://www.ufpe.br/revistaenfermagem/index.php/revista/search/results >.