Quality of local healthcare facilities and deciding on in-facility
                        delivery: identifying contributors to healthcare-seeking behavior among
                        pregnant Malawian women

Abstract Abstract The choice of healthcare facility by older persons is an important factor in their healthcare seeking behavior, and this can be associated with a number of factors. This study investigated the relationship between social support and healthcare facility choice of older persons in Nigeria. Other factors associated with the choice of healthcare facilities by older persons were also identified. Quantitative data were collected from a sample of 3,696 elderly aged 60 years above (55.6% male; 44.4% females; mean age = 69.2, SD = 8.60) who were selected through multi-stage systematic random sampling. Binary logistic regression analysis revealed that older persons who received social support were more likely to seek treatment in formal healthcare facilities, while older persons who did not receive any form of social support were more likely to seek treatment in informal healthcare facilities. Membership of social or religious groups was found to be a predictor of health seeking behavior among the older adults. Sex, age, level of education, and ability to handle activities of daily living (ADL), and ease of access to the nearest health facility, were found to be significantly associated with choice of healthcare facilities. The article concludes that there is need for conscious planning to provide formal supports to ease access of older persons to available health facilities. Such facilitation should include financial support and removal of existing physical and cultural barriers to health care utilization by older persons.

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How Can One Strengthen a Tiered Healthcare System through Health System Reform? Lessons Learnt from Beijing, China

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17218040 ◽

2020 ◽

Vol 17 (21) ◽

pp. 8040

Author(s):

Shuduo Zhou ◽

Jin Xu ◽

Xiaochen Ma ◽

Beibei Yuan ◽

Xiaoyun Liu ◽

...

Keyword(s):

Primary Care ◽

Ambulatory Care ◽

Healthcare System ◽

Primary Healthcare ◽

Healthcare Facilities ◽

Healthcare Seeking ◽

Seeking Behavior ◽

Tertiary Hospitals ◽

Healthcare Seeking Behavior ◽

The Impact

How one can reshape the current healthcare sector into a tiered healthcare system with clarified division of functions between primary care facilities and hospitals, and improve the utilization of primary care, is a worldwide problem, especially for the low and middle-income countries (LMICs). This paper aimed to evaluate the impact of the Beijing Reform on healthcare-seeking behavior and tried to explain the mechanism of the change of patient flow. In this before and after study, we evaluated the changes of outpatient visits and inpatient visits among different levels of health facilities. Using the monitored and statistical data of 373 healthcare institutions 1-year before and 1-year after the Beijing Reform, interrupted time series analysis was applied to evaluate the impact of the reform on healthcare-seeking behavior. Semi-structured interviews were used to further explore the mechanisms of the changes. One year after the reform, the flow of outpatients changed from tertiary hospitals to community health centers with an 11.90% decrease of outpatients in tertiary hospitals compared to a 15.01% increase in primary healthcare facilities. The number of ambulatory care visits in primary healthcare (PHC) showed a significant upward trend (P < 0.10), and the reform had a significant impact on the average number of ambulatory care visits per institution in Beijing’s tertiary hospitals (p < 0.10). We concluded that the Beijing Reform has attracted a substantial number of ambulatory care visits from hospitals to primary healthcare facilities in the short-term. Comprehensive reform policies were necessary to align incentives among relative stakeholders, which was a critical lesson for other provinces in China and other LMICs.

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Healthcare-Seeking Behavior among Chinese Older Adults: Patterns and Predictive Factors

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062969 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2969

Author(s):

Yanbing Zeng ◽

Yuanyuan Wan ◽

Zhipeng Yuan ◽

Ya Fang

Keyword(s):

Older Adults ◽

Predictive Factors ◽

Medical Insurance ◽

Utilization Rate ◽

Heckman Selection Model ◽

Healthcare Seeking ◽

Inpatient Services ◽

Medical Institutions ◽

Seeking Behavior ◽

Healthcare Seeking Behavior

This study aimed to investigate the patterns and predictive factors of healthcare-seeking behavior among older Chinese adults. A sample of 10,914 participants aged ≥60 years from the 2011, 2013 and 2015 China Health and Retirement Longitudinal Study (CHARLS) was included. The bivariate analyses and Heckman selection model was used to identify predictors of healthcare-seeking behavior. Results shows that the utilization rate of outpatient services increased from 21.61% in 2011 to 32.41% in 2015, and that of inpatient services increased from 12.44% to 17.68%. In 2015, 71.93% and 92.18% chose public medical institutions for outpatient and inpatient services, 57.63% and 17.00% chose primary medical institutions. The individuals who were female, were younger, lived in urban, central or western regions, had medical insurance, had poor self-rated health and exhibited activity of daily living (ADL) impairment were more inclined to outpatient and inpatient services. Transportation, medical expenses, the out-of-pocket ratio and the urgency of the disease were associated with provider selection. The universal medical insurance schemes improved health service utilization for the elderly population but had little impact on the choice of medical institutions. The older adults preferred public institutions to private institutions, preferred primary institutions for outpatient care, and higher-level hospitals for hospitalization.

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