Estimation of an index of regional health needs in Spain using count regression models with filter

Abstract Regression models are extensively used in many epidemiological studies to understand the linkage between specific outcomes of interest and their risk factors. However, regression models in general examine the average effects of the risk factors and ignore subgroups with different risk profiles. As a result, interventions are often geared towards the average member of the population, without consideration of the special health needs of different subgroups within the population. This paper demonstrates the value of using rule-based analysis methods that can identify subgroups with heterogeneous risk profiles in a population without imposing assumptions on the subgroups or method. The rules define the risk pattern of subsets of individuals by not only considering the interactions between the risk factors but also their ranges. We compared the rule-based analysis results with the results from a logistic regression model in The Environmental Determinants of Diabetes in the Young (TEDDY) study. Both methods detected a similar suite of risk factors, but the rule-based analysis was superior at detecting multiple interactions between the risk factors that characterize the subgroups. A further investigation of the particular characteristics of each subgroup may detect the special health needs of the subgroup and lead to tailored interventions.

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Health system response to large scale migration: the case of Emilia-Romagna region

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.801 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Quargnolo ◽

L Mammana ◽

G Gherardi ◽

C Bodini ◽

D Damosto ◽

...

Keyword(s):

Health Promotion ◽

Health System ◽

Asylum Seekers ◽

Health Needs ◽

Vulnerable Groups ◽

System Response ◽

National Guidelines ◽

Regional Health ◽

Health Response ◽

Emilia Romagna Region

Abstract Background In Italy, recent changes in migration flows posed complex public health challenges. The Emilia-Romagna region (ERR) was one of the first regions to adopt specific policies addressing the health of newly arrived asylum seekers. In our study, we analysed the regional health system response comparing it to the regional and national guidelines, in order to assess its strengths and its critical areas. Methods In 2019, we conducted a survey among the referents of the regional clinics that provide healthcare to asylum seekers, in order to learn about local policies, challenges and best practices. A questionnaire with 35 closed and 11 open questions was administered and analysed through descriptive statistical analysis and text analysis. Results Regional policies showed good responsiveness and Local Health Authorities (LHAs) adhered to the guidelines. A special permit was introduced to grant asylum seekers access to healthcare, which also allowed integration of health data into the regional health information system. However, data integration was done in only 2 clinics out of 14. Instances of discretion in issuing the special permit were reported, due to ambiguity in the rules and inadequate training of office workers. Policies and LHAs protocols focused greatly on the arrival phase and on Communicable Diseases (CDs) surveillance. Other areas - such as protection of vulnerable groups, health promotion, NCDs - were prioritized in the national guidelines, but unevenly considered throughout the region, also due to lack of resources. Some clinics responded autonomously to these gaps with local resources. Conclusions The ERR health response to the influx of asylum seekers was rapid but incomplete. Interventions focused more on CDs surveillance than on responding to asylum seekers' health needs in terms of quality, access and equity. Areas to be strengthened include protection of vulnerable groups, health promotion and NCDs, together with coordination and long-term planning. Key messages The Emilia-Romagna region health response to the influx of asylum seekers reflects an emergency approach focused on communicable diseases, while NCDs and health promotion are relatively neglected. The health system in Emilia-Romagna needs to be strengthened in its capacity to respond to asylum seekers’ health needs. Health policies and practices should be planned to ensure equity and quality.

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Associations between Disability and Infertility among U.S. Reproductive-Aged Women

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063202 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3202

Author(s):

Sandie Ha ◽

Valerie Martinez

Keyword(s):

Regression Models ◽

Health Needs ◽

Care Seeking ◽

Health Issues ◽

Cross Sectional ◽

Logistic Regression Models ◽

History Of ◽

Nationally Representative ◽

Sectional Analysis ◽

Reproductive Aged Women

We aim to evaluate the association between self-reported disabilities and infertility and whether disabilities are associated with decreased likelihood of seeking infertility-related care. This US nationally representative cross-sectional analysis includes 3789 non-pregnant women aged 18–49 years without history of hysterectomy or oophorectomy (NHANES, 2013–2018). Disabilities and infertility were both self-reported in personal interviews with trained interviewers. Logistic regression models estimated the adjusted odds ratio (aOR) and 95% confidence intervals for the association between disabilities and infertility and related care seeking. Models adjusted for potential confounders and complex probability sampling. Compared to women without disabilities, women with disabilities (WWD) had higher odds of infertility (aOR: 1.78 (1.31–2.40)). Similar findings were observed for sensory (2.32 (1.52–3.52)) and cognitive disabilities (1.77 (1.28–2.44)). Among women with infertility, WWD were less likely to seek infertility-related care (0.68 (0.32–1.44)) but these estimates were not statistically significant. WWD have increased odds of reporting infertility, and if affected, are less likely to visit a health care provider for this condition. While more research is needed to understand reproductive health issues and needs among WWD, it is important to push for more equitable policies and practices to address the health needs of this underserved population.

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Does health insurance matters to the use of health service for elderly in urban China? A nationwide cross-sectional study

10.21203/rs.2.13672/v1 ◽

2019 ◽

Author(s):

Wenhui Mao ◽

Yaoguang Zhang ◽

Ling Xu ◽

Zhiwen Miao ◽

Di Dong ◽

...

Keyword(s):

Health Insurance ◽

Health Services ◽

Multivariate Regression ◽

Regression Models ◽

Hospital Admissions ◽

Perceived Health ◽

Health Needs ◽

Income Groups ◽

Outpatient Visits ◽

Use Of Health Services

Abstract Background China’s rapidly aging population is raising many challenges for the delivery and financing of health care. The Urban Residents Basic Medical Insurance (URBMI) has provided financial protection for the urban elderly population not covered by other health insurance schemes since 2007. We conducted a national level assessment to measure on the perceived health needs of this population as well as their use of health services. Methods Data on individuals over the age of 60 were extracted from two National Health Service Surveys conducted in 2008 and 2013. Multivariate regression models were used to estimate associations of socioeconomic factors and perceived health needs with the use of health services while controlling for demographic characteristics and year of survey. Findings Perceived health needs increased significantly between 2008 and 2013, regardless of insurance enrollment, age group or income level. In 2013, over 75% of individuals reported having at least one Non-communicable disease (NCD). Outpatient services decreased for those without insurance but increased for those with insurance. Middle- and high-income groups with insurance experienced a faster growth in outpatient visits and hospital admissions than the low-income group. Proportion of forgone hospital admissions, and proportion of forgone hospital admissions due to financial difficulties decreased. Yet there were still over 20% elderly forgone necessary hospital admissions, among which more than 40% were caused by financial barriers in 2013. Multivariate regression models found an increase of outpatient visits and hospital admissions from 2008 to 2013 when controlling for socioeconomic and health need factors. Conclusion Perceived health needs among the elderly increased at an alarming rate, and results showed a high prevalence of NCDs. Use of overall services increased and forgone necessary admissions decreased after the implementation of URBMI, indicating the improvement of access to health services. However, high-income groups had the highest increase in service use calling for further attention to issues related to equity. The service benefit packages offered by health insurance schemes should provide more support to the care of NCD patients.

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Beyond Ideology: The Emerging Roles of New Zealand's Crown Health Enterprises

International Journal of Health Services ◽

10.2190/l0rn-r2mt-0pl6-utjg ◽

1997 ◽

Vol 27 (1) ◽

pp. 89-108 ◽

Cited By ~ 11

Author(s):

Pauline Barnett ◽

Laurence Malcolm

Keyword(s):

Social Services ◽

Health Sector ◽

Health Needs ◽

Political Climate ◽

Regional Health ◽

Chief Executives ◽

Health Authorities ◽

Strategic Approach ◽

Crown Health ◽

Regional Health Authorities

New Zealand has experienced radical public sector restructuring over the last decade, including the corporatization and subsequent privatization of state trading units and the reform of social services, including health. In 1991 a new government proposed and then implemented more radical health reforms, which included the corporatization of state-owned provider units (23 crown health enterprises) and the creation of an internal market with purchasers (four regional health authorities) separated from providers. Interviews with chief executives of crown health enterprises suggest that provider units are seeking a wider role than envisaged, with an interest in the health needs of their populations and undertaking some purchasing on their behalf. The purchasers see a narrower role for crown health enterprises. Both purchasers and providers report that competition between providers is not particularly helpful (and with only limited opportunities for this to occur), with collaboration being seen as more useful. Providers are critical of purchasers' ability to adopt a strategic approach. Unlike other aspects of New Zealand's restructuring, there appears to be a retreat from some of the more radical facets of the reforms, reflecting both the resistance of the health sector and a newly uncertain political climate.

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