Does health insurance matter to the use of health services for the elderly in China? A multiyear, nationwide, cross-sectional study

The aim of the present study was to assess social inequalities in health status, health behavior and the use of health services based on education level. A population-based cross-sectional study was carried out involving 1,518 elderly residents of Campinas, São Paulo State, Brazil. Significant demographic and social differences were found between schooling strata. Elderly individuals with a higher degree of schooling are in greater proportion alcohol drinkers, physically active, have healthier diets and a lower prevalence of hypertension, diabetes, dizziness, headaches, back pain, visual impairment and denture use, and better self-rated health. But, there were no differences in the use of health services in the previous two weeks, in hospitalizations or surgeries in the previous year, nor in medicine intake over the previous three days. Among elderly people with hypertension and diabetes, there were no differences in the regular use of health services and medication. The results demonstrate social inequalities in different health indicators, along with equity in access to some health service components.

Download Full-text

Responsiveness of health care services towards the elderly in Tanzania: Does health insurance make a difference? A cross-sectional study

10.21203/rs.3.rs-18102/v3 ◽

2020 ◽

Author(s):

Paul Joseph Amani ◽

Malale Tungu ◽

Anna-Karin Hurtig ◽

Angwara Denis Kiwara ◽

Gasto Frumence ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Waiting Time ◽

Inpatient Care ◽

Health Care Services ◽

The Elderly ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Care Services

Abstract BackgroundResponsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients’ expectations. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population. MethodsA community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) living in Igunga and Nzega districts, was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and 12 months were selected. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance adjusted for sociodemographic factors.ResultsA total of 1453 and 744 elderly, of whom 50.1% and 63% had health insurance, used outpatient and inpatient health services, respectively. All domains were rated relatively highly but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (−1; 95% CI: −1.45, −0.45) and inpatient (−2; 95% CI: −2.69, −1.30) care. Conclusion The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked poorly. Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. A continuous monitoring of health care system responsiveness is recommended.

Download Full-text

Responsiveness of health care services towards the elderly in Tanzania: Does health insurance make a difference? A cross-sectional study

10.21203/rs.3.rs-18102/v2 ◽

2020 ◽

Author(s):

Paul Joseph Amani ◽

Malale Tungu ◽

Anna-Karin Hurtig ◽

Angwara Denis Kiwara ◽

Gasto Frumence ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Waiting Time ◽

Inpatient Care ◽

Health Care Services ◽

The Elderly ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Care Services

Abstract Introduction Responsiveness has become an important health systems performance indicator in evaluating the ability of the health care systems to meet the expectations of the patients. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania, in order to contribute with relevant knowledge to improve the performance of the health care system among the elderly in the country. Methods A community-based cross-sectional study was conducted in 2017 where a pre-tested household survey administered to elderly (60 +) living in Igunga and Nzega districts was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and twelve months were selected. Responsiveness was measured based on the WHO-SAGE questionnaire that included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance and socio-demographic factors.Results A total of 1453 and 744 elderly, of whom 50.1% and 63% had health insurance, used the outpatient and inpatient health services respectively. All the different domains were rated relatively high but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (-1; 95% CI: -1.45, -0.45) and inpatient (-2; 95% CI: -2.69, -1.30) care. Conclusion The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked low. Further research is necessary to reveal the reasons for the lower responsiveness among insured elderly. A continuous monitoring of the health care system responsiveness is recommended.

Download Full-text

Responsiveness of health care services towards the elderly in Tanzania: does health insurance make a difference? A cross-sectional study

International Journal for Equity in Health ◽

10.1186/s12939-020-01270-9 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Paul Joseph Amani ◽

Malale Tungu ◽

Anna-Karin Hurtig ◽

Angwara Denis Kiwara ◽

Gasto Frumence ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Waiting Time ◽

Inpatient Care ◽

Health Care Services ◽

The Elderly ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Care Services

Abstract Background Responsiveness has become an important health system performance indicator in evaluating the ability of health care systems to meet patients’ expectations. However, its measurement in sub-Saharan Africa remains scarce. This study aimed to assess the responsiveness of the health care services among the insured and non-insured elderly in Tanzania and to explore the association of health insurance (HI) with responsiveness in this population. Methods A community-based cross-sectional study was conducted in 2017 where a pre-tested household survey, administered to the elderly (60 + years) living in Igunga and Nzega districts, was applied. Participants with and without health insurance who attended outpatient and inpatient health care services in the past three and 12 months were selected. Responsiveness was measured based on the short version of the World Health Organization (WHO) multi-country responsiveness survey study, which included the dimensions of quality of basic amenities, choice, confidentiality, autonomy, communication and prompt attention. Quantile regression was used to assess the specific association of the responsiveness index with health insurance adjusted for sociodemographic factors. Results A total of 1453 and 744 elderly, of whom 50.1 and 63% had health insurance, used outpatient and inpatient health services, respectively. All domains were rated relatively highly but the uninsured elderly reported better responsiveness in all domains of outpatient and inpatient care. Waiting time was the dimension that performed worst. Possession of health insurance was negatively associated with responsiveness in outpatient (− 1; 95% CI: − 1.45, − 0.45) and inpatient (− 2; 95% CI: − 2.69, − 1.30) care. Conclusion The uninsured elderly reported better responsiveness than the insured elderly in both outpatient and inpatient care. Special attention should be paid to those dimensions, like waiting time, which ranked poorly. Further research is necessary to reveal the reasons for the lower responsiveness noted among insured elderly. A continuous monitoring of health care system responsiveness is recommended.

Download Full-text

Access Differentials in Primary Healthcare among Vulnerable Populations in a Health Insurance Setting in Kumasi Metropolis, Ghana: A Cross-Sectional Study

Advances in Public Health ◽

10.1155/2021/9911436 ◽

2021 ◽

Vol 2021 ◽

pp. 1-14

Author(s):

Gertrude Acquah-Hagan ◽

Daniel Boateng ◽

Emmanuel Appiah-Brempong ◽

Peter Twum ◽

Joseph Amankwa Atta ◽

...

Keyword(s):

Health Insurance ◽

Pregnant Women ◽

Vulnerable Populations ◽

Primary Healthcare ◽

Healthcare Access ◽

The Elderly ◽

Cross Sectional Study ◽

Vulnerable Groups ◽

Sectional Study ◽

Cross Sectional

Background. Access to healthcare remains a challenge towards the achievement of the Sustainable Development Goals in Ghana. There still remain inequalities in the distribution of health services especially among vulnerable groups despite sustained efforts to strengthen the health system. This study was conducted to analyze access differentials among different vulnerable groups in the context of primary healthcare under a National Health Insurance Scheme (NHIS) in Ghana. Methods. This study was a descriptive cross-sectional study conducted among multilevel participants of vulnerable groups in Kumasi Metropolis: 710 vulnerable people constituting elderly/aged (n = 359), pregnant women (n = 117), head poters (teenage girls who migrated from the northern Ghana mainly to the capital cities of the Ashanti and Greater Accra region to help in carrying of goods for their livelihood) (n = 86), sex workers (n = 75), and other vulnerable groups (people with disabilities and street participants) (n = 73). Data were collected using a semistructured questionnaire. Poisson regression with robust variance was used to access the association between vulnerability and access to healthcare. Results. Close to a fifth, 18.5% of the study respondents were unable to access care at any point in time during the last 12 months. Reasons for the inability to access healthcare included limited funding (69.7%), poor attitude of service providers (7.6%), distance to health centers (8.3%), and religious reasons (6.2%). More than 95% of respondents were insured under the NHIS, but acceptability of service provision under the NHIS was low among the vulnerable groups. In the crude models, pregnant women had lower prevalence of access to medications as compared to the elderly (prevalence ratio (PR): 0.88; 95% CI: 0.80–0.98). Head poters and other vulnerable groups were also less likely to view healthcare as affordable as compared to the elderly. The differences in healthcare access observed were attenuated after adjustment for sociodemographic characteristics and healthcare-related factors. Conclusions. Despite the introduction of a NHIS in Ghana, this study highlights challenges in healthcare access among vulnerable populations independent of the type of vulnerability. This suggests the need for stakeholders to work to address access differentials in the NHIS and adopt other innovative care strategies that may have broader applicability for all populations.

Download Full-text

Does health insurance contribute to improved utilization of health care services for the elderly in rural Tanzania? A cross-sectional study

Global Health Action ◽

10.1080/16549716.2020.1841962 ◽

2020 ◽

Vol 13 (1) ◽

pp. 1841962

Author(s):

Malale Tungu ◽

Paul Joseph Amani ◽

Anna-Karin Hurtig ◽

Angwara Dennis Kiwara ◽

Mughwira Mwangu ◽

...

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Care Services ◽

The Elderly ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Care Services ◽

Rural Tanzania

Download Full-text

Hearing loss and use of health services: a population-based cross-sectional study among Finnish older adults

BMC Geriatrics ◽

10.1186/s12877-016-0356-5 ◽

2016 ◽

Vol 16 (1) ◽

Cited By ~ 4

Author(s):

Tuija M. Mikkola ◽

Hannele Polku ◽

Päivi Sainio ◽

Päivikki Koponen ◽

Seppo Koskinen ◽

...

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Health Services ◽

Population Based ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Use Of Health Services

Download Full-text

Frailty in the elderly: prevalence and associated factors

Revista Brasileira de Enfermagem ◽

10.1590/0034-7167-2016-0633 ◽

2017 ◽

Vol 70 (4) ◽

pp. 747-752 ◽

Cited By ~ 22

Author(s):

Jair Almeida Carneiro ◽

Rafael Rodrigues Cardoso ◽

Meiriellen Silva Durães ◽

Maria Clara Araújo Guedes ◽

Frederico Leão Santos ◽

...

Keyword(s):

The Elderly ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated ◽

Robust Variance ◽

The North ◽

History Of ◽

Prevalence Ratios ◽

Use Of Health Services

ABSTRACT Objective: to know the prevalence and factors associated with frailty in elderly assisted by the Centro Mais Vida de Referência em Assistência à Saúde do Idoso (Mais Vida Health Reference Center for the Elderly) in the North of Minas Gerais, Brazil. Method: cross-sectional study, with sampling by convenience. Data collection occurred in 2015. Demographic and socioeconomic variables, morbidities, use of health services and the score of the Edmonton Frail Scale were analyzed. The adjusted prevalence ratios were obtained by multiple analysis of Poisson regression with robust variance. Results: 360 elderly aged 65 or older were evaluated. Frailty prevalence was 47.2%. The variables associated with frailty were the following: advanced age elderly, who live without a partner, have a caregiver, present depressive symptoms, osteoarticular disease, as well as history of hospitalization and falls in the last twelve months. Conclusion: knowledge of factors associated with frailty allows development of health actions aimed at the elderly.

Download Full-text