Quality of Life: Erosions and Opportunities Under Managed Care

2000 ◽  
Vol 28 (2) ◽  
pp. 144-158 ◽  
Author(s):  
E. Haavi Morreim
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Managed Care ◽  
Functional Status ◽  
General Public ◽  
Access To Health Care ◽  
New Technologies ◽  
Access To Health ◽  
Disease Specific

In recent years a number of commentators have discussed the importance of measuring quality of life (QL) in health care. We want to know whether an intervention will help people to live better, not just longer, and whether some treatments cause more trouble than they are worth. New technologies promise wondrous benefits. But when millions of people have no insured access to health care, and when many others face increasingly stringent limits on care, technologies’ high costs require us to choose what we should do from the broader universe of what we can do.The challenges to measuring QL are formidable. Researchers debate whether to measure general QL or disease-specific QL; whether to focus on functional status such as the patient's ability to walk and dress himself, or on the value people ascribe to that functional status; whether to seek the values of the general public, or to concentrate on people actually affected by a given disease or disability.

scholarly journals HEALTH UNDER OCCUPATION Counter Strategies and Resistance Tactics of Palestinians and the Health System in the State of Palestine

2019 ◽  
Author(s):  
Sigge Andersson
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
The State ◽  
Health Determinants ◽  
Theory Approach ◽  
Access To Health ◽  
The Impact

The impact of occupation on health and access to health care is a significant issue for the state, health sector and citizens of Palestine, who struggle with difficulties related to an enduring sociopolitical stalemate. The study presents narratives from the field, conceptually exploring if and how occupation affects health and access to health care and how the situation is tackled by Palestinians in general and by health system actors specifically. A grounded theory approach analyzing in-depth interviews with health staff and field memos was used, with semi-quantification of emerging concepts through surveys of Hebron students that assessed health-related quality of life and health literacy with psychometric instruments (SF36 and GSE) and assumed health determinants. One key theme in the data analysis was isolation as a result of multiple barriers, including the wall and checkpoints, imprisonment and violence, which have an impact on determinants of health and quality of life in Palestine. In the survey 54% (n=90) were affected by such factors of occupation. Barriers affect access to health care, especially in rural areas. Mentally and materially breaking free from barriers of occupation seems to be a common task in all levels of Palestinian society. Achieving this goal requires different counter strategies and tactics. Presently, Palestine depends on ad hoc coping strategies, including the use of mobile clinics. Other ways to cope emerged in the data as well. Results from this mixed-methods study suggest that isolation is a main concern for Palestinians, resulting from barriers in policies of occupation that affect health and access to health care. Another concept emerging from the analysis was tactics and strategies against occupation in society.

Access to Health Care and Quality of Life for Underserved Men with Prostate Cancer

2011 ◽  
Vol 27 (4) ◽  
pp. 267-277 ◽  
Author(s):  
Sally L. Maliski ◽  
Sarah E. Connor ◽  
Charlotte Oduro ◽  
Mark S. Litwin
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Health Care ◽  
Access To Health Care ◽  
Access To Health

scholarly journals Cognitive Impairment and Cardiovascular Disease: A Comparison of Risk Factors, Disability, Quality of Life, and Access to Health Care

2019 ◽  
Vol 135 (1) ◽  
pp. 132-140 ◽  
Author(s):  
Mary L. Adams ◽  
Joseph Grandpre ◽  
David L. Katz ◽  
Douglas Shenson
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Health Care ◽  
Cognitive Impairment ◽  
Access To Health Care ◽  
Sedentary Lifestyle ◽  
High Cholesterol ◽  
Access To Health

Objectives: Cognitive difficulties or impairment may be an early step in the development of dementia. Several modifiable risk factors for cardiovascular disease (CVD) may also increase the risk of dementia. The objective of our study was to compare adults with subjective cognitive impairment (SCI), using the Behavioral Risk Factor Surveillance System (BRFSS) cognitive disability measure, with adults who reported CVD. Methods: We examined data on 3 key outcomes among 302 008 adult respondents aged ≥45 in the 2017 BRFSS: respondents with SCI only, respondents with CVD only, and respondents with both conditions. We compared measures of disability, quality of life, access to health care, and a composite measure of the following 7 risk factors: current smoking, diabetes, high cholesterol, hypertension, inadequate fruit and vegetable consumption, obesity, and sedentary lifestyle. We also estimated population-attributable risk (PAR). Results: Among respondents, 7.9% reported SCI only, 11.1% reported CVD only, and 3.2% reported both conditions, with differences by age and sex. Adults with SCI only were more likely than adults with CVD only to report other disability, worse access to health care, and poorer quality of life, even though adults with CVD were older. Compared with adults with neither condition, adults with any of the 3 outcomes were more likely to report having each of the 7 risk factors; we found a linear association with an increasing number of risk factors. Five or 6 risk factors contributed to PARs for each of the 3 key outcomes. PARs for SCI only were highest for ever smoking (17.2%) and sedentary lifestyle (12.8%), whereas for CVD only, PARs were highest for hypertension (35.5%) and high cholesterol (22.9%). Conclusion: Despite differences between adults with SCI and adults with CVD in several demographic and health-related measures, the overall similarity in PARs for SCI and CVD suggests potential benefits from using effective CVD interventions to address SCI.

Access to health care and Informal Patient Payments for health care in Serbia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Buch Mejsner ◽  
S Lavasani Kjær ◽  
L Eklund Karlsson
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Health Care Services ◽  
Local Population ◽  
Civil Servants ◽  
Care Providers ◽  
Care Services ◽  
Access To Health

Abstract Background Evidence often shows that migrants in the European region have poor access to quality health care. Having a large number of migrants seeking towards Europe, crossing through i.e. Serbia, it is crucial to improve migrants' access to health care and ensure equality in service provision Aim To investigate what are the barriers and facilitators of access to health care in Serbia, perceived by migrants, policy makers, health care providers, civil servants and experts working with migrants. Methods six migrants in an asylum center and eight civil servants in the field of migration were conducted. A complementary questionnaire to key civil servants working with migrants (N = 19) is being distributed to complement the data. The qualitative and quantitative data will be analysed through Grounded Theory and Logistic Regression respectively. Results According to preliminary findings, migrants reported that they were able to access the health care services quite easily. Migrants were mostly fully aware of their rights to access these health care services. However, the interviewed civil servants experienced that, despite the majority of migrants in camps were treated fairly, some migrants were treated inappropriately by health care professionals (being addressed inappropriately, poor or lacking treatment). The civil servants believed that local Serbs, from their own experiences, were treated poorer than migrants (I.e. paying Informal Patient Payments, poor quality of and access to health care services). The interviewed migrants were trusting towards the health system, because they felt protected by the official system that guaranteed them services. The final results will be presented at the conference. Conclusions There was a difference in quality of and access to health care services of local Serbs and migrants in the region. Migrants may be protected by the official health care system and thus have access to and do not pay additional fees for health care services. Key messages Despite comprehensive evidence on Informal Patient Payments (IPP) in Serbia, further research is needed to highlight how health system governance and prevailing policies affect IPP in migrants. There may be clear differences in quality of and access to health care services between the local population and migrants in Serbia.

scholarly journals Quality of life of Zambian breast cancer women receiving care at the cancer diseases hospital Lusaka

2020 ◽  
Vol 10 (9) ◽  
pp. 57
Author(s):  
Masadza Wezzie ◽  
Siankulu Elaine ◽  
Kawalika Micheal ◽  
Victoria Mwiinga-Kalusopa ◽  
Patricia Katowa-Mukwato
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Sexual Functioning ◽  
Access To Health Care ◽  
Symptom Experience ◽  
Symptom Scale ◽  
Financial Status ◽  
Access To Health ◽  
Cancer Diseases

Background: Breast cancer is the most frequently diagnosed malignancy among women in the world with an estimation of 1.67 million new diagnoses worldwide in 2012 estimated at 25% of all cancers. In Zambia, breast cancer is the second most common cancer affecting women and accounts for 9% of all histologically proven cancers among patients admitted at the country’s only Cancer Diseases Hospital Most of the patients receive multiple treatment modalities; Surgery, Chemotherapy, Radiation Therapy and Hormonal Therapy, each with its own long-term side effects with a potential to affect  the women’s functionality, self-image and sexuality consequently the general quality of life of these women.Methods: A descriptive cross-sectional study design was used to investigate the Quality of Life (QoL) and factors influencing QoL among women with breast cancer receiving care at Zambia’s only Cancer Diseases Hospital. A total of 130 breast cancer patients on treatment who were willing to participate in the study were selected using simple random sampling. Data was collected using the European Organization for Research and Treatment in Cancer Quality of Life Questionnaire (EORTCQLQ–C30) and its breast cancer supplementary measure (QLQ-BR23). The tool assessed QoL across the physical, role, cognitive, emotional, and social functioning and sexual function domains.Results: Overall, just about half (52.5%) of the 130 respondents had high Quality of Life. QoL which was measured by the EORTCQLQ–C30 under the five domains (Physical, role, emotional, cognitive and sexual functioning) was high in four out of the five which scored above the global mean score of 68. Only the emotional functioning domain scored (65) below the mean. Conversely, the symptom scale scored high on all the eight sub items of fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation and diarrhea which signified high symptom experience among respondents. Similarly using the breast cancer supplementary measure (QLQ-BR23), two out of the four functional subscales (body image and sexual functioning) score high than average while sexual enjoyment and future perspectives score low. On the symptom scale, three out of the four scales scored higher than averages, signifying high symptom experience. Demographic characteristics which had significant association with QoL were age (p < .023), level of education (p < .023) and financial status (p < .000). Other factors that had significant association with QoL were type of treatment being received (p < .023), the severity of condition (p < .000), access to health care services (p < .000) and social support (p < .000).Conclusions: A diagnosis of breast cancer and its subsequent treatment affects several facets of a woman’s life ranging from physical, emotional, social and financial aspects consequently affecting the entire QoL. However the QoL varies and is influenced by a number of factors including age at diagnosis of cancer, level of education, financial status, type of treatment received, severity of the condition, access to health care facilities and social support. Therefore any intervention aimed at improving the QoL should be multidimensional.

Healthcare infrastructure development in rural India: a critical analysis of its status and future challenges

2019 ◽  
Vol 25 (12) ◽  
pp. 1-9
Author(s):  
Nenavath Sreenu
Keyword(s):  
Health Care ◽  
Rural Areas ◽  
Access To Health Care ◽  
Health Care Facilities ◽  
Rural India ◽  
Infrastructure Development ◽  
Poor Access ◽  
Access To Health ◽  
Future Challenges

At present, the development of healthcare infrastructure in India is poor and needs fundamental reforms in order to deal with emerging challenges. This study surveys the growth of the healthcare infrastructure. The development of infrastructure and health care facilities, the position of the workforce, and the quality of service delivery are important challenges that are confronting healthcare centres in rural India. This article critically analyses the future challenges of Indian healthcare infrastructure development in rural areas, discussing the burden of disease, widespread financial deficiency, the vaccination policy and poor access to health care as some of the main issues. Life expectancy, literacy and per capita income are further considerations.

scholarly journals What Does the Public Want? Structural Consideration of Citizen Preferences in Health Care Coverage Decisions

2018 ◽  
Vol 3 (2) ◽  
pp. 238146831879962
Author(s):  
Irina Cleemput ◽  
Stephan Devriese ◽  
Laurence Kohn ◽  
Carl Devos ◽  
Janine van Til ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
General Public ◽  
Decision Makers ◽  
Added Value ◽  
Policy Makers ◽  
Health Care Coverage ◽  
Criteria Weights ◽  
Societal Preferences

Background. Multi-criteria decision analysis can improve the legitimacy of health care reimbursement decisions by taking societal preferences into account when weighting decision criteria. This study measures the relative importance of health care coverage criteria according to the Belgian general public and policy makers. Criteria are structured into three domains: therapeutic need, societal need, and new treatments’ added value. Methods. A sample of 4,288 citizens and 161 policy makers performed a discrete choice experiment. Data were analyzed using multinomial logistic regression analysis. Level-independent criteria weights were determined using the log-likelihood method. Results. Both the general public and policy makers gave the highest weight to quality of life in the appraisal of therapeutic need (0.43 and 0.53, respectively). The general public judged life expectancy (0.14) as less important than inconvenience of current treatment (0.43), unlike decision makers (0.32 and 0.15). The general public gave more weight to “impact of a disease on public expenditures” (0.65) than to “prevalence of the disease” (0.56) when appraising societal need, whereas decision makers’ weights were 0.44 and 0.56, respectively. When appraising added value, the general public gave similar weights to “impact on quality of life” and “impact on prevalence” (0.37 and 0.36), whereas decision makers judged “impact on quality of life” (0.39) more important than “impact on prevalence” (0.29). Both gave the lowest weight to impact on life expectancy (0.14 and 0.21). Limitations. Comparisons between the general public and policy makers should be treated with caution because the policy makers’ sample size was small. Conclusion. Societal preferences can be measured and used as decision criteria weights in multi-criteria decision analysis. This cannot replace deliberation but can improve the transparency of health care coverage decision processes.

scholarly journals Mobile Midwesterners: The Impact of Migration on Aging, Health, and Community

2013 ◽  
Vol 34 (1) ◽  
pp. 6-17 ◽  
Author(s):  
Matthew Dalstrom
Keyword(s):  
Quality Of Life ◽  
Health Care ◽  
Access To Health Care ◽  
Family Members ◽  
Seasonal Migration ◽  
Retirement Communities ◽  
Health Seeking ◽  
Health Seeking Behaviors ◽  
The Impact

As the population in the US ages, there is increasing need to study aging and its relationship to quality of life, health, and community. Quality of life is closely correlated with belonging to a community. Unfortunately, as seniors age there is a propensity for them to become increasingly isolated as their mobility decreases and their friends and family members die or move away. As a result, some seniors in the Midwest have begun to migrate to RV parks in the Lower Rio Grande Valley (“LRGV”) in south Texas that function as temporary retirement communities for the winter. While there, they reconnect with friends and family members and engage in a variety of social, civic, and exercise related activities. Further, they participate in a variety of health seeking behaviors such as health screenings, trading medications, and using the Mexican health care system. This article explores these practices and discusses how Winter Texans choose the LRGV, how new members become integrated into RV parks, and how life in the parks impacts health and access to health care services. It also highlights the impact that seasonal migration has on community formation, health seeking behaviors, and the diversity of retirement communities.

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