Healthcare in a pure gatekeeping system: utilization of primary, mental and emergency care in the prison population over time

Abstract Background This study investigates the prisoner and prison-level factors associated with healthcare utilization (HCU) and the dynamic effects of previous HCU and health events. We analyze administrative data collected on annual adult prisoner-stay HCU (n = 10,136) including physical and mental chronic disease diagnoses, acute health events, penal circumstances and prison-level factors between 2013 and 2017 in 4 prisons of Canton of Vaud, Switzerland. Utilization of four types of health services: primary, nursing, mental and emergency care; are assessed using multivariate and multi-level negative binomial regressions with fixed/random effects and dynamic models conditional on prior HCU and lagged health events. Results In a prison setting with health screening on detention, removal of financial barriers to care and a nurse-led gatekeeping system, we find that health status, socio-demographic characteristics, penal history, and the prison environment are associated with HCU overtime. After controlling for chronic and past acute illnesses, female prisoners have higher HCU, younger adults more emergencies, and prisoners from Africa, Eastern Europe, and the Americas lower HCU. New prisoners, pretrial detainees or repeat offenders utilize more all types of care. Overcrowding increases primary care but reduces utilization of mental and emergency services. Higher expenditure on medical staff resources is associated with more primary care visits and less emergency visits. The dynamics of HCU across types of care shows persistence over time related to emergency use, previous somatic acute illnesses, and acting out events. There is also evidence of substitution between psychiatric and primary care. Conclusions The prison healthcare system provides an opportunity to diagnose and treat unmet health needs for a marginalized population. Access to psychiatric and chronic disease management during incarceration and prevention of emergency or acute events can reduce future demand for care. Prioritization of high-risk patients and continuity of care inside and outside of prisons may reduce public health pressures in the criminal system. The prison environment and prisoners’ penal circumstances impacts healthcare utilization, suggesting better coordination between the criminal justice and prison health systems is required.

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The association between an increased reimbursement cap for chronic disease coverage and healthcare utilization in China: an interrupted time series study

Health Policy and Planning ◽

10.1093/heapol/czaa087 ◽

2020 ◽

Vol 35 (8) ◽

pp. 1029-1038 ◽

Cited By ~ 1

Author(s):

Menghan Shen ◽

Wen He ◽

Eng-Kiong Yeoh ◽

Yushan Wu

Keyword(s):

Time Series ◽

Chronic Disease ◽

Healthcare Utilization ◽

Interrupted Time Series ◽

Claim Data ◽

Health Events ◽

Outpatient Visits ◽

Insurance Claim Data ◽

Adverse Health Events ◽

Series Study

Abstract Hypertension and diabetes are highly prevalent in China and pose significant health and economic burdens, but large gaps in care remain for people with such conditions. In this article, drawing on administrative insurance claim data from China’s Urban Employee Basic Medical Insurance (UEBMI), we use an interrupted time series design to examine whether an increase in the monthly reimbursement cap for outpatient visits using chronic disease coverage affects healthcare utilization. The cap was increased by 50 yuan per chronic disease on 1 January 2016, in one of the largest cities in China. Compared with the year before the increase, patients with only hypertension increased their spending using chronic disease coverage by 17.8 yuan (P < 0.001) or 11.6%, and those with only diabetes increased their spending using chronic disease coverage by 19.5 yuan (P < 0.001) or 10.6%, with the differences almost entirely driven by spending on drugs. In addition, these two groups of patients reduced their spending using standard outpatient coverage by 13.9 yuan (P < 0.001) or 5.7% and 14.9 yuan (P = 0.03) or 5.2%, respectively, and thus had no changes in total outpatient spending. Patients with both hypertension and diabetes, meanwhile, increased their spending using chronic disease coverage by 54.8 yuan (P < 0.001) or 18.1% and decreased their spending using standard outpatient coverage by 16.1 yuan (P = 0.002) or 6.1%, with no changes in their probability of hospitalization. Among patients with both hypertension and diabetes who had fewer-than-average outpatient visits in 2015, the hospitalization rate decreased after the 2016 reimbursement cap increase (adjusted odds ratio = 0.702, P = 0.01). These findings suggest that increasing financial protection for patients with hypertension and diabetes may be an important strategy for reducing adverse health events, such as hospitalization, in China.

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Patient-Physician Relational Continuity and Health System Utilization Among Albertans

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.842 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Tanmay Patil ◽

Rizwan Shahid ◽

Alka Patel ◽

Scott Oddie

Keyword(s):

Primary Care ◽

Emergency Department ◽

Chronic Disease ◽

Health System ◽

Ambulatory Care ◽

Healthcare Utilization ◽

Emergency Department Visits ◽

System Utilization ◽

Relational Continuity ◽

Online Mapping

IntroductionThe Office of the Auditor General report on Chronic Disease Management in 2014 identified that in Alberta there are no processes to identify individuals with chronic diseases who do not have or cannot find a Primary Health Care (PHC) physician, and provide them with ongoing care. Objectives and ApproachLinked provincial administrative data (Practitioner Claims, National Ambulatory Care Reporting System, Discharge Abstract Database, Clinical Risk Groupers) to identify Albertans with chronic disease who do not have any contact or have low relational continuity with primary care physicians, and examine their healthcare utilization (Hospitalizations, Ambulatory Care Sensitive Conditions, 30-day Hospital Readmissions, Emergency Department visits, and Family practice Sensitive conditions). Usual Provider Continuity index was used to measure relational continuity. Used GIS software to combine findings from secondary data analysis and produced an interactive Online Mapping Application. Ongoing spatial and regression analysis will examine relationship between relational continuity and healthcare utilization. ResultsThe majority of individuals in Alberta with no or low primary care visits were men (62.6%), did not have a chronic disease (94.9%), and belonged to the healthy or healthcare non-user status. Albertans were grouped based on patient-physician relational continuity, and it was seen that the likelihood of emergency department visits and 30-day readmissions declined with increase in continuity, however similar results were not seen in case of hospitalizations. To promote utilization of findings an Online Mapping Application was used to present population groups and their characteristics. Univariate and multivariate analysis will be conducted to examine relation between relational continuity and healthcare utilization, especially usage that could be avoided through regular contact with primary care, while controlling for socio-demographic and health related factors. Conclusion/ImplicationsThe results emphasize that the focus should not be on those with no or low number of primary care visits. Strategies focused on linking patients to PHC services and fostering patient-provider relationship are critical to meet the health needs of Albertans and create efficiencies in health system utilization.

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Managing chronic disease in primary care: a review

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1576048326 ◽

2020 ◽

pp. 504-508

Author(s):

Meriam Alabdallah ◽

Abdulmajeed Almalki ◽

Ahmed Alsaedi ◽

Ahmed Abdullah ◽

Faisal Aljuhine ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease

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The Effect of The Primary Care Services on The Intensity of Emergency Care Admissions to Public Hospitals in Turkey: An Ecological Study

Journal of Basic and Clinical Health Sciences ◽

10.30621/jbachs.2018.420 ◽

2018 ◽

Vol 2 (3) ◽

Author(s):

Duran Ada ◽

Belgin Ünal

Keyword(s):

Primary Care ◽

Emergency Care ◽

Ecological Study ◽

Public Hospitals ◽

Care Services ◽

Primary Care Services

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Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

BMC Public Health ◽

10.1186/s12889-021-11280-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ka Chun Chong ◽

Hong Fung ◽

Carrie Ho Kwan Yam ◽

Patsy Yuen Kwan Chau ◽

Tsz Yu Chow ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Public Sector ◽

System Dynamics ◽

The Elderly ◽

Healthcare Services ◽

Dynamics Simulation ◽

Public And Private ◽

The Public ◽

The Impact

Abstract Background The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme. Methods Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources. Results The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period. Conclusions Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.

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Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18062926 ◽

2021 ◽

Vol 18 (6) ◽

pp. 2926

Author(s):

Chuan De Foo ◽

Shilpa Surendran ◽

Geronimo Jimenez ◽

John Pastor Ansah ◽

David Bruce Matchar ◽

...

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Management ◽

Chronic Disease Management ◽

Early Stage ◽

Healthcare Delivery ◽

Stage Of Development ◽

Facilitators And Barriers ◽

Design Options ◽

First Contact

The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN’s face in chronic disease management. The objective of this study is to map features of PCN to Starfield’s “4Cs” framework. The “4Cs” of primary care—comprehensiveness, first contact access, coordination and continuity—offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN’s empowering features that fulfil the “4Cs”. On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the “4Cs”. However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management.

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