Effect of the COVID-19 Pandemic on Cost-Related Prescription Nonredemption, Health care Seeking and Hospitalization in Hungary: A Nationally Representative Cross-Sectional Study

Background: Although, negative repercussions of inadequate health service use on the health outcomes has been presumably exacerbated by COVID-19, the impact of the pandemic measures has been not evaluated properly yet. Objective: Our study aimed to quantify the COVID-19 pandemic measures’ effect on the general practitioner (GP) visit, specialist care, hospitalization and cost-related prescription nonredemption (CRPNR) among adults in Hungary, and to identify the social strata susceptible to the pandemic effect. Methods: This community-based cross-sectional study based on nationally representative data of 6,611 (Nprepandemic=5,603 and Npandemic=1,008) subjects aged 18 years and above. Data were obtained from the European Health Interview Survey 2019 (EHIS) and International Social Survey Program 2021 (ISSP) for prepandemic and pandemic, respectively. Multivariable logistic regression models were applied to determine the sociodemographic and clinical factors influencing the health care use by odds ratios (OR) along with the corresponding 95% confidence intervals (CI). To identify the social strata susceptible to pandemic effect, the interaction of the time of data collection with level of education, marital status, and ethnicity, was also tested. Results: While, the CRPNR did not changed, the frequency of GP visit, specialist care and hospitalization rate were remarkably reduced by 22.2%, 26.4%, and 6.7%, respectively, during the pandemic in Hungary. Roma proved to be not specifically affected by the pandemic in any studied respect. The pandemic restructuring of health care impacted the social subgroups evenly with respect to hospital care. However, the pandemic effect was weaker among primary educated adults (ORhigh-school vs primary-education =0.434; 95% CI 0.243-0.776, ORhigh-school vs primary-education =0.598; 95% CI 0.364-0.985), and among widows (ORwidowed vs married =2.284; 95% CI 1.043-4.998, ORwidowed vs married=1.915; 95% CI 1.157-3.168) on the frequency of GP visit and specialist visit; and the prepandemic CRPNR inequality by level of education was increased (ORhigh-school vs primary-education =0.236; 95% CI 0.075-0.743). Conclusion: Primary educated and widowed did not follow the general trend, and their prepandemic limited health care use was not reduced further during pandemic, resulting in an inequality reduction. The vulnerability of primary educated to CRPNR was the only gap widened in the pandemic period. This shows that although the management of pandemic health care use restrictions was implemented by increasing the social inequality in Hungary, the prevention of inequity in drug availability for primary educated individuals could require more support.

The Impacts Of A Free Health Insurance Policy In Vietnam

<p>Social Health Insurance (SHI) is promoted as a policy that tackles the impoverishing effects of catastrophic spending that results from unexpected health shocks. This thesis contributes to the literature on the impact of social health insurance by examining the impact of a policy introduced in Vietnam in 2005. The new policy provided free health insurance for all children under six years. Using a difference-in-difference estimation strategy and eight national household surveys conducted between 2002 and 2016, I examine a variety of direct, indirect, and spill over effects of the policy. The direct effects of the policy are on insurance coverage, health care use, health care expenses, and self-reported morbidity of targeted children. The indirect effects are the persistent effects of the policy on the same set of health outcomes (and education outcomes) beyond the period of exposure to the policy. A third set of impacts cover spill over effects of the policy - on the health and education outcomes of older children living with targeted children, and a variety of household-level outcomes that reflect various dimensions of the wellbeing of household members. The results show that a free health insurance policy for young children has significant impacts on the health outcomes of children while they are covered by the policy and these persist, and also extend to educational outcomes beyond the age of eligibility. The policy also has positive spill over effects on older (untargeted) children living in targeted households, and positive effects on household wage income, and income per capita. On the other hand, the policy has no effects on the standard of living, household health expenditure, caloric consumption, and the likelihood of household spending on catastrophic healthcare.</p>

The Impacts Of A Free Health Insurance Policy In Vietnam

<p>Social Health Insurance (SHI) is promoted as a policy that tackles the impoverishing effects of catastrophic spending that results from unexpected health shocks. This thesis contributes to the literature on the impact of social health insurance by examining the impact of a policy introduced in Vietnam in 2005. The new policy provided free health insurance for all children under six years. Using a difference-in-difference estimation strategy and eight national household surveys conducted between 2002 and 2016, I examine a variety of direct, indirect, and spill over effects of the policy. The direct effects of the policy are on insurance coverage, health care use, health care expenses, and self-reported morbidity of targeted children. The indirect effects are the persistent effects of the policy on the same set of health outcomes (and education outcomes) beyond the period of exposure to the policy. A third set of impacts cover spill over effects of the policy - on the health and education outcomes of older children living with targeted children, and a variety of household-level outcomes that reflect various dimensions of the wellbeing of household members. The results show that a free health insurance policy for young children has significant impacts on the health outcomes of children while they are covered by the policy and these persist, and also extend to educational outcomes beyond the age of eligibility. The policy also has positive spill over effects on older (untargeted) children living in targeted households, and positive effects on household wage income, and income per capita. On the other hand, the policy has no effects on the standard of living, household health expenditure, caloric consumption, and the likelihood of household spending on catastrophic healthcare.</p>

Trends in Health Care Use and Spending for Young Children With Neurologic Impairment

BACKGROUND AND OBJECTIVES: Children with neurologic impairment (NI) are a growing subset of children who frequently use health care. We examined health care use and spending trends across services for children with NI during their first 5 years of life. METHODS: This was a retrospective study of 13 947 children with NI in the multistate IBM Medicaid MarketScan Database (2009–2017). We established birth cohorts of children with NI and analyzed claims from birth to 5 years. NI, identified by using International Classification of Diseases, 9th Revision, diagnosis codes, was defined as ≥1 neurologic diagnosis that was associated with functional and/or intellectual impairment. We measured annual health care use and per-member-per-year spending by inpatient, emergency department (ED), and outpatient services. Population trends in use and spending were assessed with logistic and linear regression, respectively. RESULTS: During their first versus fifth year, 66.8% vs 5.8% of children with NI used inpatient services, and 67.8% vs 44.4% used ED services. Annual use in both categories decreased over 0–5 years (inpatient odds ratio: 0.35, 95% confidence interval: 0.34 to 0.36; ED odds ratio: 0.78, 95% confidence interval: 0.77 to 0.79). The use of outpatient services (primary care, specialty care, home health) decreased gradually. Per-member-per-year spending on inpatient services remained the largest spending category: $83 352 (90.2% of annual spending) in the first year and $1944 (25.5%) in the fifth year. CONCLUSIONS: For children with early-onset NI from 0–5 years, use and spending on inpatient services decreased dramatically; ED and outpatient service use decreased more gradually. These findings may help systems, clinicians, and families optimize care by anticipating and adjusting for shifting use of health care services.

Opportunities to Impact Disability: Trends, Costs, and Evidence-Based Interventions

As healthcare shifts to a focus on social determinants and population health, and older adults increasingly seek to “age in community,” it is vital to understand the functional capabilities and related costs for older adults with disability. This symposium will present data on five major areas related to older adult disability. The 1st presenter will describe recent national disability trends. The 2nd will present Medicare costs by disability, dementia, and community-dwelling status in order to illustrate how these different demographic groups vary in Medicare expenditures over time. This information is critical to policymakers and health systems leaders to plan for these populations. They will then describe a 3rd project, which employs a novel longitudinal modeling approach, Group Based Trajectory Modeling, to identify and describe the distinct trajectories of Emergency Department use after incident disability. This work assesses the heterogeneity in health care use after disability, which may be shaped by available supports. The 4th presentation will describe a combined analysis of the 11 sites that have published data from implementations of the CAPABLE program. This program is a 10 session, home-based interprofessional program that provides an occupational therapist, a nurse, and a handyworker to addresses older adults’ self-identified functional goals by enhancing individual capacity and the home environment. Taken together, these presentations can inform interventions and policies that improve the health and quality of life of older adults with disabilities.

Delivery of Home and Community Based Services During a Pandemic: Unexpected Consequences

The COVID-19 pandemic required AAAs to pause essential services, serving as a catalyst for innovation. We examined such innovations as part of an explanatory mixed-methods, positive deviance study of AAA partnerships with health and social service organizations. We identified 8 AAAs with many partners serving areas with lower levels of health care use, and 3 AAAs with few partners serving areas with higher levels of health care use. We interviewed AAA and partners, (total = 123). Using the constant comparative method, we identified recurrent themes: 1) AAAs adapted to increased demand for services by developing new ways to deliver services, 2) the pandemic raised awareness of unmet needs such as social connection, 3) changes in delivery of services included embracing technology, and 4) AAAs and their partners identified resources to rapidly pivot services. AAAs and partners demonstrated resiliency to not only to sustain programs, but to innovate throughout the pandemic.