Improvement in perinatal care for extremely premature infants in Denmark from 1994 to 2011

DEFF Research Database (Denmark)

Hasselager, Asbjørn Børch; Børch, Klaus; Pryds, Ole Axel

2016-01-01

INTRODUCTION: Major advances in perinatal care over the latest decades have increased the survival rate of extremely premature infants. Centralisation of perinatal care was implemented in Denmark from 1995. This study evaluates the effect of organisational changes of perinatal care on survival......PVL) and intraventricular haemorrhage grade 3-4 (IVH 3-4). RESULTS: A total of 184, 83 and 127 infants were included from the cohorts. Delivery rates at level 3 Neonatal Intensive Care Unit (NICU) hospitals increased from 69% to 87%. Transfer rates to level 3 NICU almost doubled during the period. Survival rates were...

End-of-life decisions in perinatal care. A view from health-care providers

Directory of Open Access Journals (Sweden)

Patricia Grether

2015-11-01

Full Text Available Objective. To examine the opinions of a perinatal health team regarding decisions related to late termination of pregnancy and severely ill newborns. Materials and Methods. An anonymous questionnaire was administered to physicians, social workers, and nurses in perinatal care. Differences were evaluated using the chi square and Student’s t tests. Results. When considering severely ill fetuses and newborns, 82% and 93% of participants, respectively, opted for providing palliative care, whereas 18% considered feticide as an alter- native. Those who opted for palliative care aimed to diminish suffering and those who opted for intensive care intended to protect life or sanctity of life. There was poor knowledge about the laws that regulate these decisions. Conclusions. Although there is no consensus on what decisions should be taken with severely ill fetuses or neonates, most participants considered palliative care as the first option, but feticide or induced neonatal death was not ruled out.

Trends in health care expenditure among US adults with heart failure: The Medical Expenditure Panel Survey 2002-2011.

Science.gov (United States)

Echouffo-Tcheugui, Justin B; Bishu, Kinfe G; Fonarow, Gregg C; Egede, Leonard E

2017-04-01

Population-based national data on the trends in expenditures related to heart failure (HF) are scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition. Using 10-year data (2002-2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194US adults aged ≥18years) and a 2-part model (adjusting for demographics, comorbidities, and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency department, inpatient hospital, pharmacy, home health care, and other medical expenditures). Compared with expenditures for individuals without HF ($5511 [95% CI 5405-5617]), individuals with HF had a 4-fold higher mean expenditures of ($23,854 [95% CI 21,733-25,975]). Individuals with HF had $3446 (95% CI 2592-4299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95% CI 18,359-24,272) in 2002/2003 to $27,152 (95% CI 20,066-34,237) in 2010/2011, and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/y and the adjusted total incremental expenditure was $5.8 billion/y. Heart failure is costly and over a recent 10-year period, and direct expenditure related to HF increased markedly, mainly driven by inpatient costs. Copyright © 2017 Elsevier Inc. All rights reserved.

Estimates of state-level health-care expenditures associated with disability.

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Anderson, Wayne L; Armour, Brian S; Finkelstein, Eric A; Wiener, Joshua M

2010-01-01

We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002-2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. The DAHE for all U.S. adults totaled $397.8 billion in 2006, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total, the DAHE were $118.9 billion for the Medicare population, $161.1 billion for Medicaid recipients, and $117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.

Substandard factors in perinatal care in The Netherlands : a regional audit of perinatal deaths

NARCIS (Netherlands)

Wolleswinkel-van den Bosch, JH; Vredevoogd, CB; Borkent-Polet, M; van Eyck, J; Fetter, WPF; Lagro-Janssen, TLM; Rosink, IH; Treffers, PE; Amelink, M; Richardus, JH; Verloove-Vanhorick, P; Mackenbach, JP

Background. To determine: 1) whether substandard factors were present in cases of perinatal death, and to what extent another course of action might have resulted in a better outcome, and 2) whether there were differences in the frequency of substandard factors by level of care, particularly between

Health Care Expenditure of Rural Households in Pondicherry, India

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Poornima Varadarajan

2013-11-01

Full Text Available Background: Shortcomings in healthcare delivery has led people to spend a substantial proportion of their incomes on medical treatment. World Health Organization (2005 estimates reveal that every year 25 million households are forced into poverty by illness and the struggle to pay for healthcare. Thus we planned to calculate the health care expenditure of rural households and to assess the households incurring catastrophic health expenditure. Methods: A cross-sectional study was conducted in the service area of Sri Manakula Vinayagar Medical College and Hospital from May to August 2011. A total of 100 households from the 4 adjoining villages of our Institute were selected for operational and logistic feasibility. The household’s capacity to pay, out of pocket expenditure and catastrophic health expenditure were calculated. Data collection was done using a pretested questionnaire by the principal investigator and the analysis was done using SPSS (version 16. Results: The average income in the highest income quintile was Rs 51,885 but the quintile ratio was 14.98. The median subsistence expenditure was Rs 4,520. About 18% of households got impoverished paying for health care. About 81% of households were incurring out of pocket expenditure and 66% were facing catastrophic health expenses of 40%.Conclusion There was very high out of pocket spending and a high prevalence of catastrophic expenditure noted. Providing quality care at affordable cost and appropriate risk pooling mechanism are warranted to protect households from such economic threats.

Comparison of Perinatal Outcome of Preterm Births Starting in Primary Care versus Secondary Care in Netherlands: A Retrospective Analysis of Nationwide Collected Data

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A. J. van der Ven

2014-01-01

Full Text Available Introduction. In Netherlands, the obstetric care system is divided into primary and secondary care by risk level of the pregnancy. We assessed the incidence of preterm birth according to level of care and the association between level of care at time of labor onset and delivery and adverse perinatal outcome. Methods. Singleton pregnancies recorded in Netherlands Perinatal Registry between 1999 and 2007, with spontaneous birth between 25+0 and 36+6 weeks, were included. Three groups were compared: (1 labor onset and delivery in primary care; (2 labor onset in primary care and delivery in secondary care; (3 labor onset and delivery in secondary care. Multivariable logistic regression analyses were performed to calculate the risk of perinatal mortality and Apgar score ≤4. Results. Of all preterm deliveries, 42% had labor onset and 7.9% had also delivery in primary care. Women with labor onset between 34+0 and 36+6 weeks who were referred before delivery to secondary care had the lowest risk of perinatal mortality (aOR 0.49 (0.30–0.79. Risk of perinatal mortality (aOR 1.65; 95% CI 1.20–2.27 and low Apgar score (aOR 1.95; 95% CI 1.53–2.48 were significantly increased in preterm home delivery. Conclusion. Referral before delivery is associated with improved perinatal outcome in the occurrence of preterm labor onset in primary care.

Perinatal mortality disparities between public care and private obstetrician-led care: a propensity score analysis.

Science.gov (United States)

Adams, N; Tudehope, D; Gibbons, K S; Flenady, V

2018-01-01

To examine whether disparities in stillbirth, and neonatal and perinatal mortality rates, between public and private hospitals are the result of differences in population characteristics and/or clinical practices. Retrospective cohort study. A metropolitan tertiary centre encompassing public and private hospitals. Women accessed care from either a private obstetrician or from public models of care - predominantly midwife-led care or care shared between midwives, general practitioners, and obstetricians. A total of 131 436 births during 1998-2013: 69 037 public and 62 399 private. Propensity score matching was used to select equal-sized public and private cohorts with similar characteristics. Logistic regression analysis was then used to explore the impact of public-private differences in the use of assisted reproductive technologies, plurality, major congenital anomalies, birth method, and gestational age. Stillbirth, and neonatal and perinatal mortality rates. After controlling for maternal and pregnancy factors, perinatal mortality rates were higher in the public than in the private cohort (adjusted odds ratio, aOR 1.53; 95% confidence interval, 95% CI 1.29-1.80; stillbirth aOR 1.56, 95% CI 1.26-1.94; neonatal death aOR 1.48, 95% CI 1.15-1.89). These disparities reduced by 15.7, 20.5, and 19.6%, respectively, after adjusting for major congenital anomalies, birth method, and gestational age. Perinatal mortality occurred more often among public than private births, and this disparity was not explained by population differences. Differences in clinical practices seem to be partly responsible. The impact of differences in clinical practices on maternal and neonatal morbidity was not examined. Further research is required. Private obstetrician-led care: more obstetric intervention and earlier births reduce perinatal mortality. Background Babies born in Australian public hospitals tend to die more often than those born in private hospitals. Our aim was to determine

Obesity and people with disabilities: the implications for health care expenditures.

Science.gov (United States)

Anderson, Wayne L; Wiener, Joshua M; Khatutsky, Galina; Armour, Brian S

2013-12-01

This study estimates additional average health care expenditures for overweight and obesity for adults with disabilities vs. without. Descriptive and multivariate methods were used to estimate additional health expenditures by service type, age group, and payer using 2004-2007 Medical Expenditure Panel Survey data. In 2007, 37% of community-dwelling Americans with disabilities were obese vs. 27% of the total population. People with disabilities had almost three times ($2,459) the additional average obesity cost of people without disabilities ($889). Prescription drug expenditures for obese people with disabilities were three times as high and outpatient expenditures were 74% higher. People with disabilities in the 45- to 64-year age group had the highest obesity expenditures. Medicare had the highest additional average obesity expenditures among payers. Among people with prescription drug expenditures, obese people with disabilities had nine times the prevalence of diabetes as normal weight people with disabilities. Overweight people with and without disabilities had lower expenditures than normal-weight people with and without disabilities. Obesity results in substantial additional health care expenditures for people with disabilities. These additional expenditures pose a serious current and future problem, given the potential for higher obesity prevalence in the coming decade. Copyright © 2013 The Obesity Society.

Trends in Health Care Expenditure among U.S. Adults with Heart Failure - The Medical Expenditure Panel Survey 2002–2011

Science.gov (United States)

Echouffo-Tcheugui, Justin B.; Bishu, Kinfe G.; Fonarow, Gregg C; Egede, Leonard E.

2017-01-01

Background Population-based national data on the trends in expenditures related to heart failure (HF) is scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition. Methods Using 10-year data (2002–2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194 U.S adults aged ≥18 years) and a two-part model (adjusting for demographics, comorbidities and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures). Results Compared to expenditures for individuals without HF ($5,511 [95% confidence interval (CI): 5,405–5,617]), individuals with HF had a four-fold higher mean expenditures of ($23,854 [95%CI: 21,733–25,975]). Individuals with HF had $3,446 (95%CI: 2,592–4,299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95%CI: 18,359–24,272) in 2002/2003 to $27,152 (95%CI: 20,066–34,237) in 2010/2011; and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/year and the adjusted total incremental expenditure $5.8 billion/year. Conclusions Heart failure is costly and over a recent 10-year period, direct expenditure related to HF increased markedly, mainly driven by inpatient costs. PMID:28454834

Household expenditure for dental care in low and middle income countries.

Directory of Open Access Journals (Sweden)

Mohd Masood

Full Text Available This study assessed the extent of household catastrophic expenditure in dental health care and its possible determinants in 41 low and middle income countries. Data from 182,007 respondents aged 18 years and over (69,315 in 18 low income countries, 59,645 in 15 lower middle income countries and 53,047 in 8 upper middle income countries who participated in the WHO World Health Survey (WHS were analyzed. Expenditure in dental health care was defined as catastrophic if it was equal to or higher than 40% of the household capacity to pay. A number of individual and country-level factors were assessed as potential determinants of catastrophic dental health expenditure (CDHE in multilevel logistic regression with individuals nested within countries. Up to 7% of households in low and middle income countries faced CDHE in the last 4 weeks. This proportion rose up to 35% among households that incurred some dental health expenditure within the same period. The multilevel model showed that wealthier, urban and larger households and more economically developed countries had higher odds of facing CDHE. The results of this study show that payments for dental health care can be a considerable burden on households, to the extent of preventing expenditure on basic necessities. They also help characterize households more likely to incur catastrophic expenditure on dental health care. Alternative health care financing strategies and policies targeted to improve fairness in financial contribution are urgently required in low and middle income countries.

Effect of the maternal care manual from the perinatal education ...

African Journals Online (AJOL)

Objectives. To assess changes in the quality of antenatal and intrapartum care rendered by midwives following intervention with the Maternal Care Manual from the Perinatal Education Programme (PEP). Design. A prospective controlled study. Setting. A study town and two control towns in the Eastern Cape. Subjects.

Using quantile regression to examine health care expenditures during the Great Recession.

Science.gov (United States)

Chen, Jie; Vargas-Bustamante, Arturo; Mortensen, Karoline; Thomas, Stephen B

2014-04-01

To examine the association between the Great Recession of 2007-2009 and health care expenditures along the health care spending distribution, with a focus on racial/ethnic disparities. Secondary data analyses of the Medical Expenditure Panel Survey (2005-2006 and 2008-2009). Quantile multivariate regressions are employed to measure the different associations between the economic recession of 2007-2009 and health care spending. Race/ethnicity and interaction terms between race/ethnicity and a recession indicator are controlled to examine whether minorities encountered disproportionately lower health spending during the economic recession. The Great Recession was significantly associated with reductions in health care expenditures at the 10th-50th percentiles of the distribution, but not at the 75th-90th percentiles. Racial and ethnic disparities were more substantial at the lower end of the health expenditure distribution; however, on average the reduction in expenditures was similar for all race/ethnic groups. The Great Recession was also positively associated with spending on emergency department visits. This study shows that the relationship between the Great Recession and health care spending varied along the health expenditure distribution. More variability was observed in the lower end of the health spending distribution compared to the higher end. © Health Research and Educational Trust.

Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.

Science.gov (United States)

Miller, Margaret; Hearn, Lydia; van der Pligt, Paige; Wilcox, Jane; Campbell, Karen J

2014-01-01

Almost half of Australian women of child-bearing age are overweight or obese, with a rate of 30-50% reported in early pregnancy. Maternal adiposity is a costly challenge for Australian obstetric care, with associated serious maternal and neonatal complications. Excess gestational weight gain is an important predictor of offspring adiposity into adulthood and higher maternal weight later in life. Current public health and perinatal care approaches in Australia do not adequately address excess perinatal maternal weight or gestational weight gain. This paper argues that the failure of primary health-care providers to offer systematic advice and support regarding women's weight and related lifestyle behaviours in child-bearing years is an outstanding 'missed opportunity' for prevention of inter-generational overweight and obesity. Barriers to action could be addressed through greater attention to: clinical guidelines for maternal weight management for the perinatal period, training and support of maternal health-care providers to develop skills and confidence in raising weight issues with women, a variety of weight management programs provided by state maternal health services, and clear referral pathways to them. Attention is also required to service systems that clearly define roles in maternal weight management and ensure consistency and continuity of support across the perinatal period.

Chronic condition combinations and health care expenditures and out-of-pocket spending burden among adults, Medical Expenditure Panel Survey, 2009 and 2011.

Science.gov (United States)

Meraya, Abdulkarim M; Raval, Amit D; Sambamoorthi, Usha

2015-01-29

Little is known about how combinations of chronic conditions in adults affect total health care expenditures. Our objective was to estimate the annual average total expenditures and out-of-pocket spending burden among US adults by combinations of conditions. We conducted a cross-sectional study using 2009 and 2011 data from the Medical Expenditure Panel Survey. The sample consisted of 9,296 adults aged 21 years or older with at least 2 of the following 4 highly prevalent chronic conditions: arthritis, diabetes mellitus, heart disease, and hypertension. Unadjusted and adjusted regression techniques were used to examine the association between chronic condition combinations and log-transformed total expenditures. Logistic regressions were used to analyze the relationship between chronic condition combinations and high out-of-pocket spending burden. Among adults with chronic conditions, adults with all 4 conditions had the highest average total expenditures ($20,016), whereas adults with diabetes/hypertension had the lowest annual total expenditures ($7,116). In adjusted models, adults with diabetes/hypertension and hypertension/arthritis had lower health care expenditures than adults with diabetes/heart disease (P expenditures compared with those with diabetes and heart disease. However, the difference was only marginally significant (P = .04). Among adults with arthritis, diabetes, heart disease, and hypertension, total health care expenditures differed by type of chronic condition combinations. For individuals with multiple chronic conditions, such as heart disease and diabetes, new models of care management are needed to reduce the cost burden on the payers.

The SATELLITE Sexual Violence Assessment and Care Guide for Perinatal Patients

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Ross, Ratchneewan; Roller, Cyndi; Rusk, Tom; Martsolf, Donna; Draucker, Claire

2011-01-01

Sexual violence (SV) is a prevalent public health problem affecting millions of women across the lifespan. Poor pregnancy outcomes have been shown to be related to SV experiences; therefore, the perinatal period is an important time for healthcare practitioners (HCPs) to intervene. Various healthcare organizations suggest or even mandate screening for SV. Although SV screening tools are available, many practitioners do not routinely screen their patients. Barriers to screening include lack of comfort with or knowledge about how to screen and intervene, and reluctance on the part of the patient to disclose information. The SATELLITE Sexual Violence Assessment and Care Guide for Patients in the Perinatal Period was designed to overcome these barriers. The guide leads practitioners through the process of setting the context for screening, the screening itself, and the interventions after a positive screen finding, including specific questions to be asked and statements to be made by the practitioner in providing care for an SV survivor. By using this guide, nurse practitioners can increase their feelings of comfort and confidence as they assess and care for SV survivors during the perinatal period. PMID:22506255

Washington state foster care: dental utilization and expenditures.

Science.gov (United States)

Melbye, Molly L R; Chi, Donald L; Milgrom, Peter; Huebner, Colleen E; Grembowski, David

2014-01-01

To identify factors associated with dental utilization and expenditures for children enrolled in Washington State (WA) foster care (FC). This cross-sectional study used 2008 Medicaid enrollment and claims files for children ages WA FC program for ≥11 months (N = 10,177). Regression models were used to examine associations between utilization and expenditures and sex, race, age group, Supplemental Security Income (SSI) (i.e., disability), substance abuse, behavior problems, placement setting (Foster Home Care, Kinship Care, Group Care, Other), and urbanicity. Only 43 percent of the children utilized any dental care; the adjusted mean expenditure was $198.35 [95% confidence interval (CI) $181.35, $215.36]. Fewer utilized diagnostic (41 percent), preventive (39 percent), restorative (11 percent), or complex (5 percent) services. Associated with utilization (P ≤ 0.01) were: female [ARR = 1.05, 95% CI(1.01, 1.10)]; 0-2 years [ARR = 0.18, 95% CI(0.15, 0.21)], [3-5 years ARR = 0.78, 95% CI(0.74, 0.83)]; Native American [ARR = 0.85, 95% CI(0.80, 0.91)]; SSI [ARR = 1.10, 95% CI(1.04, 1.17)]; Kinship Care [ARR = 0.94, 95% CI(0.90, 0.98)]; Group Care [ARR = 1.25 95% CI(1.15, 1.37)]; and urban/rural urbanicity with population WA FC for ≥11 months during 2008 did not receive dental care. Research is needed to determine the level of unmet need among children in FC and interventions to improve access to oral health of the children. Enforcement of existing federal legislation is needed. © 2013 American Association of Public Health Dentistry.

Clinical and scientific results in perinatal care of pregnancy complicated by insulin dependent diabetes mellitus in Croatia.

Science.gov (United States)

Djelmis, J

1998-01-01

At the Department of Obstetrics and Gynecology, Perinatal Unit for Diabetes and Fetal Growth, School of Medicine, Zagreb, perinatal care of pregnancies complicated with insulin dependent diabetes melitus (IDDM), has been performed for more than 36 years. The intention of this review is to show our own results in the management of IDDM pregnancies and the latest clinical advances in perinatal care of such pregnancies. Pregnancy complicated with IDDM is at risk because of numerous maternal, fetal and neonatal complications. Recent advances in medicine, especially in diabetology and perinatology, helps clinician avoid or lessen antenatal or perinatal complications in IDDM pregnancies. The main result of improved perinatal care is that today fetal and neonatal mortality in IDDM pregnancy is almost equal to that of healthy pregnant population. Intensive preconceptual care and optimal regulation of IDDM have resulted not only in decreased perinatal mortality but also in a decreased rate of congenital malformation. Tight glycemia control during pregnancy has a beneficial effect on fetal growth. Intensive control of fetal growth, verification of lung maturation at term by amniocenthesis, and control of fetal oxygenation will result in delivery of a mature eutrophic newborn with the lowest rate of neonatal complications possible. Perinatal mortality of less than 2% in IDDM pregnancy can be obtained by planned delivery between 38 and 39 weeks of gestation by either vaginal route or cesarean section, depending on indications. After delivery, intensive care of the newborn is necessary.

eHealth as the Next-Generation Perinatal Care: An Overview of the Literature.

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van den Heuvel, Josephus Fm; Groenhof, T Katrien; Veerbeek, Jan Hw; van Solinge, Wouter W; Lely, A Titia; Franx, Arie; Bekker, Mireille N

2018-06-05

Unrestricted by time and place, electronic health (eHealth) provides solutions for patient empowerment and value-based health care. Women in the reproductive age are particularly frequent users of internet, social media, and smartphone apps. Therefore, the pregnant patient seems to be a prime candidate for eHealth-supported health care with telemedicine for fetal and maternal conditions. This study aims to review the current literature on eHealth developments in pregnancy to assess this new generation of perinatal care. We conducted a systematic literature search of studies on eHealth technology in perinatal care in PubMed and EMBASE in June 2017. Studies reporting the use of eHealth during prenatal, perinatal, and postnatal care were included. Given the heterogeneity in study methods, used technologies, and outcome measurements, results were analyzed and presented in a narrative overview of the literature. The literature search provided 71 studies of interest. These studies were categorized in 6 domains: information and eHealth use, lifestyle (gestational weight gain, exercise, and smoking cessation), gestational diabetes, mental health, low- and middle-income countries, and telemonitoring and teleconsulting. Most studies in gestational diabetes and mental health show that eHealth applications are good alternatives to standard practice. Examples are interactive blood glucose management with remote care using smartphones, telephone screening for postnatal depression, and Web-based cognitive behavioral therapy. Apps and exercise programs show a direction toward less gestational weight gain, increase in step count, and increase in smoking abstinence. Multiple studies describe novel systems to enable home fetal monitoring with cardiotocography and uterine activity. However, only few studies assess outcomes in terms of fetal monitoring safety and efficacy in high-risk pregnancy. Patients and clinicians report good overall satisfaction with new strategies that enable

Trends in the distribution of South African health care expenditure

African Journals Online (AJOL)

1990-08-04

Aug 4, 1990 ... This paper considers the distribution of health expenditure between the public ... An understanding of past health care expenditure patterns is a prerequisite to any .... of this total and local government for 8% in the same year.

Approaches to health-care provider education and professional development in perinatal depression: a systematic review.

Science.gov (United States)

Legere, Laura E; Wallace, Katherine; Bowen, Angela; McQueen, Karen; Montgomery, Phyllis; Evans, Marilyn

2017-07-24

Perinatal depression is the most common mental illness experienced by pregnant and postpartum women, yet it is often under-detected and under-treated. Some researchers suggest this may be partly influenced by a lack of education and professional development on perinatal depression among health-care providers, which can negatively affect care and contribute to stigmatization of women experiencing altered mood. Therefore, the aim of this systematic review is to provide a synthesis of educational and professional development needs and strategies for health-care providers in perinatal depression. A systematic search of the literature was conducted in seven academic health databases using selected keywords. The search was limited to primary studies and reviews published in English between January 2006 and May/June 2015, with a focus on perinatal depression education and professional development for health-care providers. Studies were screened for inclusion by two reviewers and tie-broken by a third. Studies that met inclusion criteria were quality appraised and data extracted. Results from the studies are reported through narrative synthesis. Two thousand one hundred five studies were returned from the search, with 1790 remaining after duplicate removal. Ultimately, 12 studies of moderate and weak quality met inclusion criteria. The studies encompassed quantitative (n = 11) and qualitative (n = 1) designs, none of which were reviews, and addressed educational needs identified by health-care providers (n = 5) and strategies for professional development in perinatal mental health (n = 7). Consistently, providers identified a lack of formal education in perinatal mental health and the need for further professional development. Although the professional development interventions were diverse, the majority focused on promoting identification of perinatal depression and demonstrated modest effectiveness in improving various outcomes. This systematic review reveals a

A STUDY OF PERINATAL OUTCOME IN TWIN GESTATION IN A TERTIARY CARE CENTER

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Rinku Girija

2017-02-01

Full Text Available BACKGROUND Perinatal mortality is an index of obstetric care. Twin pregnancy is a high-risk pregnancy since most often the foetus in born prematurely or retarded physically; it may turn out to be a dreaded event, especially in rare instances of simultaneous death of twins or death of one twin in mid trimester thereby worsening the prognosis of the surviving twin. The aim of the study is to study the perinatal mortality and morbidity of twin gestation and factors affecting the same in a tertiary care center. MATERIALS AND METHODS This is a prospective study. 100 successive cases of multiple pregnancy beyond 28 weeks of gestation admitted during the study period were followed from the antenatal period upon their admission to the antenatal ward and the labour room. 100 cases of singleton pregnancies during the same period taken as control. Detailed obstetric history, family history of twins, intake of ovulation inducing agents, time of diagnosis of twin pregnancy confirmed by USS examination were noted. Maternal antenatal complications like anaemia, hypertension, jaundice, etc. noted. The mode of onset of labour, presentation of foetus noted and if possible confirmed by USS, routine and special investigation like PIH profile, FBS, PPBS. Doppler USS done wherever necessary. Study Setting and Design- It is a prospective observational study of 100 consecutive twin gestations of gestational age 28 weeks and above at a tertiary care hospital attached to Government Medical College, Thiruvananthapuram, for a period of 6 months. Perinatal outcome including perinatal morbidity and mortality in relation to gestational age, mode of delivery, chorionicity, birth weight of the baby and NICU admission were analysed. RESULTS Data collected was analysed with descriptive statistics like percentage, proportion, rates, ratio and chi-square test. CONCLUSION In spite of so many advances in Obstetrics and Neonatology, the perinatal mortality and morbidity in twin

Perinatal outcomes of low-risk planned home and hospital births under midwife-led care in Japan.

Science.gov (United States)

Hiraizumi, Yoshie; Suzuki, Shunji

2013-11-01

It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan. A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively. Perinatal outcomes included length of labor of 24 h or more, augmentation of labor pains, delivery mode, severe perineal laceration, postpartum hemorrhage of 1000 mL or more, maternal fever of 38°C or more and neonatal asphyxia (Apgar score, home delivery (34 vs 21%, P = 0.011). There were no significant differences in the incidence of adverse perinatal outcomes between women with obstetric shared care and women with primary midwife-led care (regardless of being hospital delivery or home delivery). Approximately one-quarter of low-risk women with primary midwife-led care required obstetric care during labor or postpartum. However, primary midwife-led care during labor at home and hospital for low-risk pregnant women was not associated with adverse perinatal outcomes in Japan. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

Dental care needs, use and expenditures among U.S. children with and without special health care needs.

Science.gov (United States)

Iida, Hiroko; Lewis, Charlotte; Zhou, Chuan; Novak, Louise; Grembowski, David

2010-01-01

Controversy exists in the literature about whether dental care needs, use and expenditures differ between children with and without special health care needs (SHCN). The authors used data from the 2005 Medical Expenditure Panel Survey (MEPS) for children younger than 18 years. The MEPS questionnaire included the Children with Special Health Care Needs Screener, which defines a child as having SHCN if he or she meets at least one of five specific criteria. Using bivariate and multivariable regression analyses, the authors evaluated the effect of SHCN on unmet dental care needs, type of dental care received and average dental care expenditures. Children with special health care needs (CSHCN) had an adjusted odds ratio (AOR) of 1.49 (95 percent confidence interval [CI] = 1.09-2.05) of having unmet dental care needs compared with children without SHCN, and CSHCN who met four or five screener criteria had an AOR of 2.2 (95 percent CI = 1.16-4.20). CSHCN used more dental care services and were more likely to receive only nonpreventive care. Average dental care expenditures were not statistically different between CSHCN and children without SHCN, and there was variability among CSHCN in unmet dental care needs and use. Unmet dental care needs are associated independently with SHCN status and complexity (based on the number of screener criteria the child met). The CSHCN populations in MEPS varied in their ability to obtain and use needed dental care services. Practice Implications. It is important to consider the diversity of CSHCN when developing systems of dental care for this population.

Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs.

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Nakku, Juliet E M; Okello, Elialilia S; Kizza, Dorothy; Honikman, Simone; Ssebunnya, Joshua; Ndyanabangi, Sheila; Hanlon, Charlotte; Kigozi, Fred

2016-07-22

Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda. Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach. Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training. This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.

Poor perinatal care practices in urban slums: Possible role of social mobilization networks

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Khan Zulfia

2009-01-01

Full Text Available Background: Making perinatal care accessible to women in marginalized periurban areas poses a public health problem. Many women do not utilize institutional care in spite of physical accessibility. Home-based care by traditional birth attendants (TBA is hazardous. Inappropriate early neonatal feeding practices are common. Many barriers to perinatal care can be overcome by social mobilization and capacity building at the community level. Objectives: To determine the existing perinatal practices in an urban slum and to identify barriers to utilization of health services by mothers. Study Design: This is a cross-sectional descriptive study. Setting and Participants: The high-risk periurban areas of Nabi Nagar, Aligarh has a population of 40,000 living in 5,480 households. Mothers delivering babies in September 2007 were identified from records of social mobilization workers (Community Mobilization Coordinators or CMCs already working in an NGO in the area. A total of 92 mothers were interviewed at home. Current perinatal practices and reasons for utilizing or not utilizing health services were the topics of inquiry. Statistical Analysis: Data was tabulated and analyzed using SPSS 12. Results: Analyses revealed that 80.4% of mothers had received antenatal care. However, this did not translate into safe delivery practices as more than 60% of the women had home deliveries conducted by traditional untrained or trained birth attendants. Reasons for preferring home deliveries were mostly tradition (41.9% or related to economics (30.7%. A total of 56% of the deliveries were conducted in the squatting position and in 25% of the cases, the umbilical cord was cut using the edge of a broken cup. Although breast-feeding was universal, inappropriate early neonatal feeding practices were common. Prelacteal feeds were given to nearly 50% of the babies and feeding was delayed beyond 24 hours in 8% of the cases. Several mothers had breastfeeding problems

Utilizing leadership to achieve high reliability in the delivery of perinatal care

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Parrotta C

2012-11-01

Full Text Available Carmen Parrotta,1 William Riley,1 Les Meredith21School of Public Health, University of Minnesota, Minneapolis, MN, 2Premier Insurance Management Services Inc, Charlotte, NC, USAAbstract: Highly reliable care requires standardization of clinical practices and is a prerequisite for patient safety. However, standardization in complex hospital settings is extremely difficult to attain and health care leaders are challenged to create care delivery processes that ensure patient safety. Moreover, once high reliability is achieved in a hospital unit, it must be maintained to avoid process deterioration. This case study examines an intervention to implement care bundles (a collection of evidence-based practices in four hospitals to achieve standardized care in perinatal units. The results show different patterns in the rate and magnitude of change within the hospitals to achieve high reliability. The study is part of a larger nationwide study of 16 hospitals to improve perinatal safety. Based on the findings, we discuss the role of leadership for implementing and sustaining high reliability to ensure freedom from unintended injury.Keywords: care bundles, evidence-based practice, standardized care, process improvement

Out-of-pocket expenditure on maternity care for hospital births in Uttar Pradesh, India.

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Goli, Srinivas; Rammohan, Anu; Moradhvaj

2018-02-27

The studies measured Out-of-Pocket Expenditure (OOPE) for hospital births previously suffer from serious data limitations. To overcome such limitations, we designed a hospital-based study for measuring the levels and factors of OOPE on maternity care for hospital births by its detailed components. Data were collected from women for non-complicated deliveries 24-h before the survey and complicated deliveries 48-h prior to the survey at the hospital settings in Uttar Pradesh, India during 2014. The simple random sampling design was used in the selection of respondents. Bivariate analyses were used to estimate mean expenditure on Antenatal care services (ANCs), Delivery care and Total Maternity Expenditure (TME). Multivariate linear regression was employed to examine the factor associated with the absolute and relative share of expenditure in couple's annual income on ANCs, delivery care, and TME. The findings show that average expenditure on maternal health care is high ($155) in the study population. Findings suggest that factors such as income, place, and number of ANCs, type, and place of institutional delivery are significantly associated with both absolute and relative expenditure on maternity care. The likelihood of incidence of catastrophic expenditure on maternity care is significantly higher for women delivered in private hospitals (β = 2.427, p maternity care for hospital births reported in this study is much higher as it was collected with a better methodology, although with smaller sample size. Therefore, ongoing maternity benefit scheme in India in general and Uttar Pradesh in particular need to consider the levels of OOPE on maternity care and demand-side and supply-side factors determining it for a more effective policy to reduce the catastrophic burden on households and help women to achieve better maternity health outcomes in poor regional settings like Uttar Pradesh in India.

Oocyte Donation Pregnancies- Non-Disclosure of Oocyte Recipient Status to Obstetric Care Providers and Perinatal Outcomes.

LENUS (Irish Health Repository)

2017-11-01

Oocyte donation pregnancies- non-disclosure of oocyte recipient (OR) status to obstetric care providers and perinatal outcomes.Many studies report a higher rate of pregnancy-induced hypertension (PIH) and severe pre-eclampsia (PET) in OR pregnancies. The objective is to determine the rates of non-disclosure of OR pregnancy to obstetric care providers and also the rates of perinatal complications.

What drives health care expenditure?--Baumol's model of 'unbalanced growth' revisited.

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Hartwig, Jochen

2008-05-01

The share of health care expenditure in GDP rises rapidly in virtually all OECD countries, causing increasing concern among politicians and the general public. Yet, economists have to date failed to reach an agreement on what the main determinants of this development are. This paper revisits Baumol's [Baumol, W.J., 1967. Macroeconomics of unbalanced growth: the anatomy of urban crisis. American Economic Review 57 (3), 415-426] model of 'unbalanced growth', showing that the latter offers a ready explanation for the observed inexorable rise in health care expenditure. The main implication of Baumol's model in this context is that health care expenditure is driven by wage increases in excess of productivity growth. This hypothesis is tested empirically using data from a panel of 19 OECD countries. Our tests yield robust evidence in favor of Baumol's theory.

Health care utilization in the elderly Mexican population: Expenditures and determinants

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García-Peña Carmen

2011-03-01

Full Text Available Abstract Background Worldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social or because of the increase that comes with older age (individual. Objective To analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly. Methods A secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT, 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age. Results Higher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were $240.6 am dlls, whereas in households exclusively with elderly the expenditure was $308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization. Conclusions The conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age

Health care utilization in the elderly Mexican population: expenditures and determinants.

Science.gov (United States)

González-González, César; Sánchez-García, Sergio; Juárez-Cedillo, Teresa; Rosas-Carrasco, Oscar; Gutiérrez-Robledo, Luis M; García-Peña, Carmen

2011-03-29

Worldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social) or because of the increase that comes with older age (individual). To analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly. A secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT), 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age. Higher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were $240.6 am dlls, whereas in households exclusively with elderly the expenditure was $308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization. The conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age. The projected increase in hospitalization and health care needs for this

Health care expenditure in the Islamic Republic of Iran versus other high spending countries.

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Khosravi, Bahman; Soltani, Shahin; Javan-Noughabi, Javad; Faramarzi, Ahmad

2017-01-01

Background: In all countries, health expenditures are a main part of government expenditure, and governments try to find policies and strategies to reduce this expenditure. Overall expenditure index has been raised 30 times during the past 20 years in Iran, while in the health sector, the growth in health expenditures index has been 71 times. The present study aimed at examining health care expenditure in the Islamic Republic of Iran versus other high spending countries. Methods: A comparative panel study was conducted in selected countries with the high mean of health expenditure per capita. Data were collected from the WORLD BANK. Out- of- pocket (OOP), health expenditure per capita, public and private health expenditure, and total health expenditure were compared among the selected counties. Results: Iran has the lowest health expenditure per capita compared to other countries and the USA has the highest health expenditures per capita. In Iran, out- of- pocket expenditure, with more than 50%, was the most cost, while in Luxembourg it was the least cost during 2004 to 2014, with less than 12%. Conclusion: Our findings revealed that politicians and health care executives should find a stable source to finance the health system. Stable sources of financing lead to having a steady trend in health expenditure.

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

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Phillips, Charles D.

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges.

Science.gov (United States)

Phillips, Charles D

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

The Pediatric Home Care/Expenditure Classification Model (P/ECM: A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

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Charles D. Phillips

2015-01-01

Full Text Available Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

Process value of care safety: women's willingness to pay for perinatal services.

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Anezaki, Hisataka; Hashimoto, Hideki

2017-08-01

To evaluate the process value of care safety from the patient's view in perinatal services. Cross-sectional survey. Fifty two sites of mandated public neonatal health checkup in 6 urban cities in West Japan. Mothers who attended neonatal health checkups for their babies in 2011 (n = 1316, response rate = 27.4%). Willingness to pay (WTP) for physician-attended care compared with midwife care as the process-related value of care safety. WTP was estimated using conjoint analysis based on the participants' choice over possible alternatives that were randomly assigned from among eight scenarios considering attributes such as professional attendance, amenities, painless delivery, caesarean section rate, travel time and price. The WTP for physician-attended care over midwife care was estimated 1283 USD. Women who had experienced complications in prior deliveries had a 1.5 times larger WTP. We empirically evaluated the process value for safety practice in perinatal care that was larger than a previously reported accounting-based value. Our results indicate that measurement of process value from the patient's view is informative for the evaluation of safety care, and that it is sensitive to individual risk perception for the care process. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care.

Systematic analysis of research underfunding in maternal and perinatal health.

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Fisk, N M; Atun, R

2009-02-01

Little published evidence supports the widely held contention that research in pregnancy is underfunded compared with other disease areas. To assess absolute and relative government and charitable funding for maternal and perinatal research in the UK and internationally. SEARCH STRATEGY, SELECTION CRITERIA, DATA COLLECTION, AND ANALYSIS: Major research funding bodies and alliances were identified from an Internet search and discussions with opinion leaders/senior investigators. Websites and annual reports were reviewed for details of strategy, research spend, grants awarded, and allocation to maternal and/or perinatal disease using generic and disease-specific search terms. Within the imprecision in the data sets, global philanthropy concentrated on service provision rather than research. Although research expenditure has been deemed as appropriate for 'reproductive health' disease burden in the UK, there are no data on the equity of maternal/perinatal research spend against disease burden, which globally may justify a manyfold increase. This systematic review of research expenditure and priorities from national and international funding bodies suggests relative underinvestment in maternal/perinatal health. Contributing factors include the low political priority given to women's health, the challenging nature of clinical research in pregnancy, and research capacity dearth as a consequence of chronic underinvestment.

Characteristics of care management agencies affect expenditure on home help and day care services: A population-based cross-sectional study in Japan.

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Feng, Mei; Igarashi, Ayumi; Noguchi-Watanabe, Maiko; Yoshie, Satoru; Iijima, Katsuya; Yamamoto-Mitani, Noriko

2017-11-01

The financial interests of care management agencies can affect how care managers assist clients' use of long-term care insurance services. The present study examined the relationship between clients' service expenditures, and whether the home help and day care service agencies belonged to the same organization as the care management agency. Population-based data were obtained from a suburban municipality in Japan. We investigated 4331 persons with care needs certificates (levels 1-5), including those using home help (n = 1780) or day care (n = 2141) services. Data on the service expenditures, and clients' and agencies' characteristics were analyzed using multiple linear regression analyses controlling for potential confounders. Home help service users spent an average of US$558.1 ± 590.1 for home help service, and day care service users spent US$665.0 ± 415.9 for day care service. Living alone, living in a condominium/apartment, higher care needs, more severe cognitive impairment and lower use of other services were associated with higher home help service expenditure. Day care service expenditure increased with older age, female sex, higher care needs, more severe cognitive impairment and higher physical function. Clients whose service agencies and care management agencies belonged to the same organization had higher expenditures, even after adjusting for confounders (home help: β = 0.126, P = 0.007; day care: β = 0.085, P = 0.002, respectively). Financial interests of care management agencies might significantly influence clients' service expenditure. We should develop an effective system to minimize this influence. Geriatr Gerontol Int 2017; 17: 2224-2231. © 2017 Japan Geriatrics Society.

Collective labor supply and child care expenditures: theory and application

NARCIS (Netherlands)

van Klaveren, C.; Ghysels, J.

2010-01-01

In this study we examine the collective labor supply choices of dual-earner parents and take into account child care expenditures. We find that the individual labor supplies are hardly affected by changes in the prices of child care services. In addition, the child care price effects on the

Association between fee-for-service expenditures and morbidity burden in primary care

DEFF Research Database (Denmark)

Kristensen, Troels; Olsen, Kim Rose; Schroll, Henrik

2014-01-01

BACKGROUND: In primary care, fee-for-services (FFS) tariffs are often based on political negotiation rather than costing systems. The potential for comprehensive measures of patient morbidity to explain variation in negotiated FFS expenditures has not previously been examined. OBJECTIVES...... fees are based on average costing. However, our results indicate that there may be room for improvement of the association between politically negotiated FFS expenditures and morbidity in primary care....

Impact of Provider Participation in ACO Programs on Preventive Care Services, Patient Experiences, and Health Care Expenditures in US Adults Aged 18-64.

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Hong, Young-Rock; Sonawane, Kalyani; Larson, Samantha; Mainous, Arch G; Marlow, Nicole M

2018-05-15

Little is known about the impact of accountable care organization (ACO) on US adults aged 18-64. To examine whether having a usual source of care (USC) provider participating in an ACO affects receipt of preventive care services, patient experiences, and health care expenditures among nonelderly Americans. A cross-sectional analysis of the 2015 Medical Organizations Survey linked with the Medical Expenditure Panel Survey. Survey respondents aged 18-64 with an identified USC and continuous health insurance coverage during 2015. Preventative care services (routine checkup, flu vaccination, and cancer screening), patient experiences with health care (access to care, interaction quality with providers, and global satisfaction), and health care expenditures (total and out-of-pocket expenditures) for respondents with USC by ACO and non-ACO provider groups. Among 1563, nonelderly Americans having a USC, we found that nearly 62.7% [95% confidence interval (CI), 58.6%-66.7%; representing 15,722,208 Americans] were cared for by ACO providers. Our analysis showed no significant differences in preventive care services or patient experiences between ACO and non-ACO groups. Adjusted mean total health expenditures were slightly higher for the ACO than non-ACO group [$7016 (95% CI, $4949-$9914) vs. $6796 (95% CI, $4724-$9892)]; however, this difference was not statistically significant (P=0.250). Our findings suggest that having a USC provider participating in an ACO is not associated with preventive care services use, patient experiences, or health care expenditures among a nonelderly population.

Perinatal safety: from concept to nursing practice.

Science.gov (United States)

Lyndon, Audrey; Kennedy, Holly Powell

2010-01-01

Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians' individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient's best interest can be viewed as their "agency for safety." However, collective agency for safety and commitment to support nurses in their role of advocacy is missing in many perinatal care settings. This article draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse's role in maintaining safety during labor and birth in acute care settings and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care.

Perinatal Safety: From Concept to Nursing Practice

Science.gov (United States)

Kennedy, Holly Powell

2010-01-01

Communication and teamwork problems are leading causes of documented preventable adverse outcomes in perinatal care. An essential component of perinatal safety is the organizational culture in which clinicians work. Clinicians’ individual and collective authority to question the plan of care and take action to change the direction of a clinical situation in the patient’s best interest can be viewed as their “agency for safety.” However, collective agency for safety and commitment to support nurses in their advocacy role is missing in many perinatal care settings. This paper draws from Organizational Accident Theory, High Reliability Theory, and Symbolic Interactionism to describe the nurse’s role in maintaining safety during labor and birth in acute care settings, and suggests actions for supporting the perinatal nurse at individual, group, and systems levels to achieve maximum safety in perinatal care. PMID:20147827

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study.

Science.gov (United States)

Hung, Man; Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

2015-01-01

Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties.

Association between the safe delivery app and quality of care and perinatal survival in Ethiopia

DEFF Research Database (Denmark)

Lund, Stine; Boas, Ida Marie; Bedesa, Tariku

2016-01-01

the health care workers' knowledge and skills in neonatal resuscitation as long as 12 months after introduction. Perinatal mortality was nonsignificantly reduced after the intervention. The results are highly relevant in low-income countries, where quality of care is challenged by a lack of continuing......Importance: Health apps in low-income countries are emerging tools with the potential to improve quality of health care services, but few apps undergo rigorous scientific evaluation. Objective: To determine the effects of the safe delivery app (SDA) on perinatal survival and on health care workers......' knowledge and skills in neonatal resuscitation. Design, setting, and participants: In a cluster-randomized clinical trial in 5 rural districts of Ethiopia, 73 health care facilities were randomized to the mobile phone intervention or to standard care (control). From September 1, 2013, to February 1, 2015...

Determinants of outpatient expenditure within primary care in the Brazilian National Health System

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Bruna Camilo Turi

2017-04-01

Full Text Available ABSTRACT CONTEXT AND OBJECTIVE: One of the big challenges facing governments worldwide is the financing of healthcare systems. Thus, it is necessary to understand the factors and key components associated with healthcare expenditure. The aim here was to identify demographic, socioeconomic, lifestyle and clinical factors associated with direct healthcare expenditure within primary care, among adults attended through the Brazilian National Health System in the city of Bauru. DESIGN AND SETTING: Cross-sectional study conducted in five primary care units in Bauru (SP, Brazil. METHODS: Healthcare expenditure over the last 12 months was assessed through medical records of adults aged 50 years or more. Annual healthcare expenditure was assessed in terms of medication, laboratory tests, medical consultations and the total. Body mass index, waist circumference, hypertension, age, sex, physical activity and smoking were assessed through face-to-face interviews. RESULTS: The total healthcare expenditure for 963 participants of this survey was US$ 112,849.74 (46.9% consultations, 35.2% medication and 17.9% laboratory tests. Expenditure on medication was associated with overweight (odds ratio, OR = 1.80; 95% confidence interval, CI: 1.07-3.01, hypertension (OR = 3.04; 95% CI: 1.91-4.82 and moderate physical activity (OR = 0.56; 95% CI: 0.38-0.81. Expenditure on consultations was associated with hypertension (OR = 1.67; 95% CI: 1.12-2.47 and female sex (OR = 1.70; 95% CI: 1.14-2.55. CONCLUSIONS: Our results showed that overweight, lower levels of physical activity and hypertension were independent risk factors associated with higher healthcare expenditure within primary care.

Common perinatal mental disorders in northern Viet Nam: community prevalence and health care use

Science.gov (United States)

Tran, Thach; La, Buoi thi; Kriitmaa, Kelsi; Rosenthal, Doreen; Tran, Tuan

2010-01-01

Abstract Objective To establish the prevalence of common perinatal mental disorders their determinants, and their association with preventive health care use among women in one rural and one urban province in northern Viet Nam. Methods We conducted a cross-sectional survey of cohorts of pregnant women and mothers of infants recruited systematically in 10 randomly-selected communes. The women participated in psychiatrist-administered structured clinical interviews and separate structured interviews to assess sociodemographic factors, reproductive health, the intimate partner relationship, family violence and the use of preventive and psychiatric health care. Associations between these variables and perinatal mental disorders were explored through univariate analyses and multivariable logistic regression. Findings Among women eligible for the study (392), 364 (93%) were recruited. Of these, 29.9% (95% confidence interval, CI: 25.20–34.70) were diagnosed with a common perinatal mental disorder (CPMD). The frequency of such disorders during pregnancy and in the postpartum period was the same. Their prevalence was higher among women in rural provinces (odds ratio, OR: 2.17; 95% CI: 1.19–3.93); exposed to intimate partner violence (OR: 2.11; 95% CI: 1.12–3.96); fearful of other family members (OR: 3.36; 95% CI: 1.05–10.71) or exposed to coincidental life adversity (OR: 4.40; 95% CI: 2.44–7.93). Fewer women with a CPMD used iron supplements than women without a CPMD, but the results were not statistically significant (P = 0.05). None of the women studied had ever received mental health care. Conclusion Perinatal depression and anxiety are prevalent in women in northern Viet Nam. These conditions are predominantly determined by social factors, including rural residence, poverty and exposure to family violence. At present the needs of women with common perinatal mental disorders are unrecognized and not attended to and their participation in essential

The effect of health care expenditure on patient outcomes : evidence from English neonatal care

OpenAIRE

Watson, Samuel I.; Arulampalam, Wiji; Petrou, Stavros; HASH(0x55897e290a30)

2017-01-01

The relationship between health care expenditure and health outcomes has been the subject of recent academic inquiry in order to inform cost-effectiveness thresholds for health technology assessment agencies. Previous studies in public health systems have relied upon data aggregated at the national or regional level; however, there remains debate about whether the supply side effect of changes to expenditure are identifiable using data at this level of aggregation. We use detailed patient dat...

Patient-Reported Outcomes and Total Health Care Expenditure in Prediction of Patient Satisfaction: Results From a National Study

Science.gov (United States)

Zhang, Weiping; Chen, Wei; Bounsanga, Jerry; Cheng, Christine; Franklin, Jeremy D; Crum, Anthony B; Voss, Maren W; Hon, Shirley D

2015-01-01

Background Health care quality is often linked to patient satisfaction. Yet, there is a lack of national studies examining the relationship between patient satisfaction, patient-reported outcomes, and medical expenditure. Objective The aim of this study is to examine the contribution of physical health, mental health, general health, and total health care expenditures to patient satisfaction using a longitudinal, nationally representative sample. Methods Using data from the 2010-2011 Medical Expenditure Panel Survey, analyses were conducted to predict patient satisfaction from patient-reported outcomes and total health care expenditures. The study sample consisted of adult participants (N=10,157), with sampling weights representative of 233.26 million people in the United States. Results The results indicated that patient-reported outcomes and total health care expenditure were associated with patient satisfaction such that higher physical and mental function, higher general health status, and higher total health care expenditure were associated with higher patient satisfaction. Conclusions We found that patient-reported outcomes and total health care expenditure had a significant relationship with patient satisfaction. As more emphasis is placed on health care value and quality, this area of research will become increasingly needed and critical questions should be asked about what we value in health care and whether we can find a balance between patient satisfaction, outcomes, and expenditures. Future research should apply big data analytics to investigate whether there is a differential effect of patient-reported outcomes and medical expenditures on patient satisfaction across different medical specialties. PMID:27227131

Impacts of informal caregiver availability on long-term care expenditures in OECD countries.

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Yoo, Byung-Kwang; Bhattacharya, Jay; McDonald, Kathryn M; Garber, Alan M

2004-12-01

To quantify the effects of informal caregiver availability and public funding on formal long-term care (LTC) expenditures in developed countries. Secondary data were acquired for 15 Organization for Economic Cooperation and Development (OECD) countries from 1970 to 2000. Secondary data analysis, applying fixed- and random-effects models to time-series cross-sectional data. Outcome variables are inpatient or home heath LTC expenditures. Key explanatory variables are measures of the availability of informal caregivers, generosity in public funding for formal LTC, and the proportion of the elderly population in the total population. Aggregated macro data were obtained from OECD Health Data, United Nations Demographic Yearbooks, and U.S. Census Bureau International Data Base. Most of the 15 OECD countries experienced growth in LTC expenditures over the study period. The availability of a spouse caregiver, measured by male-to-female ratio among the elderly, is associated with a $28,840 (1995 U.S. dollars) annual reduction in formal LTC expenditure per additional elderly male. Availability of an adult child caregiver, measured by female labor force participation and full-time/part-time status shift, is associated with a reduction of $310 to $3,830 in LTC expenditures. These impacts on LTC expenditure vary across countries and across time within a country. The availability of an informal caregiver, particularly a spouse caregiver, is among the most important factors explaining variation in LTC expenditure growth. Long-term care policies should take into account behavioral responses: decreased public funding in LTC may lead working women to leave the labor force to provide more informal care.

Recent trends in workload, input costs, and expenditures in the Air Force Medical Service Direct Care System.

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Robbins, Anthony S; Moilanen, Dale A; Fonseca, Vincent P; Chao, Susan Y

2002-04-01

A study was conducted to examine the relationship between two types of trends in the Air Force Medical Service Direct Care System (AFMS/DCS): trends in expenditures, total and by categories; and trends in medical workload, defined as the sum of inpatient admissions and outpatient clinic visits. Expenditure and medical workload data were extracted from the Medical Expense and Performance Reporting System Executive Query System. Medical inflation data were obtained from the Bureau of Labor Statistics Producer Price Index series. Between fiscal years 1995 and 1999, the AFMS/DCS experienced a 21.2% decrease in medical workload, but total (nominal) expenditures declined only 3.6%. Of all expenditure categories, only inpatient medical care, outpatient medical care, and military-funded private sector care for active duty personnel (supplemental care) have any direct relationship with AFMS/DCS medical workload. Real expenditures for the three categories above decreased by 20.3% during the 5-year period. Accounting for inflation and considering only expenditures related to medical workload, these results suggest that the AFMS/DCS is spending approximately 20% less money to do approximately 20% less work.

Promoting antenatal steroid use for fetal maturation: results from the California Perinatal Quality Care Collaborative.

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Wirtschafter, David D; Danielsen, Beate H; Main, Elliott K; Korst, Lisa M; Gregory, Kimberly D; Wertz, Andrew; Stevenson, David K; Gould, Jeffrey B

2006-05-01

The California Perinatal Quality Care Collaborative (CPQCC) was formed to seek perinatal care improvements by creating a confidential multi-institutional database to identify topics for quality improvement (QI). We aimed to evaluate this approach by assessing antenatal steroid administration before preterm (24 to 33 weeks of gestation) delivery. We hypothesized that mean performance would improve and the number of centers performing below the lowest quartile of the baseline year would decrease. In 1998, a statewide QI cycle targeting antenatal steroid use was announced, calling for the evaluation of the 1998 baseline data, dissemination of recommended interventions using member-developed educational materials, and presentations to California neonatologists in 1999-2000. Postintervention data were assessed for the year 2001 and publicly released in 2003. A total of 25 centers voluntarily participated in the intervention. Antenatal steroid administration rate increased from 76% of 1524 infants in 1998 to 86% of 1475 infants in 2001 (P < .001). In 2001, 23 of 25 hospitals exceeded the 1998 lower-quartile cutoff point of 69.3%. Regional collaborations represent an effective strategy for improving the quality of perinatal care.

Does a Belief in a "Just World" Affect Health Care Providers' Reactions to Perinatal Illness?

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Clyman, Ronald I.; And Others

1980-01-01

A test was used to assess the degree to which pediatricians and nurses specializing in perinatal care believe in a just world in which good is rewarded and evil is punished. Results indicate that the cause of some perinatal problems are more likely to be attributed to parents by health providers with a greater belief in a just world. (JMD)

Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads.

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Philpot, Lindsey M; Stockbridge, Erica L; Padrón, Norma A; Pagán, José A

2016-06-01

Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211).

Federalism and regional health care expenditures: an empirical analysis for the Swiss cantons.

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Crivelli, Luca; Filippini, Massimo; Mosca, Ilaria

2006-05-01

Switzerland (7.2 million inhabitants) is a federal state composed of 26 cantons. The autonomy of cantons and a particular health insurance system create strong heterogeneity in terms of regulation and organisation of health care services. In this study we use a single-equation approach to model the per capita cantonal expenditures on health care services and postulate that per capita health expenditures depend on some economic, demographic and structural factors. The empirical analysis demonstrates that a larger share of old people tends to increase health costs and that physicians paid on a fee-for-service basis swell expenditures, thus highlighting a possible phenomenon of supply-induced demand.

Effect of Workplace Weight Management on Health Care Expenditures and Quality of Life.

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Michaud, Tzeyu L; Nyman, John A; Jutkowitz, Eric; Su, Dejun; Dowd, Bryan; Abraham, Jean M

2016-11-01

We examined the effectiveness of the weight management program used by the University of Minnesota in reducing health care expenditures and improving quality of life of its employees, and also in reducing their absenteeism during a 3-year intervention. A differences-in-differences regression approach was used to estimate the effect of weight management participation. We further applied ordinary least squares regression models with fixed effects to estimate the effect in an alternative analysis. Participation in the weight management program significantly reduced health care expenditures by $69 per month for employees, spouses, and dependents, and by $73 for employees only. Quality-of-life weights were 0.0045 points higher for participating employees than for nonparticipating ones. No significant effect was found for absenteeism. The workplace weight management used by the University of Minnesota reduced health care expenditures and improved quality of life.

A survey comparing the attitudes toward perinatal bereavement care of nurses from three Asian cities.

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Chan, Moon Fai; Lou, Feng-lan; Arthur, David Gordon

2010-12-01

Caring for parents whose infant has died is extremely demanding, difficult, and stressful. In some situations, nurses may experience personal failure, feel helpless, and need to distance themselves from bereaved parents because they are unable to deal with the enormity of the parental feelings of loss. The aim of the study was to describe and compare attitudes toward perinatal bereavement care across a sample of nurses working in five obstetrics and gynecology settings from three Asian cities, as well as the factors associated with these attitudes. A survey was conducted, and 573 nurses were recruited from 2006 to 2007. The data were collected using the perinatal bereavement attitudes scale, which involves an 11-item self-report questionnaire. Nurses' attitudes were mainly positive, but differed across cities, with the attitude of Jinan nurses being significantly more positive than nurses from the other two cities, and the attitude of Hong Kong nurses being significantly the lowest. Positive attitudes were associated with position, and nurses who were well informed of hospital policy and received training for bereavement care were statistically significantly more likely to have a positive attitude toward perinatal bereavement care. Although nurses' attitudes to prenatal bereavement care differ significantly across the three Asian cities, they are generally similar. The differences observed could be related to the wider social, cultural, and organizational circumstances of nursing practice.

Perinatal death audits in a peri-urban hospital in Kampala, Uganda ...

African Journals Online (AJOL)

Background: The perinatal mortality of 70 deaths per 1,000 total births in Uganda is unacceptably high. Perinatal death audits are important for improvement of perinatal care and reduction of perinatal morality. We integrated perinatal death audits in routine care, and describe its effect on perinatal mortality rate at Nsambya ...

Assessing the quality of bereavement care after perinatal death: development and piloting of a questionnaire to assess parents' experiences.

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Aiyelaagbe, Esther; Scott, Rebecca E; Holmes, Victoria; Lane, Emma; Heazell, Alexander E P

2017-10-01

Understanding parents' experience of care is essential to develop high-quality perinatal bereavement services. This study aimed at developing a questionnaire to identify parents' needs and record their experience of care. The patient experience questionnaire was developed by professionals and parents, and piloted in a tertiary maternity unit. Responses were received from 58 parents. Sensitivity and kindness of staff and time spent with their baby were ranked as 'very important' by 95% of parents. Care in these areas largely met their needs (90%), although 5% of respondents stated that partners could have been more involved. Between 8% and 15% of respondents did not feel that language used at the diagnosis of fetal death was sensitive, clear and unambiguous. Parents did not always receive written information about their care (5%) or post-mortem (13%). Analysis of bereaved parents' responses identified areas for improvement including greater involvement of partners and a need for timely information. Impact statement What is already known on this subject?: Good quality bereavement care after perinatal death reduces the negative emotional, psychological and social effects for parents. Description of parents' experiences is a potential means to improve the quality of perinatal bereavement care. What do the results of this study add?: Parents' needs and experiences of care after perinatal death were recorded using a patient-experience questionnaire designed by a multi-professional team and parents. Staff behaviour, particularly sensitivity and kindness was highly valued by parents. Giving both verbal and written information could be improved. Training is needed for professionals, particularly those who come into contact with bereaved parents less frequently. What are the implications of these findings for clinical practice and/or further research?: Description of parents' priorities and views can be used to identify areas for improvement in perinatal bereavement care

Censored Quantile Instrumental Variable Estimates of the Price Elasticity of Expenditure on Medical Care.

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Kowalski, Amanda

2016-01-02

Efforts to control medical care costs depend critically on how individuals respond to prices. I estimate the price elasticity of expenditure on medical care using a censored quantile instrumental variable (CQIV) estimator. CQIV allows estimates to vary across the conditional expenditure distribution, relaxes traditional censored model assumptions, and addresses endogeneity with an instrumental variable. My instrumental variable strategy uses a family member's injury to induce variation in an individual's own price. Across the conditional deciles of the expenditure distribution, I find elasticities that vary from -0.76 to -1.49, which are an order of magnitude larger than previous estimates.

Long term health care consumption and cost expenditure in systolic heart failure.

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Mejhert, Märit; Lindgren, Peter; Schill, Owe; Edner, Magnus; Persson, Hans; Kahan, Thomas

2013-04-01

The prevalence, health care consumption, and mortality increase in elderly patients with heart failure. This study aimed to analyse long term cost expenditure and predictors of health care consumption in these patients. We included 208 patients aged 60 years or older and hospitalised with heart failure (NYHA class II-IV and left ventricular systolic dysfunction); 58% were men, mean age 76 years, and mean ejection fraction 0.34. Data on all hospital admissions, discharge diagnoses, lengths of stay, and outpatient visits were collected from the National Board of Health and Welfare. We obtained data of all health care consumption for each individual. After 8-12 years of prospective follow up 72% were dead (median survival 4.6 years). Main drivers of health care expenditure were non-cardiac (40%) and cardiac (29%) hospitalizations, and visits to primary care centres (16%), and hospital outpatient clinics (15%). On average, health care expenditures were € 36,447 per patient during follow up. The average yearly cost per patient was about 5,700€, in contrast to the estimated consumption of primary and hospital care in the general population: € 1,956 in 65-74 year olds and € 2,701 in 75-84 year olds. Poor quality of life (Nottingham Health Profile) was the strongest independent predictor of total health care consumption and costs (pheart failure are at least two-fold higher than in the general population. Quality of life is a strong independent predictor of health care consumption. Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

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van Diem Mariet Th

2012-07-01

Full Text Available Abstract Background Perinatal (mortality audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in mortality are usually part of the audit group. This makes such an audit a delicate matter. Methods The purpose of this study was to implement unit-based perinatal mortality audit in all 15 perinatal cooperation units in the northern region of the Netherlands between September 2007 and March 2010. These units consist of hospital-based and independent community-based perinatal caregivers. The implementation strategy encompassed an information plan, an organization plan, and a training plan. The main outcomes are the number of participating perinatal cooperation units at the end of the project, the identified substandard factors (SSF, the actions to improve care, and the opinions of the participants. Results The perinatal mortality audit was implemented in all 15 perinatal cooperation units. 677 different caregivers analyzed 112 cases of perinatal mortality and identified 163 substandard factors. In 31% of cases the guidelines were not followed and in 23% care was not according to normal practice. In 28% of cases, the documentation was not in order, while in 13% of cases the communication between caregivers was insufficient. 442 actions to improve care were reported for ‘external cooperation’ (15%, ‘internal cooperation’ (17%, ‘practice organization’ (26%, ‘training and education’ (10%, and ‘medical performance’ (27%. Valued aspects of the audit meetings were: the multidisciplinary character (13%, the collective and non-judgmental search for substandard factors (21%, the perception of safety (13%, the motivation to reflect on one’s own professional performance (5%, and the inherent postgraduate education (10%. Conclusion

Training traditional birth attendants on the WHO Essential Newborn Care reduces perinatal mortality.

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Garcés, Ana; McClure, Elizabeth M; Hambidge, Michael; Krebs, Nancy F; Mazariegos, Manolo; Wright, Linda L; Moore, Janet; Carlo, Waldemar A

2012-05-01

To evaluate the impact of birth attendant training using the World Health Organization Essential Newborn Care (ENC) course among traditional birth attendants, with a particular emphasis on the effect of acquisition of skills on perinatal outcomes. Population-based, prospective, interventional pre-post design study. 11 rural clusters in Chimaltenango, Guatemala. Health care providers. This study analyzed the effect of training and implementation of the ENC health care provider training course between September 2005 and December 2006. The primary outcome measure was the rate of death from all causes in the first seven days after birth in fetuses/infants ≥1500g. Secondary outcome measures were overall rate of stillbirth, rate of perinatal death, which included stillbirths plus neonatal deaths in the first seven days in fetuses/infants ≥1500g. Perinatal mortality decreased from 39.5/1000 pre-ENC to 26.4 post-ENC (RR 0.72; 95%CI 0.54-0.97). This reduction was attributable almost entirely to a decrease in the stillbirth rate of 21.4/1000 pre-Essential Newborn Care to 7.9/1000 post-ENC (RR 0.40; 95%CI 0.25-0.64). Seven-day neonatal mortality did not decrease (18.3/1000 to 18.6/1000; RR 1.05; 95%CI 0.70-1.57). Essential Newborn Care training reduced stillbirths in a population-based controlled study with deliveries conducted almost exclusively by traditional birth attendants. Scale-up of this intervention in other settings might help assess reproducibility and sustainability. © Published [2012]. This article is a U.S. Government work and is in the public domain in the USA. Acta Obstetricia et Gynecologica Scandinavica© 2012 Nordic Federation of Societies of Obstetrics and Gynecology.

Perinatal transport: problems in neonatal intensive care capacity.

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Gill, A B; Bottomley, L; Chatfield, S; Wood, C

2004-05-01

To assess the quantity and nature of transfers within the Yorkshire perinatal service, with the aim of identifying suitable outcome measures for the assessment of future service improvements. Collection of data on perinatal transfers from all neonatal and maternity units located in the Yorkshire region of the United Kingdom from May to November 2000. Expectant mothers (in utero transfers) and neonates (ex utero transfers). None Quantification of in utero and ex utero transfers; the reasons for and resources required to support transfers; the nature of each transfer (acute, specialist, non-acute, into or out of region). In the period studied, there were 800 transfers (337 in utero; 463 ex utero); 306 transfers were "acute" (80% of transfers in utero), 214 because of specialist need, and 280 "non-acute". Some 37% of capacity transfers occurred from the two level 3 units in the region. Of 254 transfers out of the 14 neonatal units for intensive care, 44 (17.3%) were transferred to hospitals outside the normal neonatal commissioning boundaries. The study highlights a continuing apparent lack of capacity within the neonatal service in the Yorkshire region, resulting in considerable numbers of neonatal and maternal transfers.

"Can I Ask That?": Perspectives on Perinatal Care After Resettlement Among Karen Refugee Women, Medical Providers, and Community-Based Doulas.

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LaMancuso, Kate; Goldman, Roberta E; Nothnagle, Melissa

2016-04-01

This study characterized the perspectives of Karen refugee women in Buffalo, NY, their medical providers, and Karen interpreters/doulas on perinatal care for Karen women in resettlement. In-depth qualitative interviews with Karen women (14), Karen doulas/interpreters and key informants (8), and medical providers (6) were informed by the social contextual model and focused on women's questions about and opinions of perinatal care in Buffalo and on providers' experiences caring for Karen patients. Karen women expressed gratitude for and understanding of perinatal care in Buffalo, and providers described Karen patients as agreeable but shy. Karen doulas offered an alternative view that exposed women's many questions and concerns, and described how doula training empowered them as patients' advocates. Low self-efficacy, trauma histories, and cultural expectations may contribute to Karen women's seeming agreeability. Doulas/interpreters possess insider knowledge of women's concerns and facilitate communication between patients and the care team.

Two types of health care systems and their influence on the introduction of perinatal care: an epidemiological twin model in Berlin from 1950 to 1990.

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Arabin, B; Raum, E; Mohnhaupt, A; Schwartz, F W

1999-06-01

When perinatal medicine emerged as a new medical discipline in the 1960s, Berlin was as one of the world's leading centers. During that time, the city was separated into two parts, each fostering its own health care system. After the destruction of the Berlin Wall, it was possible to speak with the citizens of East Berlin and to access their database systems. This created the singular opportunity to objectively compare the development of perinatal care in both parts of Berlin. Rates of maternal, perinatal, and infant mortality as well as the rate of preterm deliveries were evaluated over time and between East and West Berlin. The timing of introduction of 20 specific perinatal interventions was evaluated across 18 hospitals with more than 500 deliveries (11 in West Berlin and 7 in East Berlin). Interviews were conducted with 100 gynecologists, 100 midwives, and 100 women who had recently delivered their first child from each side of the city regarding their opinions of the importance of these interventions for the quality of perinatal medicine and how they would distribute a budget to improve maternity care. Maternal, perinatal, and infant mortality decreased in both parts of Berlin until 1990 (p Berlin, though the preterm delivery rate was slightly lower in East Berlin compared with West Berlin (p Berlin. In contrast, certain public health measures--such as maternal transport, screening programs for diabetes, and support of breastfeeding--were introduced much earlier in East Berlin. There were significant differences between the beliefs of gynecologists, midwives, and mothers in East and West Berlin. In general, citizens of East Berlin were more enthusiastic about technological medical advances, whereas citizens of West Berlin were more supportive of public health and alternative methods. In addition, there were significant differences between female and male physicians in their beliefs about how to improve health care, regardless of whether they resided in East

[Application of Epigenetics in Perinatal Nursing Care].

Science.gov (United States)

Chou, Hsueh-Fen; Kao, Chien-Huei; Gau, Meei-Ling

2017-04-01

Epigenetics is a field of biomedicine that expanded tremendously during the 1980s. Epigenetics is the study of heritable changes in gene expression independent of underlying DNA (DeoxyriboNucleic Acid) sequence, which not only affect this generation but will be passed to subsequent generations. Although conception is the critical moment for making decisions regarding gene mapping and fetal health, studies have shown that perinatal nursing care practices also affect the genetic remodeling processes and the subsequent health of the mother and her offspring. To optimize maternal-infant and the offspring health, it is important to ensure that the new mother get adequate nutrition, reduce stress levels, adopt gentle birth practices, facilitate exclusive breastfeeding, and avoid contacting toxic substances.

Determinants of Medical and Health Care Expenditure Growth for Urban Residents in China: A Systematic Review Article.

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Zhu, Xiaolong; Cai, Qiong; Wang, Jin; Liu, Yun

2014-12-01

In recent years, medical and health care consumption has risen, making health risk an important determinant of household spending and welfare. We aimed to examine the determinants of medical and health care expenditure to help policy-makers in the improvement of China's health care system, benefiting the country, society and every household. This paper employs panel data from China's provinces from 2001 to 2011 with all possible economic variations and studies the determinants of medical and healthcare expenditure for urban residents. CPI (consumer price index) of medical services and the resident consumption level of urban residents have positive influence on medical and health care expenditures for urban residents, while the local medical budget, the number of health institutions, the incidence of infectious diseases, the year-end population and the savings of urban residents will not have effect on medical and health care expenditure for urban residents. This paper proposed three relevant policy suggestions for Chinese governments based on the findings of the research.

Perinatal health care services for imprisoned pregnant women and associated outcomes: a systematic review.

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Bard, Eleanor; Knight, Marian; Plugge, Emma

2016-09-29

Women are an increasing minority of prisoners worldwide, and most are of childbearing age. Prisons offer unique opportunities for improving the pregnancy outcomes of these high-risk women, and no systematic review to date has looked at their care. This systematic review identified studies describing models of perinatal health care for imprisoned women which report maternal and child health and care outcomes. We systematically searched for literature published between 1980 and April 2014. Studies were eligible if they included a group of imprisoned pregnant women, a description of perinatal health care and any maternal or infant health or care outcomes. Two authors independently extracted data. We described relevant outcomes in prisons (including jails) under models of care we termed PRISON, PRISON+ and PRISON++, depending on the care provided. Where outcomes were available on a comparison group of women, we calculated odds ratios with 95 % confidence intervals. Eighteen studies were reported, comprising 2001 imprisoned pregnant women. Fifteen were in the US, two in the UK and one in Germany. Nine contained a comparison group of women comprising 849 pregnant women. Study quality was variable and outcome reporting was inconsistent. There was some evidence that women in prisons receiving enhanced prison care, PRISON+, were less likely to have inadequate prenatal care (15.4 % vs 30.7 %, p prisons receiving usual care (PRISON). Women participating in two PRISON++ interventions, that is, interventions which included not only enhanced care in prisons but also coordination of community care on release, demonstrated reductions in long term recidivism rates (summary OR 0 · 37, 95 % CI 0 · 19-0 · 70) compared to pregnant women in the same prisons who did not participate in the intervention. Enhanced perinatal care can improve both short and long-term outcomes but there is a lack of data. Properly designed programmes with rigorous evaluation are needed to

Long-term care cost drivers and expenditure projection to 2036 in Hong Kong

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Chan Wai

2009-09-01

Full Text Available Abstract Background Hong Kong's rapidly ageing population, characterised by one of the longest life expectancies and the lowest fertility rate in the world, is likely to drive long-term care (LTC expenditure higher. This study aims to identify key cost drivers and derive quantitative estimates of Hong Kong's LTC expenditure to 2036. Methods We parameterised a macro actuarial simulation with data from official demographic projections, Thematic Household Survey 2004, Hong Kong's Domestic Health Accounts and other routine data from relevant government departments, Hospital Authority and other LTC service providers. Base case results were tested against a wide range of sensitivity assumptions. Results Total projected LTC expenditure as a proportion of GDP reflected secular trends in the elderly dependency ratio, showing a shallow dip between 2004 and 2011, but thereafter yielding a monotonic rise to reach 3.0% by 2036. Demographic changes would have a larger impact than changes in unit costs on overall spending. Different sensitivity scenarios resulted in a wide range of spending estimates from 2.2% to 4.9% of GDP. The availability of informal care and the setting of formal care as well as associated unit costs were important drivers of expenditure. Conclusion The "demographic window" between the present and 2011 is critical in developing policies to cope with the anticipated burgeoning LTC burden, in concert with the related issues of health care financing and retirement planning.

Association of antenatal care with facility delivery and perinatal survival – a population-based study in Bangladesh

Directory of Open Access Journals (Sweden)

Pervin Jesmin

2012-10-01

Full Text Available Abstract Background Antenatal Care (ANC during pregnancy can play an important role in the uptake of evidence-based services vital to the health of women and their infants. Studies report positive effects of ANC on use of facility-based delivery and perinatal mortality. However, most existing studies are limited to cross-sectional surveys with long recall periods, and generally do not include population-based samples. Methods This study was conducted within the Health and Demographic Surveillance System (HDSS of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b in Matlab, Bangladesh. The HDSS area is divided into an icddr,b service area (SA where women and children receive care from icddr,b health facilities, and a government SA where people receive care from government facilities. In 2007, a new Maternal, Neonatal, and Child Health (MNCH program was initiated in the icddr,b SA that strengthened the ongoing maternal and child health services including ANC. We estimated the association of ANC with facility delivery and perinatal mortality using prospectively collected data from 2005 to 2009. Using a before-after study design, we also determined the role of ANC services on reduction of perinatal mortality between the periods before (2005 – 2006 and after (2008–2009 implementation of the MNCH program. Results Antenatal care visits were associated with increased facility-based delivery in the icddr,b and government SAs. In the icddr,b SA, the adjusted odds of perinatal mortality was about 2-times higher (odds ratio (OR 1.91; 95% confidence intervals (CI: 1.50, 2.42 among women who received ≤1 ANC compared to women who received ≥3 ANC visits. No such association was observed in the government SA. Controlling for ANC visits substantially reduced the observed effect of the intervention on perinatal mortality (OR 0.64; 95% CI: 0.52, 0.78 to non-significance (OR 0.81; 95% CI: 0.65, 1.01, when comparing cohorts before

Neonatal Abstinence Syndrome: Trend and Expenditure in Louisiana Medicaid, 2003-2013.

Science.gov (United States)

Okoroh, Ekwutosi M; Gee, Rebekah E; Jiang, Baogong; McNeil, Melissa B; Hardy-Decuir, Beverly A; Zapata, Amy L

2017-07-01

Objectives Determine trends in incidence and expenditure for perinatal drug exposure and neonatal abstinence syndrome (NAS) among Louisiana's Medicaid population. We also describe the maternal characteristics of NAS affected infants. Methods Retrospective cohort analysis using linked Medicaid and vital records data from 2003 to 2013. Conducted incidence and cost trends for drug exposed infants with and without NAS. Also performed comparison statistics among drug exposed infants with and without NAS and those not drug exposed. Results As rate of perinatal drug exposure increased, NAS rate per 1000 live Medicaid births also increased, from 2.1 (2003) to 3.6 (2007) to 8.0 (2013) (P for trend Medicaid also increased from $1.3 million to $3.6 million to $8.7 million (P for trend Medicaid infants quadrupled and the cost for caring for the affected infants increased six-fold. Medicaid, as the predominant payer for pregnant women and children affected by substance use disorders, must play a more active role in expanding access to comprehensive substance abuse treatment programs.

Eliminating Perinatal HIV Transmission

Centers for Disease Control (CDC) Podcasts

In this podcast, CDC’s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students.

Health care expenditures of children and adults with spina bifida in a privately insured U.S. population.

Science.gov (United States)

Ouyang, Lijing; Grosse, Scott D; Armour, Brian S; Waitzman, Norman J

2007-07-01

We provide new estimates of medical care utilization and expenditures over the lifespan for persons living with spina bifida in the United States. Updated estimates are essential for calculations of lifetime costs and for economic evaluations of prevention and management strategies for spina bifida. We analyzed data from the 2001-2003 MarketScan database on paid medical and prescription drug claims of persons covered by employer-sponsored health insurance in the United States. Medical care utilization and expenditures during 2003 were analyzed for persons with a diagnosis of spina bifida recorded during 2001-2003 who had 12 months of coverage in a fee-for-service health plan. To calculate expenditures during infancy, a separate analysis was performed for those born during 2002 with claims and expenditures data during the first 12 months of life. We compared medical expenditures for persons with and without spina bifida by age groups. Average incremental medical expenditures comparing patients with spina bifida and those without were $41,460 per year at age 0, $14,070 at ages 1-17, $13,339 at ages 18-44, and $10,134 at ages 45-64. Children ages 1-17 years with spina bifida had average medical expenditures 13 times greater than children without spina bifida. Adults with spina bifida had average medical expenditures three to six times greater than adults without spina bifida in this privately insured population. Although per capita medical care utilization and expenditures are highest among children, adults constitute an important and growing share of the population living with spina bifida. (c) 2007 Wiley-Liss, Inc.

Toward estimating the impact of changes in immigrants' insurance eligibility on hospital expenditures for uncompensated care

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Curtis Lesley H

2003-01-01

Full Text Available Abstract Background The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA of 1996 gave states the option to withdraw Medicaid coverage of nonemergency care from most legal immigrants. Our goal was to assess the effect of PRWORA on hospital uncompensated care in the United States. Methods We collected the following state-level data for the period from 1994 through 1999: foreign-born, noncitizen population and health uninsurance rates (US Census Current Population Survey; percentage of teaching hospitals (American Hospital Association Annual Survey of Hospitals; and each state's decision whether to implement the PRWORA Medicaid bar for legal permanent residents or to continue offering nonemergency Medicaid coverage using state-only funds (Urban Institute. We modeled uncompensated care expenditures by state (also from the Annual Survey of Hospitals in both univariate and multivariable regression analyses. Results When measured at the state level, there was no significant relationship between uncompensated care expenditures and states' percentage of noncitizen immigrants. Uninsurance rates were the only significant factor in predicting uncompensated hospital care expenditures by state. Conclusions Reducing the number of uninsured patients would most surely reduce hospital expenditures for uncompensated care. However, data limitations hampered our efforts to obtain a monetary estimate of hospitals' financial losses due specifically to the immigrant eligibility changes in PRWORA. Quantifying the impact of these provisions on hospitals will require better data sources.

Análisis del gasto en salud reproductiva en México, 2003 Analysis of reproductive health expenditures in Mexico, 2003

Directory of Open Access Journals (Sweden)

Lucero Cahuana-Hurtado

2006-11-01

estimate reproductive health expenditures in Mexico during 2003; analyze how costs were distributed across the main programs, funding entities, and providers of health goods and services; and evaluate the relationship between reproductive health expenditures and economic indicators in different states, using health accounts methods. METHODS: We estimated reproductive health expenditures between January and December 2003, at the national and state level. We used health accounts methods adjusted for the particular characteristics of Mexico on the basis of information from public and private sources. Expenditures were calculated for the four main reproductive health programs (maternal-perinatal health, family planning, cervical and uterine cancer, and breast cancer according to different funding entities, goods and services providers, and functions of health care, in both the public and private sector. We estimated public expenditures by state per beneficiary, and analyzed how these costs were related with pubic health care expenditures and annual per capita gross domestic product (GDP for each state. RESULTS: The reproductive health expenditures in Mexico during the year 2003 were US$ 2.912 6 billion, a figure that represented 0.5% of the national GDP in 2003 and slightly more than 8% of the total health care expenditures. Costs were higher for public entities (53.5% than for private entities (46.5%. The maternal-perinatal health program accounted for the highest costs, mainly from deliveries and complications; direct payments from households accounted for nearly 50% of the total figure. Costs for family planning were accrued mainly in the public sector, and represented 5.9% of the total expenditure. Of the total spending on reproductive health, 7.9% was devoted to cervical and uterine cancer and breast cancer programs. Mean public expenditures on reproductive health per beneficiary were US$ 680.03, and differences between states were associated with differences in public

The relationship of post-acute home care use to Medicaid utilization and expenditures.

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Payne, Susan M C; DiGiuseppe, David L; Tilahun, Negussie

2002-06-01

To describe the use of post-acute home care (PAHC) and total Medicaid expenditures among hospitalized nonelderly adult Medicaid eligibles and to test whether health services utilization rates or total Medicaid expenditures were lower among Medicaid eligibles who used PAHC compared to those who did not. 5,299 Medicaid patients aged 18-64 discharged in 1992-1996 from 29 hospitals in the Cleveland Health Quality Choice (CHQC) project. Linked Ohio Medicaid claims and CHQC medical record abstract data. One stay per patient was randomly selected. Observational study. To control for treatment selection bias, we developed a model predicting the probability (propensity) a patient would be referred to PAHC, as a proxy for the patient's need for PAHC. We matched 430 patients who used Medicaid-covered PAHC ("USE") to patients who did not ("NO USE") by their propensity scores. Study outcomes were inpatient re-admission rates and days of stay (DOS), nursing home admission rates and DOS, and mean total Medicaid expenditures 90 and 180 days after discharge. Of 3,788 medical patients, 12.1 percent were referred to PAHC; 64 percent of those referred used PAHC. Of 1,511 surgical patients, 10.9 percent were referred; 99 percent of those referred used PAHC. In 430 pairs of patients matched by propensity score, mean total Medicaid expenditures within 90 days after discharge were $7,649 in the USE group and $5,761 in the NO USE group. Total Medicaid expenditures were significantly higher in the USE group compared to the NO USE group for medical patients after 180 days (p analysis indicates the results may be influenced by unmeasured variables, most likely functional status and/or care-giver support. Thirty-six percent of the medical patients referred to PAHC did not receive Medicaid-covered services. This suggests potential underuse among medical patients. The high post-discharge expenditures suggest opportunities for reducing costs through coordinating utilization or diverting it to

Merger & Acquisition and Capital Expenditure in Health Care

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Ouyang, Wenjing; Hilsenrath, Peter E.

2017-01-01

Investment, especially through merger and acquisition (M&A), is a leading topic of concern among health care managers. In addition, the implications of this activity for organization and market concentration are of great interest to policy makers. Using a sample of 2256 firm-year observations in the health care industry during the period from 1985 to 2011, this article provides novel evidence that managers learn from financial markets in making capital expenditure (CAPEX) and M&A investment decisions. Within the industry, managers in the Drugs subsector are most likely to do so, whereas managers in the Medical Equipment and Supplies are least likely to do so. We find informative stock prices improve firm financial performance. This article highlights the importance of financial markets for real economic activity in the health care industry. PMID:28220717

Equity and efficiency in Italian health care.

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Paci, P; Wagstaff, A

1993-04-01

Health care finance and provision in Italy is unusual by international standards: public financing relies heavily on both general taxation and social insurance, and although the vast majority of expenditure is publicly financed, the majority of care is provided by the private sector. The system suffers, however, from a chronic failure to control expenditures and its record on perinatal and infant mortality is poor. Hospitals in Italy have a low bed-occupancy rate by international standards and the per diem system of reimbursing private hospitals encourages unduly long stays. Costs per inpatient day are high by international standards, but costs per admission are close to the OECD average. Ambulatory care costs are extremely low, but this appears to be due to the fact that GPs see so many patients that their role is inevitably mainly administrative. Consumption of medicines is extremely high, but because the cost per item is low, expenditure per capita is not unduly high. Despite the emphasis on social insurance, the financing system appears to be progressive. There is evidence of inequalities in health in Italy, and some evidence that health care is not provided equally to those in the same degree of need.

Health Care Expenditure among People with Disabilities: Potential Role of Workplace Health Promotion and Implications for Rehabilitation Counseling

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Karpur, Arun; Bruyere, Susanne M.

2012-01-01

Workplace health-promotion programs have the potential to reduce health care expenditures, especially among people with disabilities. Utilizing nationally representative survey data, the authors provide estimates for health care expenditures related to secondary conditions, obesity, and health behaviors among working-age people with disabilities.…

Contemporary view of the effect of managed care on the ethics in perinatal medicine.

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Schwartz, Peter A

2003-03-01

Managed care has significantly altered the patient-physician relationship, and these changes have created new ethical challenges within that relationship. The physician's obligation of beneficence has been challenged by his contract with managed care. Physicians have faced increasing apparent and real conflicts of interest. The patient's right of choice has been challenged by her contract with managed care. Within perinatal medicine, those challenges have affected mode of delivery, use of technology, length of stay, and pharmaceutical choices. Additional challenges and opportunities to enhance quality of care lie ahead in the evolution of the health care system.

The relationship between modifiable health risks and group-level health care expenditures. Health Enhancement Research Organization (HERO) Research Committee.

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Anderson, D R; Whitmer, R W; Goetzel, R Z; Ozminkowski, R J; Dunn, R L; Wasserman, J; Serxner, S

2000-01-01

To assess the relationship between modifiable health risks and total health care expenditures for a large employee group. Risk data were collected through voluntary participation in health risk assessment (HRA) and worksite biometric screenings and were linked at the individual level to health care plan enrollment and expenditure data from employers' fee-for-service plans over the 6-year study period. The setting was worksite health promotion programs sponsored by six large private-sector and public-sector employers. Of the 50% of employees who completed the HRA, 46,026 (74.7%) met all inclusion criteria for the analysis. Eleven risk factors (exercise, alcohol use, eating, current and former tobacco use, depression, stress, blood pressure, cholesterol, weight, and blood glucose) were dichotomized into high-risk and lower-risk levels. The association between risks and expenditures was estimated using a two-part regression model, controlling for demographics and other confounders. Risk prevalence data were used to estimate group-level impact of risks on expenditures. Risk factors were associated with 25% of total expenditures. Stress was the most costly factor, with tobacco use, overweight, and lack of exercise also being linked to substantial expenditures. Modifiable risk factors contribute substantially to overall health care expenditures. Health promotion programs that reduce these risks may be beneficial for employers in controlling health care costs.

Bucking the trend? Health care expenditures in low-income countries 1990-1995.

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Jowett, M

1999-01-01

Health care expenditures in low-income countries are analysed for the years 1990 and 1995 using four key indicators. Key findings include a substantial reduction in public spending per capita across low-income countries between 1990-95; a significant shift towards private expenditures, which appears increasingly to be substituting rather than supplementing public expenditures; a fall in total and public health spending in many countries despite growth in national income, contradicting the relationship found in other studies. Two possible explanations are put forward. First that the patterns found are a direct result of the structural adjustment policies adopted by many low-income countries, which aim to control and often cut public financing, whilst promoting private health expenditures. Secondly, that following the wave of privatization of state industries, many governments are finding problems adapting to their new role as a tax collector, and are thus not benefiting from economic growth to the extent that might be expected.

Annual Report on Children's Health Care: Dental and Orthodontic Utilization and Expenditures for Children, 2010-2012.

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Berdahl, Terceira; Hudson, Julie; Simpson, Lisa; McCormick, Marie C

2016-01-01

To examine general dental and orthodontic utilization and expenditures by health insurance status, public health insurance eligibility, and sociodemographic characteristics among children aged 0 to 17 years using data from 2010-2012. Nationally representative data from the Medical Expenditure Panel Survey (2010-2012) provided data on insurance status, public health insurance eligibility, and visits to dental providers for both general dental care and orthodontic care. Overall, 41.9% of US children reported an annual dental office-based visit for general (nonorthodontic) dental care. Fewer Hispanic (34.7%) and non-Latino black children (34.8%) received dental care compared to non-Hispanic whites (47.3%) and Asians (40.3%). Children living in families with the lowest income were also the least likely to have a visit (32.9%) compared to children in the highest-income families (54.7%). Among children eligible for public coverage, Medicaid-eligible children had the lowest percentage of preventive dental visits (29.2%). Socioeconomic and racial/ethnic disparities in use and expenditures for orthodontic care are much greater than those for general and preventive dental care. Average expenditures for orthodontic care were $1,823, of which 56% ($1,023) was paid out of pocket by families. Our findings provide a baseline assessment for examining trends in the future, especially as coverage patterns for children may change as the Affordable Care Act is implemented and the future of the State Child Health Insurance Program remains uncertain beyond 2017. Published by Elsevier Inc.

Evidence of effectiveness of preventive dental care in reducing dental treatment use and related expenditures.

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Pourat, Nadereh; Choi, Moonkyung Kate; Chen, Xiao

2018-02-06

Preventive dental health services are intended to reduce the likelihood of development of tooth decay and the need for more intensive treatment overtime. The evidence on the effectiveness of preventive dental care in reducing treatment services and expenditures is lagging for adults, particularly those with lower incomes and chronic conditions. We assessed the impact of preventive dental services on dental treatment service use and expenditures overall and by category of service. We calculated the annual numbers of preventive (periodic diagnostic and prophylactic procedures) and treatment (restorative, surgery, prosthodontic, endodontic, and periodontic) services per beneficiary using Medicaid enrollment and claims data for beneficiaries with three categories of conditions (diabetes, heart disease, and respiratory disease) from 10 largest California counties. We used Cragg hurdle exponential regression models controlling for past service use, demographics, length of enrollment, and county. We found that using preventive services in 2005-2007 was associated with higher likelihood and number of treatment dental services used, but associated with lower treatment expenditures in 2008. The reduction in expenditures was noted only in restorative, prosthodontics, and periodontic services. The findings provide much needed evidence of the contribution of preventive dental care in maintaining oral health of low-income adults with chronic conditions and potential for savings to the Medicaid program. Providing lower cost preventive dental care to the individuals with chronic conditions would achieve better oral health and lower treatment expenditures. © 2018 American Association of Public Health Dentistry.

Maternal care receptivity and its relation to perinatal and neonatal mortality. A rural study.

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Bhardwaj, N; Hasan, S B; Zaheer, M

1995-04-01

A longitudinal study was conducted on 212 pregnant women from May 1987 to April 1988. Maternal Care Receptivity (MCR) "an innovative approach" was adopted for the assessment of maternal care services provided to pregnant mothers at their door steps. During follow-up, scores were allotted to each of the services rendered and antenatal status of pregnant women. Depending on the score--MCR was classified as high (11 to 8), moderate (7 to 4) or poor (3 to 0). Perinatal and neonatal deaths were recorded and an inverse relationship between MCR and perinatal and mortalities was observed (z = 5.46, p women with high MCR. One of the most important cause of high PNMR and neonatal mortality rate in developing countries is poor MCR, i.e., under utilization of even the existing maternal health services. The main reasons for this under utilization appear to be poverty, illiteracy, ignorance and lack of faith in modern medicine.

Quality-quantity decomposition of income elasticity of U.S. hospital care expenditure using state-level panel data.

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Chen, Weiwei; Okunade, Albert; Lubiani, Gregory G

2014-11-01

Economic theory suggests that income growth could lead to changes in consumption quantity and quality as the spending on a commodity changes. Similarly, the volume and quality of healthcare consumption could rise with incomes because of demographic changes, usage of innovative medical technologies, and other factors. Hospital healthcare spending is the largest component of aggregate US healthcare expenditures. The novel contribution of our paper is estimating and decomposing the income elasticity of hospital care expenditures (HOCEXP) into its quantity and quality components. By using a 1999-2008 panel dataset of the 50 US states, results from the seemingly unrelated regressions model estimation reveal the income elasticity of HOCEXP to be 0.427 (std. error=0.044), with about 0.391 (calculated std. error=0.044) arising from care quality improvements and 0.035 (std. error=0.050) emanating from the rise in usage volume. Our novel research findings suggest the following: (i) the quantity part of hospital expenditure is inelastic to income change; (ii) almost the entire income-induced rise in hospital expenditure comes from care quality changes; and (iii) the 0.427 income elasticity of HOCEXP, the largest component of total US healthcare expenditure, makes hospital care a normal commodity and a much stronger technical necessity than aggregate healthcare. Policy implications are discussed. Copyright © 2013 John Wiley & Sons, Ltd.

Out-of-pocket expenditures for primary health care in Tajikistan: a time-trend analysis.

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Schwarz, Joëlle; Wyss, Kaspar; Gulyamova, Zulfiya M; Sharipov, Soleh

2013-03-18

Aligned with the international call for universal coverage of affordable and quality health care, the government of Tajikistan is undertaking reforms of its health system aiming amongst others at reducing the out-of-pocket expenditures (OPE) of patients seeking care. Household surveys were conducted in 2005, 2007, 2008 and 2011 to explore the scale and determinants of OPE of users in four district of Tajikistan, where health care is legally free of charge at the primary level. Using the data from four cross-sectional household surveys conducted between 2005 and 2011, time trends in OPE for consultation fees, drugs and transport costs of adult users of family medicine services were analysed. To investigate differences along the economic status, an asset index was constructed using principal component analysis. Adjusted for inflation, OPE for primary care have substantially increased in the period 2005 to 2011. While the proportion of patients reporting the payment of informal consultation fees to providers and their amount were constant over time, the proportion of patients reporting expenditures for drugs has increased, and the median amounts have doubled from 5.3 US$ to 10.7 US$. Thus, the expenditures on medicine represent the biggest financial burden for patients accessing a primary care facility. Regression models showed that in 2011 patients from the most remote district with spread-out villages reported significant higher expenditures on medicine. Besides the steady increase in the median amount for OPE, the proportion of patients reporting making an informal payment to their care provider showed great variations across district of residence (between 20% and 73%) and economic status (between 33% among the 'worst-off' group and 68% among the 'better-off' group). In a context of limited governmental funds allocated to health and financing reforms aiming to improve financial access to primary care, the present paper indicates that in Tajikistan OPE - especially

Coping with health-care costs: implications for the measurement of catastrophic expenditures and poverty.

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Flores, Gabriela; Krishnakumar, Jaya; O'Donnell, Owen; van Doorslaer, Eddy

2008-12-01

In the absence of formal health insurance, we argue that the strategies households adopt to finance health care have important implications for the measurement and interpretation of how health payments impact on consumption and poverty. Given data on source of finance, we propose to (a) approximate the relative impact of health payments on current consumption with a 'coping'-adjusted health expenditure ratio, (b) uncover poverty that is 'hidden' because total household expenditure is inflated by financial coping strategies and (c) identify poverty that is 'transient' because necessary consumption is temporarily sacrificed to pay for health care. Measures that ignore coping strategies not only overstate the risk to current consumption and exaggerate the scale of catastrophic payments but also overlook the long-run burden of health payments. Nationally representative data from India reveal that coping strategies finance as much as three-quarters of the cost of inpatient care. Payments for inpatient care exceed 10% of total household expenditure for around 30% of hospitalized households but less than 4% sacrifice more than 10% of current consumption to accommodate this spending.Ignoring health payments leads to underestimate poverty by 7-8% points among hospitalized households; 80% of this adjustment is hidden poverty due to coping.

Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia

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Rodin, Urelija; Filipović-Grčić, Boris; Đelmiš, Josip; Glivetić, Tatjana; Juras, Josip; Mustapić, Željka; Grizelj, Ruža

2015-01-01

Context. Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons. Objective. Description of perinatal health care quality assessment key indicators in Croatia. Methods. Retrospective review of reports from all maternities from 2001 to 2014. Results. According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM) was reduced by 31%, fetal mortality (FM) by 32%, and early neonatal mortality (ENM) by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks' (wks) gestational age (GA) was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32–36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22–27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014. Conclusions. The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment. PMID:26693484

Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia

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Urelija Rodin

2015-01-01

Full Text Available Context. Perinatal mortality indicators are considered the most important measures of perinatal outcome. The indicators reliability depends on births and deaths reporting and recording. Many publications focus on perinatal deaths underreporting and misclassification, disabling proper international comparisons. Objective. Description of perinatal health care quality assessment key indicators in Croatia. Methods. Retrospective review of reports from all maternities from 2001 to 2014. Results. According to reporting criteria for birth weight ≥500 g, perinatal mortality (PNM was reduced by 31%, fetal mortality (FM by 32%, and early neonatal mortality (ENM by 29%. According to reporting criteria for ≥1000 g, PNM was reduced by 43%, FM by 36%, and ENM by 54%. PNM in ≥22 weeks’ (wks gestational age (GA was reduced by 28%, FM by 30%, and ENM by 26%. The proportion of FM at 32–36 wks GA and at term was the highest between all GA subgroups, as opposed to ENM with the highest proportion in 22–27 wks GA. Through the period, the maternal mortality ratio varied from 2.4 to 14.3/100,000 live births. The process indicators have been increased in number by more than half since 2001, the caesarean deliveries from 11.9% in 2001 to 19.6% in 2014. Conclusions. The comprehensive perinatal health monitoring represents the basis for the perinatal quality assessment.

Explaining the increased health care expenditures associated with gastroesophageal reflux disease among elderly Medicare beneficiaries with chronic obstructive pulmonary disease: a cost-decomposition analysis

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Ajmera M

2014-04-01

Full Text Available Mayank Ajmera,1 Amit D Raval,1 Chan Shen,2 Usha Sambamoorthi1 1Department of Pharmaceutical Systems and Policy, School of Pharmacy, School of Medicine, West Virginia University, Morgantown, WV, USA; 2Department of Biostatistics and Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA Objective: To estimate excess health care expenditures associated with gastroesophageal reflux disease (GERD among elderly individuals with chronic obstructive pulmonary disease (COPD and examine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors to the excess expenditures, using the Blinder-Oaxaca linear decomposition technique. Methods: This study utilized a cross-sectional, retrospective study design, using data from multiple years (2006-2009 of the Medicare Current Beneficiary Survey linked with fee-for-service Medicare claims. Presence of COPD and GERD was identified using diagnoses codes. Health care expenditures consisted of inpatient, outpatient, prescription drugs, dental, medical provider, and other services. For the analysis, t-tests were used to examine unadjusted subgroup differences in average health care expenditures by the presence of GERD. Ordinary least squares regressions on log-transformed health care expenditures were conducted to estimate the excess health care expenditures associated with GERD. The Blinder-Oaxaca linear decomposition technique was used to determine the contribution of predisposing characteristics, enabling resources, need variables, personal health care practices, and external environment factors, to excess health care expenditures associated with GERD. Results: Among elderly Medicare beneficiaries with COPD, 29.3% had co-occurring GERD. Elderly Medicare beneficiaries with COPD/GERD had 1.5 times higher ($36,793 vs $24,722 [P<0.001] expenditures than did those with COPD/no GERD. Ordinary

Information Architecture for Perinatal Registration in the Netherlands.

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Goossen, William T F; Arns-Schiere, Anne Marieke

In the Netherlands, the perinatal registry has undergone significant changes in the past decades. The purpose of this article is to describe the current health care information architecture for the national perinatal registry, including how the national data set is arranged and how electronic messages are used to submit data. We provide implications for women's health care providers based on the creation and implementation of the Dutch perinatal registry system. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Care for perinatal illness in rural Nepal: a descriptive study with cross-sectional and qualitative components

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Manandhar Madan

2003-08-01

Full Text Available Abstract Background Maternal, perinatal and neonatal mortality rates remain high in rural areas of developing countries. Most deliveries take place at home and care-seeking behaviour is often delayed. We report on a combined quantitative and qualitative study of care seeking obstacles and practices relating to perinatal illness in rural Makwanpur district, Nepal, with particular emphasis on consultation strategies. Methods The analysis included a survey of 8798 women who reported a birth in the previous two years [of whom 3557 reported illness in their pregnancy], on 30 case studies of perinatal morbidity and mortality, and on 43 focus group discussions with mothers, other family members and health workers. Results Early pregnancy was often concealed, preparation for birth was minimal and trained attendance at birth was uncommon. Family members were favoured attendants, particularly mothers-in-law. The most common recalled maternal complications were prolonged labour, postpartum haemorrhage and retained placenta. Neonatal death, though less definable, was often associated with cessation of suckling and shortness of breath. Many home-based care practices for maternal and neonatal illness were described. Self-medication was common. There were delays in recognising and acting on danger signs, and in seeking care beyond the household, in which the cultural requirement for maternal seclusion, and the perceived expense of care, played a part. Of the 760 women who sought care at a government facility, 70% took more than 12 hours from the decision to seek help to actual consultation. Consultation was primarily with traditional healers, who were key actors in the ascription of causation. Use of the government primary health care system was limited: the most common source of allopathic care was the district hospital. Conclusions Major obstacles to seeking care were: a limited capacity to recognise danger signs; the need to watch and wait; and an

Allowing Spouses to Be Paid Personal Care Providers: Spouse Availability and Effects on Medicaid-Funded Service Use and Expenditures

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Newcomer, Robert J.; Kang, Taewoon; Doty, Pamela

2012-01-01

Purpose of the Study: Medicaid service use and expenditure and quality of care outcomes in California's personal care program known as In-Home Supportive Service (IHSS) are described. Analyses investigated Medicaid expenditures, hospital use, and nursing home stays, comparing recipients who have paid spouse caregivers with those having other…

Eliminating Perinatal HIV Transmission

Centers for Disease Control (CDC) Podcasts

2012-11-26

In this podcast, CDC’s Dr. Steve Nesheim discusses perinatal HIV transmission, including the importance of preventing HIV among women, preconception care, and timely HIV testing of the mother. Dr. Nesheim also introduces the revised curriculum Eliminating Perinatal HIV Transmission intended for faculty of OB/GYN and pediatric residents and nurse midwifery students.  Created: 11/26/2012 by Division of HIV/AIDS Prevention.   Date Released: 11/26/2012.

A Call to Revisit the Prenatal Period as a Focus for Action Within the Reproductive and Perinatal Care Continuum.

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Handler, Arden; Johnson, Kay

2016-11-01

Objectives The broad maternal and child health community has witnessed increased attention to the entire continuum of reproductive and perinatal health concerns over the past few years. However, both recent discouraging trends in prenatal care access and utilization and a renewed understanding of prenatal care as a critical anchor of the reproductive/perinatal health continuum for women who do get pregnant demand a new effort to focus on the prenatal period as a gateway for maternal and infant health. Methods This commentary: describes the Medicaid expansions and the momentum for universal access to prenatal care of the 1980-1990s; examines the pivot away from this goal and its aftermath; provides a rationale for why renewed attention to prenatal care and the prenatal period is essential; and, explores the potential focus of an updated prenatal care agenda. Conclusion We conclude that increasing women's access to high quality prenatal care will require substantial effort at the clinical, community, policy, and system levels. Only when attention is paid to all phases of the reproductive/perinatal health continuum with an emphasis on continuity between all periods, and on the social determinants that affect health and well-being, will our nation be able to ensure the health of all women across the life course (whether or not they ever become mothers), while simultaneously fulfilling our nation's promise that all children-no matter their income or race/ethnicity-will have the opportunity to be born well.

Health Care Expenditures After Initiating Long-term Services and Supports in the Community Versus in a Nursing Facility.

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Newcomer, Robert J; Ko, Michelle; Kang, Taewoon; Harrington, Charlene; Hulett, Denis; Bindman, Andrew B

2016-03-01

Individuals who receive long-term services and supports (LTSS) are among the most costly participants in the Medicare and Medicaid programs. To compare health care expenditures among users of Medicaid home and community-based services (HCBS) versus those using extended nursing facility care. Retrospective cohort analysis of California dually eligible adult Medicaid and Medicare beneficiaries who initiated Medicaid LTSS, identified as HCBS or extended nursing facility care, in 2006 or 2007. Propensity score matching for demographic, health, and functional characteristics resulted in a subsample of 34,660 users who initiated Medicaid HCBS versus extended nursing facility use. Those with developmental disabilities or in managed care plans were excluded. Average monthly adjusted acute, postacute, long-term, and total Medicare and Medicaid expenditures for the 12 months following initiation of either HCBS or extended nursing facility care. Those initiating extended nursing facility care had, on average, $2919 higher adjusted total health care expenditures per month compared with those who initiated HCBS. The difference was primarily attributable to spending on LTSS $2855. On average, the monthly LTSS expenditures were higher for Medicare $1501 and for Medicaid $1344 when LTSS was provided in a nursing facility rather than in the community. The higher cost of delivering LTSS in a nursing facility rather than in the community was not offset by lower acute and postacute spending. Medicare and Medicaid contribute similar amounts to the LTSS cost difference and both could benefit financially by redirecting care from institutions to the community.

The capital expenditure process for the health care supervisor.

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Rogers, M M

1993-12-01

Competition for health care capital dollars has increased as third-party and government reimbursement decreases, patient volume decreases, and alternative services increase. Given this rationing situation, it is more important than ever that the health care supervisor carefully document and present a capital expenditure request. This request should outline skillfully the benefits and costs of undertaking a new service or replacing an old asset. A supervisor who can quantify the costs and benefits of a project and utilize one of the four common capital budgeting techniques: payback period, net present value, profitability index, or internal rate of return, will certainly be taking a step in the right direction for ensuring a serious evaluation of his or her proposal. This article attempts to explain this process using both narrative and quantitative examples.

Improving Perinatal Mental Health Care for Women Veterans: Description of a Quality Improvement Program.

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Katon, Jodie G; Lewis, Lacey; Hercinovic, Selma; McNab, Amanda; Fortney, John; Rose, Susan M

2017-08-01

Purpose We describe results from a quality improvement project undertaken to address perinatal mental healthcare for women veterans. Description This quality improvement project was conducted in a single VA healthcare system between 2012 and 2015 and included screening for depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) three times during the perinatal period, a dedicated maternity care coordinator (MCC), an on-site clinical social worker, and an on-site obstetrician/gynecologist (Ob/gyn). Information on prior mental health diagnosis was collected by the MCC or Ob/gyn. The prevalence of perinatal depressive symptoms and receipt of mental healthcare among those with such symptoms are reported by presence of a pre-pregnancy mental health diagnosis. Assessment Of the 199 women who used VA maternity benefits between 2012 and 2015, 56% (n = 111) had at least one pre-pregnancy mental health diagnosis. Compared to those without a pre-pregnancy mental health diagnosis, those with such a diagnosis were more likely to be screened for perinatal depressive symptoms at least once (61.5% vs. 46.8%, p = 0.04). Prevalence of depressive symptoms was 46.7% among those with a pre-pregnancy mental health diagnosis and 19.2% among those without. Among those with a pre-pregnancy mental health diagnosis and depressive symptoms (n = 35), 88% received outpatient mental healthcare and 77% met with the clinical social worker. Among those without a pre-pregnancy mental health diagnosis and depressive symptoms (n = 8), none received outpatient mental healthcare, but 77.8% met with the clinical social worker. Conclusion Improving perinatal mental healthcare for women veterans requires a multidisciplinary approach, including on-site integrated mental healthcare.

Health Care Expenditures for Children with Autism Spectrum Disorders in Medicaid

Science.gov (United States)

Wang, Li; Leslie, Douglas L.

2010-01-01

Objective: To study trends in health care expenditures associated with autism spectrum disorders (ASDs) in state Medicaid programs. Method: Using Medicaid data from 42 states from 2000 to 2003, patients aged 17 years and under who were continuously enrolled in fee-for-service Medicaid were studied. Patients with claims related to autistic disorder…

Perinatal Practices & Traditions Among Asian Indian Women.

Science.gov (United States)

Goyal, Deepika

2016-01-01

As the population in the United States grows more diverse, nurses caring for childbearing women must be aware of the many cultural traditions and customs unique to their patients. This knowledge and insight supports women and their families with the appropriate care, information, and resources. A supportive relationship builds trust, offers guidance, and allows for the new family to integrate information from nurses and other healthcare providers with the practice of certain perinatal cultural traditions. The Asian Indian culture is rich in tradition, specifically during the perinatal period. To support the cultural beliefs and practices of Asian Indian women during this time, nurses need to be aware of and consider multiple factors. Many women are navigating the new role of motherhood while making sense of and incorporating important cultural rituals. The purpose of this article is to provide an overview of perinatal cultural practices and traditions specific to the Asian Indian culture that perinatal nurses may observe in the clinical setting. Cultural traditions and practices specific to the pregnancy and postpartum period are described together with symbolism and implications for nursing practice. It is important to note that information regarding perinatal customs is provided in an effort to promote culturally sensitive nursing care and may not pertain to all Asian Indian women living in the United States.

Gender Difference in Health-Care Expenditure: Evidence from India Human Development Survey.

Directory of Open Access Journals (Sweden)

Nandita Saikia

Full Text Available While the gender disparity in health and mortality in various stages of life in India is well documented, there is limited evidence on female disadvantage in health-care expenditure (HCE.Examine the gender difference in HCE in short-term and major morbidity in India, and understand the role of factors underlying the difference.Using two rounds of nationally representative panel data-the India Human Development Survey (IHDS 2004-2005 and 2011-2012 (IHDS I & II-we calculate morbidity prevalence rate and mean HCE by gender, and examine the adjusted effect of gender on major morbidity-related HCE by using a two-part regression model. Further, we performed Oaxaca-Blinder decomposition of the gender gap in HCE in major morbidity to understand the contribution of demographic and socio-economic factors.Health-care expenditure on females was systematically lower than on males across all demographic and socio-economic groups. Multivariate analysis confirms that female HCE is significantly lower than male HCE even after controlling demographic and socio-economic factors (β = -0.148, p = 0.000, CI:-0.206-0.091. For both short-term and major morbidity, a female disadvantage on HCE increased from IHDS I to IHDS II. For instance, the male-female gap in major morbidity related expenditure increased from INR 1298 to INR 4172. A decomposition analysis of gender gap in HCE demonstrates that about 48% of the gap is attributable to differences in demographic and socio-economic factors (endowment effect, whereas 50% of the gap is due to the differential effect of the determinants (coefficient effect.Indians spend less on female health care than on male health care. Most of the gender gap in HCE is not due to differential distribution of factors affecting HCE.

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

OpenAIRE

Phillips, Charles D.

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...

Health Care Expenditure and GDP in Oil Exporting Countries: Evidence From OPEC Data, 1995-2012.

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Fazaeli, Ali Akbar; Ghaderi, Hossein; Salehi, Masoud; Fazaeli, Ali Reza

2015-06-11

There is a large body of literature examining income in relation to health expenditures. The share of expenditures in health sector from GDP in developed countries is often larger than in non-developed countries, suggesting that as the level of economic growth increases, health spending increase, too. This paper estimates long-run relationships between health expenditures and GDP based on panel data of a sample of 12 countries of the Organization of the Petroleum Exporting Countries (OPEC), using data for the period 1995-2012. We use panel data unit root tests, cointegration analysis and ECM model to find long-run and short-run relation. This study examines whether health is a luxury or a necessity for OPEC countries within a unit root and cointegration framework. Panel data analysis indicates that health expenditures and GDP are co-integrated and have Engle and Granger causality. In addition, in oil countries that have oil export income, the share of government expenditures in the health sector is often greater than in private health expenditures similar developed countries. The findings verify that health care is not a luxury good and income has a robust relationship to health expenditures in OPEC countries.

Do health care workforce, population, and service provision significantly contribute to the total health expenditure? An econometric analysis of Serbia.

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Santric-Milicevic, M; Vasic, V; Terzic-Supic, Z

2016-08-15

In times of austerity, the availability of econometric health knowledge assists policy-makers in understanding and balancing health expenditure with health care plans within fiscal constraints. The objective of this study is to explore whether the health workforce supply of the public health care sector, population number, and utilization of inpatient care significantly contribute to total health expenditure. The dependent variable is the total health expenditure (THE) in Serbia from the years 2003 to 2011. The independent variables are the number of health workers employed in the public health care sector, population number, and inpatient care discharges per 100 population. The statistical analyses include the quadratic interpolation method, natural logarithm and differentiation, and multiple linear regression analyses. The level of significance is set at P Total health expenditure increased by 1.21 standard deviations, with an increase in health workforce growth rate by 1 standard deviation. Furthermore, this rate decreased by 1.12 standard deviations, with an increase in (negative) population growth rate by 1 standard deviation. Finally, the growth rate increased by 0.38 standard deviation, with an increase of the growth rate of inpatient care discharges per 100 population by 1 standard deviation (P < 0.001). Study results demonstrate that the government has been making an effort to control strongly health budget growth. Exploring causality relationships between health expenditure and health workforce is important for countries that are trying to consolidate their public health finances and achieve universal health coverage at the same time.

Action plan to reduce perinatal mortality.

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Bhakoo, O N; Kumar, R

1990-01-01

The government of India has set a goal of reducing perinatal mortality from its current rate of 48/1000 to 30-35/1000 by the year 2000. Perinatal deaths result from maternal malnutrition, inadequate prenatal care, complications of delivery, and infections in the postpartum period. Since reductions in perinatal mortality require attention to social, economic, and behavioral factors, as well as improvements in the health care delivery system, a comprehensive strategy is required. Social measures, such as raising the age at marriage to 18 years for females, improving the nutritional status of adolescent girls, reducing the strenuousness of work during pregnancy, improving female literacy, raising women's status in the society and thus in the family, and poverty alleviation programs, would all help eliminate the extent of complications of pregnancy. Measures required to enhance infant survival include improved prenatal care, prenatal tetanus toxoid immunization, use of sterile disposable cord care kits, the provision of mucus extractors and resuscitation materials to birth attendants, the creation of neonatal care units in health facilities, and more efficient referral of high-risk newborns and mothers. Since 90% of births in rural India take place at home priority must be given to training traditional birth attendants in the identification of high risk factors during pregnancy, delivery, and the newborn period.

The implementation of unit-based perinatal mortality audit in perinatal cooperation units in the northern region of the Netherlands

NARCIS (Netherlands)

van Diem, M.T.; Timmer, A.; Bergman, K.A.; Bouman, K.; van Egmond, N.; Stant, D.A.; Ulkeman, L.H.M.; Veen, W.B.; Erwich, J.J.H.M.

2012-01-01

Background: Perinatal (mortality) audit can be considered to be a way to improve the careprocess for all pregnant women and their newborns by creating an opportunity to learn from unwanted events in the care process. In unit-based perinatal audit, the caregivers involved in cases that result in

Provider report of the existence of detection and care of perinatal depression: quantitative evidence from public obstetric units in Mexico.

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Castro, Filipa de; Place, Jean Marie; Allen-Leigh, Betania; Rivera-Rivera, Leonor; Billings, Deborah

2016-08-01

To provide evidence on perinatal mental healthcare in Mexico. Descriptive and bivariate analyses of data from a cross-sectional probabilistic survey of 211 public obstetric units. Over half (64.0%) of units offer mental healthcare; fewer offer perinatal depression (PND) detection (37.1%) and care (40.3%). More units had protocols/guidelines for PND detection and for care, respectively, in Mexico City-Mexico state (76.7%; 78.1%) than in Southern (26.5%; 36.4%), Northern (27.3%; 28.1%) and Central Mexico (50.0%; 52.7%). Protocols and provider training in PND, implementation of brief screening tools and psychosocial interventions delivered by non-clinical personnel are needed.

Escalating Health Care Expenditures in Cancer Decedents' Last Year of Life: A Decade of Evidence from a Retrospective Population-Based Cohort Study in Taiwan.

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Hung, Yen-Ni; Liu, Tsang-Wu; Wen, Fur-Hsing; Chou, Wen-Chi; Tang, Siew Tzuh

2017-04-01

No population-based longitudinal studies on end-of-life (EOL) expenditures were found for cancer decedents. This population-based, retrospective cohort study examined health care expenditures from 2001 to 2010 among 339,546 Taiwanese cancer decedents' last year of life. Individual patient-level data were linked from administrative datasets. Health care expenditures were converted from Taiwan dollars to U.S. dollars by health-specific purchasing power parity conversions to account for different health-purchasing powers. Associations of patient, physician, hospital, and regional factors with EOL care expenditures were evaluated by multilevel linear regression model by generalized estimating equation method. Mean annual EOL care expenditures for Taiwanese cancer decedents increased from 2000 to 2010 from U.S. $49,591 to U.S. $68,773, respectively, with one third of spending occurring in the patients' last month. Increased EOL care expenditures were associated with male gender, younger age, being married, diagnosed with hematological malignancies and cancers other than lung, gastric, and hepatic-pancreatic cancers, and dying within 7-24 months of diagnosis. Patients spent less at EOL when they had higher comorbidities and metastatic disease, died within 6 months of diagnosis, were under care of oncologists, gastroenterologists, and intensivists, and received care at a teaching hospital with more terminally ill cancer patients. Higher EOL care expenditures were associated with greater EOL care intensity at the primary hospital and regional levels. Taiwanese cancer decedents consumed considerable National Health Insurance disbursements at EOL, totaling more than was consumed in six developed non-U.S. countries surveyed in 2010. To slow increasing cost and improve EOL cancer care quality, interventions to ensure appropriate EOL care provision should target hospitals and clinicians less experienced in providing EOL care and those who tend to provide aggressive EOL care to

Escalating Health Care Expenditures in Cancer Decedents' Last Year of Life: A Decade of Evidence from a Retrospective Population‐Based Cohort Study in Taiwan

Science.gov (United States)

Hung, Yen‐Ni; Liu, Tsang‐Wu; Wen, Fur‐Hsing; Chou, Wen‐Chi

2017-01-01

Abstract Background. No population‐based longitudinal studies on end‐of‐life (EOL) expenditures were found for cancer decedents. Methods. This population‐based, retrospective cohort study examined health care expenditures from 2001 to 2010 among 339,546 Taiwanese cancer decedents' last year of life. Individual patient‐level data were linked from administrative datasets. Health care expenditures were converted from Taiwan dollars to U.S. dollars by health‐specific purchasing power parity conversions to account for different health‐purchasing powers. Associations of patient, physician, hospital, and regional factors with EOL care expenditures were evaluated by multilevel linear regression model by generalized estimating equation method. Results. Mean annual EOL care expenditures for Taiwanese cancer decedents increased from 2000 to 2010 from U.S. $49,591 to U.S. $68,773, respectively, with one third of spending occurring in the patients' last month. Increased EOL care expenditures were associated with male gender, younger age, being married, diagnosed with hematological malignancies and cancers other than lung, gastric, and hepatic‐pancreatic cancers, and dying within 7–24 months of diagnosis. Patients spent less at EOL when they had higher comorbidities and metastatic disease, died within 6 months of diagnosis, were under care of oncologists, gastroenterologists, and intensivists, and received care at a teaching hospital with more terminally ill cancer patients. Higher EOL care expenditures were associated with greater EOL care intensity at the primary hospital and regional levels. Conclusion. Taiwanese cancer decedents consumed considerable National Health Insurance disbursements at EOL, totaling more than was consumed in six developed non‐U.S. countries surveyed in 2010. To slow increasing cost and improve EOL cancer care quality, interventions to ensure appropriate EOL care provision should target hospitals and clinicians less experienced in

Political or dental power in private and public service provision: a study of municipal expenditures for child dental care

DEFF Research Database (Denmark)

Andersen, L. B.; Bech, M.; Lauridsen, J.

2012-01-01

Both professionals and politicians may affect expenditures for highly professional services provided in the public and private sector. We investigated Danish publicly financed child dental care with a special focus on the influence of politicians and dentists on the expenditure level. By studying...... from 1996 to 2001 for 226 Danish municipalities, thus allowing for the control for heterogeneity between municipalities and for intra-municipal correlations across time. The results point to differences in expenditures between municipalities with privately and publicly produced dental care. Furthermore...... spatial patterns in expenditure levels across municipalities, we are able to test the influences of these two main actors and the networks through which learning is achieved. Four hypotheses on the existence of different spatial spillover effects are tested. The empirical analysis is based on annual data...

Causes of perinatal death at a tertiary care hospital in Northern Tanzania 2000–2010: a registry based study

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Mmbaga Blandina T

2012-12-01

Full Text Available Abstract Background Perinatal mortality reflects maternal health as well as antenatal, intrapartum and newborn care, and is an important health indicator. This study aimed at classifying causes of perinatal death in order to identify categories of potentially preventable deaths. Methods We studied a total of 1958 stillbirths and early neonatal deaths above 500 g between July 2000 and October 2010 registered in the Medical Birth Registry and neonatal registry at Kilimanjaro Christian Medical Centre (KCMC in Northern Tanzania. The deaths were classified according to the Neonatal and Intrauterine deaths Classification according to Etiology (NICE. Results Overall perinatal mortality was 57.7/1000 (1958 out of 33 929, of which 1219 (35.9/1000 were stillbirths and 739 (21.8/1000 were early neonatal deaths. Major causes of perinatal mortality were unexplained asphyxia (n=425, 12.5/1000, obstetric complications (n=303, 8.9/1000, maternal disease (n=287, 8.5/1000, unexplained antepartum stillbirths after 37 weeks of gestation (n= 219, 6.5/1000, and unexplained antepartum stillbirths before 37 weeks of gestation (n=184, 5.4/1000. Obstructed/prolonged labour was the leading condition (251/303, 82.8% among the obstetric complications. Preeclampsia/eclampsia was the leading cause (253/287, 88.2% among the maternal conditions. When we excluded women who were referred for delivery at KCMC due to medical reasons (19.1% of all births and 36.0% of all deaths, perinatal mortality was reduced to 45.6/1000. This reduction was mainly due to fewer deaths from obstetric complications (from 8.9 to 2.1/1000 and maternal conditions (from 8.5 to 5.5/1000. Conclusion The distribution of causes of death in this population suggests a great potential for prevention. Early identification of mothers at risk of pregnancy complications through antenatal care screening, teaching pregnant women to recognize signs of pregnancy complications, timely access to obstetric care

QUALITY OF PERINATAL CARE IN SLOVENIA 2003–2008

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Tanja Premru-Sršen

2018-02-01

Full Text Available Background: The purpose of this analysis was to find whether the quality indicators of perinatal care in Slovenia change. Methods: We used the same quality indicators which are used in the European project Europeristat1 to compare the quality of perinatal care among the countries of the European Union. We used two 5-year periods, from 1998 to 2002 (reference period and from 2003 to 2008 (observed period. Data for perinatal quality were collected from the National Perinatal Information System of the Republic of Slovenia.2 Statistical significance was tested using the Pearson’s chi-square test. Results: Between 1998 and 2002, there were 87.679 labours ending in the delivery of 88.678 new- borns, and between 2003 and 2008, there were 90.662 labours ending in the delivery of 91.736 babies. In the observed period (2003 do 2008 mothers had statistically significantly higher educational level, a higher percentage came to their first pregnancy examination before the 12th week of gestation (84.0 % vs. 75.3 %, a higher percentage conceived after assisted reproductive techniques (2.0 % vs. 1.7 %, and the incidence of multiple pregnancies was higher (1.7 % vs. 1.6 %. Significantly lower were the percentages of labours without medical interventions (34.7 % vs. 41.9 % and of spontaneous onset of labour (74.0 % vs. 92.6 %. The percentages of induced labours and of elective cesarean sections increased dramatically (20.1 % vs. 6.6 % and 6.0 % vs. 0.9 %. The increase in the overall percentage of cesarean sections (14.8 % vs. 11.0 % is mainly due to increased incidence of elective cesarean sections, but the percentage of operative termination of vaginal labour increased as well (3.1 % vs. 2.6 %. The incidence of episiotomies was lower (48.7 % vs. 51.0 % and so was the incidence of 2nd degree perineal lacerations (4.5 % vs. 5.4 %, while the incidence of 3rd–4th degree lacerations was higher (0.3 % vs. 0.2 %. Transfusion was required in a lower percentage (0

The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures.

Science.gov (United States)

Janssens, Wendy; Goedecke, Jann; de Bree, Godelieve J; Aderibigbe, Sunday A; Akande, Tanimola M; Mesnard, Alice

2016-01-01

Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. A household survey was conducted in rural Kwara State, Nigeria, among 5,761 individuals. Data were obtained using biomedical and socio-economic questionnaires. Health care utilization, NCCD-related health expenditures and distances to health care providers were compared by sex and by wealth quintile, and a Heckman regression model was used to estimate health expenditures taking selection bias in health care utilization into account. The prevalence of NCCDs in our sample was 6.2%. NCCD-affected individuals from the wealthiest quintile utilized formal health care nearly twice as often as those from the lowest quintile (87.8% vs 46.2%, p = 0.002). Women reported foregone formal care more often than men (43.5% vs. 27.0%, p = 0.058). Health expenditures relative to annual consumption of the poorest quintile exceeded those of the highest quintile 2.2-fold, and the poorest quintile exhibited a higher rate of catastrophic health spending (10.8% among NCCD-affected households) than the three upper quintiles (4.2% to 6.7%). Long travel distances to the nearest provider, highest for the poorest quintile, were a significant deterrent to seeking care. Using distance to the nearest facility as instrument to account for selection into health care utilization, we estimated out-of-pocket health care expenditures for NCCDs to be significantly higher in the lowest wealth quintile compared to the three upper quintiles. Facing potentially high health care costs and poor accessibility of health care facilities, many individuals suffering from NCCDs-particularly women and the poor-forego formal care, thereby increasing the risk of more severe illness in the future. When seeking care, the poor spend less on treatment than the rich, suggestive of lower

Midwives' perceptions and experiences of caring for women who experience perinatal mental health problems: An integrative review.

Science.gov (United States)

Noonan, Maria; Doody, Owen; Jomeen, Julie; Galvin, Rose

2017-02-01

perinatal mental health is an important public health issue and consideration must be given to care provision for effective support and care of women in the perinatal period. to synthesise primary research on midwives' perceived role in Perinatal Mental Health (PMH). integrative review. Whittemore and Knafl's (2005) framework was employed. A systematic search of the literature was completed. Studies were included if they met the following criteria: primary qualitative, quantitative and mixed methods research studies published in peer reviewed journals between January 2006 to February 2016, where the population of interest were midwives and the outcomes of interest were their perceived role in the management of women with PMH problems. The methodological quality of studies was assessed using the relevant CASP (Critical Appraisal Skills Programmes, 2014) criteria for quantitative and qualitative research studies. Data extraction, quality assessment and thematic analysis were conducted. a total of 3323 articles were retrieved and 22 papers were included in the review (15 quantitative, 6 qualitative and one mixed method study). The quality of the studies included was good overall. Two overarching themes emerged relating to personal and professional engagement. Within personal engagement four sub themes are presented: knowledge, skills, decision making and attitude. Within professional engagement four themes are presented: continuous professional development, organisation of care, referral, and support. the findings indicate midwives require continuous professional development opportunities that address knowledge, attitudes to PMH, communication and assessment skills. However educational and training support in the absence of appropriate referral pathways and support systems will have little benefit. Copyright © 2016 Elsevier Ltd. All rights reserved.

Predictors of Home Care Expenditures and Death at Home for Cancer Patients in an Integrated Comprehensive Palliative Home Care Pilot Program

Science.gov (United States)

Howell, Doris M.; Abernathy, Tom; Cockerill, Rhonda; Brazil, Kevin; Wagner, Frank; Librach, Larry

2011-01-01

Purpose: Empirical understanding of predictors for home care service use and death at home is important for healthcare planning. Few studies have examined these predictors in the context of the publicly funded Canadian home care system. This study examined predictors for home care use and home death in the context of a “gold standard” comprehensive palliative home care program pilot in Ontario where patients had equal access to home care services. Methods: Secondary clinical and administrative data sources were linked using a unique identifier to examine multivariate factors (predisposing, enabling, need) on total home care expenditures and home death for a cohort of cancer patients enrolled in the HPCNet pilot. Results: Subjects with gastrointestinal symptoms (OR: 1.64; p=0.03) and those with higher income had increased odds of dying at home (OR: 1.14; phome care expenditures. Conclusions: Predictors of home death found in earlier studies appeared less important in this comprehensive palliative home care pilot. An income effect for home death observed in this study requires examination in future controlled studies. Relevance: Access to palliative home care that is adequately resourced and organized to address the multiple domains of issues that patients/families experience at the end of life has the potential to enable home death and shift care appropriately from limited acute care resources. PMID:22294993

Is more neonatal intensive care always better? Insights from a cross-national comparison of reproductive care.

Science.gov (United States)

Thompson, Lindsay A; Goodman, David C; Little, George A

2002-06-01

Despite high per capita health care expenditure, the United States has crude infant survival rates that are lower than similarly developed nations. Although differences in vital recording and socioeconomic risk have been studied, a systematic, cross-national comparison of perinatal health care systems is lacking. To characterize systems of reproductive care for the United States, Australia, Canada, and the United Kingdom, including a detailed analysis of neonatal intensive care and mortality. Comparison of selected indicators of reproductive care and mortality from 1993-2000 through a systematic review of journal and government publications and structured interviews of leaders in perinatal and neonatal care. Compared with the other 3 countries, the United States has more neonatal intensive care resources yet provides proportionately less support for preconception and prenatal care. Unlike the United States, the other countries provided free family planning services and prenatal and perinatal physician care, and the United Kingdom and Australia paid for all contraception. The United States has high neonatal intensive care capacity, with 6.1 neonatologists per 10 000 live births; Australia, 3.7; Canada, 3.3; and the United Kingdom, 2.7. For intensive care beds, the United States has 3.3 per 10 000 live births; Australia and Canada, 2.6; and the United Kingdom, 0.67. Greater neonatal intensive care resources were not consistently associated with lower birth weight-specific mortality. The relative risk (United States as reference) of neonatal mortality for infants birth weight rates were notably higher in the United States, partially explaining the high crude mortality rates. The United States has significantly greater neonatal intensive care resources per capita, compared with 3 other developed countries, without having consistently better birth weight-specific mortality. Despite low birth weight rates that exceed other countries, the United States has proportionately

Validity of a questionnaire measuring the world health organization concept of health system responsiveness with respect to perinatal services in the Dutch obstetric care system.

Science.gov (United States)

van der Kooy, Jacoba; Valentine, Nicole B; Birnie, Erwin; Vujkovic, Marijana; de Graaf, Johanna P; Denktaş, Semiha; Steegers, Eric A P; Bonsel, Gouke J

2014-12-03

The concept of responsiveness, introduced by the World Health Organization (WHO), addresses non-clinical aspects of health service quality that are relevant regardless of provider, country, health system or health condition. Responsiveness refers to "aspects related to the way individuals are treated and the environment in which they are treated" during health system interactions. This paper assesses the psychometric properties of a newly developed responsiveness questionnaire dedicated to evaluating maternal experiences of perinatal care services, called the Responsiveness in Perinatal and Obstetric Health Care Questionnaire (ReproQ), using the eight-domain WHO concept. The ReproQ was developed between October 2009 and February 2010 by adapting the WHO Responsiveness Questionnaire items to the perinatal care context. The psychometric properties of feasibility, construct validity, and discriminative validity were empirically assessed in a sample of Dutch women two weeks post partum. A total of 171 women consented to participation. Feasibility: the interviews lasted between 20 and 40 minutes and the overall missing rate was 8%. Construct validity: mean Cronbach's alphas for the antenatal, birth and postpartum phase were: 0.73 (range 0.57-0.82), 0.84 (range 0.66-0.92), and 0.87 (range 0.62-0.95) respectively. The item-own scale correlations within all phases were considerably higher than most of the item-other scale correlations. Within the antenatal care, birth care and post partum phases, the eight factors explained 69%, 69%, and 76% of variance respectively. Discriminative validity: overall responsiveness mean sum scores were higher for women whose children were not admitted. This confirmed the hypothesis that dissatisfaction with health outcomes is transferred to their judgement on responsiveness of the perinatal services. The ReproQ interview-based questionnaire demonstrated satisfactory psychometric properties to describe the quality of perinatal care in the

The effectiveness of regionalization of perinatal care services--a systematic review.

Science.gov (United States)

Rashidian, A; Omidvari, A H; Vali, Y; Mortaz, S; Yousefi-Nooraie, R; Jafari, M; Bhutta, Z A

2014-10-01

Several reports recommend the implementation of perinatal regionalization for improvements in maternal and neonatal outcomes, while research evidence on the effectiveness of perinatal regionalization has been limited. The interventional studies have been assessed for robust evidence on the effectiveness of perinatal regionalization on improving maternal and neonatal health outcomes. Bibliographic databases of Medline, EMbase, EconLit, HMIC have been searched using sensitive search terms for interventional studies that reported important patient or process outcomes. At least two authors assessed eligibility for inclusion and the risk of biases and extracted data from the included studies. As meta-analysis was not possible, a narrative analysis as well as a 'vote-counting' analysis has been conducted for important outcomes. After initial screenings 53 full text papers were retrieved. Eight studies were included in the review from the USA, Canada and France. Studies varied in their designs, and in the specifications of the intervention and setting. Only three interrupted time series studies had a low risk of bias, of which only one study reported significant reductions in neonatal and infant mortality. Studies of higher risk of bias were more likely to report improvements in outcomes. Implementing perinatal regionalization programs is correlated with improvements in perinatal outcomes, but it is not possible to establish a causal link. Despite several high profile policy statements, evidence of effect is weak. It is necessary to assess the effectiveness of perinatal regionalization using robust research designs in a more diverse range of countries.

ENERGY EXPENDITURE AND INTAKE COMPARISONS IN CHILEAN CHILDREN 4-5 YEARS ATTENDING DAY-CARE CENTRES.

Science.gov (United States)

Salazar, Gabriela; Vásquez, Fabián; Rodríguez, Maria P; Andrade, Ana M; Anziani, Maria A; Vio, Fernando; Coward, Williams

2015-09-01

the doubly labelled water (DLW) method has an accuracy of 1% and within-subject precision of 5-8%, depending on subject's age and environments issues. Energy intake assessment is prone to errors (>15- 20%) depending in the method utilized. to quantify DLW methodology errors in four to five year olds that could affect the comparison with energy intake. energy expenditure (TEE, by DLW), was assessed during 14 days in 18 preschool children, who attended eight hours daily to day-care centres. Energy intake was determined by a combined method: food weighing during weekdays and recall after leaving the Centre (17h to sleep time) plus 24 h recall, during the weekend. Several assumptions affecting DLW total error were assessed to determine their influence in the comparison to energy intake (i.e. background variability, space ratio, proportion of water subject to fractionation, food quotient value). the individual mean energy expenditure was 1 373 ± 177 kcal and the energy intake (1 409 ± 161 kcal). The overall difference between intake and expenditure was 42.9 kcal/day (limits of agreement + 259.1 to -112.3 kcal/day). TEE measurement error only explained a minor quantity (2.4%), between both measurements, and the observed mean isotope dilution space was 1.030 ± 0.010 confirming the value utilized in adults studies. energy expenditure data is similar to other studies in preschool children. The small difference found between energy intake and expenditure may be attributed to the applied energy intake methodology, the homogeneous diet at care centres during the week-days and the lower DLW methodology error. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Relationship between maternal hemoglobin and perinatal outcome

International Nuclear Information System (INIS)

Bakhtiar, U.J.; Khan, Y.; Nisar, R.

2007-01-01

To Study the Relationship between Maternal Hemoglobin and Perinatal outcome in a cohort of 860 pregnant women and to highlight the importance of antenatal care regarding maternal health and fetal outcome. All Singleton pregnancies delivering at Pakistan Railway Hospital Rawalpindi from January 2004 to December 2005 that fulfilled the required criteria were included. Out of the 860 patients, 402 were anemic (<11gm/dl) and 458 were non anemic. Perinatal outcome included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low apgr scores and intrauterine fetal deaths. Risk of preterm and Low birth weight among anemic women was 3.4 and 1.8 times more than non anaemic women. The neonates of anemic woman also had 1.7 times increased risk of having low apgr scores at 1 min. Among anemic women there was 2.2 times greater risk of intrauterine fetal death than the non-anemic women. Regular antenatal care from first trimester has a vital role in assessing and managing maternal anemia timely and it directly affects the perinatal outcome. The patients with anemia have also higher risk of having low birth weight, preterm births and intra uterine fetal death. (author)

Potentially avoidable perinatal deaths in Denmark and Sweden 1991

DEFF Research Database (Denmark)

Langhoff-Roos, J; Borch-Christensen, H; Larsen, S

1996-01-01

to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths. MATERIAL AND METHODS: Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing......BACKGROUND: Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries...

Potentially avoidable perinatal deaths in Denmark and Sweden 1991

DEFF Research Database (Denmark)

Langhoff-Roos, J; Borch-Christensen, H; Larsen, S

1996-01-01

BACKGROUND: Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries...... to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths. MATERIAL AND METHODS: Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing...

Equity in Health Care Expenditure in Nigeria

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Olanrewaju Olaniyan

2013-07-01

Full Text Available Equity isone of the basic principles of health systems and features explicitly in theNigerian health financing policy. Despite acclaimed commitment to theimplementation of this policy through various pro-poor health programmes andinterventions, the level of inequity in health status and access to basichealth care interventions remain high. This paper examines the equity of healthcare expenditure by individuals in Nigeria. The paper evaluated equity in out-of-pocketspending( OOP for the country and separately for the six geopolitical zones ofthe country.The methodological framework rests onKakwani Progressivity Indices (KPIs, ReynoldSmolensky indices andconcentration indices (CIs using data from the 2004 Nigerian National LivingStandard Survey( NLSS collected by the National Bureau of Statistics. .The results reveal that health financing isregressive with the incidence disproportionately rest on poor households withabout 70% of the total expenditure on health is through out-of-pocket paymentsby households. Poor households are prone to bear most of the expenses in theevent of any health shock. The catastrophic consequences thus push some intopoverty, and aggravate the poverty of others.The paper therefore suggests that thecountry’s health financingsystems must be designed not only to allow people to access services when theyare needed, but must also protect household, from financial catastrophe, byreducing OOP spending through risk pooling and prepayment schemes within thehealth system.Keywords:                            Equity, Health careexpenditure, Kakwani progressivity index, Nigeria.

Mobile phone intervention reduces perinatal mortality in zanzibar

DEFF Research Database (Denmark)

Lund, Stine; Rasch, Vibeke; Hemed, Maryam

2014-01-01

BACKGROUND: Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies......, evidence for its role in health care is sparse. OBJECTIVE: We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. METHODS: This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities...... care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth...

Perinatal market penetration rate. A tool to evaluate regional perinatal programs.

Science.gov (United States)

Powers, W F; McGill, L

1987-01-01

Very small babies born in tertiary centers fare better than outborn babies referred for tertiary care after birth. Viewing the 1001-1500 gm regional cohort of fetuses as a potential "market" for center delivery, and measuring a center's penetration into this market, quantitates how well a center draws to itself these small, high-risk fetuses for delivery. An Illinois center's annual penetration rate into its regional market for the years 1973-1983 is presented and significant increases are found. The penetration rates of nine Illinois perinatal centers are calculated and wide discrepancies are found. Defining a high-risk regional cohort as a market stresses a perinatal center's obligation to its region. The penetration rate into a defined market measures how well a center fulfills this obligation.

Provider report of the existence of detection and care of perinatal depression: quantitative evidence from public obstetric units in Mexico

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Filipa de Castro

2016-07-01

Full Text Available Objective. To provide evidence on perinatal mental healthcare in Mexico. Materials and methods. Descriptive and bivariate analyses of data from a cross-sectional probabilistic survey of 211 public obstetric units. Results. Over half (64.0% of units offer mental healthcare; fewer offer perinatal depression (PND detection (37.1% and care (40.3%. More units had protocols/guidelines for PND detection and for care, respectively, in Mexico City-Mexico state (76.7%; 78.1% than in Southern (26.5%; 36.4%, Northern (27.3%; 28.1% and Central Mexico (50.0%; 52.7%. Conclusion. Protocols and provider training in PND, implementation of brief screening tools and psychosocial interventions delivered by non-clinical personnel are needed.      DOI: http://dx.doi.org/10.21149/spm.v58i4.8028

Introduction of a qualitative perinatal audit at Muhimbili National Hospital, Dar es Salaam, Tanzania

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Thomas Angela N

2009-09-01

Full Text Available Abstract Background Perinatal death is a devastating experience for the mother and of concern in clinical practice. Regular perinatal audit may identify suboptimal care related to perinatal deaths and thus appropriate measures for its reduction. The aim of this study was to perform a qualitative perinatal audit of intrapartum and early neonatal deaths and propose means of reducing the perinatal mortality rate (PMR. Methods From 1st August, 2007 to 31st December, 2007 we conducted an audit of perinatal deaths (n = 133 with birth weight 1500 g or more at Muhimbili National Hospital (MNH. The audit was done by three obstetricians, two external and one internal auditors. Each auditor independently evaluated the cases narratives. Suboptimal factors were identified in the antepartum, intrapartum and early neonatal period and classified into three levels of delay (community, infrastructure and health care. The contribution of each suboptimal factor to adverse perinatal outcome was identified and the case graded according to possible avoidability. Degree of agreement between auditors was assessed by the kappa coefficient. Results The PMR was 92 per 1000 total births. Suboptimal factors were identified in 80% of audited cases and half of suboptimal factors were found to be the likely cause of adverse perinatal outcome and were preventable. Poor foetal heart monitoring during labour was indirectly associated with over 40% of perinatal death. There was a poor to fair agreement between external and internal auditors. Conclusion There are significant areas of care that need improvement. Poor monitoring during labour was a major cause of avoidable perinatal mortality. This type of audit was a good starting point for quality assurance at MNH. Regular perinatal audits to identify avoidable causes of perinatal deaths with feed back to the staff may be a useful strategy to reduce perinatal mortality.

Professional's Perspectives on Care Management of Young People with Perinatally Acquired HIV during Transition: A Qualitative Study in Adult Care Setting.

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Enora Le Roux

Full Text Available Increasing numbers of young people with perinatally acquired HIV are surviving to adulthood. When they come of age, they leave pediatric services in which they were followed and have to be transferred to the adult health care system. Difficulties in adaptation to adult care and the numbers of young people lost to follow up after transfer to adult care have been reported. This transition phase and their retention in adult care are crucial in maintaining the clinical status of these young with HIV in adulthood. Our study aimed to explore how HIV professionals working in adult care perceive and adapt their practices to young people in transition.Qualitative interviews were conducted with 18 health and social services professionals in hospitals or patient associations in France. A thematic analysis was conducted.Adult care professionals were found to be making a distinction between these young people and their patients who were infected during adulthood. On the basis of the healthcare teams' experience, a simplified categorization of these young people into four levels can be used: those "who have everything good"; those who have some deficiencies that must be addressed; those "who have everything bad"; and those lost to follow up. Professionals interviewed highlighted the difficulties they encountered with young people in transition. Three types of problematic situations were identified: problems of acceptance of the disease; communication problems; and problems of disorientation in the new care environment.Despite the lack of specific training or national policy recommendations for the integration of young people with perinatally acquired HIV into adult services, all the adult healthcare teams interviewed tried to adapt their practice to this population. The results suggested that professional involvement during transition should depend on the characteristics of the patient, not be limited to a single transition model and that a dedicated

Role of traditional birth attendants (TBAs) in provision of antenatal and perinatal care at home amongst the urban poor in Delhi, India.

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Singh, Samiksha; Chhabra, Pragti; Sujoy, Rachna

2012-01-01

More than 80% of deliveries amongst the urban poor are conducted at home, mostly by traditional birth attendants (TBAs). In all, 29 eligible TBAs in the study area were identified and interviewed to assess their knowledge and practices regarding antenatal and perinatal care. Their knowledge about complications in antenatal and perinatal period was inadequate. The majority provided inadequate advice to the mothers. Over seventy-nine percent (79.3%) gave injections of oxytocin. Sixteen (55.2%) did not wait or waited for less than 10 minutes for the mother to expel the placenta. Fourteen (48.3%) encountered excessive vaginal bleeding, but none knew how to manage it. Overall knowledge and care provided by the TBAs was poor.

Disparities in Perinatal Quality Outcomes for Very Low Birth Weight Infants in Neonatal Intensive Care

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Lake, Eileen T; Staiger, Douglas; Horbar, Jeffrey; Kenny, Michael J; Patrick, Thelma; Rogowski, Jeannette A

2015-01-01

Objective To determine if hospital-level disparities in very low birth weight (VLBW) infant outcomes are explained by poorer hospital nursing characteristics. Data Sources Nurse survey and VLBW infant registry data. Study Design Retrospective study of 8,252 VLBW infants in 98 Vermont Oxford Network hospital neonatal intensive care units (NICUs) nationally. NICUs were classified into three groups based on their percent of infants of black race. Two nurse-sensitive perinatal quality standards were studied: nosocomial infection and breast milk. Data Collection Primary nurse survey (N = 5,773, 77 percent response rate). Principal Findings VLBW infants born in high-black concentration hospitals had higher rates of infection and discharge without breast milk than VLBW infants born in low-black concentration hospitals. Nurse understaffing was higher and practice environments were worse in high-black as compared to low-black hospitals. NICU nursing features accounted for one-third to one-half of the hospital-level health disparities. Conclusions Poorer nursing characteristics contribute to disparities in VLBW infant outcomes in two nurse-sensitive perinatal quality standards. Improvements in nursing have potential to improve the quality of care for seven out of ten black VLBW infants who are born in high-black hospitals in this country. PMID:25250882

Characteristics that perinatal nurse managers desire in new nurse hires.

Science.gov (United States)

Falls, Emily; Hensel, Desiree

2012-04-01

Nursing leaders have proposed that nurses must have the Quality and Safety Education for Nurses (QSEN) competencies to work in complex health care systems. Using the QSEN framework, this study explored what characteristics perinatal nurse managers desired most in new nurses. This study used a survey design and a convenience sample of perinatal nurse managers working in Indiana hospitals (N = 46). Managers were more likely to hire nurses with experience, positive references, and excellent attendance. Of the QSEN competencies, managers looked most for teamwork and collaboration, followed by safety and patient-centered care. In addition to the traditional qualities desired in new nurses, the QSEN competencies are gaining importance among perinatal managers. Copyright 2012, SLACK Incorporated.

Political or dental power in private and public service provision: a study of municipal expenditures for child dental care.

Science.gov (United States)

Andersen, Lotte Bøgh; Bech, Mickael; Lauridsen, Jørgen

2012-07-01

Both professionals and politicians may affect expenditures for highly professional services provided in the public and private sector. We investigated Danish publicly financed child dental care with a special focus on the influence of politicians and dentists on the expenditure level. By studying spatial patterns in expenditure levels across municipalities, we are able to test the influences of these two main actors and the networks through which learning is achieved. Four hypotheses on the existence of different spatial spillover effects are tested. The empirical analysis is based on annual data from 1996 to 2001 for 226 Danish municipalities, thus allowing for the control for heterogeneity between municipalities and for intra-municipal correlations across time. The results point to differences in expenditures between municipalities with privately and publicly produced dental care. Furthermore, dentists appear to be the most important actors for the spatial spillover effects, and these effects are especially strong for municipalities situated in the same county that use private dental clinics. There is no evidence of political spatial spillover effects between municipalities.

Factors related to main preventable perinatal injuries of public hospital in the Brazilian Federal District.

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Pamella Padilha BRITO

2015-02-01

Full Text Available Introduction: The quality of prenatal care, childbirth and newborn are determinants of perinatal morbidity and mortality. The realization of a adequate prenatal care and skilled birth assistance would reduce the incidence of injuries and perinatal deaths that are largely preventable. Method: Descriptive and exploratory study of quantitative and qualitative nature.  Interview and review of medical records of thirty mothers and newborns were made. The results were chart using the SPSS software, version 20.0, for processing and statistical analysis. We performed thematic analysis of interviews, and tabulated according to their frequencies, identifying the differences and similarities between data. Results: The most frequent perinatal injuries were prematurity (74.2%, Respiratory Distress (71%, Underweight (51.6%, Infection or Sepsis (41.9%, Perinatal Asphyxia (19.4%  and Oligohydramnio (19.4%. These injuries were related to several factors such as inadequate prenatal care, with fewer than six prenatal consultations (70% and late onset (50%, and presence of maternal health problems such as: changes in amniotic fluid (50% and preterm labor (50%. The interviewees added other factors such as failures in the care professional (43%, failures in care and service (33%, difficulty of access (19% and breast self-care failures (16.6%. Conclusion: Stood out in this study the occurrence of perinatal injuries in children of mothers with stable socio-demographic profile and in term newborns as also the percentage of deaths (16.1%. The perinatal injuries and deaths could have been avoided with qualified prenatal care, childbirth and newborn care.

CHARACTERISTICS OF INDONESIAN HOUSEHOLD’S LIVING EXPENDITURE

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Duddy Roesmara Donna

2014-09-01

Full Text Available The aim of this study is to estimate and analize the characteristics of Indonesian household expenditure on goods and services, for example food, clothes, household utensils, housing, medical care, education, oil and transportation, gas, electricity and communication. Linear Expenditure System (LES model and seemingly uncorrelated regression (SUR estimation method were applied. This study has some conclusions. First, if ones have more incomes, they will proportionally allocate them for housing, oil and transportation, education, food, and medical care. Second, medical care, education and communication are categorized as superior or deluxe commodities. Third, the approximation of minimum living expenditure to survive is Rp 147.236 for a household per week.  

Seeking help for perinatal psychological distress: a meta-synthesis of women's experiences.

Science.gov (United States)

Button, Susan; Thornton, Alexandra; Lee, Suzanne; Shakespeare, Judy; Ayers, Susan

2017-10-01

Women may not seek help for perinatal psychological distress, despite regular contact with primary care services. Barriers include ignorance of symptoms, inability to disclose distress, others' attitudes, and cultural expectations. Much of the evidence has been obtained from North American populations and may not, therefore, extrapolate to the UK. To understand the factors affecting women's decision to seek help for perinatal distress. Meta-synthesis of the available published qualitative evidence on UK women's experiences of seeking help for perinatal distress. Systematic searches were conducted in accordance with PRISMA guidelines. Databases searched were PubMed, Scopus, PsycINFO, PsycARTICLES, CINAHL, and Academic Search Complete. Searches of grey literature and references were also conducted. Studies were eligible for inclusion if they reported qualitative data on UK women's experiences of perinatal distress and contact with healthcare professionals. The synthesis was conducted using meta-ethnography. In all, 24 studies were eligible for inclusion. Metasynthesis identified three main themes: identifying a problem, the influence of healthcare professionals, and stigma. These themes build on current understanding of help seeking by identifying the need for women to be able to frame their experience, for healthcare professionals to educate women about their roles, the need for continuity of care, and the way that being seen as a 'bad mother' causes women to self-silence. Perinatal care provision needs to allow for continuity of care and for staff training that facilitates awareness of factors that influence women's help seeking. Further research is required, particularly in relation to effective means of identifying perinatal psychological distress. © British Journal of General Practice 2017.

Utility of local health registers in measuring perinatal mortality: a case study in rural Indonesia.

Science.gov (United States)

Burke, Leona; Suswardany, Dwi Linna; Michener, Keryl; Mazurki, Setiawaty; Adair, Timothy; Elmiyati, Catur; Rao, Chalapati

2011-03-17

Perinatal mortality is an important indicator of obstetric and newborn care services. Although the vast majority of global perinatal mortality is estimated to occur in developing countries, there is a critical paucity of reliable data at the local level to inform health policy, plan health care services, and monitor their impact. This paper explores the utility of information from village health registers to measure perinatal mortality at the sub district level in a rural area of Indonesia. A retrospective pregnancy cohort for 2007 was constructed by triangulating data from antenatal care, birth, and newborn care registers in a sample of villages in three rural sub districts in Central Java, Indonesia. For each pregnancy, birth outcome and first week survival were traced and recorded from the different registers, as available. Additional local death records were consulted to verify perinatal mortality, or identify deaths not recorded in the health registers. Analyses were performed to assess data quality from registers, and measure perinatal mortality rates. Qualitative research was conducted to explore knowledge and practices of village midwives in register maintenance and reporting of perinatal mortality. Field activities were conducted in 23 villages, covering a total of 1759 deliveries that occurred in 2007. Perinatal mortality outcomes were 23 stillbirths and 15 early neonatal deaths, resulting in a perinatal mortality rate of 21.6 per 1000 live births in 2007. Stillbirth rates for the study population were about four times the rates reported in the routine Maternal and Child Health program information system. Inadequate awareness and supervision, and alternate workload were cited by local midwives as factors resulting in inconsistent data reporting. Local maternal and child health registers are a useful source of information on perinatal mortality in rural Indonesia. Suitable training, supervision, and quality control, in conjunction with computerisation to

Medicaid CMS-64 New Adult Group Expenditures

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U.S. Department of Health & Human Services — This dataset reports summary level expenditure data associated with the new adult group established under the Affordable Care Act. These state expenditures are...

The body and ontology: Perinatal death and bereavement in the techno-scientific landscape of hospital care

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Paul Richard Cassidy

2015-08-01

Full Text Available This study takes the body (of mother and child, the technoscientific hospital landscape and professional ritual as the locus of an endeavour to understand the embodied experience of perinatal death, in order to better comprehend how alternate understandings and ontologies of motherhood, personhood and bereavement emerge during care enactments.  Grounded in a descriptive and ethnographic approach the research analyses data from the entries of 22 members of a pregnancy loss support forum and 10 narrative style interviews. The research traces embodied experience from pregnancy, through diagnosis to the spatialised experience of the hospital, including the birth, postmortem contact and disposal of the corpse. Bounded by the sudden destruction of ontological security many of these women experience an existential crisis that results in a destructed stigmatised self. The research explores how overly medicalised obstetric care enacts understandings of perinatal death and bereavement that further problematizes postmortem relationships, creating toxic identities and embodied selves. Conversely, woman-centred midwifery that takes relational and social understandings as a basis for care can create the material conditions of possibility for a restoration of confidence in carnal self and a reconstruction of social bonds and order. Assembled through practice, discourse and policy, these bodies are individually, socially and politically enacted, but they are also multiple, mutable and enfolded assemblages of nature and culture. The research proposes that healthcare practice would benefit by considering natural stillbirths, just as contemporary obstetrics advocates natural childbirth.

Collaborative survey of perinatal loss in planned and unplanned home births. Northern Region Perinatal Mortality Survey Coordinating Group.

Science.gov (United States)

1996-11-23

To document the outcome of planned and unplanned births outside hospital. Confidential review of every pregnancy ending in stillbirth or neonatal death in which plans had been made for home delivery, irrespective of where delivery eventually occurred. The review was part of a sustained collaborative survey of all perinatal deaths. Northern Regional Health Authority area. All 558,691 registered births to women normally resident in the former Northern Regional Health Authority area during 1981-94. Perinatal death. The estimated perinatal mortality during 1981-94 among women booked for a home birth was 14 deaths in 2888 births. This was less than half that among all women in the region. Only three of the 14 women delivered outside hospital. Independent review suggested that two of the 14 deaths might have been averted by different management. Both births occurred in hospital, and in only one was management before admission of the mother judged inappropriate. Perinatal loss to the 64 women who booked for hospital delivery but delivered outside and to the 67 women who delivered outside hospital without ever making arrangements to receive professional care during labour accounted for the high perinatal mortality (134 deaths in 3466 deliveries) among all births outside hospital. The perinatal hazard associated with planned home birth in the few women who exercised this option (unplanned delivery outside hospital.

Convergence and determinants of health expenditures in OECD countries.

Science.gov (United States)

Nghiem, Son Hong; Connelly, Luke Brian

2017-08-17

This study examines the trend and determinants of health expenditures in OECD countries over the 1975-2004 period. Based on recent developments in the economic growth literature we propose and test the hypothesis that health care expenditures in countries of similar economic development level may converge. We hypothesise that the main drivers for growth in health care costs include: aging population, technological progress and health insurance. The results reveal no evidence that health expenditures among OECD countries converge. Nevertheless, there is evidence of convergence among three sub-groups of countries. We found that the main driver of health expenditure is technological progress. Our results also suggest that health care is a (national) necessity, not a luxury good as some other studies in this field have found.

Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994-2013.

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Kayvan Bozorgmehr

Full Text Available Access to health care for asylum-seekers and refugees (AS&R in Germany is initially restricted before regular access is granted, allegedly leading to delayed care and increasing costs of care. We analyse the effects of (a restricted access; and (b two major policy reforms (1997, 2007 on incident health expenditures for AS&R in 1994-2013.We used annual, nation-wide, aggregate data of the German Federal Statistics Office (1994-2013 to compare incident health expenditures among AS&R with restricted access (exposed to AS&R with regular access (unexposed. We calculated incidence rate differences (∆IRt and rate ratios (IRRt, as well as attributable fractions among the exposed (AFe and the total population (AFp. The effects of between-group differences in need, and of policy reforms, on differences in per capita expenditures were assessed in (segmented linear regression models. The exposed and unexposed groups comprised 4.16 and 1.53 million person-years. Per capita expenditures (1994-2013 were higher in the group with restricted access in absolute (∆IRt = 375.80 Euros [375.77; 375.89] and relative terms (IRR = 1.39. The AFe was 28.07% and the AFp 22.21%. Between-group differences in mean age and in the type of accommodation were the main independent predictors of between-group expenditure differences. Need variables explained 50-75% of the variation in between-group differences over time. The 1997 policy reform significantly increased ∆IRt adjusted for secular trends and between-group differences in age (by 600.0 Euros [212.6; 986.2] and sex (by 867.0 Euros [390.9; 1342.5]. The 2007 policy reform had no such effect.The cost of excluding AS&R from health care appears ultimately higher than granting regular access to care. Excess expenditures attributable to the restriction were substantial and could not be completely explained by differences in need. An evidence-informed discourse on access to health care for AS&R in Germany is needed; it

Executive function, episodic memory, and Medicare expenditures.

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Bender, Alex C; Austin, Andrea M; Grodstein, Francine; Bynum, Julie P W

2017-07-01

We examined the relationship between health care expenditures and cognition, focusing on differences across cognitive systems defined by global cognition, executive function, or episodic memory. We used linear regression models to compare annual health expenditures by cognitive status in 8125 Nurses' Health Study participants who completed a cognitive battery and were enrolled in Medicare parts A and B. Adjusting for demographics and comorbidity, executive impairment was associated with higher total annual expenditures of $1488 per person (P episodic memory impairment was found. Expenditures exhibited a linear relationship with executive function, but not episodic memory ($584 higher for every 1 standard deviation decrement in executive function; P < .01). Impairment in executive function is specifically and linearly associated with higher health care expenditures. Focusing on management strategies that address early losses in executive function may be effective in reducing costly services. Copyright © 2017 the Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

Bridging between professionals in perinatal care: Towards shared care in The Netherlands

NARCIS (Netherlands)

Posthumus, AP; Schölmerich, V.L.N.; Waelput, AJ; Vos, AA; De Jong-Potjer, LC; Bakker, R.; Bonsel, G.J.; Groenewegen, P.; Steegers, EA; Denktas, S

2013-01-01

Relatively high perinatal mortality rates in the Netherlands have required a critical assessment of the national obstetric system. Policy evaluations emphasized the need for organizational improvement, in particular closer collaboration between community midwives and obstetric caregivers in

Health care-seeking behaviours and health expenditures in adults aged 45 years and older in China, 2011-2013.

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Li, Jiasen; Feng, Xing Lin

2017-05-01

To provide an assessment of China's progress to universal health coverage (UHC) from the perspective of people-centred care. We obtained data on 28 103 participants from the China Health and Retirement Longitudinal Study (CHALRS) during 2011-2013. We used logistic regressions and generalised linear models to analyse care-seeking behaviours and medical expenditures. We found that 95.5% of the subjects were covered by social health insurance in 2013, and nearly 60% subjects in need of medical care were self-medicated. Health insurance was a strong predictor for the access to outpatient care. Use of pure and mixed self-medication increased by 15% and 32% respectively, while use of pure outpatient care fell by 10% between 2011 and 2013, after adjusting for predisposing, service needs and enabling factors. Such trends were particularly evident for the Urban Resident Basic Medical Insurance and the New Cooperative Medical Scheme, which covered more than 80%. The monthly out-of-pocket medical expenditures and the probability of encountering catastrophic health expenditures for outpatient care were four times larger than that for self-medication. Between 2011 and 2013, outpatient care medical costs rose by nearly 50%, whereas there was no such obvious trend for self-medication. People with insurance schemes offering lower cost sharing incurred consistently higher out-of-pocket outpatient payments. The monitoring of global progress to UHC should incorporate self-medication. In China, it seems that the current reform and the huge government investment have not resulted in access to affordable quality care. To achieve UHC, not only universal insurance, but system-level efforts are needed. © 2017 John Wiley & Sons Ltd.

Influence of culture and community perceptions on birth and perinatal care of immigrant women: doulas' perspective.

Science.gov (United States)

Kang, Hye-Kyung

2014-01-01

A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influence of cultural and community beliefs on immigrant women's birth and perinatal care, as well as their own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural brokers, and emotional and social support. Also, doulas share a consistent set of professional values, including empowerment, informed choice, cultural relativism, and scientific/evidence-based practice, but do not always recognize these values as culturally based. More emphasis on cultural self-awareness in doula training, expanding community doula programs, and more integration of doula services in health-care settings are recommended.

How and why do countries differ in their governance and financing-related administrative expenditure in health care? An analysis of OECD countries by health care system typology

NARCIS (Netherlands)

Hagenaars, L.L.; Klazinga, N.S.; Muller, M.; Morgan, D.J.; Jeurissen, P.P.T.

2018-01-01

INTRODUCTION: Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending

Associations of government health expenditures, the supply of health care professionals, and country literacy with prenatal care use in ten West African countries.

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Taylor, Yhenneko J; Laditka, Sarah B; Laditka, James N; Brunner Huber, Larissa R; Racine, Elizabeth F

2017-03-01

Social and health care context may influence prenatal care use. We studied associations of government health expenditures, supply of health care professionals, and country literacy rates with prenatal care use in ten West African countries, controlling for individual factors. We used data from Demographic and Health Surveys (n = 58,512) and random effect logistic regression models to estimate the likelihood of having any prenatal care and adequate prenatal care. Each percentage increase in the literacy rate was associated with 4% higher odds of having adequate prenatal care (p = .029). Higher literacy rates among women may help to promote adequate prenatal care.

How and why do countries differ in their governance and financing-related administrative expenditure in health care? An analysis of OECD countries by health care system typology

NARCIS (Netherlands)

Hagenaars, Luc L.; Klazinga, Niek S.; Mueller, Michael; Morgan, David J.; Jeurissen, Patrick P. T.

2017-01-01

Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between

Propensity Analysis on Consumption Expenditure of Rural Residents in Hebei Province, China

OpenAIRE

Liu, Meng; Wang, Guirong; Wang, Huijun

2009-01-01

Consumption expenditure of rural residents can be divided into eight types of indices, such as food consumption expenditure, clothing consumption expenditure, household equipment and service consumption expenditure, health care consumption expenditure, transportation and communication consumption expenditure, cultural and educational entertainment and service consumption expenditure, housing consumption expenditure, and other goods and services consumption expenditure. Changes in structures o...

A pilot study of expenditures on, and utilization of resources in, health care in adults with congenital heart disease.

Science.gov (United States)

Moons, P; Siebens, K; De Geest, S; Abraham, I; Budts, W; Gewillig, M

2001-05-01

Congenital cardiac disease may be a chronic condition, necessitating life-long follow-up for a substantial proportion of the patients. Such patients, therefore, are often presumed to be high users of resources for health care. Information on utilization of resources in adults with congenital heart disease, however, is scarce. This retrospective pilot study, performed in Belgium, investigated 192 adults with congenital heart disease to measure the annual expenditures and utilization of health care and compared the findings with data from the general population. We also sought to explore demographic and clinical parameters as predictors for the expenditures. Hospitalization was documented in 20.3% of the patients, with a median length of stay of 5 days. The overall payment by health insurance associations in 1997 was 1794.5 ECU per patient, while patients paid on average 189.5 ECU out-of-pocket. For medication, the average reimbursement and out-of-pocket expenses were estimated at 78 ECU and 20 ECU, respectively. Expenditures for patients with congenital heart disease were considerably higher than the age and gender-corrected expenditures for the general population (411.7 ECU), though this difference was accounted for by only one-eighth of the cohort of those with congenital heart disease. In general, higher expenditures were associated with abnormal left ventricular end-diastolic diameter, female gender, functional impairment and higher age, although the explained variance was limited. Our study has provided pilot data on the economic outcomes for patients with congenital heart diseases. We have identified parameters that could predict expenditure, but which will have to be examined in future research. This is needed to develop guidelines for health insurance for those with congenital heart diseases.

The impact of population ageing on future Danish drug expenditure

DEFF Research Database (Denmark)

Kildemoes, Helle Wallach

expenditure among the elderly partly is due the high "costs of dying". Aims The aim of this study was to estimate the impact of the ageing Danish population on future total expenditures on out-of-hospital prescription drugs and to describe the association between age and drug expenditure among survivors......Background Population ageing is likely to place an increasing burden on future health care budgets. Several studies have demonstrated that the impact of ageing on future hospital expenditures will be overestimated when not accounting for proximity to death. This is because greater health care...... compared to that of decedents. Methods Taking expenditure during the last year of life and the changes in mortality rates into account, future drug expenditure was projected by multiplying estimated mean annual drug expenditure according to age, gender and survival status by the predicted future number...

Instrument Psychometrics: Parental Satisfaction and Quality Indicators of Perinatal Palliative Care.

Science.gov (United States)

Wool, Charlotte

2015-10-01

Despite a life-limiting fetal diagnosis, prenatal attachment often occurs in varying degrees resulting in role identification by an individual as a parent. Parents recognize quality care and report their satisfaction when interfacing with health care providers. The aim was to test an instrument measuring parental satisfaction and quality indicators with parents electing to continue a pregnancy after learning of a life-limiting fetal diagnosis. A cross sectional survey design gathered data using a computer-mediated platform. Subjects were parents (n=405) who opted to continue a pregnancy affected by a life-limiting diagnosis. Factor analysis using principal component analysis with Varimax rotation was used to validate the instrument, evaluate components, and summarize the explained variance achieved among quality indicator items. The Prenatal Scale was reduced to 37 items with a three-component solution explaining 66.19% of the variance and internal consistency reliability of 0.98. The Intrapartum Scale included 37 items with a four-component solution explaining 66.93% of the variance and a Cronbach α of 0.977. The Postnatal Scale was reduced to 44 items with a six-component solution explaining 67.48% of the variance. Internal consistency reliability was 0.975. The Parental Satisfaction and Quality Indicators of Perinatal Palliative Care Instrument is a valid and reliable measure for parent-reported quality care and satisfaction. Use of this instrument will enable clinicians and researchers to measure quality indicators and parental satisfaction. The instrument is useful for assessing, analyzing, and reporting data on quality for care delivered during the prenatal, intrapartum, and postnatal periods.

Characteristics, treatment, and health care expenditures of Medicare supplemental-insured patients with painful diabetic peripheral neuropathy, post-herpetic neuralgia, or fibromyalgia.

Science.gov (United States)

Johnston, Stephen S; Udall, Margarita; Alvir, Jose; McMorrow, Donna; Fowler, Robert; Mullins, Daniel

2014-04-01

To describe the characteristics, treatment, and health care expenditures of Medicare Supplemental-insured patients with painful diabetic peripheral neuropathy (pDPN), post-herpetic neuralgia (PHN), or fibromyalgia. Retrospective cohort study. United States clinical practice, as reflected within a database comprising administrative claims from 2.3 million older adults participating in Medicare supplemental insurance programs. Selected patients were aged ≥65 years, continuously enrolled in medical and prescription benefits throughout years 2008 and 2009, and had ≥1 medical claim with an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for DPN, PHN, or fibromyalgia, followed within 60 days by a medication or pain intervention procedure used in treating pDPN, PHN, or fibromyalgia during 2008-2009. Utilization of, and expenditures on, pain-related and all-cause pharmacotherapy and medical interventions in 2009. The study included 25,716 patients with pDPN (mean age 75.2 years, 51.2% female), 4,712 patients with PHN (mean age 77.7 years, 63.9% female), and 25,246 patients with fibromyalgia (mean age 74.4 years, 73.0% female). Patients typically had numerous comorbidities, and many were treated with polypharmacy. Mean annual expenditures on total pain-related health care and total all-cause health care, respectively, (in 2010 USD) were: $1,632, $24,740 for pDPN; $1,403, $16,579 for PHN; and $1,635, $18,320 for fibromyalgia. In age-stratified analyses, pain-related health care expenditures decreased as age increased. The numerous comorbidities, polypharmacy, and magnitude of expenditures in this sample of Medicare supplemental-insured patients with pDPN, PHN, or fibromyalgia underscore the complexity and importance of appropriate management of these chronic pain patients. Wiley Periodicals, Inc.

[Perinatal mortality in foreign workers (author's transl)].

Science.gov (United States)

Höfling, H J; Jonas, R; Brusis, E; Lochmüller, H; Selbmann, H K; Holzmann, K; Zander, J

1975-03-01

From 1970 to 1972, there were 216 perinatal deaths among 5595 newborns at the I. Frauenklinik der Universität München. 54 of these deaths were children of foreign workers (so-called "Gastarbeiter"). The data have been processed on punch cards and analysed by a computer. The differences noted underwent significance testing by the CHI-Quadrat test. Only statistical significant results are published. The perinatal mortality in the above period shows no difference between foreign and German ward patients. There is, however, a significant lower perinatal mortality in private patients. We feel that this difference is due to a significant lower rate of prematures in the private patient group. The cocial status as well as higher interest and motivation in health resulting in better prenatal care are discussed as causal reasons for this fact.

Obesity and health expenditures: evidence from Australia.

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Buchmueller, Thomas C; Johar, Meliyanni

2015-04-01

Rising rates of obesity are a public health concern in every industrialized country. This study investigates the relationship between obesity and health care expenditure in Australia, where the rate of obesity has tripled in the last three decades. Now one in four Australians is considered obese, defined as having a body mass index (BMI, kg/m(2)) of 30 or over. The analysis is based on a random sample survey of over 240,000 adults aged 45 and over that is linked at the individual-level to comprehensive administrative health care claims for the period 2006-2009. This sub-population group has an obesity rate that is nearly 30% and is a major consumer of health services. Relative to the average annual health expenditures of those with normal weight, we find that the health expenditures of those with a BMI between 30 and 35 (obese type I) are 19% higher and expenditures of those with BMI greater than 35 (obese type II/III) are 51% higher. We find large and significant differences in all types of care: inpatient, emergency department, outpatient and prescription drugs. The obesity-related health expenditures are higher for obese type I women than men, but in the obese type II/III state, obesity-related expenditures are higher for men. When we stratify further by age groups, we find that obesity has the largest impact among men over age 75 and women aged 60-74 years old. In addition, we find that obesity impacts health expenditures not only through its link to chronic diseases, but also because it increases the cost of recovery from acute health shocks. Copyright © 2015 Elsevier B.V. All rights reserved.

Evaluation of extrapolation methods for actual state expenditures on health care in Russian Federation

Directory of Open Access Journals (Sweden)

S. A. Banin

2016-01-01

Full Text Available Forecasting methods, extrapolation ones in particular, are used in health care for medical, biological and clinical research. The author, using accessible internet space, has not met a single publication devoted to extrapolation of financial parameters of health care activities. This determined the relevance of the material presented in the article: based on health care financing dynamics in Russia in 2000–2010 the author examined possibility of application of basic perspective extrapolation methods - moving average, exponential smoothing and least squares. It is hypothesized that all three methods can equally forecast actual public expenditures on health care in medium term in Russia’s current financial and economic conditions. The study result was evaluated in two time periods: within the studied interval and a five-year period. It was found that within the study period all methods have an average relative extrapolation error of 3–5%, which means high precision of the forecast. The study shown a specific feature of the least squares method which were gradually accumulating results so their economic interpretation became possible only in the end of the studied period. That is why the extrapolating results obtained by least squares method are not applicable in an entire study period and rather have a theoretical value. Beyond the study period, however, this feature was found to be the most corresponding to the real situation. It was the least squares method that proved to be the most appropriate for economic interpretation of the forecast results of actual public expenditures on health care. The hypothesis was not confirmed, the author received three differently directed results, while each method had independent significance and its application depended on evaluation study objectives and real social, economic and financial situation in Russian health care system.

Why some women fail to give birth at health facilities: a qualitative study of women’s perceptions of perinatal care from rural Southern Malawi

Directory of Open Access Journals (Sweden)

Kumbani Lily

2013-02-01

Full Text Available Abstract Background Despite Malawi government’s policy to support women to deliver in health facilities with the assistance of skilled attendants, some women do not access this care. Objective The study explores the reasons why women delivered at home without skilled attendance despite receiving antenatal care at a health centre and their perceptions of perinatal care. Methods A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using a semi- structured interview guide that collected information on women’s perception on perinatal care. A total of 12 in- depth interviews were conducted with women that had delivered at home in the period December 2010 to March 2011. The women were asked how they perceived the care they received from health workers before, during, and after delivery. Data were manually analyzed using thematic analysis. Results Onset of labor at night, rainy season, rapid labor, socio-cultural factors and health workers’ attitudes were related to the women delivering at home. The participants were assisted in the delivery by traditional birth attendants, relatives or neighbors. Two women delivered alone. Most women went to the health facility the same day after delivery. Conclusions This study reveals beliefs about labor and delivery that need to be addressed through provision of appropriate perinatal information to raise community awareness. Even though, it is not easy to change cultural beliefs to convince women to use health facilities for deliveries. There is a need for further exploration of barriers that prevent women from accessing health care for better understanding and subsequently identification of optimal solutions with involvement of the communities themselves.

Influence of Culture and Community Perceptions on Birth and Perinatal Care of Immigrant Women: Doulas’ Perspective

Science.gov (United States)

Kang, Hye-Kyung

2014-01-01

A qualitative study examined the perceptions of doulas practicing in Washington State regarding the influence of cultural and community beliefs on immigrant women’s birth and perinatal care, as well as their own cultural beliefs and values that may affect their ability to work interculturally. The findings suggest that doulas can greatly aid immigrant mothers in gaining access to effective care by acting as advocates, cultural brokers, and emotional and social support. Also, doulas share a consistent set of professional values, including empowerment, informed choice, cultural relativism, and scientific/evidence-based practice, but do not always recognize these values as culturally based. More emphasis on cultural self-awareness in doula training, expanding community doula programs, and more integration of doula services in health-care settings are recommended. PMID:24453465

Sustainability of recurrent expenditure on public social welfare programmes: expenditure analysis of the free maternal care programme of the Ghana National Health Insurance Scheme.

Science.gov (United States)

Ankrah Odame, Emmanuel; Akweongo, Patricia; Yankah, Ben; Asenso-Boadi, Francis; Agyepong, Irene

2014-05-01

Sustainability of public social welfare programmes has long been of concern in development circles. An important aspect of sustainability is the ability to sustain the recurrent financial costs of programmes. A free maternal care programme (FMCP) was launched under the Ghana National Health Insurance Scheme (NHIS) in 2008 with a start-up grant from the British Government. This article examines claims expenditure under the programme and the implications for the financial sustainability of the programme, and the lessons for donor and public financing of social welfare programmes. Records of reimbursement claims for services and medicines by women benefitting from the policy in participating facilities in one sub-metropolis in Ghana were analysed to gain an understanding of the expenditure on this programme at facility level. National level financial inflow and outflow (expenditure) data of the NHIS, related to implementation of this policy for 2008 and 2009, were reviewed to put the facility-based data in the national perspective. A total of US$936 450.94 was spent in 2009 by the scheme on FMCP in the sub-metropolis. The NHIS expenditure on the programme for the entire country in 2009 was US$49.25 million, exceeding the British grant of US$10.00 million given for that year. Subsequently, the programme has been entirely financed by the National Health Insurance Fund. The rapidly increasing, recurrent demands on this fund from the maternal delivery exemption programme-without a commensurate growth on the amounts generated annually-is an increasing threat to the sustainability of the fund. Provision of donor start-up funding for programmes with high recurrent expenditures, under the expectation that government will take over and sustain the programme, must be accompanied by clear long-term analysis and planning as to how government will sustain the programme.

Evaluation of cardiopulmonary factors critical to successful emergency perinatal air transport.

Science.gov (United States)

1982-03-01

Regionalization of specialized perinatal care is a fully viable and progressing concept. The two major components of regionalized care are the level III care facility and the air transport service. In descending importance, the medical transport team...

Out-of-pocket expenditure on institutional delivery in India.

Science.gov (United States)

Mohanty, Sanjay K; Srivastava, Akanksha

2013-05-01

Though promotion of institutional delivery is used as a strategy to reduce maternal and neonatal mortality, about half of the deliveries in India are conducted at home without any medical care. Among women who deliver at home, one in four cites cost as barrier to facility-based care. The relative share of deliveries in private health centres has increased over time and the associated costs are often catastrophic for poor households. Though research has identified socio-economic, demographic and geographic barriers to the utilization of maternal care, little is known on the cost differentials in delivery care in India. The objective of this paper is to understand the regional pattern and socio-economic differentials in out-of-pocket (OOP) expenditure on institutional delivery by source of provider in India. The study utilizes unit data from the District Level Household and Facility Survey (DLHS-3), conducted in India during 2007-08. Descriptive statistics, principal component analyses and a two-part model are used in the analyses. During 2004-08, the mean OOP expenditure for a delivery in a public health centre in India was US$39 compared with US$139 in a private health centre. The predicted expenditure for a caesarean delivery was six times higher than for a normal delivery. With an increase in the economic status and educational attainment of mothers, the propensity and rate of OOP expenditure increases, linking higher OOP expenditure to quality of care. The OOP expenditure in public health centres, adjusting for inflation, has declined over time, possibly due to increased spending under the National Rural Health Mission. Based on these findings, we recommend that facilities in public health centres of poorly performing states are improved and that public-private partnership models are developed to reduce the economic burden for households of maternal care in India.

The Social Nature of Perceived Illness Representations of Perinatal Depression in Rural Uganda.

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Sarkar, Nandini D P; Bardaji, Azucena; Peeters Grietens, Koen; Bunders-Aelen, Joske; Baingana, Florence; Criel, Bart

2018-06-07

While the global health community advocates for greater integration of mental health into maternal health agendas, a more robust understanding of perinatal mental health, and its role in providing integrated maternal health care and service delivery, is required. The present study uses the Illness Representation Model, a theoretical cognitive framework for understanding illness conceptualisations, to qualitatively explore multiple stakeholder perspectives on perinatal depression in rural Uganda. A total of 70 in-depth interviews and 9 focus group discussions were conducted with various local health system stakeholders, followed by an emergent thematic analysis using NVivo 11. Local communities perceived perinatal depression as being both the fault of women, and not. It was perceived as having socio-economic and cultural causal factors, in particular, as being partner-related. In these communities, perinatal depression was thought to be a common occurrence, and its negative consequences for women, infants and the community at large were recognised. Coping and help-seeking behaviours prescribed by the participants were also primarily socio-cultural in nature. Placing the dynamics and mechanisms of these local conceptualisations of perinatal depression alongside existing gaps in social and health care systems highlights both the need of, and the opportunities for, growth and prioritisation of integrated perinatal biomedical, mental, and social health programs in resource-constrained settings.

A perinatal care quality and safety initiative: are there financial rewards for improved quality?

Science.gov (United States)

Kozhimannil, Katy B; Sommerness, Samantha A; Rauk, Phillip; Gams, Rebecca; Hirt, Charles; Davis, Stanley; Miller, Kristi K; Landers, Daniel V

2013-08-01

Although costs of providing care may decrease with hospital initiatives to improve obstetric and neonatal outcomes, the accompanying reduced adverse outcomes may negatively affect hospital revenues. In 2008 a Minnesota-based hospital system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which used evidence-based care bundles to guide management of obstetric services. A pre-post analysis of financial impacts of ZBI was conducted by using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009-2011) the initiative. For the Fairview Health Services hospitals, after adjusting for relevant covariates, implementation of ZBI was associated with a mean 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (adjusted odds ratio [AOR] = 0.89, p = .076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008. Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering improved quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize QI. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost.

Impacts of online and group perinatal education: a mixed methods study protocol for the optimization of perinatal health services.

Science.gov (United States)

Roch, Geneviève; Borgès Da Silva, Roxane; de Montigny, Francine; Witteman, Holly O; Pierce, Tamarha; Semenic, Sonia; Poissant, Julie; Parent, André-Anne; White, Deena; Chaillet, Nils; Dubois, Carl-Ardy; Ouimet, Mathieu; Lapointe, Geneviève; Turcotte, Stéphane; Prud'homme, Alexandre; Painchaud Guérard, Geneviève; Gagnon, Marie-Pierre

2018-05-29

Prenatal education is a core component of perinatal care and services provided by health institutions. Whereas group prenatal education is the most common educational model, some health institutions have opted to implement online prenatal education to address accessibility issues as well as the evolving needs of future parents. Various studies have shown that prenatal education can be effective in acquisition of knowledge on labour and delivery, reducing psychological distress and maximising father's involvement. However, these results may depend on educational material, organization, format and content. Furthermore, the effectiveness of online prenatal education compared to group prenatal education remains unclear in the literature. This project aims to evaluate the impacts of group prenatal education and online prenatal education on health determinants and users' health status, as well as on networks of perinatal educational services maintained with community-based partners. This multipronged mixed methods study uses a collaborative research approach to integrate and mobilize knowledge throughout the process. It consists of: 1) a prospective cohort study with quantitative data collection and qualitative interviews with future and new parents; and 2) a multiple case study integrating documentary sources and interviews with stakeholders involved in the implementation of perinatal information service networks and collaborations with community partners. Perinatal health indicators and determinants will be compared between prenatal education groups (group prenatal education and online prenatal education) and standard care without these prenatal education services (control group). This study will provide knowledge about the impact of online prenatal education as a new technological service delivery model compared to traditional group prenatal education. Indicators related to the complementarity of these interventions and those available in community settings will

Determinants of health care expenditures and the contribution of associated factors: 16 cities and provinces in Korea, 2003-2010.

Science.gov (United States)

Han, Kimyoung; Cho, Minho; Chun, Kihong

2013-11-01

The purpose of this study was to classify determinants of cost increases into two categories, negotiable factors and non-negotiable factors, in order to identify the determinants of health care expenditure increases and to clarify the contribution of associated factors selected based on a literature review. The data in this analysis was from the statistical yearbooks of National Health Insurance Service, the Economic Index from Statistics Korea and regional statistical yearbooks. The unit of analysis was the annual growth rate of variables of 16 cities and provinces from 2003 to 2010. First, multiple regression was used to identify the determinants of health care expenditures. We then used hierarchical multiple regression to calculate the contribution of associated factors. The changes of coefficients (R(2)) of predictors, which were entered into this analysis step by step based on the empirical evidence of the investigator could explain the contribution of predictors to increased medical cost. Health spending was mainly associated with the proportion of the elderly population, but the Medicare Economic Index (MEI) showed an inverse association. The contribution of predictors was as follows: the proportion of elderly in the population (22.4%), gross domestic product (GDP) per capita (4.5%), MEI (-12%), and other predictors (less than 1%). As Baby Boomers enter retirement, an increasing proportion of the population aged 65 and over and the GDP will continue to increase, thus accelerating the inflation of health care expenditures and precipitating a crisis in the health insurance system. Policy makers should consider providing comprehensive health services by an accountable care organization to achieve cost savings while ensuring high-quality care.

Learning from deaths: Parents' Active Role and ENgagement in The review of their Stillbirth/perinatal death (the PARENTS 1 study).

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Bakhbakhi, Danya; Siassakos, Dimitrios; Burden, Christy; Jones, Ffion; Yoward, Freya; Redshaw, Maggie; Murphy, Samantha; Storey, Claire

2017-10-02

Following a perinatal death, a formal standardised multi-disciplinary review should take place, to learn from the death of a baby and facilitate improvements in future care. It has been recommended that bereaved parents should be offered the opportunity to give feedback on the care they have received and integrate this feedback into the perinatal mortality review process. However, the MBRRACE-UK Perinatal Confidential Enquiry (2015) found that only one in 20 cases parental concerns were included in the review. Although guidance suggests parental opinion should be sought, little evidence exists on how this may be incorporated into the perinatal mortality review process. The purpose of the PARENTS study was to investigate bereaved parents' views on involvement in the perinatal mortality review process. A semi-structured focus group of 11 bereaved parents was conducted in South West England. A purposive sampling technique was utilised to recruit a diverse sample of women and their partners who had experienced a perinatal death more than 6 months prior to the study. A six-stage thematic analysis was followed to explore parental perceptions and expectations of the perinatal mortality review process. Four over-arching themes emerged from the analysis: transparency; flexibility combined with specificity; inclusivity; and a positive approach. It was evident that the majority of parents were supportive of their involvement in the perinatal mortality review process and they wanted to know the outcome of the meeting. It emerged that an individualised approach should be taken to allow flexibility on when and how they could contribute to the process. The emotional aspects of care should be considered as well as the clinical care. Parents identified that the whole care pathway should be examined during the review including antenatal, postnatal, and neonatal and community based care. They agreed that there should be an opportunity for parents to give feedback on both good and

[Avoidable perinatal deaths and the environment outside the health care system: a case study in a city in Greater Metropolitan Rio de Janeiro].

Science.gov (United States)

Rosa, Maria L G; Hortale, Virginia Alonso

2002-01-01

This paper focuses on the role of environmental factors external to the health care system in the occurrence of perinatal deaths in maternity hospitals belonging to the local health system in a city in Greater Metropolitan Rio de Janeiro in 1994. Elements from the political and administrative context that contribute to an understanding of the relationship between failures in health care and structural deficiencies in these maternity hospitals were divided into four groups of variables: distribution of resources, spatial and temporal factors, organizational and managerial features, and action by interest groups. Semi-structured interviews were conducted. The study concluded that poor performance in four groups of variables may have contributed to perinatal mortality: distribution of resources was insufficient to provide quality in health care, especially in private maternity hospitals; there was no formal or informal regional or hierarchical organization of obstetric care in the city; Ministry of Health guidelines were ignored in all four maternity hospitals, while in three of the hospitals there were no admissions procedures and delivery and fetal follow-up listed in their own rules; and the level of actual participation was low.

Perinatal outcomes following an earlier post-term labour induction policy

DEFF Research Database (Denmark)

Hedegaard, M.; Lidegaard, Ø; Skovlund, C W

2015-01-01

: Perinatal outcomes were estimated using a logistic regression analysis with adjustment for gestational age, maternal age, parity, plurality, smoking and body mass index. MAIN OUTCOME MEASURES: Perinatal outcomes. RESULTS: A total of 770 926 infants were included. Labour induction from 37 weeks increased...... from 9.7% in 2000-02 to 22.5% in 2011-12. From 2003-05 to 2011-12, the risk of umbilical cord pH care units...

Perinatal mortality rate in the Netherlands compared to other European countries: a secondary analysis of Euro-PERISTAT data.

Science.gov (United States)

de Jonge, Ank; Baron, Ruth; Westerneng, Myrte; Twisk, Jos; Hutton, Eileen K

2013-08-01

the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality rate at term in the Netherlands contributes to its poor ranking. secondary analyses using published data from the Euro-PERISTAT study. women that gave birth in 2004 in the 29 European regions and countries called 'countries' included in the Euro-PERISTAT study (4,328,441 women in total and 1,940,977 women at term). odds ratios and 95% confidence intervals were calculated for the comparison of perinatal mortality rates between European countries and the Netherlands, through logistic regression analyses using summary country data. combined perinatal mortality rates overall and at term. Perinatal deaths below 28 weeks, between 28 and 37 weeks and from 37 weeks onwards per 1000 total births. compared to the Netherlands, perinatal mortality rates at term were significantly higher for Denmark and Latvia and not significantly different compared to seven other countries. Eleven countries had a significantly lower rate, and for eight the term perinatal mortality rate could not be compared. The Netherlands had the highest number of perinatal deaths before 28 weeks per 1000 total births (4.3). the relatively high perinatal mortality rate in the Netherlands is driven more by extremely preterm births than births at term. Although the PERISTAT data cannot be used to show that the Dutch maternity care system is safe, neither should they be used to argue that the system is unsafe. The PERISTAT data alone do not support changes to the Dutch maternity care system that reduce the possibility for women to choose a home birth while benefits of these changes are uncertain. Copyright © 2013 Elsevier Ltd. All rights reserved.

Barriers to midwives and nurses addressing mental health issues with women during the perinatal period: The Mind Mothers study.

Science.gov (United States)

Higgins, Agnes; Downes, Carmel; Monahan, Mark; Gill, Ailish; Lamb, Stephen A; Carroll, Margaret

2018-01-03

To explore barriers to midwives and nurses addressing mental health issues with women during the perinatal period. Perinatal mental health is considered an important public health issue with health policy internationally identifying the importance of psychological support for women in the perinatal period. Midwives and primary care nurses are ideally positioned to detect mental distress early, but evidence suggests that they are reluctant to discuss mental health issues with women during pregnancy or in the postnatal period. The research used a descriptive design. A total of 809 midwives and nurses completed an anonymous, online or hard copy survey. Designed by the research team, the survey listed 26 potential barriers to the provision of perinatal mental health care. Participants identified organisational factors as presenting the greatest barriers. Organisational barriers included lack of perinatal mental health services, absence of care pathways, heavy workload, lack of time, lack of privacy and not seeing women regularly enough to build a relationship. Over 50% of participants identified practitioner-related barriers, such as lack of knowledge on perinatal mental health and cultural issues; lack of skill, in particular, skills to respond to a disclosure of a mental health issue; and fears of causing women offence and distress. Findings also indicated that the context of care and education influenced the degree to which participants perceived certain items as barriers. Midwives and primary care nurses encounter many organisational- and practitioner-related barriers that negatively impact on their ability to incorporate mental health care into their practice. Midwifery and nursing services need to develop strategies to address system- and practitioner-related barriers, including the development of services and care pathways, and the provision of culturally sensitive education on perinatal mental health in order to support practitioners to address issues with

Universal Coverage on a Budget: Impacts on Health Care Utilization and Out-Of-Pocket Expenditures in Thailand

NARCIS (Netherlands)

S. Limwattananon (Supon); S. Neelsen (Sven); O.A. O'Donnell (Owen); P. Prakongsai (Phusit); V. Tangcharoensathien (Viroj); E.K.A. van Doorslaer (Eddy)

2013-01-01

textabstractWe estimate the impact on health care utilization and out-of-pocket (OOP) expenditures of a major reform in Thailand that extended health insurance to one-quarter of the population to achieve universal coverage while keeping health spending below 4% of GDP. Identification is through

Psychosocial impact of perinatal loss among Muslim women

Directory of Open Access Journals (Sweden)

Sutan Rosnah

2012-06-01

Full Text Available Abstract Background Women of reproductive age are vulnerable to psychosocial problems, but these have remained largely unexplored in Muslim women in developing countries. The aim of this study was to explore and describe psychosocial impact and social support following perinatal loss among Muslim women. Methods A qualitative study was conducted in a specialist centre among Muslim mothers who had experienced perinatal loss. Purposive sampling to achieve maximum variation among Muslims in relation to age, parity and previous perinatal death was used. Data was collected by focus group discussion and in-depth unstructured interview until the saturation point met. Sixteen mothers who had recent perinatal loss of wanted pregnancy, had received antenatal follow up from public or private health clinics, and had delivery in our centre participated for the study. All of them had experienced psychological difficulties including feelings of confusion, emptiness and anxiety over facing another pregnancy. Results Two out of sixteen showed anger and one felt guilt. They reported experiencing a lack of communication and privacy in the hospital during the period of grief. Family members and friends play an important role in providing support. The majority agreed that the decision makers were husbands and families instead of themselves. The respondents felt that repetitive reminder of whatever happened was a test from God improved their sense of self-worth. They appreciated this reminder especially when it came from husband, family or friends closed to them. Conclusion Muslim mothers who had experienced perinatal loss showed some level of adverse psychosocial impact which affected their feelings. Husbands and family members were the main decision makers for Muslim women. Health care providers should provide psychosocial support during antenatal, delivery and postnatal care. On-going support involving husband should be available where needed.

Perinatal mortality rate in the Netherlands compared to other European countries: a secondary analysis of Euro-PERISTAT data

NARCIS (Netherlands)

de Jonge, J.; Baron, R.; Westerneng, M.; Twisk, J.; Hutton, E.K.

2013-01-01

Objective: the poor perinatal mortality ranking of the Netherlands compared to other European countries has led to questioning the safety of primary care births, particularly those at home. Primary care births are only planned at term. We therefore examined to which extent the perinatal mortality

Does antenatal care timing influence stillbirth risk in the third trimester? A secondary analysis of perinatal death audit data in South Africa.

Science.gov (United States)

Lavin, T; Pattinson, R C

2018-01-01

To explore stillbirth risk across gestation in three provinces of South Africa with different antenatal care schedules. Retrospective audit of perinatal death data using South Africa's Perinatal Problem Identification Programme. In 2008, the Basic Antenatal Care Programme was introduced in Limpopo and Mpumalanga provinces, reducing appointments to five visits at booking, 20, 26, 32, 38 weeks and 41 weeks if required. In the Western Cape province seven appointments remained at booking, 20, 26, 32, 34, 36, 38 and 41 weeks if required. All audited stillbirths (n = 4211) between October 2013 to August 2015 in Limpopo, Mpumalanga and Western Cape. Stillbirth risk (26-42 weeks of gestation, >1000 g) across gestation was calculated using Yudkin's method. Stillbirth risk was compared between provinces and relative risks were calculated between Limpopo/ Mpumalanga and Western Cape. Stillbirth risk across gestation. Stillbirth risk peaked at 38 weeks of gestation in Limpopo (relative risk [RR] 3.11, 95% CI 2.40-4.03, P risk at 38 weeks gestation in Limpopo and Mpumalanga were statistically greater than both the 37 and 39 weeks gestation within provinces (P risk occurs after a 6-week absence of antenatal care. This calls for a refocus on the impact of reduced antenatal care visits during the third trimester. Reduced antenatal care in the third trimester may increase stillbirth risk. © 2017 Royal College of Obstetricians and Gynaecologists.

The Impact of Certificate-of-Need Laws on Nursing Home and Home Health Care Expenditures.

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Rahman, Momotazur; Galarraga, Omar; Zinn, Jacqueline S; Grabowski, David C; Mor, Vincent

2016-02-01

Over the past two decades, nursing homes and home health care agencies have been influenced by several Medicare and Medicaid policy changes including the adoption of prospective payment for Medicare-paid postacute care and Medicaid-paid long-term home and community-based care reforms. This article examines how spending growth in these sectors was affected by state certificate-of-need (CON) laws, which were designed to limit the growth of providers and have remained unchanged for several decades. Compared with states without CON laws, Medicare and Medicaid spending in states with CON laws grew faster for nursing home care and more slowly for home health care. In particular, we observed the slowest growth in community-based care in states with CON for both the nursing home and home health industries. Thus, controlling for other factors, public postacute and long-term care expenditures in CON states have become dominated by nursing homes. © The Author(s) 2015.

The burden of abdominal obesity with physical inactivity on health expenditure in Brazil

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Jamile S. Codogno

2015-03-01

Full Text Available The purpose of this study was to analyze the association between the clustering of physical inactivity with abdominal obesity and public health care expenditure in Brazilian adults. The sample was composed of 963 patients of both genders, randomly selected in the Brazilian Public Health care System during 2010. Entire health care expenditures during the last year were computed and stratified into: medical consultations, medication dispensing, laboratory tests and overall expenditure. Waist circumference was used to diagnose abdominal obesity and physical activity was assessed by previously validated questionnaire. Sedentary and abdominally obese patients (OR= 3.01 [OR95%CI= 1.81-4.99] had higher likelihood be inserted in the group of higher expenditures than only abdominally obese patients (OR= 1.66 [OR95%CI= 1.07-2.59]. There is a synergic effect between abdominal obesity and physical inactivity on overall health care expenditures.

The Social Nature of Perceived Illness Representations of Perinatal Depression in Rural Uganda

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Nandini D. P. Sarkar

2018-06-01

Full Text Available While the global health community advocates for greater integration of mental health into maternal health agendas, a more robust understanding of perinatal mental health, and its role in providing integrated maternal health care and service delivery, is required. The present study uses the Illness Representation Model, a theoretical cognitive framework for understanding illness conceptualisations, to qualitatively explore multiple stakeholder perspectives on perinatal depression in rural Uganda. A total of 70 in-depth interviews and 9 focus group discussions were conducted with various local health system stakeholders, followed by an emergent thematic analysis using NVivo 11. Local communities perceived perinatal depression as being both the fault of women, and not. It was perceived as having socio-economic and cultural causal factors, in particular, as being partner-related. In these communities, perinatal depression was thought to be a common occurrence, and its negative consequences for women, infants and the community at large were recognised. Coping and help-seeking behaviours prescribed by the participants were also primarily socio-cultural in nature. Placing the dynamics and mechanisms of these local conceptualisations of perinatal depression alongside existing gaps in social and health care systems highlights both the need of, and the opportunities for, growth and prioritisation of integrated perinatal biomedical, mental, and social health programs in resource-constrained settings.

Favorable Cardiovascular Health Is Associated With Lower Health Care Expenditures and Resource Utilization in a Large US Employee Population: The Baptist Health South Florida Employee Study.

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Osondu, Chukwuemeka U; Aneni, Ehimen C; Valero-Elizondo, Javier; Salami, Joseph A; Rouseff, Maribeth; Das, Sankalp; Guzman, Henry; Younus, Adnan; Ogunmoroti, Oluseye; Feldman, Theodore; Agatston, Arthur S; Veledar, Emir; Katzen, Barry; Calitz, Chris; Sanchez, Eduardo; Lloyd-Jones, Donald M; Nasir, Khurram

2017-03-13

To examine the association of favorable cardiovascular health (CVH) status with 1-year health care expenditures and resource utilization in a large health care employee population. Employees of Baptist Health South Florida participated in a health risk assessment from January 1 through September 30, 2014. Information on dietary patterns, physical activity, blood pressure, blood glucose level, total cholesterol level, and smoking were collected. Participants were categorized into CVH profiles using the American Heart Association's ideal CVH construct as optimal (6-7 metrics), moderate (3-5 metrics), and low (0-2 metrics). Two-part econometric models were used to analyze health care expenditures. Of 9097 participants (mean ± SD age, 42.7±12.1 years), 1054 (11.6%) had optimal, 6945 (76.3%) had moderate, and 1098 (12.1%) had low CVH profiles. The mean annual health care expenditures among those with a low CVH profile was $10,104 (95% CI, $8633-$11,576) compared with $5824 (95% CI, $5485-$6164) and $4282 (95% CI, $3639-$4926) in employees with moderate and optimal CVH profiles, respectively. In adjusted analyses, persons with optimal and moderate CVH had a $2021 (95% CI, -$3241 to -$801) and $940 (95% CI, -$1560 to $80) lower mean expenditure, respectively, than those with low CVH. This trend remained even after adjusting for demographic characteristics and comorbid conditions as well as across all demographic subgroups. Similarly, health care resource utilization was significantly lower in those with optimal CVH profiles compared with those with moderate or low CVH profiles. Favorable CVH profile is associated with significantly lower total medical expenditures and health care utilization in a large, young, ethnically diverse, and fully insured employee population. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model

OpenAIRE

Moore, Donna; Drey, Nicholas; Ayers, Susan

2017-01-01

BACKGROUND: Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-...

The impact of the Perinatal Education Programme on cognitive ...

African Journals Online (AJOL)

Assessment of cognitive knowledge by means of multiple-choice ... midwives use the Perinatal Education Programme in an outreach ... used the Afrikaans translation of the Programme, because .... improvements in patient care practices.

Nursing diagnosis of grieving: content validity in perinatal loss situations.

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Paloma-Castro, Olga; Romero-Sánchez, José Manuel; Paramio-Cuevas, Juan Carlos; Pastor-Montero, Sonia María; Castro-Yuste, Cristina; Frandsen, Anna J; Albar-Marín, María Jesús; Bas-Sarmiento, Pilar; Moreno-Corral, Luis Javier

2014-06-01

To validate the content of the NANDA-I nursing diagnosis of grieving in situations of perinatal loss. Using the Fehring's model, 208 Spanish experts were asked to assess the adequacy of the defining characteristics and other manifestations identified in the literature for cases of perinatal loss. The content validity index was 0.867. Twelve of the 18 defining characteristics were validated, seven as major and five as minor. From the manifestations proposed, "empty inside" was considered as major. The nursing diagnosis of grieving fits in content to the cases of perinatal loss according to experts. The results have provided evidence to support the use of the diagnosis in care plans for said clinical situation. © 2013 NANDA International.

PELAYANAN KESEHATAN PERINATAL DI DAERAH PEDESAAN UJUNG BERUNG

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Anna Alisjahbana

2012-09-01

Full Text Available A survey on perinatal care in a rural area at Ujung Berung district, located 15—20 km outside Bandung, West Java was conducted. Three villages with a population of 40,787 were selected. Health services were provided by one health post and several family planning posts. In this study 1303 pregnant women were followed throughout the 28 weeks of pregnancy until the infant is 28 days of age. Among the 1303 pregnant women 5.7% had received tetanus toxoid immunization. Perinatal mortality rate (PMR was 43.6 per thousand and incidence of low birth weight was 14.3 percent. Only 12.8% pregnant women were using some kind of contraception before the last pregnancy. The PMR decreased in spite of the low percentage users. The main causes of death during perinatal period vece asphyxia neonatorum and infections. The incidence of tetanus neonatorum during neonatal period was 17 per thousand live births. An evaluation of health service activities showed 47.5% of these pregnant women had antenatal care. Care during delivery and early postnatal period was carried out by TBAs. No significant difference was found between the PMR of trained and untrained TBAs. Another aspect of health service activities is referral to the health centre or hospital. A total of 3.8 percent infants were referred because of neo­natal problems; among these, refusal was 12.5% due to the totalistic attitude of the parents in the village. The results showed that coverage of pregnant women and their infants by safe health care services is very low. This may be due to lack of facilities and health personnel, and probably also due to the confidence of village people for traditional health care providers. Thus, education and training as well as supervision of traditional health care providers and their integration into the formal health care structure is of extreme importance.  

Gender disparities in medical expenditures attributable to hypertension in the United States.

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Basu, Rituparna; Franzini, Luisa; Krueger, Patrick M; Lairson, David R

2010-01-01

We sought to examine and attempt to explain gender disparities in hypertension-attributable expenditure among noninstitutionalized individuals in the United States. Using the 2001-2004 Medical Expenditure Panel Survey and the Aday and Andersen health care use model, we estimated hypertension-attributable health care expenditures for inpatient stay, outpatient visits, prescription drugs, office visits, and emergency room (ER) visits among men and women by applying the method of recycled prediction. Hypertensive individuals were identified using International Classification of Diseases, 9th edition, codes or self-report of a diagnosis of hypertension. The adjusted mean hypertension-attributable expenditure per individual was significantly higher for women than for men for prescription drugs, inpatient stays, office visits, outpatient visits and ER visits expenditures. However, as age increased, the gender difference in adjusted mean expenditures became smaller and eventually reversed. This reversal occurred at different ages for different expenditures. For prescription drugs, office visits and outpatient expenditures, the reversal in expenditures occurred around age 50 to 59. The maximum difference was observed in outpatient expenditures, where women's average expenditure was $102 more than men's below age 45 but $103 less than men's above age 75. These differences remained significant even after controlling for predisposing, enabling, and need predictors of health care use. Our findings imply that there are gender disparities in hypertension-related expenditures, but that this disparity depends on age. These findings support recent findings on gender disparities in heart diseases and raise the question of physicians' bias in their diagnostic or prognostic approaches to hypertension in men and women. Copyright 2010 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Social class related inequalities in household health expenditure and economic burden: evidence from Kerala, south India

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Narayana Delampady

2011-01-01

Full Text Available Abstract Background In the Indian context, a household's caste characteristics are most relevant for identifying its poverty and vulnerability status. Inadequate provision of public health care, the near-absence of health insurance and increasing dependence on the private health sector have impoverished the poor and the marginalised, especially the scheduled tribe population. This study examines caste-based inequalities in households' out-of-pocket health expenditure in the south Indian state of Kerala and provides evidence on the consequent financial burden inflicted upon households in different caste groups. Methods Using data from a 2003-2004 panel survey in Kottathara Panchayat that collected detailed information on health care consumption from 543 households, we analysed inequality in per capita out-of-pocket health expenditure across castes by considering households' health care needs and types of care utilised. We used multivariate regression to measure the caste-based inequality in health expenditure. To assess health expenditure burden, we analysed households incurring high health expenses and their sources of finance for meeting health expenses. Results The per capita health expenditures reported by four caste groups accord with their status in the caste hierarchy. This was confirmed by multivariate analysis after controlling for health care needs and influential confounders. Households with high health care needs are more disadvantaged in terms of spending on health care. Households with high health care needs are generally at higher risk of spending heavily on health care. Hospitalisation expenditure was found to have the most impoverishing impacts, especially on backward caste households. Conclusion Caste-based inequality in household health expenditure reflects unequal access to quality health care by different caste groups. Households with high health care needs and chronic health care needs are most affected by this inequality

Do we provide affordable, accessible and administrable health care? An assessment of SES differential in out of pocket expenditure on delivery care in India.

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Pradhan, Jalandhar; Dwivedi, Rinshu

2017-03-01

Reproductive and Child Health (RCH) financing is a key area of focus which can lead towards an overall empowerment of women through financial inclusion. The major objectives of this paper are: first; to examine the socio-economic differentials in Out of Pocket Expenditure (OOPE) on delivery care, second; to look into the role of insurance coverage, third; to analyse various sources of financing, and fourth; to measure the adjusted effect of various covariates on the level of OOPE. Data were extracted from the National Sample Survey Organisations (NSSO), 71st round "Key indicators of social consumption in India, Health" conducted by the GoI during January to June 2014. Multivariate Generalised Linear Regression Model (GLRM) has been used to analyse the various covariates of OOPE on maternity care. Multivariate analysis has demonstrated a significant association between socioeconomic status of women and the level of OOPE on delivery care. Level of education, urban residence, higher caste and social group affiliation, strong economic conditions, and use of private facilities for the child birth among the mothers were a significant predictor of the expenditure on maternity care. Despite various efforts by the central and state governments to reduce financial burden, still a large number of households are paying a significant amount from their own pockets. There is an immediate need to re-look in the aspects of insurance coverage and high level of OOPE in delivery care. Copyright © 2016 Elsevier B.V. All rights reserved.

The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures

NARCIS (Netherlands)

Janssens, Wendy; Goedecke, Jann; de Bree, Godelieve J.; Aderibigbe, Sunday A.; Akande, Tanimola M.; Mesnard, Alice

2016-01-01

Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. A household survey was conducted in rural Kwara State,

Treatment Expenditure Pattern of Epileptic Patients: A Study from a Tertiary Care Hospital, Kolkata, India

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Abhik Sinha

2014-01-01

Full Text Available Introduction. Neurological diseases are very important causes of prolonged morbidity and disability leading to profound financial loss. Epilepsy is one of the most important neurological disorders. It being a cost intensive disorder poses a significant economic burden to the country. Aims and Objectives. The study was conducted among the persons with epilepsy (PWE to assess their expenditure pattern for epilepsy treatment and its rural urban difference. Materials and Methods. 315 PWE selected by systematic random sampling and their caregivers were interviewed with the predesigned, pretested semistructured proforma. Subsequently data were compiled and analyzed using SPSS 18.0 software. Results and Conclusion. Majority of the study population were in the age group of 16–30 years. Majority belonged to classes IV and V of Prasad socioeconomic status scale. Average total expenditure per month for treatment of epilepsy was 219 INR, mainly contributed by drugs, travel, investigations, and so forth. Rural population was having higher treatment expenditure for epilepsy specially for travel and food and lodging in order to get epilepsy treatment. Wage loss in the last three months was present in 42.86% study subjects which was both affected by seizure episodes and travel for visits. Better district care would have helped in this situation.

Factors associated with and causes of perinatal mortality in northeastern Tanzania

DEFF Research Database (Denmark)

Schmiegelow, Christentze; Minja, Daniel; Oesterholt, Mayke

2012-01-01

, including preeclampsia, small-for-gestational age, preterm delivery, anemia, and health-seeking behavior. Fetal growth was monitored using ultrasound. Finally, the specific causes of the perinatal deaths were evaluated. Main outcome measure. Perinatal mortality. Results. Forty-six deaths occurred. Key...... to the antenatal care program (adjusted OR 0.027, 95%CI 0.003-0.26, p = 0.002) protected against perinatal mortality. The cause of death in 43% of cases was attributed to complications related to labor and specifically to intrapartum asphyxia (30%) and neonatal infection (13%). Among the remaining deaths, 27% (7....../26) were attributed to preeclampsia and 23% (6/26) to small-for-gestational age. Of these, 54% (14/26) were preterm. Conclusions. Preeclampsia, small-for-gestational age and preterm delivery were key risk factors and causes of perinatal mortality in this area of Tanzania. Maternal anemia was also strongly...

Trends in Australian government health expenditure by age: a fiscal incidence analysis.

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Tapper, Alan; Phillimore, John

2014-11-01

Australian government health expenditure per capita has grown steadily across the past few decades, but little is known about trends in the age distribution of health expenditure. In this paper, the Australian Bureau of Statistics (ABS) fiscal incidence studies, which track expenditure at the household level between 1984 and 2010, are used to shed light on this topic. The main finding was that spending has shifted focus from the younger half to the older half of the population. This shift is evident in three areas: (1) acute care (hospitals); (2) community health services (doctors); and (3) pharmaceuticals. Together, these areas account for approximately 88% of expenditure. The trend is independent of demographic aging. It is unlikely to reflect changes in population health. Its explanation is open to debate. Growth in expenditure per household has been more than threefold faster for elderly than young households. Across this period, expenditure per household per week has increased by 51% for the young, by 79% for the middle aged and by 179% for the elderly. This age-related growth is most prominent in expenditure on acute care, community health services and pharmaceuticals. WHAT IS KNOWN ABOUT THE TOPIC?: The Productivity Commission has published figures that relate age and Australian heath expenditure. However, there has been no published study of age-related trends in Australian health expenditure. WHAT DOES THIS PAPER ADD?: In addition to tracking age-related trends across 26 years, this paper adds a breakdown of those trends into four categories of expenditure, namely acute care, community health services, pharmaceutical benefits, and other. This breakdown shows that the trends vary by expenditure type. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: The paper shows that forward projections in health expenditure need to take into account age-related trends as well as demographic trends.

Progressive universalism? The impact of targeted coverage on health care access and expenditures in Peru.

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Neelsen, Sven; O'Donnell, Owen

2017-12-01

Like other countries seeking a progressive path to universalism, Peru has attempted to reduce inequalities in access to health care by granting the poor entitlement to tax-financed basic care without charge. We identify the impact of this policy by comparing the target population's change in health care utilization with that of poor adults already covered through employment-based insurance. There are positive effects on receipt of ambulatory care and medication that are largest among the elderly and the poorest. The probability of getting formal health care when sick is increased by almost two fifths, but the likelihood of being unable to afford treatment is reduced by more than a quarter. Consistent with the shallow coverage offered, there is no impact on use of inpatient care. Neither is there any effect on average out-of-pocket health care expenditure, but medical spending is reduced by up to 25% in the top quarter of the distribution. Copyright © 2017 John Wiley & Sons, Ltd. Copyright © 2017 John Wiley & Sons, Ltd.

Impact of morbid obesity on medical expenditures in adults.

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Arterburn, D E; Maciejewski, M L; Tsevat, J

2005-03-01

Morbid obesity (body mass index (BMI) > or =40 kg/m2) is associated with substantially increased morbidity and mortality from chronic health conditions and with poorer health-related quality of life; however, less is known about the impact of morbid obesity on healthcare expenditures. To examine the impact of morbid obesity on healthcare expenditures using a nationally representative sample of US adults. We performed a cross-sectional analysis of 16 262 adults from the 2000 Medical Expenditure Panel Survey, a nationally representative survey of the noninstitutionalized civilian population of the United States. Per capita healthcare expenditures were calculated for National Institutes of Health BMI categories, based on self-reported height and weight, using a two-part, multivariable model adjusted for age, gender, race, income, education level, type of health insurance, marital status, and smoking status. Odds of incurring any healthcare expenditure and per capita healthcare expenditures associated with morbid obesity in 2000. When compared with normal-weight adults, the odds of incurring any healthcare expenditure in 2000 were two-fold greater among adults with morbid obesity. Per capita healthcare expenditures for morbidly obese adults were 81% (95% confidence interval (CI): 48-121%) greater than normal-weight adults, 65% (95% CI: 37-110%) greater than overweight adults, and 47% (95% CI: 11-96%) greater than adults with class I obesity. Excess costs among morbidly obese adults resulted from greater expenditures for office-based visits, outpatient hospital care, in-patient care, and prescription drugs. Aggregate US healthcare expenditures associated with excess body weight among morbidly obese US adults exceeded $11 billion in 2000. The economic burden of morbid obesity among US adults is substantial. Further research is needed to identify interventions to reduce the incidence and prevalence of morbid obesity and improve the health and economic outcomes of morbidly

Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania.

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Nyamtema, Angelo S; Urassa, David P; Pembe, Andrea B; Kisanga, Felix; van Roosmalen, Jos

2010-06-03

Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved. A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed. Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed. Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.

Globalization and perinatal medicine--how do we respond?

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Kurjak, Asim; Di Renzo, Gian Carlo; Stanojevic, Milan

2010-04-01

Globalization is both inevitable and usually desirable and contains advantageous and disadvantageous issues. It is a source of both hope and of apprehension and is an accelerating process in flow of information, technology, goods and services, and production means. Globalization has a complex influence on perinatal health. The bonds that link perinatologists together transcend geographic, political, religious, and lingual differences, resulting in a globalization that optimizes perinatal care. In this review, we will discuss some of the global problems facing modern perinatologists. Close to 1.5 billion people in the world, live in extreme poverty, a situation which is particularly stark in the developing world, where 80% of them live. Poor people have little or no access to qualified health services and education, and do not participate in the decisions critical to their day-to-day lives. Poverty cannot be defined solely in terms of lack of income. A person, a family, even a nation is not deemed poor only because of low economic resources. Little or no access to health services, lack of access to safe water and adequate nutrition, illiteracy or low educational level, and a distorted perception of rights and needs are also essential components of poverty. Expression of poverty in perinatal health care in developing countries are high maternal death and morbidity rates, huge perinatal and childhood losses, and high birth rates. There are good reasons to define it as a global tragedy in our time. Although the mankind has come quite far because the development of civilization and more advances in the health care were made during the past 100 years than in all previous human history, some inhabitants of our planet are not able to experience it. According to some data, every 3 s a newborn dies, and every minute a pregnant woman dies in the globalized world. All together over 10 million deaths every year, which indicates that health security is not strong enough. It is

Effectiveness of an integrated approach to reduce perinatal mortality: recent experiences from Matlab, Bangladesh

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Rahman Anisur

2011-12-01

Full Text Available Abstract Background Improving perinatal health is the key to achieving the Millennium Development Goal for child survival. Recently, several reviews suggest that scaling up available effective perinatal interventions in an integrated approach can substantially reduce the stillbirth and neonatal death rates worldwide. We evaluated the effect of packaged interventions given in pregnancy, delivery and post-partum periods through integration of community- and facility-based services on perinatal mortality. Methods This study took advantage of an ongoing health and demographic surveillance system (HDSS and a new Maternal, Neonatal and Child Health (MNCH Project initiated in 2007 in Matlab, Bangladesh in half (intervention area of the HDSS area. In the other half, women received usual care through the government health system (comparison area. The MNCH Project strengthened ongoing maternal and child health services as well as added new services. The intervention followed a continuum of care model for pregnancy, intrapartum, and post-natal periods by improving established links between community- and facility-based services. With a separate pre-post samples design, we compared the perinatal mortality rates between two periods--before (2005-2006 and after (2008-2009 implementation of MNCH interventions. We also evaluated the difference-of-differences in perinatal mortality between intervention and comparison areas. Results Antenatal coverage, facility delivery and cesarean section rates were significantly higher in the post- intervention period in comparison with the period before intervention. In the intervention area, the odds of perinatal mortality decreased by 36% between the pre-intervention and post-intervention periods (odds ratio: 0.64; 95% confidence intervals: 0.52-0.78. The reduction in the intervention area was also significant relative to the reduction in the comparison area (OR 0.73, 95% CI: 0.56-0.95; P = 0.018. Conclusion The continuum

Perinatal death: bereavement interventions used by US and Spanish nurses and midwives.

Science.gov (United States)

Steen, Sue E

2015-02-01

Little research has been published from a global perspective regarding needs of nurses and midwives related to perinatal bereavement. To identify needs and concerns of US and Spanish nurses and midwives who have worked with perinatal death and to identify the bereavement interventions they use to help families with this experience. A cross-sectional study was conducted. Data were collected in 2011 from US (n=44) and Spanish (n=15) nurses and midwives via a questionnaire. Statistically significant differences between the nurses/midwives in each country were found regarding needs relating to knowledge, communication skills and managing personal feelings. Interventions of accompanying, listening, offering keepsakes, baptism discussion, and funeral planning were also found to be significantly different between the two groups. These findings demonstrate a continued need to increase the standard and consistency of perinatal bereavement care worldwide. Bereavement education in nursing curricula and practice settings in both cultures is essential to increase the standard of care.

Time to death and the forecasting of macro-level health care expenditures: some further considerations.

Science.gov (United States)

van Baal, Pieter H; Wong, Albert

2012-12-01

Although the effect of time to death (TTD) on health care expenditures (HCE) has been investigated using individual level data, the most profound implications of TTD have been for the forecasting of macro-level HCE. Here we estimate the TTD model using macro-level data from the Netherlands consisting of mortality rates and age- and gender-specific per capita health expenditures for the years 1981-2007. Forecasts for the years 2008-2020 of this macro-level TTD model were compared to forecasts that excluded TTD. Results revealed that the effect of TTD on HCE in our macro model was similar to those found in micro-econometric studies. As the inclusion of TTD pushed growth rate estimates from unidentified causes upwards, however, the two models' forecasts of HCE for the 2008-2020 were similar. We argue that including TTD, if modeled correctly, does not lower forecasts of HCE. Copyright © 2012 Elsevier B.V. All rights reserved.

Inpatient care expenditure of the elderly with chronic diseases who use public health insurance: Disparity in their last year of life.

Science.gov (United States)

Chandoevwit, Worawan; Phatchana, Phasith

2018-06-01

The Thai elderly are eligible for the Civil Servant Medical Benefit Scheme (CS) or Universal Coverage Scheme (UCS) depending on their pre-retirement or their children work status. This study aimed to investigate the disparity in inpatient care expenditures in the last year of life among Thai elderly individuals who used the two public health insurance schemes. Using death registration and inpatient administrative data from 2007 to 2011, our subpopulation group included the elderly with four chronic disease groups: diabetes mellitus, hypertension and cardiovascular disease, heart disease, and cancer. Among 1,242,150 elderly decedents, about 40% of them had at least one of the four chronic disease conditions and were hospitalized in their last year of life. The results showed that the means of inpatient care expenditures in the last year of life paid by CS and UCS per decedent were 99,672 Thai Baht and 52,472 Thai Baht, respectively. On average, UCS used higher healthcare resources by diagnosis-related group relative weight measure per decedent compared with CS. In all cases, the rates of payment for inpatient treatment per diagnosis-related group adjusted relative weight were higher for CS than UCS. This study found that the disparities in inpatient care expenditures in the last year of life stemmed mainly from the difference in payment rates. To mitigate this disparity, unified payment rates for various types of treatment that reflect costs of hospital care across insurance schemes were recommended. Copyright © 2018 Elsevier Ltd. All rights reserved.

Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model.

Science.gov (United States)

Moore, Donna; Drey, Nicholas; Ayers, Susan

2017-02-20

Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-seeking behavior, potentially because they have a role in challenging stigma. This study draws from these findings and theoretical concepts to present a model of forum use, stigma, and disclosure. This study tested a model that measured the mediating role of stigma between online forum use and disclosure of affective symptoms to health care providers. A Web-based survey of 200 women who were pregnant or had a child younger than 5 years and considered themselves to be experiencing psychological distress was conducted. Women were recruited through social media and questions measured forum usage, perinatal mental illness stigma, disclosure to health care providers, depression and anxiety symptoms, barriers to disclosure, and demographic information. There was a significant positive indirect effect of length of forum use on disclosure of symptoms through internal stigma, b=0.40, bias-corrected and accelerated (BCa) 95% CI 0.13-0.85. Long-term forum users reported higher levels of internal stigma, and higher internal stigma was associated with disclosure of symptoms to health care providers when controlling for symptoms of depression and anxiety. Internal stigma mediates the relationship between length of forum use and disclosure to health care providers. Findings suggest that forums have the potential to enable women to recognize and reveal their internal stigma, which may in turn lead to greater disclosure of symptoms to health care providers. Clinicians could refer clients to trustworthy and

Projected lifetime risks and hospital care expenditure for traumatic injury.

Science.gov (United States)

Chang, David C; Anderson, Jamie E; Kobayashi, Leslie; Coimbra, Raul; Bickler, Stephen W

2012-08-01

The lifetime risk and expected cost of trauma care would be valuable for health policy planners, but this information is currently unavailable. The cumulative incidence rates methodology, based on a cross-sectional population analysis, offers an alternative approach to prohibitively costly prospective cohort studies. Retrospective analysis of the California Office of Statewide Health Planning and Development (OSHPD) database was performed for 2008. Trauma admissions were identified by ICD-9 primary diagnosis codes 800-959, with certain exclusions. Cumulative incidence rates were calculated as the cumulative summation of incidence risks sequentially across age groups. A total of 2.2 million admissions were identified, with mean age of 63.8 y, 49.6% men, 82.8% Whites, 5.7% Blacks, 11.3% Hispanics, and 3.1% Asians. The cumulative incidence rate for patients older than age 85 y was 1119 per 10,000 people, with the majority of risk in the elderly, compared with 24,325 per 10,000 people for all-cause hospitalizations. The rates were 946 for men, 1079 for women, 999 for non-Hispanic Whites, 568 for Blacks, 577 for Hispanics, and 395 for Asians, per 10,000 population. The cumulative expected hospital charge was $6538, compared with $81,257 for all-cause hospitalizations. The cumulative lifetime risk of trauma/injury requiring hospitalization for a person living to age 85 y in California is 11.2%, accounting for 4.6% of expected lifetime hospitalizations, but accounting for 8.0% of expected lifetime hospital expenditures. Risk of trauma is significant in the elderly. The total expenditure for all trauma hospitalizations in California was $7.62 billion in 2008. Copyright © 2012 Elsevier Inc. All rights reserved.

Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC) - Smoking-Attributable Expenditures (SAE)

Data.gov (United States)

U.S. Department of Health & Human Services — 2005-2009. SAMMEC - Smoking-Attributable Mortality, Morbidity, and Economic Costs. Smoking-attributable expenditures (SAEs) are excess health care expenditures...

Can money buy green? Demographic and socioeconomic predictors of lawn-care expenditures and lawn greenness in urban residential areas

Science.gov (United States)

Weiqi Zhou; Austin Troy; J. Morgan Grove; Jennifer C. Jenkins

2009-01-01

It is increasingly important to understand how household characteristics influence lawn characteristics, as lawns play an important ecological role in human-dominated landscapes. This article investigates household and neighborhood socioeconomic characteristics as predictors of residential lawn-care expenditures and lawn greenness. The study area is the Gwynns Falls...

Maternal and perinatal outcome in gestational diabetes mellitus in a Tertiary Care Hospital in Delhi

Directory of Open Access Journals (Sweden)

Rajesh Kumari

2018-01-01

Full Text Available Background: Gestational diabetes mellitus (GDM is defined as a carbohydrate intolerance first diagnosed in pregnancy and may be associated with adverse maternal and perinatal outcome. Aim: The aim of the study was to determine the maternal and perinatal outcome in GDM during pregnancy. Materials and Methods: It is a retrospective analysis of women diagnosed with GDM who got antenatal care and delivered in our hospital in previous 5 years. Another 191 women with normal pregnancy without GDM and other medical conditions were taken as control. The baseline characteristics (age, body mass index, religion, and socioeconomic status were noted in all cases. Diagnosis of GDM was made using oral glucose tolerance test with 75 g glucose. GDM patients were started on diet following which insulin or oral hypoglycemic agents were given if required. Maternal and perinatal outcome was noted in all women.Results: The prevalence of GDM was 5.72% (170/2970. Most patients (79.41% could be controlled on diet alone. However, 21 (12.35% needed insulin and 14 (8.23% needed oral hypoglycemic agents. Middle socioeconomic status was more common in GDM than control and pregnancy-induced hypertension was more common in GDM (13.5% than in control (6.3% (P = 0.019. Mode of delivery was not different in two groups. Instrumental deliveries and postpartum hemorrhage were also similar. However, mean birth weight was significantly higher in GDM (2848 ± 539 g than in control (2707 ± 641 g (P = 0.004. Incidence of large-for-date babies was also higher (28.2% in GDM than control (19.4% (P = 0.005. In neonatal complication, hypoglycemia was significantly higher in GDM (20.6% than in control (5.2% (P = 0.001. However, the incidence of hyperbilirubinemia and congenital malformations was not significantly different in two groups. Conclusion: The prevalence of GDM was 5.72% in this study. Adequate treatment of GDM on diet, oral hypoglycemic agents, or insulin to achieve euglycemia can

A current landscape of provincial perinatal data collection in Canada.

Science.gov (United States)

Massey, Kiran A; Magee, Laura A; Dale, Sheryll; Claydon, Jennifer; Morris, Tara J; von Dadelszen, Peter; Liston, Robert M; Ansermino, J Mark

2009-03-01

The Canadian Perinatal Network (CPN) was launched in 2005 as a national perinatal database project designed to identify best practices in maternity care. The inaugural project of CPN is focused on interventions that optimize maternal and perinatal outcomes in women with threatened preterm birth at 22+0 to 28+6 weeks' gestation. To examine existing data collection by perinatal health programs (PHPs) to inform decisions about shared data collection and CPN database construction. We reviewed the database manuals and websites of all Canadian PHPs and compiled a list of data fields and their definitions. We compared these fields and definitions with those of CPN and the Canadian Minimal Dataset, proposed as a common dataset by the Canadian Perinatal Programs Coalition of Canadian PHPs. PHPs collect information on 2/3 of deliveries in Canada. PHPs consistently collect information on maternal demographics (including both maternal and neonatal personal identifiers), past obstetrical history, maternal lifestyle, aspects of labour and delivery, and basic neonatal outcomes. However, most PHPs collect insufficient data to enable identification of obstetric (and neonatal) practices associated with improved maternal and perinatal outcomes. In addition, there is between-PHP variability in defining many data fields. Construction of a separate CPN database was needed although harmonization of data field definitions with those of the proposed Canadian Minimal Dataset was done to plan for future shared data collection. This convergence should be the goal of researchers and clinicians alike as we construct a common language for electronic health records.

Ethics in Perinatal Medicine | Adinma | Nigerian Journal of Paediatrics

African Journals Online (AJOL)

Background: The current trend in perinatal medicine addresses the challenge posed to newborn survival by newborn prematurity and other morbidities requiring neonatal newborn intensive care. These ethical concerns span through the spectrum of education, clinical practice and research, domicile in obstetrics and ...

Comorbidity and the concentration of healthcare expenditures in older patients with heart failure.

Science.gov (United States)

Zhang, James X; Rathouz, Paul J; Chin, Marshall H

2003-04-01

To examine comorbidity and concentration of healthcare expenditures in older patients with heart failure (HF) in the Medicare program. Retrospective analysis of older fee-for-service HF patients, using the 1996 Medicare Current Beneficiary Survey and linked Medicare claims. Variety of clinical settings. One thousand two hundred sixty-six older HF patients from a nationally representative survey. Medicare expenditure per person and by types of healthcare services, prevalence of comorbid conditions, and multivariate regression on the association between comorbidities and healthcare expenditure. Medicare spent an average of 16,514 dollars on medical reimbursement for each HF patient in 1996. Eighty-one percent of patients had one or more comorbid diseases according to a 17-disease grouping index. The top 20% of HF patients accounted for 63% of total expenditure. Comorbidity was associated with significantly higher Medicare expenditure. HF patients with more-expensive comorbidities included those with peripheral vascular disease (24% of patients, mean total expenditure 26,954 dollars), myocardial infarction (16% of patients, mean total expenditure 29,867 dollars), renal disease (8% of patients, mean total expenditure 33,014 dollars), and hemiplegia or paraplegia (5% of patients, mean total expenditure 33,234 dollars). Diseases and disorders other than heart failure constituted a significant fraction of the causes of inpatient admissions. Comorbid conditions were more likely to be associated with expensive inpatient care, and patients with these diseases were more likely to spend more overall and more on other types of Medicare services including home health aid, skilled nursing facility, and hospice care. Disease management should consider comorbid conditions for improving care and reducing expenditures in older patients with HF.

Medicaid Expenditures for Fee-for-Service Enrollees with Behavioral Diagnoses: Findings from a 50 State Claims Analysis.

Science.gov (United States)

Ward, Martha C; Lally, Cathy; Druss, Benjamin G

2017-01-01

Medicaid is an important funder of care for individuals with behavioral (psychiatric and/or substance use) diagnoses, and expenditures will likely increase with expansion of services under the Affordable Care Act. This study provides national estimates of Medicaid expenditures using a comprehensive sample of fee-for-service Medicaid enrollees with behavioral diagnoses. Data for analysis came from 2003 to 2004 Medicaid Analytic eXtract (MAX) files for 50 states and the District of Columbia. Individuals with behavioral diagnoses had high rates of chronic medical comorbidities, and expenditures for medical (non-behavioral) diagnoses accounted for 74 % of their health care expenditures. Total Medicaid expenditure was approximately 15 billion dollars (equivalent to 18.91 billion in 2016 dollars) for individuals with any behavioral diagnosis. Medicaid fee-for-service beneficiaries with behavioral diagnoses have a high treated prevalence of individual medical comorbid conditions, and the majority of health care expenditures in these individuals are for medical, rather than behavioral health, services.

Suboptimal care and perinatal mortality in ten European regions: Methodology and evaluation of an international audit

NARCIS (Netherlands)

Richardus, J.H.; Graafmans, W.C.; Bergsjø, P.; Lloyd, D.J.; Bakketeig, L.S.; Bannon, E.M.; Borkent-Polet, M.; Davidson, L.L.; Defoort, P.; Esparteiro Leitão, A.; Langhoff-Roos, J.; Moral Garcia, A.; Papantoniou, N.E.; Wennergren, M.; Amelink-Verburg, M.P.; Verloove-Vanhorick, S.P.; Mackenbach, J.P.

2003-01-01

Background: A European concerted action (the EuroNatal study) investigated differences in perinatal mortality between countries of Europe. This report describes the methods used in the EuroNatal international audit and discusses the validity of the results. Methods: Perinatal deaths between 1993 and

Prevalence and factors influencing perinatal mortality in rural mysore, India.

Science.gov (United States)

Siddalingappa, Hugara; Murthy M R, Nrayana; Kulkarni, Praveen; N C, Ashok

2013-12-01

With decreasing Infant Mortality Rate, Perinatal Mortality is gaining importance as it takes into consideration most of the factors influencing child birth and its survival, mortality during this period is a better indicator of quality of Maternal and Child Health services. To estimate the Prevalence of perinatal mortality and its associated risk factors. Cross sectional community based study was carried out in rural field practice area catering 26,700 population. All births during 2010 among permanent residents of this area were included. House to house survey was conducted to collect details regarding Antenatal, intra-natal and post-natal history by interviewing mother using a pre-tested questionnaire. Hospital records were also referred when available. Nine perinatal deaths had occurred out of 314 births in a span of one year with a perinatal, early neonatal mortality rates of 28.93, 19.29 per 1000 live births respectively and still birth rate of 9.55 per 100 total births. Higher Perinatal Mortality Rate(PNMR) was observed in mothers who got married before 18 years, conceived during teenage, having anaemia, delivered at home, normal vaginal deliveries and having suffered by intra-partal and placental complications. Male babies, babies fed with prelacteal feeds, born out of intra-uterine complications, having low birth weight, had delayed first cry, premature births and twin births showed higher risk for mortality. The prevalence of perinatal mortality in the present study was 28.93 per 1000 live births. Even though this was well below the national and state values indicating improved quality of Maternal and Child Health care, it also gives way for relooking into strategies for further bringing down the perinatal deaths.

An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan.

Science.gov (United States)

Jokhio, Abdul Hakeem; Winter, Heather R; Cheng, Kar Keung

2005-05-19

There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year. There is limited evidence from clinical trials to guide the development of effective maternity services in developing countries. We performed a cluster-randomized, controlled trial involving seven subdistricts (talukas) of a rural district in Pakistan. In three talukas randomly assigned to the intervention group, traditional birth attendants were trained and issued disposable delivery kits; Lady Health Workers linked traditional birth attendants with established services and documented processes and outcomes; and obstetrical teams provided outreach clinics for antenatal care. Women in the four control talukas received usual care. The primary outcome measures were perinatal and maternal mortality. Of the estimated number of eligible women in the seven talukas, 10,114 (84.3 percent) were recruited in the three intervention talukas, and 9443 (78.7 percent) in the four control talukas. In the intervention group, 9184 women (90.8 percent) received antenatal care by trained traditional birth attendants, 1634 women (16.2 percent) were seen antenatally at least once by the obstetrical teams, and 8172 safe-delivery kits were used. As compared with the control talukas, the intervention talukas had a cluster-adjusted odds ratio for perinatal death of 0.70 (95 percent confidence interval, 0.59 to 0.82) and for maternal mortality of 0.74 (95 percent confidence interval, 0.45 to 1.23). Training traditional birth attendants and integrating them into an improved health care system were achievable and effective in reducing perinatal mortality. This model could result in large improvements in perinatal and maternal health in developing countries. Copyright 2005 Massachusetts Medical Society.

[Quantitative analysis of drug expenditures variability in dermatology units].

Science.gov (United States)

Moreno-Ramírez, David; Ferrándiz, Lara; Ramírez-Soto, Gabriel; Muñoyerro, M Dolores

2013-01-01

Variability in adjusted drug expenditures among clinical departments raises the possibility of difficult access to certain therapies at the time that avoidable expenditures may also exist. Nevertheless, drug expenditures are not usually applied to clinical practice variability analysis. To identify and quantify variability in drug expenditures in comparable dermatology department of the Servicio Andaluz de Salud. Comparative economic analysis regarding the drug expenditures adjusted to population and health care production in 18 dermatology departments of the Servicio Andaluz de Salud. The 2012 cost and production data (homogeneous production units -HPU-)were provided by Inforcoan, the cost accounting information system of the Servicio Andaluz de Salud. The observed drug expenditure ratio ranged from 0.97?/inh to 8.90?/inh and from 208.45?/HPU to 1,471.95?/ HPU. The Pearson correlation between drug expenditure and population was 0.25 and 0.35 for the correlation between expenditure and homogeneous production (p=0.32 and p=0,15, respectively), both Pearson coefficients confirming the lack of correlation and arelevant degree of variability in drug expenditures. The quantitative analysis of variability performed through Pearson correlation has confirmed the existence of drug expenditure variability among comparable dermatology departments. Copyright © 2013 SEFH. Published by AULA MEDICA. All rights reserved.

DETERMINING THE INCOME ELASTICITY OF DEMAND FOR HEALTH EXPENDITURE : AN EMPIRICAL ANALYSIS

OpenAIRE

Farhana Binti MAHARUDIN; Zahariah Binti Mohd ZAIN; Irfah Najihah Binti Basir MALAN

2013-01-01

The main purpose of this study is to investigate the long-run relationship between public health care expenditure and income in Malaysia. There are many factors that affect health care expenditure positively such as income per head, population, the ageing population and national saving. The public health care is essential for economic growth and hence needs greater government involvement. The results of the unit root test indicated that all variables involved are stationary. The Johansen coin...

KEMATIAN PERINATAL HUBUNGANNYA DENGAN FAKTOR PRAKTIK KESEHATAN IBU SELAMA KEHAMILAN DI KOTA BEKASI TAHUN 2001

Directory of Open Access Journals (Sweden)

Ning Sulistiyowati

2012-11-01

Full Text Available Infants mortality rate is one of the sensitive indicators to evaluate health level of a country. However Perinatal Mortality Rate (PMR as part of infant mortality rate did not show any decline in the last ten period. The National Household Survey 1995 reported that PMR was within 48 per 1000 life births. Mother and Child Health program had promoted intensive antenatal health care to cover all pregnancies. The purpose of this program is to improve early detection of high risk pregnancies as well as to increase coverage of postnatal care of new borns. Perinatal mortality is influenced by several maternal health service, (antenatal care and delivery assistance, maternal health status, social-economic and environmental background, and traditional behavior. The objective of this analysis is to find the relation between maternal health practice during pregnancy and perinatal mortality in city of Bekasi 2001. Mother's age at delivery, educational level, parity, birth interval, smoking habit, pregnancy complication, and sex of the new born were calculated as covariates. Using case-control method, cases are mothers with perinatal deaths, and control are mothers with 7 days surviving new borns (83 case and 83 control. Based on a statistical analysis with logistic regression test the maternal health practice during pregnancy showed no significant relationship with perinatal mortality. Controlling birth interval, pregnancy complications and mother's ageat delivery, the odds ratio was OR = 2,3 (confidence interval 0,89 - 3,99 with p = 0,029 at 95% probability;, which is not significant. This result may be caused by small sample size or poor quality health service.

Perinatal outcomes of pregnancies conceived by assisted reproductive technologies

Directory of Open Access Journals (Sweden)

Šljivančanin Tamara

2015-01-01

Full Text Available Introduction. Recent epidemiological studies showed significantly higher incidence of perinatal complications in newborns and women after the use of assisted reproductive technologies (ART. Multiple pregnancies are more frequent after the use of ART. Singleton pregnancies following ART are more prone to preterm birth, low and very low birth weight (LBW and VLBW, small for gestational age (SGA and perinatal mortality. Objective. The aim of this study was to summarize the results of relevant articles and to evaluate whether the mode of conception is the determining factor for different pregnancy outcomes after assisted and natural conceptions. Methods. Eleven studies were included in this review. The following outcomes were observed: preterm and very preterm birth, SGA, LBW, VLBW, perinatal mortality, admission to neonatal intensive care unit (NICU, and Apgar score (As ≤7 at fifth minute. Qualitative analysis and quantitative assessment were performed. Results. For singletons, odds ratios were 1.794 (95% confidence interval 1.660-1.939 for preterm birth, 1.649 (1.301-2.089 for LBW, 1.265 (1.048-1.527 for SGA. Admission to NICU, As≤7 at fifth minute and perinatal mortality showed significantly different frequency after assisted conception. Summary of results for twin gestations showed no significant difference between ART and spontaneous conception for preterm birth (32-36 weeks, very preterm birth (<32 weeks, LBW and VLBW. Conclusion. Analyzed studies showed that infants from ART have significantly worse perinatal outcome compared with natural conception. More observational studies should be conducted in order to establish the exact mechanism leading to more frequent perinatal morbidity and mortality after the use of ART.

Private health care expenditure and quality in Beveridge systems: cross-regional differences in the Italian NHS.

Science.gov (United States)

Del Vecchio, Mario; Fenech, Lorenzo; Prenestini, Anna

2015-03-01

Private health care expenditure ranges from 15% to 30% of total healthcare spending in OECD countries. The literature suggests that there should be an inverse correlation between quality of public services and private expenditures. The main objective of this study is to explore the association between quality of public healthcare and private expenditures in the Italian Regional Healthcare Systems (RHSs). The institutional framework offered by the Italian NHS allows to investigate on the differences among the regions while controlling for institutional factors. The study uses micro-data from the ISTAT Household Consumption Survey (HCS) and a rich set of regional quality indicators. The results indicate that there is a positive and significant correlation between quality and private spending per capita across regions. The study also points out the strong association between the distribution of private consumption and income. In order to account for the influence of income, the study segmented data in three socio-economic classes and computed cross-regional correlations of RHSs quality and household healthcare expenditure per capita, within each class. No correlation was found between the two variables. These findings are quite surprising and call into question the theory that better quality of public services crowds out private spending, or, at the very least, it undermines the simplistic notions that higher levels of private spending are a direct consequence of poor quality in the public sector. This suggests that policies should avoid to simplistically link private spending with judgements or assessments about the functioning or efficacy of the public system and its organizations. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Perinatal outcome and near-miss morbidity between placenta previa versus abruptio placentae

International Nuclear Information System (INIS)

Siddique, S.A.; Tariq, G.; Sheikh, A.; Hussain, F.S.U.; Memon, K.A.

2010-01-01

To compare perinatal outcome and near-miss morbidities between placenta previa versus abruptio placentae in patients of antepartum haemorrhage (APH). Patients with APH diagnosed as placenta previa and abruptio placentae who delivered after 24 weeks of regnancy were selected from labour room. Outcome measures were birth weight, neonatal intensive care admission, stillbirth, perinatal mortality rates, near-miss, surgical intensive care admission, postpartum haemorrhage, hysterectomy, massive transfusion, renal failure, coagulopathy and maternal death. Stillbirth was defined as a fetus weighing greater or equal to 500 gm showing no sign of life after birth. Near-miss was defined as severe organ dysfunction which if not treated appropriately, could result in death. Descriptive statistics were calculated and chi-square was applied with significance level < 0.05. Stillbirths and perinatal mortality rates were significantly higher in abruptio placentae, 52.97% versus 18.18% and 534/1000 versus 230/1000 (p < 0.01). Near-miss cases were also significantly higher in abruptio placentae, 22.27%. Verus 11.18% (p < 0.01). Hypovolemic shock and coagulation failure were also significantly higher in abruptio placentae (p < 0.05). (author)

Perinatal mental health service provision in Switzerland and in the UK.

Science.gov (United States)

Amiel Castro, Rita T; Schroeder, Katrin; Pinard, Claudia; Blöchlinger, Patricia; Künzli, Hansjörg; Riecher-Rössler, Anita; Kammerer, Martin

2015-01-01

The epidemiology of maternal perinatal-psychiatric disorders as well as their effect on the baby is well recognised. Increasingly well researched specialised treatment methods can reduce maternal morbidity, positively affect mother-baby bonding and empower women's confidence as a mother. Here, we aimed to compare guidelines and the structure of perinatal-psychiatric service delivery in the United Kingdom and in Switzerland from the government's perspective. Swiss cantons provided information regarding guidelines and structure of service delivery in 2000. A subsequent survey using the same questionnaire was carried out in 2007. In the UK, similar information was accessed through published reports from 2000-2012. Guidelines for perinatal psychiatry exist in the UK, whereas in Switzerland in 2000 none of the 26 cantons had guidelines, and in 2007 only one canton did. Joint mother-baby admissions on general psychiatric wards were offered by 92% of the Swiss cantons. In the UK, pregnant women and joint mother-baby admissions are only advised onto specialised perinatal-psychiatric units. In Switzerland, in 2007, three specialised units (max. 24 beds) were in place corresponding to 1 unit per 2.5 million people, while in the UK there were 22 mother-baby units (168 beds) in 2012 (1 unit per 2.8 million). In the UK, less than 50% of trusts provided specialised perinatal-psychiatric health care. The main difference between the UK and Switzerland was the absence of guidelines, regular assessment and plans for future development of perinatal psychiatry in Switzerland. There are still geographical differences in the provision of perinatal-psychiatric services in the UK.

Explaining health care expenditure variation: large-sample evidence using linked survey and health administrative data.

Science.gov (United States)

Ellis, Randall P; Fiebig, Denzil G; Johar, Meliyanni; Jones, Glenn; Savage, Elizabeth

2013-09-01

Explaining individual, regional, and provider variation in health care spending is of enormous value to policymakers but is often hampered by the lack of individual level detail in universal public health systems because budgeted spending is often not attributable to specific individuals. Even rarer is self-reported survey information that helps explain this variation in large samples. In this paper, we link a cross-sectional survey of 267 188 Australians age 45 and over to a panel dataset of annual healthcare costs calculated from several years of hospital, medical and pharmaceutical records. We use this data to distinguish between cost variations due to health shocks and those that are intrinsic (fixed) to an individual over three years. We find that high fixed expenditures are positively associated with age, especially older males, poor health, obesity, smoking, cancer, stroke and heart conditions. Being foreign born, speaking a foreign language at home and low income are more strongly associated with higher time-varying expenditures, suggesting greater exposure to adverse health shocks. Copyright © 2013 John Wiley & Sons, Ltd.

How and why do countries differ in their governance and financing-related administrative expenditure in health care? An analysis of OECD countries by health care system typology.

Science.gov (United States)

Hagenaars, Luc L; Klazinga, Niek S; Mueller, Michael; Morgan, David J; Jeurissen, Patrick P T

2018-01-01

Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross-country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. We used OECD data, which include health system governance and financing-related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel). We find that governance and financing-related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross-country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single-payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference. These differences can partially be explained because multi-payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems. Copyright © 2017 John Wiley & Sons, Ltd.

Maternal hemoglobin in Peru: regional differences and its association with adverse perinatal outcomes

OpenAIRE

Gonzales, Gustavo F.; Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima, Perú. Unidad de Reproducción, Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia. Lima, Perú. Doctor en Medicina.; Tapia, Vilma; Unidad de Reproducción, Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia. Lima, Perú. Obstetríz.; Gasco, Manuel; Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia. Lima, Perú. Biólogo.; Carrillo, Carlos; Unidad de Reproducción, Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia. Lima, Perú. Doctor en Medicina.

2011-01-01

Objectives. To evaluate hemoglobin (Hb) levels in pregnant women from different geographical regions from Peru; to establish anemia and erythrocytocis rates and to establish the role of Hb on adverse perinatal outcomes using the Perinatal Information System (PIS) database of Peruvian Ministry of Health. Materials and methods. Data were obtained from 379,816 births of 43 maternity care units between 2000 and 2010. Anemia and erythrocytocis rates were determined in each geographical region as w...

Children and young people with perinatal HIV in Europe

DEFF Research Database (Denmark)

Grarup, Jesper; Kirk, Ole; Lundgren, Jens

2016-01-01

undertook an online survey of HIV cohort studies participating in the EuroCoord Network of Excellence to ascertain the number of perinatally HIV-infected (pHIV) patients included, to compare it with those published by the European Centre for Disease Prevention and Control (ECDC) and the World Health......Accurate ascertainment of the number of children living with human immunodeficiency virus (HIV) is important to plan paediatric and adolescent health services. In Europe, the first generation of perinatally HIV-infected survivors are transferring to adult care and their health needs are unknown. We...... Organization (WHO) and to assess the ability of countries to follow up pHIV patients after transfer to adult care. At the end of 2013, 16 countries in EuroCoord reported 8,229 pHIV patients in follow-up in cohorts, compared with 5,160 cumulative diagnoses reported by the ECDC in the same area. Follow-up of pHIV...

Predictors of regional Medicare expenditures for otolaryngology physician services.

Science.gov (United States)

Smith, Alden; Handorf, Elizabeth; Arjmand, Ellis; Lango, Miriam N

2017-06-01

To describe geographic variation in spending and evaluate regional Medicare expenditures for otolaryngologist services with population- and beneficiary-related factors, physician supply, and hospital system factors. Cross-sectional study. The average regional expenditures for otolaryngology physician services were defined as the total work relative value units (wRVUs) collected by otolaryngologists in a hospital referral region (HRR) per thousand Medicare beneficiaries in the HRR. A multivariable linear regression model tested associations with regional sociodemographics (age, sex, race, income, education), the physician and hospital bed supply, and the presence of an otolaryngology residency program. In 2012, the mean Medicare expenditure for otolaryngology provider services across HRRs was 224 wRVUs per thousand Medicare beneficiaries (standard deviation [SD] 104), ranging from 31 to 604 wRVUs per thousand Medicare beneficiaries. In 2013, the average Medicare expenditures for each HRR was highly correlated with expenditures collected in 2012 (Pearson correlation coefficient .997, P = .0001). Regional Medicare expenditures were independently and positively associated with otolaryngology, medical specialist, and hospital bed supply in the region, and were negatively associated with the supply of primary care physicians and presence of an otolaryngology residency program after adjusting for other factors. The magnitude of associations with physician supply and hospital factors was stronger than any population or Medicare beneficiary factor. Wide variations in regional Medicare expenditures for otolaryngology physician services, highly stable over 2 years, were strongly associated with regional health system factors. Changes in health policy for otolaryngology care may require coordination with other physician specialties and integrated hospital systems. NA. Laryngoscope, 127:1312-1317, 2017. © 2016 The American Laryngological, Rhinological and Otological Society

Reconciling medical expenditure estimates from the MEPS and NHEA, 2007.

Science.gov (United States)

Bernard, Didem; Cowan, Cathy; Selden, Thomas; Cai, Liming; Catlin, Aaron; Heffler, Stephen

2012-01-01

Provide a comparison of health care expenditure estimates for 2007 from the Medical Expenditure Panel Survey (MEPS) and the National Health Expenditure Accounts (NHEA). Reconciling these estimates serves two important purposes. First, it is an important quality assurance exercise for improving and ensuring the integrity of each source's estimates. Second, the reconciliation provides a consistent baseline of health expenditure data for policy simulations. Our results assist researchers to adjust MEPS to be consistent with the NHEA so that the projected costs as well as budgetary and tax implications of any policy change are consistent with national health spending estimates. The Medical Expenditure Panel Survey produced by the Agency for Healthcare Research and Quality, and the National Health Center for Health Statistics and the National Health Expenditures produced by the Centers for Medicare & Medicaid Service's Office of the Actuary. In this study, we focus on the personal health care (PHC) sector, which includes the goods and services rendered to treat or prevent a specific disease or condition in an individual. The official 2007 NHEA estimate for PHC spending is $1,915 billion and the MEPS estimate is $1,126 billion. Adjusting the NHEA estimates for differences in underlying populations, covered services, and other measurement concepts reduces the NHEA estimate for 2007 to $1,366 billion. As a result, MEPS is $240 billion, or 17.6 percent, less than the adjusted NHEA total.

Health care utilisation and out-of-pocket expenditure associated with back pain: a nationally representative survey of Australian women.

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Emma R Kirby

Full Text Available BACKGROUND: Back pain impacts on a significant proportion of the Australian population over the life course and has high prevalence rates among women, particularly in older age. Back pain care is characterised by multiple practitioner and self-prescribed treatment options, and the out-of-pocket costs associated with consultations and self-prescribed treatments have not been examined to date. OBJECTIVE: To analyse the extent of health care practitioner consultations and self-prescribed treatment for back pain care among Australian women, and to assess the self-reported costs associated with such usage. METHODS: Survey of 1,310 women (response rate 80.9% who reported seeking help for back pain from the '1946-51 cohort' of the Australian Longitudinal Study on Women's Health. Women were asked about their use of health care practitioners and self-prescribed treatments for back pain and the costs associated with such usage. RESULTS: In the past year 76.4% consulted a complementary and alternative practitioner, 56% an allied health practitioner and 59.2% a GP/medical specialist. Overall, women consulted with, on average, 3.0 (SD = 2.0 different health care practitioners, and had, on average, 12.2 (SD = 9.7 discrete health care practitioner consultations for back pain. Average self-reported out-of-pocket expenditure on practitioners and self-prescribed treatments for back pain care per annum was AU$873.10. CONCLUSIONS: Multiple provider usage for various but distinct purposes (i.e. pain/mobility versus anxiety/stress points to the need for further research into patient motivations and experiences of back pain care in order to improve and enhance access to and continuity of care. Our results suggest that the cost of back pain care represents a significant burden, and may ultimately limit women's access to multiple providers. We extrapolate that for Australian working-age women, total out-of-pocket expenditure on back pain care per annum is in

Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births

NARCIS (Netherlands)

de jonge, A.; van der Goes, B. Y.; Ravelli, A. C. J.; Amelink-Verburg, M. P.; Mol, B. W.; Nijhuis, J. G.; Bennebroek Gravenhorst, J.; Buitendijk, S. E.

2009-01-01

OBJECTIVE: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care. DESIGN: A nationwide cohort study. SETTING: The entire Netherlands. POPULATION: A total of 529,688 low-risk women

FACTORS CONTRIBUTING TO PERINATAL MORTALITY : OPTIMIZING OUTCOME

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Lakshmi

2015-03-01

Full Text Available OBJECTIVE: To evaluate the various causes of perinatal deaths and adopt strategies to improve perinatal outcome at a referral teaching hospital in North Kerala. METHODS: A prospective observational study conducted at Institute of Maternal and Child Health, Government Medical College, Kozhikode. All perinatal deaths during the period January 2013 to December 2014 were analysed and from this factors responsible for perinatal deaths were identified. RESULTS: Out of total 30,042 deliveries , there were 966 perinatal deaths during the study period. 566 were still births and 400 early neonatal deaths. The perinatal mortality rate was 31.1 per 1000 live births. Perinatal asphyxia was the major cause of perinatal mortality. The important factors contributing to perinatal asphyxia were prematurity (39%, abruptio placenta (19% and MSAF ( 12%. Among the antenatal factors, hypertensive disorders of pregnancy leading to iatrogenic elective preterm delivery were the most important. CONCLUSION: Perinatal asphyxia due to prematurity and low birth weight emerged as the most important cause of perinatal mortality in this study and hypertensive disorders of pregnancy were the most important antenatal complication leading to prematurity

Expenditures on health research in sub-Saharan African countries: results of a questionnaire-based survey.

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Kebede, Derege; Zielinski, Chris; Mbondji, Peter Ebongue; Sanou, Issa; Kouvividila, Wenceslas; Lusamba-Dikassa, Paul-Samson

2014-05-01

To estimate the sources of funds for health research (revenue) and the uses of these funds (expenditure). A structured questionnaire was used to solicit financial information from health research institutions. Forty-two sub-Saharan African countries. Key informants in 847 health research institutions in the 42 sub-Saharan African countries. Expenditure on health research by institutions, funders and subject areas. An estimated total of US$ 302 million was spent on health research by institutions that responded to the survey in the World Health Organization (WHO) African Region for the biennium 2005-2006. The most notable funders for health research activities were external funding, ministries of health, other government ministries, own funds and non-profit institutions. Most types of health research performers spent significant portions of their resources on in-house research, with medical schools spending 82% and government agencies 62%. Hospitals spent 38% of their resources on management, and other institutions (universities, firms, etc.) spent 87% of their resources on capital investment. Research on human immunodeficiency virus/tuberculosis and malaria accounted for 30% of funds, followed by research on other communicable diseases and maternal, perinatal and nutritional conditions (23%). Research on major health problems of the Region, such as communicable diseases, accounts for most of the research expenditures. However, the total expenditure is very low compared with other WHO regions. © The Royal Society of Medicine.

Continuity and change in mothers' narratives of perinatal hospice.

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Lathrop, Anthony; VandeVusse, Leona

2011-01-01

(1) To broadly explore the experiences of women who chose to continue pregnancies affected by lethal fetal diagnoses and (2) to develop knowledge useful to nurses and other healthcare professionals who provide perinatal hospice (PH) care. Qualitative descriptive study using narrative analysis. Fifteen women who learned during their pregnancies of a lethal fetal diagnosis and chose to continue the affected pregnancies. Participants' stories of their PH experiences were recorded in face-to-face interviews. A qualitative approach using narrative analysis was used to identify themes and develop suggestions for care. The element of time was prevalent in mothers' stories. Some aspects of mothers' experiences continued, particularly feelings of love and connection to their babies. Mothers also reported evolving changes in their thoughts and feelings. Personal changes such as increased compassion, faith, and strength were frequently mentioned. Mothers described transient phases of highs and lows. Drawing personal meanings or life lessons was the main way mothers connected their experiences to their present lives. Mothers' descriptions of their experiences can enhance nurses' understanding of perinatal loss. Established care practices, such as birth planning and creating mementoes, were supported. Nurses can help mothers experiencing loss by elucidating and reflecting their personal meanings.

Health care expenditure associated with overweight/obesity: a study among urban married women in Delhi, India.

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Agrawal, Praween; Agrawal, Sutapa

2015-08-01

Obesity is a multifaceted problem with wide-reaching medical, social and economic consequences. While health consequences are much known, but due to paucity of data, economic consequences are less known in India. The prevalence for excessive weight particularly among women population has been increasing dramatically in India in the last decades. We examined the economic burden on individual and households due to overweight and obesity among women in the national capital territory of India, Delhi. We particularly examined the health expenditure pattern in absolute amount as well as a proportion to their household expenditure among women according to their level of body mass index (BMI). A population based follow-up survey of 325 ever-married women aged 20-54 years residing in the national capital territory of Delhi in India, systematically selected from the second round of National Family Health Survey (NFHS-2, 1998-99) samples who were re-interviewed after four years in 2003. Women's expenditure on health has been seen as a gross and as a ratio of total household expenditure. Anthropometric measurements were obtained from women to compute their current body mass index. Multiple logistic regression analysis was used to estimate the odds ratios adjusting for various socio demographic confounders. A significantly (peconomic burden which accounts for more than 5% of their total household expenditure on their health compared to only 10% normal weight women. Significantly, obese and morbidly obese women were more than two times more likely to spend higher amount on their health (OR 2.29 95% CI: 1.07-4.90; p=0.033) than normal weight women. Also overweight women were significantly two times more likely to spend high proportion on their health with respect to total household expenditure (OR 2.11; 95% CI: 1.03-4.35; p=0.042) than normal weight women. There is substantial economic burden of obesity for individuals as well as for the households which calls for urgent

A Randomized Trial of Collaborative Care for Perinatal Depression in Socioeconomically Disadvantaged Women: The Impact of Comorbid Posttraumatic Stress Disorder.

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Grote, Nancy K; Katon, Wayne J; Russo, Joan E; Lohr, Mary Jane; Curran, Mary; Galvin, Erin; Carson, Kathy

2016-11-01

The comorbidity of posttraumatic stress disorder (PTSD) with antenatal depression poses increased risks for postpartum depression and may delay or diminish response to evidence-based depression care. In a secondary analysis of an 18-month study of collaborative care for perinatal depression, the authors hypothesized that pregnant, depressed, socioeconomically disadvantaged women with comorbid PTSD would show more improvement in the MOMCare intervention providing Brief Interpersonal Psychotherapy and/or antidepressants, compared to intensive public health Maternity Support Services (MSS-Plus). A multisite randomized controlled trial with blinded outcome assessment was conducted in the Seattle-King County Public Health System, July 2009-January 2014. Pregnant women were recruited who met criteria for a probable diagnosis of major depressive disorder (MDD) on the Patient Health Questionnaire-9 and/or dysthymia on the MINI-International Neuropsychiatric Interview (5.0.0). The primary outcome was depression severity at 3-, 6-, 12-and 18-month follow-ups; secondary outcomes included functional improvement, PTSD severity, depression response and remission, and quality of depression care. Sixty-five percent of the sample of 164 met criteria for probable comorbid PTSD. The treatment effect was significantly associated with PTSD status in a group-by-PTSD severity interaction, controlling for baseline depression severity (Wald χ²₁ = 4.52, P = .03). Over the 18-month follow-up, those with comorbid PTSD in MOMCare (n = 48), versus MSS-Plus (n = 58), showed greater improvement in depression severity (Wald χ²₁ = 8.51, P depression response (Wald χ²₁ = 4.13, P depression care had a greater impact on perinatal depressive outcomes for socioeconomically disadvantaged women with comorbid PTSD than for those without PTSD. Findings suggest that a stepped care treatment model for high-risk pregnant women with both MDD and PTSD could be integrated into public health systems in

A matched pair cluster randomized implementation trail to measure the effectiveness of an intervention package aiming to decrease perinatal mortality and increase institution-based obstetric care among indigenous women in Guatemala: study protocol.

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Kestler, Edgar; Walker, Dilys; Bonvecchio, Anabelle; de Tejada, Sandra Sáenz; Donner, Allan

2013-03-21

Maternal and perinatal mortality continue to be a high priority problem on the health agendas of less developed countries. Despite the progress made in the last decade to quantify the magnitude of maternal mortality, few interventions have been implemented with the intent to measure impact directly on maternal or perinatal deaths. The success of interventions implemented in less developed countries to reduce mortality has been questioned, in terms of the tendency to maintain a clinical perspective with a focus on purely medical care separate from community-based approaches that take cultural and social aspects of maternal and perinatal deaths into account. Our innovative approach utilizes both the clinical and community perspectives; moreover, our study will report the weight that each of these components may have had on reducing perinatal mortality and increasing institution-based deliveries. A matched pair cluster-randomized trial will be conducted in clinics in four rural indigenous districts with the highest maternal mortality ratios in Guatemala. The individual clinic will serve as the unit of randomization, with 15 matched pairs of control and intervention clinics composing the final sample. Three interventions will be implemented in indigenous, rural and poor populations: a simulation training program for emergency obstetric and perinatal care, increased participation of the professional midwife in strengthening the link between traditional birth attendants (TBA) and the formal health care system, and a social marketing campaign to promote institution-based deliveries. No external intervention is planned for control clinics, although enhanced monitoring, surveillance and data collection will occur throughout the study in all clinics throughout the four districts. All obstetric events occurring in any of the participating health facilities and districts during the 18 months implementation period will be included in the analysis, controlling for the cluster

Advancing perinatal patient safety through application of safety science principles using health IT.

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Webb, Jennifer; Sorensen, Asta; Sommerness, Samantha; Lasater, Beth; Mistry, Kamila; Kahwati, Leila

2017-12-19

The use of health information technology (IT) has been shown to promote patient safety in Labor and Delivery (L&D) units. The use of health IT to apply safety science principles (e.g., standardization) to L&D unit processes may further advance perinatal safety. Semi-structured interviews were conducted with L&D units participating in the Agency for Healthcare Research and Quality's (AHRQ's) Safety Program for Perinatal Care (SPPC) to assess units' experience with program implementation. Analysis of interview transcripts was used to characterize the process and experience of using health IT for applying safety science principles to L&D unit processes. Forty-six L&D units from 10 states completed participation in SPPC program implementation; thirty-two (70%) reported the use of health IT as an enabling strategy for their local implementation. Health IT was used to improve standardization of processes, use of independent checks, and to facilitate learning from defects. L&D units standardized care processes through use of electronic health record (EHR)-based order sets and use of smart pumps and other technology to improve medication safety. Units also standardized EHR documentation, particularly related to electronic fetal monitoring (EFM) and shoulder dystocia. Cognitive aids and tools were integrated into EHR and care workflows to create independent checks such as checklists, risk assessments, and communication handoff tools. Units also used data from EHRs to monitor processes of care to learn from defects. Units experienced several challenges incorporating health IT, including obtaining organization approval, working with their busy IT departments, and retrieving standardized data from health IT systems. Use of health IT played an integral part in the planning and implementation of SPPC for participating L&D units. Use of health IT is an encouraging approach for incorporating safety science principles into care to improve perinatal safety and should be incorporated

Catastrophic health expenditure and its determinants in Kenya slum communities.

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Buigut, Steven; Ettarh, Remare; Amendah, Djesika D

2015-05-14

In Kenya, where 60 to 80% of the urban residents live in informal settlements (frequently referred to as slums), out-of-pocket (OOP) payments account for more than a third of national health expenditures. However, little is known on the extent to which these OOP payments are associated with personal or household financial catastrophe in the slums. This paper seeks to examine the incidence and determinants of catastrophic health expenditure among urban slum communities in Kenya. We use a unique dataset on informal settlement residents in Kenya and various approaches that relate households OOP payments for healthcare to total expenditures adjusted for subsistence, or income. We classified households whose OOP was in excess of a predefined threshold as facing catastrophic health expenditures (CHE), and identified the determinants of CHE using multivariate logistic regression analysis. The results indicate that the proportion of households facing CHE varies widely between 1.52% and 28.38% depending on the method and the threshold used. A core set of variables were found to be key determinants of CHE. The number of working adults in a household and membership in a social safety net appear to reduce the risk of catastrophic expenditure. Conversely, seeking care in a public or private hospital increases the risk of CHE. This study suggests that a substantial proportion of residents of informal settlements in Kenya face CHE and would likely forgo health care they need but cannot afford. Mechanisms that pool risk and cost (insurance) are needed to protect slum residents from CHE and improve equity in health care access and payment.

Total expenditures per patient in hospital-owned and physician-owned physician organizations in California.

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Robinson, James C; Miller, Kelly

Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3,065,551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693,254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and

Addressing access barriers to services for mothers at risk for perinatal mood disorders: A social work perspective.

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Keefe, Robert H; Brownstein-Evans, Carol; Rouland Polmanteer, Rebecca S

2016-01-01

This article identifies variables at the micro/individual, mezzo/partner/spouse and family, and macro/health care-system levels that inhibit mothers at risk for perinatal mood disorders from accessing health and mental health care services. Specific recommendations are made for conducting thorough biopsychosocial assessments that address the mothers' micro-, mezzo-, and macro-level contexts. Finally, the authors provide suggestions for how to intervene at the various levels to remove access barriers for mothers living with perinatal mood disorders as well as their families.

Evaluating direct medical expenditures estimation methods of adults using the medical expenditure panel survey: an example focusing on head and neck cancer.

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Coughlan, Diarmuid; Yeh, Susan T; O'Neill, Ciaran; Frick, Kevin D

2014-01-01

To inform policymakers of the importance of evaluating various methods for estimating the direct medical expenditures for a low-incidence condition, head and neck cancer (HNC). Four methods of estimation have been identified: 1) summing all health care expenditures, 2) estimating disease-specific expenditures consistent with an attribution approach, 3) estimating disease-specific expenditures by matching, and 4) estimating disease-specific expenditures by using a regression-based approach. A literature review of studies (2005-2012) that used the Medical Expenditure Panel Survey (MEPS) was undertaken to establish the most popular expenditure estimation methods. These methods were then applied to a sample of 120 respondents with HNC, derived from pooled data (2003-2008). The literature review shows that varying expenditure estimation methods have been used with MEPS but no study compared and contrasted all four methods. Our estimates are reflective of the national treated prevalence of HNC. The upper-bound estimate of annual direct medical expenditures of adult respondents with HNC between 2003 and 2008 was $3.18 billion (in 2008 dollars). Comparable estimates arising from methods focusing on disease-specific and incremental expenditures were all lower in magnitude. Attribution yielded annual expenditures of $1.41 billion, matching method of $1.56 billion, and regression method of $1.09 billion. This research demonstrates that variation exists across and within expenditure estimation methods applied to MEPS data. Despite concerns regarding aspects of reliability and consistency, reporting a combination of the four methods offers a degree of transparency and validity to estimating the likely range of annual direct medical expenditures of a condition. © 2013 International Society for Pharmacoeconomics and Outcomes Research (ISPOR) Published by International Society for Pharmacoeconomics and Outcomes Research (ISPOR) All rights reserved.

Medical Expenditures and Earnings Losses Among US Adults With Arthritis in 2013.

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Murphy, Louise B; Cisternas, Miriam G; Pasta, David J; Helmick, Charles G; Yelin, Edward H

2018-06-01

We estimated the economic impact of arthritis using 2013 US Medical Expenditure Panel Survey (MEPS) data. We calculated arthritis-attributable and all-cause medical expenditures for adults age ≥18 years and arthritis-attributable earnings losses among those ages 18-64 years who had ever worked. We calculated arthritis-attributable costs using multistage regression-based methods, and conducted sensitivity analyses to estimate costs for 2 other arthritis definitions in MEPS. In 2013, estimated total national arthritis-attributable medical expenditures were $139.8 billion (range $135.9-$157.5 billion). Across expenditure categories, ambulatory care expenditures accounted for nearly half of arthritis-attributable expenditures. All-cause expenditures among adults with arthritis represented 50% of the $1.2 trillion national medical expenditures among all US adults in MEPS. Estimated total national arthritis-attributable earning losses were $163.7 billion (range $163.7-$170.0 billion). The percentage with arthritis who worked in the past year was 7.2 percentage points lower than those without arthritis (76.8% [95% confidence interval (95% CI)] 75.0-78.6 and 84.0% [95% CI 82.5-85.5], respectively, adjusted for sociodemographics and chronic conditions). Total arthritis-attributable medical expenditures and earnings losses were $303.5 billion (range $303.5-$326.9 billion). Total national arthritis-attributable medical care expenditures and earnings losses among adults with arthritis were $303.5 billion in 2013. High arthritis-attributable medical expenditures might be reduced by greater efforts to reduce pain and improve function. The high earnings losses were largely attributable to the substantially lower prevalence of working among those with arthritis compared to those without, signaling the need for interventions that keep people with arthritis in the workforce. © 2017, American College of Rheumatology.

Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country

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Ali Mohammed

2011-06-01

Full Text Available Abstract Background In developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh. Methods A total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at women's home. Results Overall 43% (95% CI: 33.7-51.8% of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9% with healthy babies (p = Conclusions This study highlights the greatly increased vulnerability of women with perinatal death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

A pilot randomized controlled trial of cognitive behavioral therapy for perinatal depression adapted for women with low incomes.

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O'Mahen, Heather; Himle, Joseph A; Fedock, Gina; Henshaw, Erin; Flynn, Heather

2013-07-01

Perinatal women with identified depression in prenatal care settings have low rates of engagement and adherence with depression-specific psychotherapy. We report the feasibility and symptom outcomes of Cognitive Behavioral Therapy (CBT) modified (mCBT) to address the needs of perinatal, low-income women with Major Depressive Disorder (MDD). Pregnant women (n = 1421) were screened for depressive symptoms in obstetrics clinics in conjunction with prenatal care visits. A total of 59 women met diagnostic criteria for MDD; 55 women were randomly assigned to mCBT or Treatment as Usual (TAU). The mCBT intervention included an initial engagement session, outreach, specific perinatal content and interpersonal components. Measures were gathered at pre-treatment, 16 week post-randomization, and 3-month follow-up. Most participants attended at least one CBT session and met study criteria for treatment adherence. Active research staff outreach promoted engagement and retention in the trial. Treatment satisfaction was rated as very good. In both observed and multiple imputation results, women who received mCBT demonstrated greater improvement in depressed mood than those in TAU at 16-week post-randomization and 3-month follow-up, Cohen's d = -0.71 (95% CI -4.93, -5.70). Modified CBT offers promise as a feasible and acceptable treatment for perinatal women with low-incomes in prenatal care settings. Targeted delivery and content modifications are needed to engage populations tailored to setting and psychosocial challenges specific to the perinatal period. © 2013 Wiley Periodicals, Inc.

Mental health trajectories and related factors among perinatal women.

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Lin, Pei-Chao; Hung, Chich-Hsiu

2015-06-01

To investigate Taiwanese women's mental health trajectories from the third trimester of pregnancy to four weeks postpartum and the correlations of these trajectories with perceived social support and demographic characteristics. Previous studies have reported differences between prenatal and postpartum mental health status. A repeated design study was conducted in a medical hospital in Southern Taiwan. One-hundred and ninety-four Taiwanese women completed the Chinese Health Questionnaire and Social Support Scale at the 36th prenatal week and first and fourth week postpartum. Three linear mental health trajectories for perinatal women were identified. Consistently poor perinatal mental health was reported by 16·0% of the participants. Less social support was associated with lower prenatal mental health scores. Younger age was a risk factor for consistently poor perinatal health. Vaginal delivery was associated with improved mental health after childbirth. Mental health was worse in the third trimester of pregnancy than postpartum. Less social support was associated with lower prenatal mental health scores, and this association was similarly distributed between women with consistently poor and improved mental health after birth. Health care providers should assess women's mental health status and provide timely interventions during the perinatal period. Social support should be provided for pregnant women, especially younger women or those with lower perceived social support. © 2015 John Wiley & Sons Ltd.

Psychological and social consequences among mothers suffering from perinatal loss: perspective from a low income country.

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Gausia, Kaniz; Moran, Allisyn C; Ali, Mohammed; Ryder, David; Fisher, Colleen; Koblinsky, Marge

2011-06-09

In developed countries, perinatal death is known to cause major emotional and social effects on mothers. However, little is known about these effects in low income countries which bear the brunt of perinatal mortality burden. This paper reports the impact of perinatal death on psychological status and social consequences among mothers in a rural area of Bangladesh. A total of 476 women including 122 women with perinatal deaths were assessed with the Edinburgh Postnatal Depression Scale (EPDS-B) at 6 weeks and 6 months postpartum, and followed up for negative social consequences at 6 months postpartum. Trained female interviewers carried out structured interviews at women's home. Overall 43% (95% CI: 33.7-51.8%) of women with a perinatal loss at 6 weeks postpartum were depressed compared to 17% (95% CI: 13.7-21.9%) with healthy babies (p = death to experience negative psychological and social consequences. There is an urgent need to develop appropriate mental health care services for mothers with perinatal deaths in Bangladesh, including interventions to develop positive family support.

Can facility delivery reduce the risk of intrapartum complications-related perinatal mortality? Findings from a cohort study.

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Khanam, Rasheda; Baqui, Abdullah H; Syed, Mamun Ibne Moin; Harrison, Meagan; Begum, Nazma; Quaiyum, Abdul; Saha, Samir K; Ahmed, Saifuddin

2018-06-01

Intrapartum complications increase the risk of perinatal deaths. However, population-based data from developing countries assessing the contribution of intrapartum complications to perinatal deaths is scarce. Using data from a cohort of pregnant women followed between 2011 and 2013 in Bangladesh, this study examined the rate and types of intrapartum complications, the association of intrapartum complications with perinatal mortality, and if facility delivery modified the risk of intrapartum-related perinatal deaths. Trained community health workers (CHWs) made two-monthly home visits to identify pregnant women, visited them twice during pregnancy and 10 times in the first two months postpartum. During prenatal visits, CHWs collected data on women's prior obstetric history, socio-demographic status, and complications during pregnancy. They collected data on intrapartum complications, delivery care, and pregnancy outcome during the first postnatal visit within 7 days of delivery. We examined the association of intrapartum complications and facility delivery with perinatal mortality by estimating odds ratios (OR) and 95% confidence intervals (CI) adjusting for covariates using multivariable logistic regression analysis. The overall facility delivery rate was low (3922/24 271; 16.2%). Any intrapartum complications among pregnant women were 20.9% (5,061/24,271) and perinatal mortality was 64.7 per 1000 birth. Compared to women who delivered at home, the risk of perinatal mortality was 2.4 times higher (OR = 2.40; 95% CI = 2.08-2.76) when delivered in a public health facility and 1.3 times higher (OR = 1.32, 95% CI = 1.06-1.64) when delivered in a private health facility. Compared to women who had no intrapartum complications and delivered at home, women with intrapartum complications who delivered at home had a substantially higher risk of perinatal mortality (OR = 3.45; 95% CI = 3.04-3.91). Compared to women with intrapartum complications who

Perinatal care in British Columbia: Diagnosis and management of hemolytic disease of the newborn

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Hardyment, A. F.; Manning, R. Elizabeth; Kinnis, Claire

1974-01-01

We undertook to measure standards of perinatal care in British Columbia by studying the management of hemolytic disease of the newborn as the sample situation. Our data show that many isoimmunized pregnant women are delivered in hospitals that have infrequent experience with this problem, and by physicians who have little experience with this disease. The physician referral pattern, in regard to maternal isoimmunization, indicated that the more severely affected patients were managed by specialists, particularly those attached to teaching hospitals. However, 25% of the infants treated by exchange transfusion were managed by nonspecialists in nonteaching hospitals. Hospital record search, used as a method of medical audit and as a source of data for comparison with physician reports, did not result in dependable or complete information. Rates of disagreement between items from two data sources, physician report and hospital record, were frequently very high. Our experience suggests that comparison of these two data sources is not an ideal method of assessment of quality of care. A smaller caseload of isoimmunized pregnant women will result from the present prevention program. Nevertheless, cases will continue to occur. Our work supports the conclusion that a program of continuing education covering the diagnosis and management of hemolytic disease of the newborn is still necessary. PMID:4213290

Medical Care Expenditures for Individuals with Prediabetes: The Potential Cost Savings in Reducing the Risk of Developing Diabetes.

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Khan, Tamkeen; Tsipas, Stavros; Wozniak, Gregory

2017-10-01

The United States has 86 million adults with prediabetes. Individuals with prediabetes can prevent or delay the development of type 2 diabetes through lifestyle modifications such as participation in the National Diabetes Prevention Program (DPP), thereby mitigating the medical and economic burdens associated with diabetes. A cohort analysis of a commercially insured population was conducted using individual-level claims data from Truven Health MarketScan ® Lab Database to identify adults with prediabetes, track whether they develop diabetes, and compare medical expenditures for those who are newly diagnosed with diabetes to those who are not. This study then illustrates how reducing the risk of developing diabetes by participation in an evidence-based lifestyle change program could yield both positive net savings on medical care expenditures and return on investment (ROI). Annual expenditures are found to be nearly one third higher for those who develop diabetes in subsequent years relative to those who do not transition from prediabetes to diabetes, with an average difference of $2671 per year. At that cost differential, the 3-year ROI for a National DPP is estimated to be as high as 42%. The results show the importance and economic benefits of participation in lifestyle intervention programs to prevent or delay the onset of type 2 diabetes.

PUBLIC EXPENDITURE ON HEALTH IN LOCAL BUDGETS

Directory of Open Access Journals (Sweden)

Cristinel ICHIM

2017-06-01

Full Text Available This paper entitled "Public expenditure on health in local budgets" aims analysing and deepening major spending categories that public authorities finance at local level, namely health expenditure. In the first part of the article we have specified the content and role of this category of expenditure in local budgets and also made some feedback on decentralization in health. In the second part of the work, based on data available in Statistical Yearbook of Romania, we have carried out an analysis of the dynamics of health spending from local budgets to emphasize their place and role in the health care expenses. The research carried out follows that the evolution and structure of health expenditure financed from local budgets is determined, along with the legislative framework in the field, by several variables that differ from one territorial administrative unit to another: the existence of sanitary units, their type, the involving of local public authorities in their development and modernization, the number and the social structure of the population. The research shows that over the period 1993-2015, the dynamics of the share of health spending in total expenditures of local budgets is sinusoidal, with a minimum threshold in 2000 of only 0.3%.

Multiple Sclerosis and Catastrophic Health Expenditure in Iran.

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Juyani, Yaser; Hamedi, Dorsa; Hosseini Jebeli, Seyede Sedighe; Qasham, Maryam

2016-09-01

There are many disabling medical conditions which can result in catastrophic health expenditure. Multiple Sclerosis is one of the most costly medical conditions through the world which encounter families to the catastrophic health expenditures. This study aims to investigate on what extent Multiple sclerosis patients face catastrophic costs. This study was carried out in Ahvaz, Iran (2014). The study population included households that at least one of their members suffers from MS. To analyze data, Logit regression model was employed by using the default software STATA12. 3.37% of families were encountered with catastrophic costs. Important variables including brand of drug, housing, income and health insurance were significantly correlated with catastrophic expenditure. This study suggests that although a small proportion of MS patients met the catastrophic health expenditure, mechanisms that pool risk and cost (e.g. health insurance) are required to protect them and improve financial and access equity in health care.

Domestic Violence Enhanced Perinatal Home Visits: The DOVE Randomized Clinical Trial.

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Sharps, Phyllis W; Bullock, Linda F; Campbell, Jacquelyn C; Alhusen, Jeanne L; Ghazarian, Sharon R; Bhandari, Shreya S; Schminkey, Donna L

2016-11-01

Perinatal intimate partner violence (IPV) is common and has significant negative health outcomes for mothers and infants. This study evaluated the effectiveness of an IPV intervention in reducing violence among abused women in perinatal home visiting programs. This assessor-blinded multisite randomized control trial of 239 women experiencing perinatal IPV was conducted from 2006 to 2012 in U.S. urban and rural settings. The Domestic Violence Enhanced Home Visitation Program (DOVE) intervention group (n = 124) received a structured abuse assessment and six home visitor-delivered empowerment sessions integrated into home visits. All participants were screened for IPV and referred appropriately. IPV was measured by the Conflicts Tactics Scale2 at baseline through 24 months postpartum. There was a significant decrease in IPV over time (F = 114.23; p < 0.001) from baseline to 1, 3, 6, 12, 18, and 24 months postpartum (all p < 0.001). Additional models examining change in IPV from baseline indicated a significant treatment effect (F = 6.45; p < 0.01). Women in the DOVE treatment group reported a larger mean decrease in IPV scores from baseline compared to women in the usual care group (mean decline 40.82 vs. 35.87). All models accounted for age and maternal depression as covariates. The DOVE intervention was effective in decreasing IPV and is brief, thereby facilitating its incorporation within well-woman and well-child care visits, as well as home visiting programs, while satisfying recommendations set forth in the Affordable Care Act for IPV screening and brief counseling.

The Change of Perinatal Mortality Over Three Decades in a Reference Centre in the Aegean Region: Neonatal Mortality has decreased but Foetal Mortality Remains Unchanged

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Nilgün Kültürsay

2017-12-01

Full Text Available Background: Perinatal, foetal and neonatal mortality statistics are important to show the development of a health care system in a country. However, in our country there are very few national and regional data about the changing pattern of perinatal neonatal mortality along with the development of new technologies in this area. Aims: Evaluation of the changes in mortality rates and the causes of perinatal and neonatal deaths within years in a perinatal reference centre which serves a high-risk population. Study Design: Cross-sectional retrospective study. Methods: The perinatal, neonatal and foetal mortality rates in the years 1979-1980 (1st time point and 1988-1989 (2nd time point were compared with the year 2008 (3rd time point. The causes of mortality were assessed by Wigglesworth classification and death reports. The neonatal mortality in the neonatal intensive care unit was also calculated. Results: Foetal mortality rates were 44/1000, 31.4/1000 and 41.75/1000 births, perinatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 births, and neonatal mortality rates were 35.6/1000, 18.8/1000 and 9/1000 live births for the three study time points, respectively. The mortality rate in neonatal intensive care unit decreased consistently from 33%, to 22.6% and 10%, respectively, together with decreasing neonatal mortality rates. The causes of perinatal deaths were foetal death 85%, immaturity 4%, and lethal congenital malformations 8% according to Wigglesworth classification in 2008, showing the high impact of foetal deaths on this high perinatal mortality rate. Infectious causes of neonatal deaths decreased but congenital anomalies increased in the last decades. Conclusion: Although neonatal mortality rate decreased significantly; foetal mortality rate has stayed unchanged since the late eighties. In order to decrease foetal and perinatal mortality rates more efficiently, reducing consanguineous marriages and providing better antenatal care for

The influence of the war on perinatal and maternal mortality in Bosnia and Herzegovina.

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Fatusić, Z; Kurjak, A; Grgić, G; Tulumović, A

2005-10-01

To investigate the influence of the war on perinatal and maternal mortality during the war conflict in Bosnia and Herzegovina. In a retrospective study we analysed perinatal and maternal mortality in the pre-war period (1988-1991), the war period (1992-1995) and the post-war period (1996-2003). We also analysed the number of deliveries, the perinatal and maternal mortality rates and their causes. During the analysed period we had a range of 3337-6912 deliveries per year, with a decreased number in the war period. During the war period and immediately after the war, the perinatal mortality rate increased to 20.9-26.3% (average 24.28%). After the war the rate decreased to 8.01% in 2003 (p war was 39/100,000 deliveries, during the war it increased to 65/100,000 and after the war it decreased to 12/100,000 deliveries (p war was because of an increased number of uterine ruptures, sepsis and bleeding due to shell injury of pregnant women. During the war we could expect a decreased number of deliveries, and an increased rate of perinatal and maternal mortality and preterm deliveries due to: inadequate nutrition, stress factors (life in refugee's centers, bombing, deaths of relatives, uncertain future...), and break down of the perinatal care system (lack of medical staff, impossibility of collecting valid health records, particularly perinatal information, and the destruction of medical buildings).

Michigan Health & Hospital Association Keystone Obstetrics: a statewide collaborative for perinatal patient safety in Michigan.

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Simpson, Kathleen Rice; Knox, G Eric; Martin, Morgan; George, Chris; Watson, Sam R

2011-12-01

Preventable harm to mothers and infants during labor and birth is a significant patient safety and professional liability issue. A Michigan Health & Hospital Association Keystone Center for Patient Safety & Quality Obstetric Collaborative Project involved perinatal teams from 15 Michigan hospitals during an 11-month period in 2009. The purpose of the project was to promote safe care practices during labor and birth using the Comprehensive Unit-based Safety Program (CUSP). Consistent with the CUSP model, this project's components included assessing and promoting a culture of safety; interdisciplinary team building; case review; learning from defects through multiple methods of education; team and individual coaching and peer encouragement; administrative support for the establishment of a fundamental safety infrastructure; and ongoing evaluation of care processes and outcomes. Study measures included 32 components of a perinatal patient infrastructure, 6 care processes during labor and birth, and 4 neonatal outcomes. Significant improvements were found in the safety culture (Safety Attitudes Questionnaire), the perinatal patient safety infrastructure components, and all care processes. Although the project was successful, getting buy-in from all members of the clinical team in each hospital for all of the measures was challenging at times. There was initial resistance to some of the measures and their various expected aspects of care. For example, some of the clinicians were initially reluctant to adopt the recommended standardized oxytocin protocol. Peer encouragement and unit-based feedback on progress in minimizing early elective births proved useful in many hospitals. A CUSP in obstetrics can be beneficial in improving the care of mothers and infants during labor and birth.

Private dental insurance expenditure in Brazil

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Cascaes, Andreia Morales; de Camargo, Maria Beatriz Junqueira; de Castilhos, Eduardo Dickie; Silva, lexandre Emídio Ribeiro; Barros, Aluísio J D

2018-01-01

ABSTRACT OBJECTIVE To quantify the household expenditure per capita and to estimate the percentage of Brazilian households that have spent with dental insurance. METHODS We analyzed data from 55,970 households that participated in the research Pesquisa de Orçamentos Familiares in 2008–2009. We have analyzed the annual household expenditure per capita with dental insurance (business and private) according to the Brazilian states and the socioeconomic and demographic characteristics of the households (sex, age, race, and educational level of the head of the household, family income, and presence of an older adult in the household). RESULTS Only 2.5% of Brazilian households have reported spending on dental insurance. The amount spent per capita amounted to R$5.10 on average, most of which consisted of private dental insurance (R$4.70). Among the characteristics of the household, higher educational level and income were associated with higher spending. São Paulo was the state with the highest household expenditure per capita (R$10.90) and with the highest prevalence of households with expenditures (4.6%), while Amazonas and Tocantins had the lowest values, in which both spent less than R$1.00 and had a prevalence of less than 0.1% of households, respectively. CONCLUSIONS Only a small portion of the Brazilian households has dental insurance expenditure. The market for supplementary dentistry in oral health care covers a restricted portion of the Brazilian population. PMID:29489995

Oral healthcare-related expenditure among people residing in Durg, Chhattisgarh: A household survey

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Swati Verma

2018-01-01

Full Text Available Background: Oral health is a functional unit of general health. Dental caries and periodontal diseases are considered as the major diseases prevailing in the modern era. Over decades, the perception toward maintaining oral health and interest for preventive oral health measures has decreased, thus increasing the healthcare expenditure. Aim: This study aims to estimate the household expenditure on oral health care among people residing in Durg, Chhattisgarh, India. Materials and Methods: Eight hundred and sixty participants were surveyed who were residents of Durg, Chhattisgarh (C.G.. Participants were selected through multistage cluster random sampling. A self-designed pretested and validated 20 item questionnaire was used to assess the expenditure on oral health care. Data collected were analyzed using IBM SPSS software version 23 for Windows (New York, USA. Frequency, mean and percentage, and Pearson's correlation coefficient tests were used to analyze the data. Results: Out of 860 individuals, 204 (23.7% were males and 656 (76.3% were females. Eight hundred and thirty-two (96.7% individuals reported using a toothbrush as an oral hygiene aid. Majority (58.3% of the families reported changing toothbrush at 3 months or more duration, while 37.8% of the families in 1 month or less. A statistically significant weak correlation was observed when education, occupation, and income were compared with annual expenditure on dental care (r = 0.219, 0.239, and 0.350, respectively. While a moderately strong correlation was observed between the socioeconomic status of families and annual expenditure on dental care (r = 0.438. Conclusion: People should be aware of preventive oral hygiene aids, and appropriate policies should be formulated which will ultimately result in decreased expenditure on a curative aspect of the dental disease.

Wealth, Health Expenditure, and Cancer: A National Perspective.

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Chahoud, Jad; Semaan, Adele; Rieber, Alyssa

2016-08-01

The US health care system is characterized by high health expenditures with penultimate outcomes. This ecological study evaluates the associations between wealth, health expenditure, and cancer outcomes at the state level. We extracted gross domestic product (GDP) and health expenditure per capita from the 2009 Bureau of Economic Analysis and the Centers for Medicare & Medicaid Services, respectively. Using data from the NCI, we retrieved colorectal cancer (CRC), breast cancer, and all-cancer age-adjusted rates and computed mortality/incidence (M/I) ratios. We used the Spearman's rank correlation to determine the association between the financial indicators and cancer outcomes, and we constructed geographic distribution maps to describe these associations. GDP per capita significantly correlated with lower M/I ratios for all cancers, breast cancer, and CRC. As for health expenditure per capita, preliminary analysis highlighted a rift between the Northeastern and Southern states, which translated into worse breast and all-cancer outcomes in Southern states. Further analysis showed that higher health expenditure significantly correlated with decreased breast cancer M/I ratio. However, CRC outcomes were not significantly affected by health expenditure, nor were all-cancer outcomes. All cancers, breast cancer, and CRC outcomes significantly correlated with wealth, whereas only breast cancer correlated with higher health expenditure. Future research is needed to evaluate the potential role of policies in optimizing resource allocation in the states' efforts against CRC and minimizing disparities in interstate cancer outcomes. Copyright © 2016 by the National Comprehensive Cancer Network.

New Fathers' Perinatal Depression and Anxiety-Treatment Options: An Integrative Review.

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O'Brien, Anthony P; McNeil, Karen A; Fletcher, Richard; Conrad, Agatha; Wilson, Amanda J; Jones, Donovan; Chan, Sally W

2017-07-01

More than 10% of fathers experience depression and anxiety during the perinatal period, but paternal perinatal depression (PPND) and anxiety have received less attention than maternal perinatal mental health problems. Few mainstream treatment options are available for men with PPND and anxiety. The aim of this literature review was to summarize the current understanding of PPND and the treatment programs specifically designed for fathers with perinatal depression. Eight electronic databases were searched using a predefined strategy, and reference lists were also hand searched. PPND and anxiety were identified to have a negative impact on family relationships, as well as the health of mothers and children. Evidence suggests a lack of support and tailored treatment options for men having trouble adjusting to the transition to fatherhood. Of the limited options available, cognitive behavioral therapy, group work, and blended delivery programs, including e-support approaches appear to be most effective in helping fathers with perinatal depression and anxiety. The review findings have important implications for the understanding of PPND and anxiety. Future research is needed to address the adoption of father-inclusive and father-specific models of care to encourage fathers' help-seeking behavior. Inclusion of male-specific requirements into support and treatment options can improve the ability of services to engage new fathers. Psychotherapeutic intervention could assist to address the cognitive differences and dissonance for men adjusting to the role of father, including male identity and role expectations.

Out-of-pocket expenditure on chronic non-communicable diseases in sub-Saharan Africa: the case of rural Malawi.

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Qun Wang

Full Text Available In Sub-Saharan Africa (SSA the disease burden of chronic non-communicable diseases (CNCDs is rising considerably. Given weaknesses in existing financial arrangements across SSA, expenditure on CNCDs is often borne directly by patients through out-of-pocket (OOP payments. This study explored patterns and determinants of OOP expenditure on CNCDs in Malawi. We used data from the first round of a longitudinal household health survey conducted in 2012 on a sample of 1199 households in three rural districts in Malawi. We used a two-part model to analyze determinants of OOP expenditure on CNCDs. 475 respondents reported at least one CNCD. More than 60% of the 298 individuals who reported seeking care incurred OOP expenditure. The amount of OOP expenditure on CNCDs comprised 22% of their monthly per capita household expenditure. The poorer the household, the higher proportion of their monthly per capita household expenditure was spent on CNCDs. Higher severity of disease was significantly associated with an increased likelihood of incurring OOP expenditure. Use of formal care was negatively associated with the possibility of incurring OOP expenditure. The following factors were positively associated with the amount of OOP expenditure: being female, Alomwe and household head, longer duration of disease, CNCDs targeted through active screening programs, higher socio-economic status, household head being literate, using formal care, and fewer household members living with a CNCD within a household. Our study showed that, in spite of a context where care for CNCDs should in principle be available free of charge at point of use, OOP payments impose a considerable financial burden on rural households, especially among the poorest. This suggests the existence of important gaps in financial protection in the current coverage policy.

Out-of-pocket expenditure on chronic non-communicable diseases in sub-Saharan Africa: the case of rural Malawi.

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Wang, Qun; Fu, Alex Z; Brenner, Stephan; Kalmus, Olivier; Banda, Hastings Thomas; De Allegri, Manuela

2015-01-01

In Sub-Saharan Africa (SSA) the disease burden of chronic non-communicable diseases (CNCDs) is rising considerably. Given weaknesses in existing financial arrangements across SSA, expenditure on CNCDs is often borne directly by patients through out-of-pocket (OOP) payments. This study explored patterns and determinants of OOP expenditure on CNCDs in Malawi. We used data from the first round of a longitudinal household health survey conducted in 2012 on a sample of 1199 households in three rural districts in Malawi. We used a two-part model to analyze determinants of OOP expenditure on CNCDs. 475 respondents reported at least one CNCD. More than 60% of the 298 individuals who reported seeking care incurred OOP expenditure. The amount of OOP expenditure on CNCDs comprised 22% of their monthly per capita household expenditure. The poorer the household, the higher proportion of their monthly per capita household expenditure was spent on CNCDs. Higher severity of disease was significantly associated with an increased likelihood of incurring OOP expenditure. Use of formal care was negatively associated with the possibility of incurring OOP expenditure. The following factors were positively associated with the amount of OOP expenditure: being female, Alomwe and household head, longer duration of disease, CNCDs targeted through active screening programs, higher socio-economic status, household head being literate, using formal care, and fewer household members living with a CNCD within a household. Our study showed that, in spite of a context where care for CNCDs should in principle be available free of charge at point of use, OOP payments impose a considerable financial burden on rural households, especially among the poorest. This suggests the existence of important gaps in financial protection in the current coverage policy.

Causes of death and associated conditions (Codac) - a utilitarian approach to the classification of perinatal deaths

NARCIS (Netherlands)

Froen, J. Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W.; Facchinetti, Fabio; Fretts, Ruth C.; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J.; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C.; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon C. S.; Torabi, Rozbeh

2009-01-01

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose

Perinatal tuberculosis: a diagnostic challenge

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Edna Lúcia S. de Souza

Full Text Available Despite the high prevalence of tuberculosis in adults and children, the congenital and perinatal forms of tuberculosis are rare. In Brazil, there has been only one published case of congenital tuberculosis and two cases of the perinatal form of this disease. We report a case of perinatal tuberculosis presenting with pneumonia. Alcohol-acid-resistant bacilli were found in the gastric lavage. Diagnosis of this disease presentation requires a high index of suspicion.

PARENTS 2 study protocol: pilot of Parents' Active Role and ENgagement in the review of Their Stillbirth/perinatal death.

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Bakhbakhi, Danya; Siassakos, Dimitrios; Storey, Claire; Heazell, Alexander; Lynch, Mary; Timlin, Laura; Burden, Christy

2018-01-10

The perinatal mortality review meeting that takes place within the hospital following a stillbirth or neonatal death enables clinicians to learn vital lessons to improve care for women and their families for the future. Recent evidence suggests that parents are unaware that a formal review following the death of their baby takes place. Many would welcome the opportunity to feedback into the meeting itself. Parental involvement in the perinatal mortality review meeting has the potential to improve patient satisfaction, drive improvements in patient safety and promote an open culture within healthcare. Yet evidence on the feasibility of involving bereaved parents in the review process is lacking. This paper describes the protocol for the Parents' Active Role and Engangement iN the review of their Stillbirth/perinatal death study (PARENTS 2) , whereby healthcare professionals' and stakeholders' perceptions of parental involvement will be investigated, and parental involvement in the perinatal mortality review will be piloted and evaluated at two hospitals. We will investigate perceptions of parental involvement in the perinatal mortality review process by conducting four focus groups. A three-round modified Delphi technique will be employed to gain a consensus on principles of parental involvement in the perinatal mortality review process. We will use three sequential rounds, including a national consensus meeting workshop with experts in stillbirth, neonatal death and bereavement care, and a two-stage anonymous online questionnaire. We will pilot a new perinatal mortality review process with parental involvement over a 6-month study period. The impact of the new process will be evaluated by assessing parents' experiences of their care and parents' and staff perceptions of their involvement in the process by conducting further focus groups and using a Parent Generated Index questionnaire. This study has ethical approval from the UK Health Research Authority. We will

High-Expenditure Pharmaceutical Use Among Children in Medicaid.

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Cohen, Eyal; Hall, Matt; Lopert, Ruth; Bruen, Brian; Chamberlain, Lisa J; Bardach, Naomi; Gedney, Jennifer; Zima, Bonnie T; Berry, Jay G

2017-09-01

Medication use may be a target for quality improvement, cost containment, and research. We aimed to identify medication classes associated with the highest expenditures among pediatric Medicaid enrollees and to characterize the demographic, clinical, and health service use of children prescribed these medications. Retrospective, cross-sectional study of 3 271 081 Medicaid-enrolled children. Outpatient medication spending among high-expenditure medication classes, defined as the 10 most expensive among 261 mutually exclusive medication classes, was determined by using transaction prices paid to pharmacies by Medicaid agencies and managed care plans among prescriptions filled and dispensed in 2013. Outpatient medications accounted for 16.6% of all Medicaid expenditures. The 10 most expensive medication classes accounted for 63.9% of all medication expenditures. Stimulants (amphetamine-type) accounted for both the highest proportion of expenditures (20.6%) and days of medication use (14.0%) among medication classes. Users of medications in the 10 highest-expenditure classes were more likely to have a chronic condition of any complexity (77.9% vs 41.6%), a mental health condition (35.7% vs 11.9%), or a complex chronic condition (9.8% vs 4.3%) than other Medicaid enrollees (all P costs may benefit from better delineation of the appropriate prescription of these medications. Copyright © 2017 by the American Academy of Pediatrics.

Maternal and perinatal outcomes of dengue in PortSudan, Eastern Sudan

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Elbashir Hagir M

2010-07-01

Full Text Available Abstract Aim To investigate maternal and perinatal outcomes (maternal death, preterm delivery, low birth weight and perinatal mortality of dengue at PortSudan and Elmawani hospitals in the eastern Sudan. Method This was a retrospective Cohort study where medical files of women with dengue were reviewed. Results There were 10820 deliveries and 78 (0.7% pregnant women with confirmed dengue IgM serology at the mean (SD gestational age of 29.4(8.2 weeks. While the majority of these women had dengue fever (46, 58.9%, hemorrhagic fever and dengue shock syndrome were the presentations in 18 (23.0% and 12, (15.3% of these women, respectively. There were 17(21.7% maternal deaths. Fourteen (17.9% of these 78 women had preterm deliveries and 19 (24.3% neonates were admitted to neonatal intensive care unit. Nineteen (24.3% women gave birth to low birth weight babies. There were seven (8.9% perinatal deaths. Eight (10.2% patients delivered by caesarean section due to various obstetrical indications. Conclusion Thus dengue has poor maternal and perinatal outcomes in this setting. Preventive measures against dengue should be employed in the region, and more research on dengue during pregnancy is needed.

Mobile phone intervention reduces perinatal mortality in zanzibar: secondary outcomes of a cluster randomized controlled trial.

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Lund, Stine; Rasch, Vibeke; Hemed, Maryam; Boas, Ida Marie; Said, Azzah; Said, Khadija; Makundu, Mkoko Hassan; Nielsen, Birgitte Bruun

2014-03-26

Mobile phones are increasingly used in health systems in developing countries and innovative technical solutions have great potential to overcome barriers of access to reproductive and child health care. However, despite widespread support for the use of mobile health technologies, evidence for its role in health care is sparse. We aimed to evaluate the association between a mobile phone intervention and perinatal mortality in a resource-limited setting. This study was a pragmatic, cluster-randomized, controlled trial with primary health care facilities in Zanzibar as the unit of randomization. At their first antenatal care visit, 2550 pregnant women (1311 interventions and 1239 controls) who attended antenatal care at selected primary health care facilities were included in this study and followed until 42 days after delivery. Twenty-four primary health care facilities in six districts were randomized to either mobile phone intervention or standard care. The intervention consisted of a mobile phone text message and voucher component. Secondary outcome measures included stillbirth, perinatal mortality, and death of a child within 42 days after birth as a proxy of neonatal mortality. Within the first 42 days of life, 2482 children were born alive, 54 were stillborn, and 36 died. The overall perinatal mortality rate in the study was 27 per 1000 total births. The rate was lower in the intervention clusters, 19 per 1000 births, than in the control clusters, 36 per 1000 births. The intervention was associated with a significant reduction in perinatal mortality with an odds ratio (OR) of 0.50 (95% CI 0.27-0.93). Other secondary outcomes showed an insignificant reduction in stillbirth (OR 0.65, 95% CI 0.34-1.24) and an insignificant reduction in death within the first 42 days of life (OR 0.79, 95% CI 0.36-1.74). Mobile phone applications may contribute to improved health of the newborn and should be considered by policy makers in resource-limited settings. Clinical

Dusukasi-The Heart That Cries: An Idiom of Mental Distress Among Perinatal Women in Rural Mali.

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Lasater, Molly E; Beebe, Madeleine; Warren, Nicole E; Souko, Fatoumata; Keita, Mariam; Murray, Sarah E; Bass, Judith K; Surkan, Pamela J; Winch, Peter J

2018-04-25

Perinatal mental health problems such as depression and anxiety are prevalent in low and middle-income countries. In Mali, the lack of mental health care is compounded by few studies on mental health needs, including in the perinatal period. This paper examines the ways in which perinatal women experience and express mental distress in rural Mali. We describe a process, relying on several different qualitative research methods, to identify understandings of mental distress specific to the Malian context. Participants included perinatal women, maternal health providers, and community health workers in rural southwest Mali. Participants articulated several idioms of distress, including gèlèya (difficulties), tôôrô (pain, suffering), hamin (worries, concerns), and dusukasi (crying heart), that occur within a context of poverty, interpersonal conflict, and gender inequality. These idioms of distress were described as sharing many key features and operating on a continuum of severity that could progress over time, both within and across idioms. Our findings highlight the context dependent nature of experiences and expressions of distress among perinatal women in Mali.

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach.

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Agarwal, Parul; Sambamoorthi, Usha

2015-12-01

Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.

An European concerted action investigating the validity of perinatal mortality as an outcome indicator for the quality of antenatal and perinatal care

NARCIS (Netherlands)

Richardus, J.H.; Graafmans, W.C.; Pal-de Bruin, K.M. van der; Amelink-Verburg, M.P.; Verloove-Vanhorick, S.P.; Mackenbach, J.P.

1997-01-01

In this paper the concepts, objectives, design, and data analysis procedures of the EuroNatal study are described. This sutdy started in 1996 and is a concerted action including 14 countries in Europe. The EuroNatal study aims at determining the validity of national perinatal mortality rates as an

Causes of death and associated conditions (Codac): a utilitarian approach to the classification of perinatal deaths.

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Frøen, J Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W; Facchinetti, Fabio; Fretts, Ruth C; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon C S; Torabi, Rozbeh

2009-06-10

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes.We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions.The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal).For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured.The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the most

Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: a cluster-randomised effectiveness trial.

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Bhutta, Zulfiqar A; Soofi, Sajid; Cousens, Simon; Mohammad, Shah; Memon, Zahid A; Ali, Imran; Feroze, Asher; Raza, Farrukh; Khan, Amanullah; Wall, Steve; Martines, Jose

2011-01-29

Newborn deaths account for 57% of deaths in children younger than 5 years in Pakistan. Although a large programme of trained lady health workers (LHWs) exists, the effectiveness of this training on newborn outcomes has not been studied. We aimed to evaluate the effectiveness of a community-based intervention package, principally delivered through LHWs working with traditional birth attendants and community health committees, for reduction of perinatal and neonatal mortality in a rural district of Pakistan. We undertook a cluster randomised trial between February, 2006, and March, 2008, in Hala and Matiari subdistricts, Pakistan. Catchment areas of primary care facilities and all affiliated LHWs were used to define clusters, which were allocated to intervention and control groups by restricted, stratified randomisation. The intervention package delivered by LHWs through group sessions consisted of promotion of antenatal care and maternal health education, use of clean delivery kits, facility births, immediate newborn care, identification of danger signs, and promotion of careseeking; control clusters received routine care. Independent data collectors undertook quarterly household surveillance to capture data for births, deaths, and household practices related to maternal and newborn care. Data collectors were masked to cluster allocation; those analysing data were not. The primary outcome was perinatal and all-cause neonatal mortality. Analysis was by intention to treat. This trial is registered, ISRCTN16247511. 16 clusters were assigned to intervention (23,353 households, 12,391 total births) and control groups (23,768 households, 11,443 total births). LHWs in the intervention clusters were able to undertake 4428 (63%) of 7084 planned group sessions, but were only able to visit 2943 neonates (24%) of a total 12,028 livebirths in their catchment villages. Stillbirths were reduced in intervention clusters (39·1 stillbirths per 1000 total births) compared with

Exploring perinatal shift-to-shift handover communication and process: an observational study.

NARCIS (Netherlands)

Poot, E.P.; Bruijne, M.C. de; Wouters, M.G.A.J.; Groot, C.J.M. de; Wagner, C.

2014-01-01

Rationale, aims and objectives: Loss of situation awareness (SA) by health professionals during handover is a major threat to patient safety in perinatal care. SA refers to knowing what is going on around. Adequate handover communication and process may support situation assessment, a precursor of

Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals.

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Geurtzen, R; Van Heijst, Arno; Hermens, Rosella; Scheepers, Hubertina; Woiski, Mallory; Draaisma, Jos; Hogeveen, Marije

2018-01-03

Since 2010, intensive care can be offered in the Netherlands at 24 +0  weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care. Online nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice. One hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals. Dutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents' opinions are needed in order to develop a national framework. Clinicaltrials.gov, NCT02782650 , retrospectively registered May 2016.

[Perinatal health and medical administrative data: What uses, which stakeholders, what the issues for birth data? - Special REDSIAM].

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Serfaty, A; Baron, S; Crenn-Hebert, C; Barry, Y; Tala, S

2017-10-01

The uses of medical administrative data (MAD/BDMA) emerged in perinatal health following the work on regionalization of very pre-term birth. They have become more numerous since the late 2000s. The objective of this article is to take stock of the existing work carried out within the REDSIAM-perinatality group, on MAD/BDMA and their uses for the period of "birth". The studied MADs are the Hospital Discharge Data (PMSI) and the French national health database (SNIIRAM). The material includes knowledge shared by the members of the REDSIAM-perinatality group, scientific references and gray literature. Our exploratory study shows that the uses of MAD in perinatal health are diversified at the local, regional and national levels. The works and publications, increasing, take the form of public access of processed data. Collective thinking makes it possible to move from a localized use to an institution, a network or several, to a national use and an inscription in public authorities' responses. In 2015/2016, two institutional sites provide access to data on maternal and child health: Data.Drees and ATIH ScanSanté. MAD/BDMA uses are multiple: epidemiological use (count of births by gestational age, weight in particular; perinatal indicators), quality of care, planning (maternity activities, regionalization of care). There is an increasing interest among stakeholders, producers and/or operators of MAD/BDMA (decision-makers, professionals or researchers). The BDMA, including the PMSI and the SNIIRAM, are used and relevant in Perinatal health with the rise of health networks, the territorialisation of health, in an increased demand for quality of care. Their use will increase the reliability of the data collected and an inscription in the validation studies, more and more numerous in the field of BDMA. The algorithms need to be more finely compiled, validated and enhanced. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Factors associated with perinatal mortality among public health deliveries in Addis Ababa, Ethiopia, an unmatched case control study.

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Getiye, Yemisrach; Fantahun, Mesganaw

2017-07-26

perinatal mortality is the sum of still birth (fetal death) and early neonatal death (ENND) i.e. death of live newborn before the age of 7 completed days. Perinatal mortality accounts three fourth of the deaths of the neonatal period and is one of the major challenges for under-five mortality. Therefore this study was conducted to better understand the common and avoidable factors that affect perinatal mortality in Addis Ababa, Ethiopia. An unmatched case control study design using secondary data as a source of information was conducted. Cases were still births or early neonatal deaths and controls were live births and neonates who were discharged alive from the hospital and did not die before the age of 7 days. The study period was from 1st January up to 30th February 2015. Epi-Info version 7.0 and SPSS Version 21 were used for data entry and analysis. Descriptive statistics, frequencies, proportions and diagrams were used to check the distribution of outcome variable and describe the study population. Logistic regression model was used to identify the important factors that are associated with perinatal mortality. A total of 1113(376 cases and 737 controls) maternal charts were reviewed. The mean age of the mothers for cases and controls were 26.47 ± 4.87 and 26.95 ± 4.68 respectively. Five hundred ninety seven (53.6%) mothers delivered for the first time. Factors that are significantly associated with increased risk of perinatal mortality were birth interval less than 2 years, preterm delivery, anemia, congenital anomaly, previous history of early neonatal death and low birth weight. Use of partograph was also associated with decreased risk of perinatal mortality. From factors that are associated with perinatal mortality, some of them can be prevented with early investigation of pregnant mothers on their antenatal care follow. Appropriate labor follow-up and monitoring with regular use of partograph, immediate newborn care and interventions to delay

[Maternal hemoglobin in Peru: regional differences and its association with adverse perinatal outcomes].

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Gonzales, Gustavo F; Tapia, Vilma; Gasco, Manuel; Carrillo, Carlos

2011-01-01

To evaluate hemoglobin (Hb) levels in pregnant women from different geographical regions from Peru; to establish anemia and erythrocytocis rates and to establish the role of Hb on adverse perinatal outcomes using the Perinatal Information System (PIS) database of Peruvian Ministry of Health. Data were obtained from 379,816 births of 43 maternity care units between 2000 and 2010. Anemia and erythrocytocis rates were determined in each geographical region as well as rates of adverse perinatal outcomes. To analyze data the STATA program (versión 10.0,Texas, USA) was used. The results were considered significant at panemia rate was higher in the coast (25.8%) and low forest (26.2%). Moderate/severe anemia rate in low forest was 2.6% and at the coast was 1.0%. In the highland, the highest rate of moderate/severe anemia was in the southern highlands (0.6%). The highest rate of erythrocytocis was found in the central highland (23.7%), 11.9% in the southern highland and 9.5% in the north highland. Severe anemia and erythrocytocis were associated with adverse perinatal outcomes. There are differences by Peruvian geographical region in anemia rates. In the central highlands were found the highest rates of erythrocytocis due to hypoxia effect in the high altitudes; however in the southern highlands, erythrocytocis was lower. Severe anemia and erythrocytosis were associated with increased adverse perinatal outcomes.

Total HIV/AIDS expenditures in Dehong Prefecture, Yunnan province in 2010: the first systematic evaluation of both health and non-health related HIV/AIDS expenditures in China.

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Shan, Duo; Sun, Jiangping; Yakusik, Anna; Chen, Zhongdan; Yuan, Jianhua; Li, Tao; Fu, Jeannia; Khoshnood, Kaveh; Yang, Xing; Wei, Mei; Duan, Song; Bulterys, Marc; Sante, Michael; Ye, Runhua; Xiang, Lifen; Yang, Yuecheng

2013-01-01

We assessed HIV/AIDS expenditures in Dehong Prefecture, Yunnan Province, one of the highest prevalence regions in China, and describe funding sources and spending for different categories of HIV-related interventions and at-risk populations. 2010 HIV/AIDS expenditures in Dehong Prefecture were evaluated based on UNAIDS' National AIDS Spending Assessment methodology. Nearly 93% of total expenditures for HIV/AIDS was contributed by public sources. Of total expenditures, 52.7% was allocated to treatment and care, 24.5% to program management and administration and 19.8% to prevention. Spending on treatment and care was primarily allocated to the treatment of opportunistic infections. Most (40.4%) prevention spending was concentrated on most-at-risk populations, injection drug users (IDUs), sex workers, and men who have sex with men (MSM), with 5.5% allocated to voluntary counseling and testing. Prevention funding allocated for MSM, partners of people living with HIV and prisoners and other confined populations was low compared to the disproportionate burden of HIV/AIDS in these populations. Overall, people living with HIV accounted for 57.57% of total expenditures, while most-at-risk populations accounted for only 7.99%. Our study demonstrated the applicability of NASA for tracking and assessing HIV expenditure in the context of China, it proved to be a useful tool in understanding national HIV/AIDS response from financial aspect, and to assess the extent to which HIV expenditure matches epidemic patterns. Limited funding for primary prevention and prevention for MSM, prisoners and partners of people living with HIV, signal that resource allocation to these key areas must be strengthened. Comprehensive analyses of regional and national funding strategies are needed to inform more equitable, effective and cost-effective HIV/AIDS resource allocation.

Total HIV/AIDS expenditures in Dehong Prefecture, Yunnan province in 2010: the first systematic evaluation of both health and non-health related HIV/AIDS expenditures in China.

Directory of Open Access Journals (Sweden)

Duo Shan

Full Text Available We assessed HIV/AIDS expenditures in Dehong Prefecture, Yunnan Province, one of the highest prevalence regions in China, and describe funding sources and spending for different categories of HIV-related interventions and at-risk populations.2010 HIV/AIDS expenditures in Dehong Prefecture were evaluated based on UNAIDS' National AIDS Spending Assessment methodology.Nearly 93% of total expenditures for HIV/AIDS was contributed by public sources. Of total expenditures, 52.7% was allocated to treatment and care, 24.5% to program management and administration and 19.8% to prevention. Spending on treatment and care was primarily allocated to the treatment of opportunistic infections. Most (40.4% prevention spending was concentrated on most-at-risk populations, injection drug users (IDUs, sex workers, and men who have sex with men (MSM, with 5.5% allocated to voluntary counseling and testing. Prevention funding allocated for MSM, partners of people living with HIV and prisoners and other confined populations was low compared to the disproportionate burden of HIV/AIDS in these populations. Overall, people living with HIV accounted for 57.57% of total expenditures, while most-at-risk populations accounted for only 7.99%.Our study demonstrated the applicability of NASA for tracking and assessing HIV expenditure in the context of China, it proved to be a useful tool in understanding national HIV/AIDS response from financial aspect, and to assess the extent to which HIV expenditure matches epidemic patterns. Limited funding for primary prevention and prevention for MSM, prisoners and partners of people living with HIV, signal that resource allocation to these key areas must be strengthened. Comprehensive analyses of regional and national funding strategies are needed to inform more equitable, effective and cost-effective HIV/AIDS resource allocation.

Cost and Predictors of Hospitalizations for Ambulatory Care - Sensitive Conditions Among Medicaid Enrollees in Comprehensive Managed Care Plans

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William N. Mkanta

2016-09-01

Full Text Available Introduction: Preventable hospitalizations are responsible for increasing the cost of health care and reflect ineffectiveness of the health services in the primary care setting. The objective of this study was to assess expenditure for hospitalizations and utilize expenditure differentials to determine factors associated with ambulatory care - sensitive conditions (ACSCs hospitalizations. Methods: A cross-sectional study of hospitalizations among Medicaid enrollees in comprehensive managed care plans in 2009 was conducted. A total of 25 581 patients were included in the analysis. Expenditures on hospitalizations were examined at the 50th, 75th, 90th, and 95th expenditure percentiles both at the bivariate level and in the logistic regression model to determine the impact of differing expenditure on ACSC hospitalizations. Results: Compared with patients without ACSC admissions, a larger proportion of patients with ACSC hospitalizations required advanced treatment or died on admission. Overall mean expenditures were higher for the ACSC group than for non-ACSC group (US$18 070 vs US$14 452. Whites and blacks had higher expenditures for ACSC hospitalization than Hispanics at all expenditure percentiles. Patient’s age remained a consistent predictor of ACSC hospitalization across all expenditure percentiles. Patients with ACSC were less likely to have a procedure on admission; however, the likelihood decreased as expenditure percentiles increased. At the median expenditure, blacks and Hispanics were more likely than other race/ethnic groups to have ACSC hospitalizations (odds ratio [OR]: 1.307, 95% confidence interval [CI]: 1.013-1.686 and OR 1.252, 95% CI: 1.060-1.479, respectively. Conclusion: Future review of delivery and monitoring of services at the primary care setting should include managed care plans in order to enhance access and overall quality of care for optimal utilization of the resources.

Tackling perinatal loss, a participatory action research approach: research protocol.

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Pastor-Montero, Sonia María; Romero-Sánchez, José Manuel; Paramio-Cuevas, Juan Carlos; Hueso-Montoro, César; Paloma-Castro, Olga; Lillo-Crespo, Manuel; Castro-Yuste, Cristina; Toledano-Losa, Ana Cristina; Carnicer-Fuentes, Concepción; Ortegón-Gallego, José Alejo; Frandsen, Anna J

2012-11-01

  The aim of this study was to promote changes to improve the care provided to parents who have experienced a perinatal loss through participatory action research.   The birth of a child is a joyful event for most families, however, unfortunately some pregnancies end in loss. Perinatal loss creates a heavy emotional impact not only on parents but also on health professionals, where in most cases there is an evident lack of skills, strategies and resources to cope with these kinds of situations.   Participatory action research is the methodology proposed to achieve the purpose of this study.   Participatory action research consists of five stages: outreach and awareness, induction, interaction, implementation and systematization. The working group will include professionals from the Mother and Child Unit for patients at a tertiary level public hospital in Spain. The duration of the study will be 3 years since the approval of the protocol in January 2011. The qualitative techniques used will include group dynamics such as the SWOT analysis the nominal group technique, focus groups and brainstorming, among others that will be recorded and transcribed, generating reports throughout the evolution of the group sessions and about the consensus reached. Content analysis will be conducted on the field diaries kept by the participants and researchers. This project has been funded by the Andalusian Regional Ministry of Health.   Participatory action research is a methodological strategy that allows changes in clinical practice to conduct a comprehensive transformative action in the care process for perinatal loss. © 2012 Blackwell Publishing Ltd.

Adjusting Health Expenditures for Inflation: A Review of Measures for Health Services Research in the United States.

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Dunn, Abe; Grosse, Scott D; Zuvekas, Samuel H

2018-02-01

To provide guidance on selecting the most appropriate price index for adjusting health expenditures or costs for inflation. Major price index series produced by federal statistical agencies. We compare the key characteristics of each index and develop suggestions on specific indexes to use in many common situations and general guidance in others. Price series and methodological documentation were downloaded from federal websites and supplemented with literature scans. The gross domestic product implicit price deflator or the overall Personal Consumption Expenditures (PCE) index is preferable to the Consumer Price Index (CPI-U) to adjust for general inflation, in most cases. The Personal Health Care (PHC) index or the PCE health-by-function index is generally preferred to adjust total medical expenditures for inflation. The CPI medical care index is preferred for the adjustment of consumer out-of-pocket expenditures for inflation. A new, experimental disease-specific Medical Care Expenditure Index is now available to adjust payments for disease treatment episodes. There is no single gold standard for adjusting health expenditures for inflation. Our discussion of best practices can help researchers select the index best suited to their study. © Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Redefining Perinatal Experience: A Philosophical Exploration of a Hypothetical Case of Gender-Diversity in Labour and Birth.

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Richardson, Brianna; Price, Sheri; Campbell-Yeo, Marsha

2018-05-18

Using a queer phenomenological approach, the objective of this philosophical analysis is to explore the transgender experience in highly gendered clinical areas, such as the birth unit, and make recommendations on how to provide perinatal care that is inclusive of gender diversity within these areas. This paper aims to describes a hypothetical clinical experience to provide insight on the institutional barriers that currently exist and to provide nurses and midwives with pragmatic strategies to enhance gender-diverse care in general and gendered clinical areas. Currently, general healthcare providers are not sufficiently educated on how to care for and meet the needs of people who identify as lesbian, gay, bisexual, trans, queer, queer or questioning and other communities (LGBTQ+). This vulnerable population continually faces stigma, discrimination, and marginalization, which act as barriers to accessing healthcare services. Although transgender people often have difficulty accessing healthcare in general settings, they experience an even greater challenge within traditionally gendered clinical care areas. Queer Phenomenology was used to guide a critical philosophical analysis of hypothetical case reflecting a clinical scenario regarding a transgender man's experience in labour and birth. Healthcare professionals often provide insufficient care to transgender persons, inadvertently leading to further marginalization of this vulnerable population. Special consideration to provide gender-diverse care throughout the perinatal period is needed. Structures and supports are essential to enhance the care from providers in attending to the unique needs of transgender individuals and reduce oppressive effects from heteronormative environments. Nurses and midwives are leading exemplars of providing person-centered care and are capable of advocating for equitable care amongst all populations to influence systemic change. Strategies for implementing changes that address LGBTQ

Does the pharmacy expenditure of patients always correspond with their morbidity burden? Exploring new approaches in the interpretation of pharmacy expenditure

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Abad-Díez José

2010-05-01

Full Text Available Abstract Background The computerisation of primary health care (PHC records offers the opportunity to focus on pharmacy expenditure from the perspective of the morbidity of individuals. The objective of the present study was to analyse the behaviour of pharmacy expenditure within different morbidity groups. We paid special attention to the identification of individuals who had higher values of pharmacy expenditure than their morbidity would otherwise suggest (i.e. outliers. Methods Observational study consisting of 75,574 patients seen at PHC centres in Zaragoza, Spain, at least once in 2005. Demographic and disease variables were analysed (ACG® 8.1, together with a response variable that we termed 'total pharmacy expenditure per patient'. Outlier patients were identified based on boxplot methods, adjusted boxplot for asymmetric distributions, and by analysing standardised residuals of tobit regression models. Results The pharmacy expenditure of up to 7% of attendees in the studied PHC centres during one year exceeded expectations given their morbidity burden. This group of patients was responsible for up to 24% of the total annual pharmacy expenditure. There was a significantly higher number of outlier patients within the low-morbidity band which matched up with the higher variation coefficient observed in this group (3.2 vs. 2.0 and 1.3 in the moderate- and high-morbidity bands, respectively. Conclusions With appropriate validation, the methodologies of the present study could be incorporated in the routine monitoring of the prescribing profile of general practitioners. This could not only enable evaluation of their performance, but also target groups of outlier patients and foster analyses of the causes of unusually high pharmacy expenditures among them. This interpretation of pharmacy expenditure gives new clues for the efficiency in utilisation of healthcare resources, and could be complementary to management interventions focused on

Perinatal services and outcomes in Quang Ninh province, Vietnam.

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Nga, Nguyen T; Målqvist, Mats; Eriksson, Leif; Hoa, Dinh P; Johansson, Annika; Wallin, Lars; Persson, Lars-Åke; Ewald, Uwe

2010-10-01

We report baseline results of a community-based randomized trial for improved neonatal survival in Quang Ninh province, Vietnam (NeoKIP; ISRCTN44599712). The NeoKIP trial seeks to evaluate a method of knowledge implementation called facilitation through group meetings at local health centres with health staff and community key persons. Facilitation is a participatory enabling approach that, if successful, is well suited for scaling up within health systems. The aim of this baseline report is to describe perinatal services provided and neonatal outcomes. Survey of all health facility registers of service utilization, maternal deaths, stillbirths and neonatal deaths during 2005 in the province. Systematic group interviews of village health workers from all communes. A Geographic Information System database was also established. Three quarters of pregnant women had ≥3 visits to antenatal care. Two hundred and five health facilities, including 18 hospitals, provided delivery care, ranging from 1 to 3258 deliveries/year. Totally there were 17 519 births and 284 neonatal deaths in the province. Neonatal mortality rate was 16/1000 live births, ranging from 10 to 44/1000 in the different districts, with highest rates in the mountainous parts of the province. Only 8% had home deliveries without skilled attendance, but those deliveries resulted in one-fifth of the neonatal deaths. A relatively good coverage of perinatal care was found in a Vietnamese province, but neonatal mortality varied markedly with geography and level of care. A remaining small proportion of home deliveries generated a substantial part of mortality. © 2010 The Author(s)/Journal Compilation © 2010 Foundation Acta Paediatrica.

Measurements of Daily Energy Intake and Total Energy Expenditure in People with Dementia in Care Homes: The Use of Wearable Technology.

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Murphy, J; Holmes, J; Brooks, C

2017-01-01

To estimate daily total energy expenditure (TEE) using a physical activity monitor, combined with dietary assessment of energy intake to assess the relationship between daily energy expenditure and patterns of activity with energy intake in people with dementia living in care homes. A cross-sectional study in care homes in the UK. Twenty residents with confirmed dementia diagnosis were recruited from two care homes that specialised in dementia care. A physical activity monitor (SensewearTM Armband, Body Media, Pittsburgh, PA) was employed to objectively determine total energy expenditure, sleep duration and physical activity. The armband was placed around the left upper triceps for up to 7 days. Energy intake was determined by weighing all food and drink items over 4 days (3 weekdays and 1 weekend day) including measurements of food wastage. The mean age was 78.7 (SD ± 11.8) years, Body Mass Index (BMI) 23.0 (SD ± 4.2) kg/m2; 50% were women. Energy intake (mean 7.4; SD ± 2.6) MJ/d) was correlated with TEE (mean 7.6; SD ± 1.8 MJ/d; r=0.49, p<0.05). Duration of sleeping ranged from 0.4-12.5 (mean 6.1) hrs/d and time spent lying down was 1.3-16.0 (8.3) hrs/d. On average residents spent 17.9 (6.3-23.4) hrs/d undertaking sedentary activity. TEE was correlated with BMI (r=0.52, p<0.05) and body weight (r=0.81, p<0.001) but inversely related to sleep duration (r=-0.59, p<0.01) and time lying down (r=-0.62, p<0.01). Multiple linear regression analysis revealed that after taking BMI, sleep duration and time spent lying down into account, TEE was no longer correlated with energy intake. The results show the extent to which body mass, variable activity and sleep patterns may be contributing to TEE and together with reduced energy intake, energy requirements were not satisfied. Thus wearable technology has the potential to offer real-time monitoring to provide appropriate nutrition management that is more person-centred to prevent weight loss in dementia.

Perinatal mortality in Indonesia: an unfinished agenda

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Riawati Jahja

2011-10-01

Full Text Available Perinatal mortality is a profound issue in maternal and child health due to its close relation with the maternal condition. There exist Millennium Development Goals (MDGs which are to be achieved by 2015. These are coupled with a continuing need for comprehensively monitoring and identifying factors associated with perinatal mortality, which is a primary concern for developing countries inclusive of Indonesia. Previous and on-going health programs could have brought about strategic interventions but as different attributes can emerge due to epidemiological transition, and given the fact that associated factors may remain persistent, forward thinking strategies in public health are forever in need of renewal.     Results from our research show that educational variables, poor awareness towards proper antenatal care visits and weak services at the front-line of healthcare delivery (community outreach worsen the condition of childbearing women, raising the question of biological risk factors in line with socio-economic variables.

Reaching Perinatal Women Online: The Healthy You, Healthy Baby Website and App

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Lydia Hearn

2014-01-01

Full Text Available Overwhelming evidence reveals the close link between unwarranted weight gain among childbearing women and childhood adiposity. Yet current barriers limit the capacity of perinatal health care providers (PHCPs to offer healthy lifestyle counselling. In response, today’s Internet savvy women are turning to online resources to access health information, with the potential of revolutionising health services by enabling PHCPs to guide women to appropriate online resources. This paper presents the findings of a project designed to develop an online resource to promote healthy lifestyles during the perinatal period. The methodology involved focus groups and interviews with perinatal women and PHCPs to determine what online information was needed, in what form, and how best it should be presented. The outcome was the development of the Healthy You, Healthy Baby website and smartphone app. This clinically-endorsed, interactive online resource provides perinatal women with a personalised tool to track their weight, diet, physical activity, emotional wellbeing, and sleep patterns based on the developmental stage of their child with links to quality-assured information. One year since the launch of the online resource, data indicates it provides a low-cost intervention delivered across most geographic and socioeconomic strata without additional demands on health service staff.

Intensive care unit drug costs in the context of total hospital drug expenditures with suggestions for targeted cost containment efforts.

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Altawalbeh, Shoroq M; Saul, Melissa I; Seybert, Amy L; Thorpe, Joshua M; Kane-Gill, Sandra L

2018-04-01

To assess costs of intensive care unit (ICU) related pharmacotherapy relative to hospital drug expenditures, and to identify potential targets for cost-effectiveness investigations. We offer the unique advantage of comparing ICU drug costs with previously published data a decade earlier to describe changes over time. Financial transactions for all ICU patients during fiscal years (FY) 2009-2012 were retrieved from the hospital's data repository. ICU drug costs were evaluated for each FY. ICU departments' charges were also retrieved and calculated as percentages of total ICU charges. Albumin, prismasate (dialysate), voriconazole, factor VII and alteplase denoted the highest percentages of ICU drug costs. ICU drug costs contributed to an average of 31% (SD 1.0%) of the hospital's total drug costs. ICU drug costs per patient day increased by 5.8% yearly versus 7.8% yearly for non-ICU drugs. This rate was higher for ICU drugs costs at 12% a decade previous. Pharmacy charges contributed to 17.7% of the total ICU charges. Growth rates of costs per year have declined but still drug expenditures in the ICU are consistently a significant driver in this resource intensive environment with a high impact on hospital drug expenditures. Copyright © 2017 Elsevier Inc. All rights reserved.

Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases

NARCIS (Netherlands)

de Jonge, A.; Geerts, C.C.; van der Goes, B.Y.; Mol, B.W.; Buitendijk, S.E.; Nijhuis, J.G.

2015-01-01

Objective To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births. Design A nationwide cohort study. Setting The Netherlands. Population Low-risk women in midwife-led care at the onset of labour. Methods Analysis of national registration data. Main

Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases

NARCIS (Netherlands)

de jonge, A.; Geerts, C. C.; van der Goes, B. Y.; Mol, B. W.; Buitendijk, S. E.; Nijhuis, J. G.

2015-01-01

To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births. A nationwide cohort study. The Netherlands. Low-risk women in midwife-led care at the onset of labour. Analysis of national registration data. Intrapartum and neonatal death, Apgar scores, and

The Impact of State Medical Malpractice Reform on Individual-Level Health Care Expenditures.

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Yu, Hao; Greenberg, Michael; Haviland, Amelia

2017-12-01

Past studies of the impact of state-level medical malpractice reforms on health spending produced mixed findings. Particularly salient is the evidence gap concerning the effect of different types of malpractice reform. This study aims to fill the gap. It extends the literature by examining the general population, not a subgroup or a specific health condition, and controlling for individual-level sociodemographic and health status. We merged the Database of State Tort Law Reforms with the Medical Expenditure Panel Survey between 1996 and 2012. We took a difference-in-differences approach to specify a two-part model for analyzing individual-level health spending. We applied the recycled prediction method and the bootstrapping technique to examining the difference in health spending growth between states with and without a reform. All expenditures were converted to 2010 U.S. dollars. Only two of the 10 major state-level malpractice reforms had significant impacts on the growth of individual-level health expenditures. The average annual expenditures in states with caps on attorney contingency fees increased less than that in states without the reform (p negligence rule, the average annual expenditures increased more in both states with a pure comparative fault reform (p < .05) and states with a comparative fault reform that barred recovery if the plaintiff's fault was equal to or greater than the defendant's (p < .05). A few state-level malpractice reforms had significantly affected the growth of individual-level health spending, and the direction and magnitude of the effects differed by type of reform. © Health Research and Educational Trust.

Causes of death and associated conditions (Codac – a utilitarian approach to the classification of perinatal deaths

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Harrison Catherine

2009-06-01

Full Text Available Abstract A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD, although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes. We tested the Causes of Death and Associated Conditions (Codac classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions. The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies, two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy, a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal. For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured. The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions

Causes of death and associated conditions (Codac) – a utilitarian approach to the classification of perinatal deaths

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Frøen, J Frederik; Pinar, Halit; Flenady, Vicki; Bahrin, Safiah; Charles, Adrian; Chauke, Lawrence; Day, Katie; Duke, Charles W; Facchinetti, Fabio; Fretts, Ruth C; Gardener, Glenn; Gilshenan, Kristen; Gordijn, Sanne J; Gordon, Adrienne; Guyon, Grace; Harrison, Catherine; Koshy, Rachel; Pattinson, Robert C; Petersson, Karin; Russell, Laurie; Saastad, Eli; Smith, Gordon CS; Torabi, Rozbeh

2009-01-01

A carefully classified dataset of perinatal mortality will retain the most significant information on the causes of death. Such information is needed for health care policy development, surveillance and international comparisons, clinical services and research. For comparability purposes, we propose a classification system that could serve all these needs, and be applicable in both developing and developed countries. It is developed to adhere to basic concepts of underlying cause in the International Classification of Diseases (ICD), although gaps in ICD prevent classification of perinatal deaths solely on existing ICD codes. We tested the Causes of Death and Associated Conditions (Codac) classification for perinatal deaths in seven populations, including two developing country settings. We identified areas of potential improvements in the ability to retain existing information, ease of use and inter-rater agreement. After revisions to address these issues we propose Version II of Codac with detailed coding instructions. The ten main categories of Codac consist of three key contributors to global perinatal mortality (intrapartum events, infections and congenital anomalies), two crucial aspects of perinatal mortality (unknown causes of death and termination of pregnancy), a clear distinction of conditions relevant only to the neonatal period and the remaining conditions are arranged in the four anatomical compartments (fetal, cord, placental and maternal). For more detail there are 94 subcategories, further specified in 577 categories in the full version. Codac is designed to accommodate both the main cause of death as well as two associated conditions. We suggest reporting not only the main cause of death, but also the associated relevant conditions so that scenarios of combined conditions and events are captured. The appropriately applied Codac system promises to better manage information on causes of perinatal deaths, the conditions associated with them, and the

What Contributes Most to High Health Care Costs? Health Care Spending in High Resource Patients.

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Pritchard, Daryl; Petrilla, Allison; Hallinan, Shawn; Taylor, Donald H; Schabert, Vernon F; Dubois, Robert W

2016-02-01

U.S. health care spending nearly doubled in the decade from 2000-2010. Although the pace of increase has moderated recently, the rate of growth of health care costs is expected to be higher than the growth in the economy for the near future. Previous studies have estimated that 5% of patients account for half of all health care costs, while the top 1% of spenders account for over 27% of costs. The distribution of health care expenditures by type of service and the prevalence of particular health conditions for these patients is not clear, and is likely to differ from the overall population. To examine health care spending patterns and what contributes to costs for the top 5% of managed health care users based on total expenditures. This retrospective observational study employed a large administrative claims database analysis of health care claims of managed care enrollees across the full age and care spectrum. Direct health care expenditures were compared during calendar year 2011 by place of service (outpatient, inpatient, and pharmacy), payer type (commercially insured, Medicare Advantage, and Medicaid managed care), and therapy area between the full population and high resource patients (HRP). The mean total expenditure per HRP during calendar year 2011 was $43,104 versus $3,955 per patient for the full population. Treatment of back disorders and osteoarthritis contributed the largest share of expenditures in both HRP and the full study population, while chronic renal failure, heart disease, and some oncology treatments accounted for disproportionately higher expenditures in HRP. The share of overall expenditures attributed to inpatient services was significantly higher for HRP (40.0%) compared with the full population (24.6%), while the share of expenditures attributed to pharmacy (HRP = 18.1%, full = 21.4%) and outpatient services (HRP = 41.9%, full = 54.1%) was reduced. This pattern was observed across payer type. While the use of physician

Reducing out-of-pocket expenditures to reduce poverty: a disaggregated analysis at rural-urban and state level in India.

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Garg, Charu C; Karan, Anup K

2009-03-01

Out-of-pocket (OOP) expenditure on health care has significant implications for poverty in many developing countries. This paper aims to assess the differential impact of OOP expenditure and its components, such as expenditure on inpatient care, outpatient care and on drugs, across different income quintiles, between developed and less developed regions in India. It also attempts to measure poverty at disaggregated rural-urban and state levels. Based on Consumer Expenditure Survey (CES) data from the National Sample Survey (NSS), conducted in 1999-2000, the share of households' expenditure on health services and drugs was calculated. The number of individuals below the state-specific rural and urban poverty line in 17 major states, with and without netting out OOP expenditure, was determined. This also enabled the calculation of the poverty gap or poverty deepening in each region. Estimates show that OOP expenditure is about 5% of total household expenditure (ranging from about 2% in Assam to almost 7% in Kerala) with a higher proportion being recorded in rural areas and affluent states. Purchase of drugs constitutes 70% of the total OOP expenditure. Approximately 32.5 million persons fell below the poverty line in 1999-2000 through OOP payments, implying that the overall poverty increase after accounting for OOP expenditure is 3.2% (as against a rise of 2.2% shown in earlier literature). Also, the poverty headcount increase and poverty deepening is much higher in poorer states and rural areas compared with affluent states and urban areas, except in the case of Maharashtra. High OOP payment share in total health expenditures did not always imply a high poverty headcount; state-specific economic and social factors played a role. The paper argues for better methods of capturing drugs expenditure in household surveys and recommends that special attention be paid to expenditures on drugs, in particular for the poor. Targeted policies in just five poor states to reduce

Cultural processes in psychotherapy for perinatal loss: Breaking the cultural taboo against perinatal grief.

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Markin, Rayna D; Zilcha-Mano, Sigal

2018-03-01

This paper argues that there is a cultural taboo against the public recognition and expression of perinatal grief that hinders parents' ability to mourn and their psychological adjustment following a loss. It is proposed that this cultural taboo is recreated within the therapy relationship, as feelings of grief over a perinatal loss are minimized or avoided by the therapist and parent or patient. Importantly, it is suggested that if these cultural dynamics are recognized within the therapy relationship, then psychotherapy has the immense opportunity to break the taboo by validating the parent's loss as real and helping the parent to mourn within an empathic and affect-regulating relationship. Specifically, it is suggested that therapists break the cultural taboo against perinatal grief and help parents to mourn through: acknowledging and not pathologizing perinatal grief reactions, considering intrapsychic and cultural factors that impact a parent's response to loss, exploring cultural reenactments within the therapy relationship, empathizing with the parent's experience of loss and of having to grieve within a society that does not recognize perinatal loss, coregulating the parent's feelings of grief and loss, and helping patients to create personally meaningful mourning rituals. Lastly, the impact of within and between cultural differences and therapist attitudes on the therapy process is discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Families at financial risk due to high ratio of out-of-pocket health care expenditures to total income.

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Bennett, Kevin J; Dismuke, Clara E

2010-05-01

High out-of-pocket expenditures for health care can put individuals and families at financial risk. Several groups, including racial/ethnic minority groups, the uninsured, rural residents, and those in poorer health are at risk for this increased burden. The analysis utilized 2004-2005 MEPS data. The dependent variables were the out-of-pocket health care spending to total income ratios for total spending, office-based visits, and prescription drugs. Multivariate analyses with instrumental variables controlled for respondent characteristics. Gender, age, rurality, insurance coverage, health status, and health care utilization were all associated with higher out-of-pocket to income ratios. Certain groups, such as women, the elderly, those in poor health, and rural residents, are at a greater financial risk due to their higher out-of-pocket to total income spending ratios. Policymakers must be aware of these increased risks in order to provide adequate resources and targeted interventions to alleviate some of this burden.

Medical Expenditures Associated With Diabetes Among Youth With Medicaid Coverage.

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Shrestha, Sundar S; Zhang, Ping; Thompson, Theodore J; Gregg, Edward W; Albright, Ann; Imperatore, Giuseppina

2017-07-01

Information on diabetes-related excess medical expenditures for youth is important to understand the magnitude of financial burden and to plan the health care resources needed for managing diabetes. However, diabetes-related excess medical expenditures for youth covered by Medicaid program have not been investigated recently. To estimate excess diabetes-related medical expenditures among youth aged below 20 years enrolled in Medicaid programs in the United States. We analyzed data from 2008 to 2012 MarketScan multistate Medicaid database for 6502 youths with diagnosed diabetes and 6502 propensity score matched youths without diabetes, enrolled in fee-for-service payment plans. We stratified analysis by Medicaid eligibility criteria (poverty or disability). We used 2-part regression models to estimate diabetes-related excess medical expenditures, adjusted for age, sex, race/ethnicity, year of claims, depression status, asthma status, and interaction terms. For poverty-based Medicaid enrollees, estimated annual diabetes-related total medical expenditure was $9046 per person [$3681 (no diabetes) vs. $12,727 (diabetes); PMedicaid enrollees, the estimated annual diabetes-related total medical expenditure was $9944 per person ($14,149 vs. $24,093; PMedicaid programs are substantial, which is larger among those with disabilities than without disabilities. Identifying cost-effective ways of managing diabetes in this vulnerable segment of the youth population is needed.

Using action research to develop midwives' skills to support women with perinatal mental health needs.

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Madden, Deirdre; Sliney, Annmarie; O'Friel, Aoife; McMackin, Barbara; O'Callaghan, Bernie; Casey, Kate; Courtney, Lisa; Fleming, Valerie; Brady, Vivienne

2018-02-01

The aim of the research was to identify and develop midwives' skills to support women with mental health needs during pregnancy, using an action research approach. A review of perinatal mental health services in a large Dublin maternity unit revealed a high number of referred women who 'did not attend' the perinatal mental health service with few guidelines in place to support midwives in identifying and referring women for specialist help. Action research using cooperative inquiry involved a mental health nurse specialist and a team of midwives, who were drawn to each other in mutual concern about an area of practice. Data were gathered from three Cooperative Inquiry meetings, which incorporated one main Action Research Cycle of constructing, planning, taking and evaluating action. Data were analysed using a thematic content analysis framework. Participants experienced varying levels of uncertainty about how to support women with perinatal mental health needs. Cooperative inquiry supported participants in making sense of how they understood perinatal mental health and how they managed challenges experienced when caring for women with perinatal mental health issues. Participants developed a referral pathway, highlighted the significance of education to support women with perinatal mental health issues and identified the value of using open questions to promote conversation with pregnant women about mental health. Midwives value education and support to identify and refer women at risk of perinatal mental health issues. Cooperative inquiry, with a focus on action and shared reflection, facilitated the drawing together of two professional groups with diverse knowledge bases to work together to develop practice in an area of mutual concern. Perinatal mental health is a significant public health issue and midwives need support to make psychosocial assessments and to negotiate access to specialist services where available and when required. © 2017 John Wiley & Sons

Disparities in health care access and receipt of preventive services by disability type: analysis of the medical expenditure panel survey.

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Horner-Johnson, Willi; Dobbertin, Konrad; Lee, Jae Chul; Andresen, Elena M

2014-12-01

To examine differences in access to health care and receipt of clinical preventive services by type of disability among working-age adults with disabilities. Secondary analysis of Medical Expenditure Panel Survey (MEPS) data from 2002 to 2008. We conducted cross-sectional logistic regression analyses comparing people with different types of disabilities on health insurance status and type; presence of a usual source of health care; delayed or forgone care; and receipt of dental checkups and cancer screening. We pooled annualized MEPS data files across years. Our analytic sample consisted of adults (18-64 years) with physical, sensory, or cognitive disabilities and nonmissing data for all variables of interest. Individuals with hearing impairment had better health care access and receipt than people with other disability types. People with multiple types of limitations were especially likely to have health care access problems and unmet health care needs. There are differences in health care access and receipt of preventive care depending on what type of disability people have. More in-depth research is needed to identify specific causes of these disparities and assess interventions to address health care barriers for particular disability groups. © Health Research and Educational Trust.

An Empirical Analysis of Rural-Urban Differences in Out-Of-Pocket Health Expenditures in a Low-Income Society of China.

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Lidan Wang

Full Text Available The paper examines whether out-of-pocket health care expenditure also has regional discrepancies, comparing to the equity between urban and rural areas, and across households.Sampled data were derived from Urban Household Survey and Rural Household Survey data for 2011/2012 for Anhui Province, and 11049 households were included in this study. The study compared differences in out-of-pocket expenditure on health care between regions (urban vs. rural areas and years (2011 vs. 2012 using two-sample t-test, and also investigated the degree of inequality using Lorenz and concentration curves.Approximately 5% and 8% of total household consumption expenditure was spent on health care for urban and rural populations, respectively. In 2012, the wealthiest 20% of urban and rural population contributed 49.7% and 55.8% of urban and rural total health expenditure respectively, while the poorest 20% took only 4.7% and 4.4%. The concentration curve for out-of-pocket expenditure in 2012 fell below the corresponding concentration curve for 2011 for both urban and rural areas, and the difference between curves for rural areas was greater than that for urban areas.A substantial and increasing gap in health care expenditures existed between urban and rural areas in Anhui. The health care financing inequality merits ample attention, with need for policymaking to focus on improving the accessibility to essential health care services, particularly for rural and poor residents. This study may provide useful information on low income areas of China.

Tei index in neonatal respiratory distress and perinatal asphyxia

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Ahmed Anwer Attia Khattab

2015-09-01

Full Text Available Cardiovascular compromise is a common complication of neonatal respiratory distress and perinatal asphyxia. Tei index is a Doppler-derived index for the assessment of overall left ventricular function that combines systolic and diastolic time intervals. Aim: Assess the role of MPI versus cardiac troponin I as early indicator of hypoxic cardiac damage in neonates with respiratory distress or perinatal asphyxia. The present work was conducted on forty neonates, 15 with neonatal respiratory distress (group I, 15 with perinatal asphyxia (group II, and 10 apparently healthy neonates as a control (group III. All have: Detailed history-thorough clinical examination-Plain X-ray-ECG-Two dimensional, M-mode and Doppler echocardiographic examination with the measurement of both myocardial performance index (MPI of the right and left ventricle-Serum cardiac troponin I. Results: There was statistically significant increase in serum cardiac troponin I in groups I and II than group III. Left and right ventricular myocardial performance index (MPI were increased in group I and II than the control group. No correlation between Tei index and each of postnatal age, apgar score at 5-min, heart rate, serum cardiac troponin I, ejection fraction and fractional shortening, but there was direct relationship between MPI and LVEDD and inverse relationship between MPI and each of EF% and FS%. But there was significant correlation between L.V. MPI and gestational age. Conclusion: Tei index was higher in neonates with respiratory distress and neonates with perinatal asphyxia than in normal neonates despite normal or even increased ejection fraction which indicates that these patients may have subclinical ventricular dysfunction which should be followed up carefully.

Projecting future drug expenditures--2009.

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Hoffman, James M; Shah, Nilay D; Vermeulen, Lee C; Doloresco, Fred; Martin, Patrick K; Blake, Sharon; Matusiak, Linda; Hunkler, Robert J; Schumock, Glen T

2009-02-01

Drug expenditure trends in 2007 and 2008, projected drug expenditures for 2009, and factors likely to influence drug expenditures are discussed. Various factors are likely to influence drug expenditures in 2009, including drugs in development, the diffusion of new drugs, drug safety concerns, generic drugs, Medicare Part D, and changes in the drug supply chain. The increasing availability of important generic drugs and drug safety concerns continue to moderate growth in drug expenditures. The drug supply chain remains dynamic and may influence drug expenditures, particularly in specialized therapeutic areas. Initial data suggest that the Medicare Part D benefit has influenced drug expenditures, but the ultimate impact of the benefit on drug expenditures remains unclear. From 2006 to 2007, total U.S. drug expenditures increased by 4.0%, with total spending rising from $276 billion to $287 billion. Drug expenditures in clinics continue to grow more rapidly than in other settings, with a 9.9% increase from 2006 to 2007. Hospital drug expenditures increased at a moderate rate of only 1.6% from 2006 to 2007; through the first nine months of 2008, hospital drug expenditures increased by only 2.8% compared with the same period in 2007. In 2009, we project a 0-2% increase in drug expenditures in outpatient settings, a 1-3% increase in expenditures for clinic-administered drugs, and a 1-3% increase in hospital drug expenditures.

Free does not mean affordable: maternity patient expenditures in a public hospital in Bangladesh

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Khan Suhaila H

2005-01-01

Full Text Available Abstract Objective This study investigated a the amount and types of out-of-pocket expenditures by patients for nominally free services in a large public hospital in Bangladesh, b the factors influencing these expenses, and c the impact of these expenses on household income. Methods Eighty-one maternity patients were interviewed during their hospitalization in the Dhaka Medical College Hospital. Patients were selected by quota sample to match the distribution of maternity patient categories in the hospital. Patients were interviewed with a semi-structured, in-depth questionnaire. Results All interviewees incurred substantial out-of-pocket expenditures for travel, hospital admission fees, medicine, tests, food, and tips. Only two of the expenditures, travel expenses and admission fees, were not supposed to be provided free of charge by the hospital. The median total per-patient expenditure was $65 (range $2–$350, equivalent to 7% (range 0.04%–225% of annual household income. Half of all patients reported that their families had to borrow to pay for care at interest rates of 5%–30% per month. A third of these families reported selling jewelry, land or household items to moneylenders. The rural patients reported more difficulty in paying for care than the urban patients. Factors increasing the expenditures were duration of hospitalization, rural residence, and necessary (e.g. C-section, hysterectomy and unnecessary (e.g. episiotomy medical procedures. Conclusion Free maternity services in Bangladesh impose large out-of-pocket expenditures on patients. Authorities could reduce the burden by reducing the duration of hospital stays, limiting use of medical procedures, eliminating tips, and moving routine services closer to potential users. Fee for service could reduce unofficial expenditures if the fee were lower than and replaced typical unofficial expenditures, otherwise adding service fees without reform of current hospital practices would

Birth weight discordance and perinatal mortality among triplets

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Egić Amira

2005-01-01

Full Text Available INTRODUCTION. The incidence of multiple births has increased in the last decade. Perinatal mortality in triplets is significantly greater than in twin and singleton births. OBJECTIVE. The objective of this study was to describe the extent of birth weight discordance among triplets and to identify its association with an increased risk of perinatal mortality. METHOD A retrospective analysis of triplet births, for the period 1993-2003, was conducted at the Gynaecological-Obstetric Clinic "Narodni Front" in Belgrade. Birth weight discordance was defined as the difference in birth weight between the largest and the smallest triplet's weight of more than 20%. RESULTS. The rate of triplets has increased by almost 75% between the first (7.7% and the last (29.6% 5-year period of the last decade. Triplets are becoming more common because of the frequent use of assisted reproductive technology as a treatment for infertility. In the period 1993-2003, there were a total of 40 triplet live births (24 weeks and greater with incidence of 0.06%. There was no clear association between maternal age, parity, method of conception, birth gestational age, and disorders complicating pregnancy with birth discordance more than 20%. Regarding birth weight groups, statistical significance occurred only in the <999 grams group for discordant and in the 2000-2499 grams group for concordant triplets. Overall, the perinatal mortality rate in the group was 10.8%, the foetal mortality rate was 1.7% (2/120, and the neonatal (0-28 days mortality rate was 9.1% (11/120. An odds ratio of 95% confidence interval shows 3 times greater risk for adverse perinatal outcome in the discordant group. However, the difference was not significant. CONCLUSION. Increasing birth weight discordance may increase the risk of adverse perinatal outcome. Triplet pregnancies, being high risk, require intensive antenatal care in order to prevent preterm delivery and ultrasound in order to diagnose foetal

Utility of qualitative methods in a clinical setting: perinatal care in the Western Province.

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Jayasuriya, V

2012-03-01

A peculiar paradox that has been observed in previous studies of antenatal care is where patients are satisfied with the services despite obvious lack of basic facilities. Qualitative methods were used to describe the experience of perinatal care in the Western province with the objective of demonstrating application of this method in a clinical setting. This paper used a 'naturalistic' approach of qualitative methods. In-depth interviews conducted with 20 postnatal mothers delivering in tertiary care institutions in the Western province was tape recorded, transcribed and content analysed. To ensure objectivity and validity of results, the principle investigator received only the anonymised data to prevent any prejudices or pre-conceptions affecting the results. The main themes emerging from the text demonstrated 'naïve trust' in the carer and a state of 'hero worship' where patients were distanced and therefore unable and unwilling to query the decisions made by the carers. This is similar to a state of patient-carer relationship described in a published model known as guarded alliance, where the relationship develops though four phases based on the level of trust and confidence in the relationship. This state explains not only why patients fail to recognise and report any deficiencies in the services but also the need for them to justify the behaviour of caregivers even when it amounts to incompetence and negligence. Qualitative methods allow the researcher to capture experiences in its 'natural' form rather than based on pre-determined protocols or plans, which may be limited to our own understanding and expectations and therefore unable to explain many idiosyncrasies of the programmes. This paper argues favourably for the use of qualitative methods in other clinical settings.

Health expenditure growth: looking beyond the average through decomposition of the full distribution.

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de Meijer, Claudine; O'Donnell, Owen; Koopmanschap, Marc; van Doorslaer, Eddy

2013-01-01

Explanations of growth in health expenditures have restricted attention to the mean. We explain change throughout the distribution of expenditures, providing insight into how expenditure growth and its explanation differ along the distribution. We analyse Dutch data on actual health expenditures linked to hospital discharge and mortality registers. Full distribution decomposition delivers findings that would be overlooked by examination of changes in the mean alone. The growth rate of hospital expenditures is greatest at the middle of the distribution and is driven mainly by changes in the distributions of determinants. Pharmaceutical expenditures increase most rapidly at the top of the distribution and are mainly attributable to structural changes, including technological progress, making treatment of the highest cost cases even more expensive. Changes in hospital practice styles make the largest contribution of all determinants to increased spending not only on hospital care but also on pharmaceuticals, suggesting important spill over effects. Copyright © 2012 Elsevier B.V. All rights reserved.

Perinatal grief in Latino parents.

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Whitaker, Claudia; Kavanaugh, Karen; Klima, Carrie

2010-01-01

Extensive research exists that describes the meaning of perinatal loss to some parents, but the experience of loss from the perspective of Latino parents is not clearly understood. Additionally, current perinatal bereavement practices used often to facilitate memory making for parents (such as viewing or holding the baby, taking photographs, or collecting mementos) are based on research done primarily with non-Latino families. Are these common practices appropriate for this population? Because there is a paucity of research on this topic, this article describes what has been written over the past 30 years on the topic of grief and perinatal loss in Latino culture.

Perinatal risk factors for strabismus

DEFF Research Database (Denmark)

Torp-Pedersen, Tobias; Boyd, Heather A; Poulsen, Gry

2010-01-01

Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype.......Little is known about the aetiological factors underlying strabismus. We undertook a large cohort study to investigate perinatal risk factors for strabismus, overall and by subtype....

Hospital-based perinatal outcomes and complications in teenage pregnancy in India.

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Mukhopadhyay, Prianka; Chaudhuri, R N; Paul, Bhaskar

2010-10-01

Teenage pregnancy is a worldwide problem bearing serious social and medical implications relating to maternal and child health. A cross-sectional observational study was undertaken to compare the different sociodemographic characteristics and perinatal outcomes of teenage primigravida mothers with those of adult primigravida mothers in a tertiary-care hospital in eastern India. A sample of 350 each in cases and comparison group comprised the study subjects. Data were collected through interviews and by observations using a pretested and predesigned schedule. Results revealed that the teenage mothers had a higher proportion (27.7%) of preterm deliveries compared to 13.1% in the adult mothers and had low-birthweight babies (38.9% vs 30.4% respectively). Stillbirth rate was also significantly higher in teenage deliveries (5.1% vs 0.9% respectively). The teenage mothers developed more adverse perinatal complications, such as preterm births, stillbirths, neonatal deaths, and delivered low-birthweight babies, when compared with those of the adult primigravida mothers. Teenage pregnancy is still a rampant and important public-health problem in India with unfavourable perinatal outcomes and needs to be tackled on a priority basis.

Perinatal Outcomes in Pregnant Women Users of Illegal Drugs.

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Oliveira, Tenilson Amaral; Bersusa, Ana Aparecida Sanches; Santos, Tatiana Fiorelli Dos; Aquino, Márcia Maria Auxiliadora de; Mariani Neto, Corintio

2016-04-01

Objective The purpose of this study was to evaluate the perinatal outcomes in pregnant women who use illicit drugs. Methods A retrospective observational study of patients who, at the time of delivery, were sent to or who spontaneously sought a public maternity hospital in the eastern area of São Paulo city. We compared the perinatal outcomes of two distinct groups of pregnant women - illicit drugs users and non-users - that gave birth in the same period and analyzed the obstetric and neonatal variables. We used Student's t-test to calculate the averages among the groups, and the Chi-square test or Fisher's exact test to compare categorical data from each group. Results We analyzed 166 women (83 users and 83 non-users) in both groups with a mean of age of 26 years. Ninety-five percent of the drug users would use crack or pure cocaine alone or associated with other psychoactive substances during pregnancy. Approximately half of the users group made no prenatal visit, compared with 2.4% in the non-users group (p illicit drugs. Conclusions The use of illicit drugs, mainly crack cocaine, represents an important perinatal risk. Any medical intervention in this population should combine adherence to prenatal care with strategies for reducing maternal exposure to illicit drugs. Thieme Publicações Ltda Rio de Janeiro, Brazil.

Maternal and neonatal health expenditure in mumbai slums (India: A cross sectional study

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Joshi Wasundhara

2011-03-01

Full Text Available Abstract Background The cost of maternity care can be a barrier to access that may increase maternal and neonatal mortality risk. We analyzed spending on maternity care in urban slum communities in Mumbai to better understand the equity of spending and the impact of spending on household poverty. Methods We used expenditure data for maternal and neonatal care, collected during post-partum interviews. Interviews were conducted in 2005-2006, with a sample of 1200 slum residents in Mumbai (India. We analysed expenditure by socio-economic status (SES, calculating a Kakwani Index for a range of spending categories. We also calculated catastrophic health spending both with and without adjustment for coping strategies. This identified the level of catastrophic payments incurred by a household and the prevalence of catastrophic payments in this population. The analysis also gave an understanding of the protection from medical poverty afforded by coping strategies (for example saving and borrowing. Results A high proportion of respondents spent catastrophically on care. Lower SES was associated with a higher proportion of informal payments. Indirect health expenditure was found to be (weakly regressive as the poorest were more likely to use wage income to meet health expenses, while the less poor were more likely to use savings. Overall, the incidence of catastrophic maternity expenditure was 41%, or 15% when controlling for coping strategies. We found no significant difference in the incidence of catastrophic spending across wealth quintiles, nor could we conclude that total expenditure is regressive. Conclusions High expenditure as a proportion of household resources should alert policymakers to the burden of maternal spending in this context. Differences in informal payments, significantly regressive indirect spending and the use of savings versus wages to finance spending, all highlight the heavier burden borne by the most poor. If a policy objective

Household utilization and expenditure on private and public health services in Vietnam.

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Ha, Nguyen Thi Hong; Berman, Peter; Larsen, Ulla

2002-03-01

The private provision of health services in Vietnam was legalized in 1989 as one of the country's means to mobilize resources and improve efficiency in the health system. Ten years after its legalization, the private sector has widely expanded its activities and become an important provider of health services for the Vietnamese people. However, little is known about its contribution to the overall objectives of the health system in Vietnam. This paper assesses the role of the private health care provider by examining utilization patterns and financial burden for households of private, as compared with public, services. We found that the private sector provided 60% of all outpatient contacts in Vietnam. There was no difference by education, sex or place of residence in the use of private ambulatory health care. Although there was evidence suggesting that rich people use private care more than the poor, this finding was not consistent across all income groups. The private sector served young children in particular. Also, people in households with several sick members at the same time relied more on private than public care, while those with severe illnesses tended to use less private care than public. The financial burden for households from private health care services was roughly a half of that imposed by the public providers. Expenditure on drugs accounted for a substantial percentage of household expenditure in general and health care expenditure in particular. These findings call for a prompt recognition of the private sector as a key player in Vietnam's health system. Health system policies should mobilize positive private sector contributions to health system goals where possible and reduce the negative effects of private provision development.

MRI of perinatal brain injury

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Rutherford, Mary; Allsop, Joanna [Imperial College, Robert Steiner MR Unit, Perinatal Imaging, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Martinez Biarge, Miriam [La Paz University Hospital, Dept of Neonatology, Madrid (Spain); Counsell, Serena [Imperial College, Robert Steiner MR Unit, Neonatal Medicine, MRC Clinical Sciences Centre, Hammersmith Hospital, London (United Kingdom); Cowan, Frances [Imperial College, Dept of Paediatrics, Hammersmith Hospital, London (United Kingdom)

2010-06-15

MRI is invaluable in assessing the neonatal brain following suspected perinatal injury. Good quality imaging requires adaptations to both the hardware and the sequences used for adults or older children. The perinatal and postnatal details often predict the pattern of lesions sustained and should be available to aid interpretation of the imaging findings. Perinatal lesions, the pattern of which can predict neurodevelopmental outcome, are at their most obvious on conventional imaging between 1 and 2 weeks from birth. Very early imaging during the first week may be useful to make management decisions in ventilated neonates but brain abnormalities may still be subtle using conventional sequences. Diffusion-weighted imaging (DWI) is very useful for the early identification of ischaemic tissue in the neonatal brain but may underestimate the final extent of injury, particularly basal ganglia and thalamic lesions. MR imaging is an excellent predictor of outcome following perinatal brain injury and can therefore be used as a biomarker in interventional trials designed to reduce injury and improve neurodevelopmental outcome. (orig.)

MRI of perinatal brain injury

International Nuclear Information System (INIS)

Rutherford, Mary; Allsop, Joanna; Martinez Biarge, Miriam; Counsell, Serena; Cowan, Frances

2010-01-01

MRI is invaluable in assessing the neonatal brain following suspected perinatal injury. Good quality imaging requires adaptations to both the hardware and the sequences used for adults or older children. The perinatal and postnatal details often predict the pattern of lesions sustained and should be available to aid interpretation of the imaging findings. Perinatal lesions, the pattern of which can predict neurodevelopmental outcome, are at their most obvious on conventional imaging between 1 and 2 weeks from birth. Very early imaging during the first week may be useful to make management decisions in ventilated neonates but brain abnormalities may still be subtle using conventional sequences. Diffusion-weighted imaging (DWI) is very useful for the early identification of ischaemic tissue in the neonatal brain but may underestimate the final extent of injury, particularly basal ganglia and thalamic lesions. MR imaging is an excellent predictor of outcome following perinatal brain injury and can therefore be used as a biomarker in interventional trials designed to reduce injury and improve neurodevelopmental outcome. (orig.)

Rate and Time Trend of Perinatal, Infant, Maternal Mortality, Natality and Natural Population Growth in Kosovo

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Azemi, Mehmedali; Gashi, Sanije; Berisha, Majlinda; Kolgeci, Selim; Ismaili-Jaha, Vlora

2012-01-01

Aim: The aim of work has been the presentation of the rate and time trends of some indicators of the heath condition of mothers and children in Kosovo: fetal mortality, early neonatal mortality, perinatal mortality, infant mortality, natality, natural growth of population etc. The treated patients were the newborn and infants in the post neonatal period, women during their pregnancy and those 42 days before and after the delivery. Methods: The data were taken from: register of the patients treated in the Pediatric Clinic of Prishtina, World Health Organization, Mother and Child Health Care, Reproductive Health Care, Ministry of Health of the Republic of Kosovo, Statistical Department of Kosovo, the National Institute of Public Health and several academic texts in the field of pediatrics. Some indicators were analyzed in a period between year 1945-2010 and 1950-2010, whereas some others were analyzed in a time period between year 2000 and 2011. Results: The perinatal mortality rate in 2000 was 29.1‰, whereas in 2011 it was 18.7‰. The fetal mortality rate was 14.5‰ during the year 2000, whereas in 2011 it was 11.0‰, in 2000 the early neonatal mortality was 14.8‰, in 2011 it was 7.5‰. The infant mortality in Kosovo was 164‰ in 1950, whereas in 2010 it was 20.5‰. The most frequent causes of infant mortality have been: lower respiratory tract infections, acute infective diarrhea, perinatal causes, congenital malformations and unclassified conditions. Maternal death rate varied during this time period. Maternal death in 2000 was 23 whereas in 2010 only two cases were reported. Regarding the natality, in 1950 it reached 46.1 ‰, whereas in 2010 it reached 14‰, natural growth of population rate in Kosovo was 29.1‰ in 1950, whereas in 2011 it was 11.0‰. Conclusion: Perinatal mortality rate in Kosovo is still high in comparison with other European countries (Turkey and Kyrgyzstan have the highest perinatal mortality rate), even though it is in a

Perinatal interventions and survival in resource-poor settings: which work, which don't, which have the jury out?

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Osrin, David; Prost, Audrey

2010-12-01

Perinatal conditions make the largest contribution to the burden of disease in low-income countries. Although postneonatal mortality rates have declined, stillbirth and early neonatal mortality rates remain high in many countries in Africa and Asia, and there is a concentration of mortality around the time of birth. Our article begins by considering differences in the interpretation of 'intervention' to improve perinatal survival. We identify three types of a single action, a collection of actions delivered in a package and a broader social or system approach. We use this classification to summarise the findings of recent systematic reviews and meta-analyses. After describing the growing evidence base for the effectiveness of community-based perinatal care, we discuss current concerns about integration: of women's and children's health programmes, of community-based and institutional care, and of formal and informal sector human resources. We end with some thoughts on the complexity of choices confronting women and their families in low-income countries, particularly in view of the growth in non-government and private sector healthcare.

Effect of same-sex marriage laws on health care use and expenditures in sexual minority men: a quasi-natural experiment.

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Hatzenbuehler, Mark L; O'Cleirigh, Conall; Grasso, Chris; Mayer, Kenneth; Safren, Steven; Bradford, Judith

2012-02-01

We sought to determine whether health care use and expenditures among gay and bisexual men were reduced following the enactment of same-sex marriage laws in Massachusetts in 2003. We used quasi-experimental, prospective data from 1211 sexual minority male patients in a community-based health center in Massachusetts. In the 12 months after the legalization of same-sex marriage, sexual minority men had a statistically significant decrease in medical care visits (mean = 5.00 vs mean = 4.67; P = .05; Cohen's d = 0.17), mental health care visits (mean = 24.72 vs mean = 22.20; P = .03; Cohen's d = 0.35), and mental health care costs (mean = $2442.28 vs mean = $2137.38; P = .01; Cohen's d = 0.41), compared with the 12 months before the law change. These effects were not modified by partnership status, indicating that the health effect of same-sex marriage laws was similar for partnered and nonpartnered men. Policies that confer protections to same-sex couples may be effective in reducing health care use and costs among sexual minority men.

Household expenditure on leprosy outpatient services in the Indian health system: A comparative study.

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Anuj Tiwari

2018-01-01

Full Text Available Leprosy is a major public health problem in many low and middle income countries, especially in India, and contributes considerably to the global burden of the disease. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. However, evidence on patient's expenditure is scarce. In this study, we estimate the expenditure in primary care (outpatient by leprosy households in two different public health settings.We performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators. The mean direct expenditure was USD 6.5 (95% CI: 2.4-17.9 in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8-7.9 per visit in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2-10.6 in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0-21.9 in Umbergaon. The age of the leprosy patients and type of health facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, the higher the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients.An enhanced public health system reduces the patient's expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy.

Household expenditure on leprosy outpatient services in the Indian health system: A comparative study.

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Tiwari, Anuj; Suryawanshi, Pramilesh; Raikwar, Akash; Arif, Mohammad; Richardus, Jan Hendrik

2018-01-01

Leprosy is a major public health problem in many low and middle income countries, especially in India, and contributes considerably to the global burden of the disease. Leprosy and poverty are closely associated, and therefore the economic burden of leprosy is a concern. However, evidence on patient's expenditure is scarce. In this study, we estimate the expenditure in primary care (outpatient) by leprosy households in two different public health settings. We performed a cross-sectional study, comparing the Union Territory of Dadra and Nagar Haveli with the Umbergaon block of Valsad, Gujrat, India. A household (HH) survey was conducted between May and October, 2016. We calculated direct and indirect expenditure by zero inflated negative binomial and negative binomial regression. The sampled households were comparable on socioeconomic indicators. The mean direct expenditure was USD 6.5 (95% CI: 2.4-17.9) in Dadra and Nagar Haveli and USD 5.4 (95% CI: 3.8-7.9) per visit in Umbergaon. The mean indirect expenditure was USD 8.7 (95% CI: 7.2-10.6) in Dadra and Nagar Haveli and USD 12.4 (95% CI: 7.0-21.9) in Umbergaon. The age of the leprosy patients and type of health facilities were the major predictors of total expenditure on leprosy primary care. The higher the age, the higher the expenditure at both sites. The private facilities are more expensive than the government facilities at both sites. If the public health system is enhanced, government facilities are the first preference for patients. An enhanced public health system reduces the patient's expenditure and improves the health seeking behaviour. We recommend investing in health system strengthening to reduce the economic burden of leprosy.

Is there a statistical relationship between economic crises and changes in government health expenditure growth? an analysis of twenty-four European countries.

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Cylus, Jonathan; Mladovsky, Philipa; McKee, Martin

2012-12-01

To identify whether, by what means, and the extent to which historically, government health care expenditure growth in Europe has changed following economic crises. Organization for Economic Cooperation and Development Health Data 2011. Cross-country fixed effects multiple regression analysis is used to determine whether statutory health care expenditure growth in the year after economic crises differs from that which would otherwise be predicted by general economic trends. Better understanding of the mechanisms involved is achieved by distinguishing between policy responses which lead to cost-shifting and all others. In the year after an economic downturn, public health care expenditure grows more slowly than would have been expected given the longer term economic climate. Cost-shifting and other policy responses are both associated with these slowdowns. However, while changes in tax-derived expenditure are associated with both cost-shifting and other policy responses following a crisis, changes in expenditure derived from social insurance have been associated only with changes in cost-shifting. Disproportionate cuts to the health sector, as well as reliance on cost-shifting to slow growth in health care expenditure, serve as a warning in terms of potentially negative effects on equity, efficiency, and quality of health services and, potentially, health outcomes following economic crises. © Health Research and Educational Trust.

Suicide During Perinatal Period: Epidemiology, Risk Factors and Clinical Correlates

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Laura Orsolini

2016-08-01

Full Text Available Perinatal period may pose a great challenge for the clinical management and treatment of psychiatric disorders in women. In fact, several mental illnesses can arise during pregnancy and/or following childbirth. Suicide and infanticide have been considered relatively rare events during the perinatal period. However, in some mental disorders (i.e. postpartum depression, bipolar disorder, postpartum psychosis, etc. have been reported a higher risk of suicidal ideation, suicide attempt or suicide. Therefore, a complete screening of mothers’ mental health should also take into account thoughts of suicide and thoughts about harming infants as well. Clinicians should carefully monitor and early identify related clinical manifestations, potential risk factors and alarm symptoms related to suicide. The present paper aims at providing a focused review about epidemiological data, risk and protective factors and an overview about the main clinical correlates associated with the suicidal behaviour during the pregnancy and postpartum period.

Health expenditure comparison of extended-release metoprolol succinate and immediate-release metoprolol tartarate

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Vaidya V

2012-02-01

Full Text Available Varun Vaidya, Pranav PatelCollege of Pharmacy and Pharmaceutical Sciences, University of Toledo, Toledo, OH, USABackground: Metoprolol, a selective beta-1 blocker, is available in two different salt forms in the market – metoprolol succinate (MS and metoprolol tartarate (MT. Both the formulations are Food and Drug Administration approved for the treatment of hypertension. Several studies have shown similar efficacies between the two salts; however, they differ in their pharmacokinetic properties and are therefore priced differently. The primary objective of this study was to compare the overall health care expenditures of hypertensive patients on MT and MS to see if the price difference in the two preparations is offset by savings in overall expenditure.Methods: Two cohorts of patients using MT and MS were selected from the 2008 Medical Expenditure Panel Survey. Propensity score matching technique was used to balance the cohorts on various parameters such as demographic information, insurance status, and comorbidity score. Patients using MT were matched to patients using MS on the logit of propensity score using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity score. Multiple regression analysis was carried out to examine the association between health expenditure and type of metoprolol salt, adjusting for other covariates.Results: A total of 742 patients were found to use metoprolol (MT-388, MS-354. After propensity score matching, a total of 582 patients were left in the sample for final analysis (291 patients in each cohort. The average annual health care expenditure was slightly higher in the MT cohort; however, after adjusting for covariates in a multivariate analysis, the difference was found to be statistically insignificant (P = 0.23.Conclusion: Both the products of metoprolol were found to have similar average annual total health care expenditure; however, MS once a day has higher out

Catastrophic Health Expenditure and Household Impoverishment: a case of NCDs prevalence in Kenya

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Daniel Mwai

2016-03-01

Full Text Available Introduction and problem: Non-Communicable Diseases (NCDs have become one of the leading causes of morbidity and mortality in Kenya. Their claim on financial and time resources adversely affects household welfare. Health care cost for NCDs in Kenya is predominantly paid by households as OOP. Health expenditure on NCD stands at 6.2% of Total Health Expenditure which is 0.4 % of the total gross domestic product of the country. This expenditure scenario could have implications on household welfare through catastrophic expenditure in Kenya. Most studies done on catastrophic expenditure in Kenya have not looked at the effect of NCD on poverty. Methodology: The paper has investigated the determinants of catastrophic health spending in a household with special focus on the NCDs. It has also investigated the effect of catastrophic expenditure on household welfare.A National household level survey data on expenditure and utilization is used. Controlling for endogeneity, the results revealed that NCDs and communicable diseases contribute significantly to the likelihood of a household incurring catastrophic expenditure. Results: Although all types of sicknesses have negative effects on household welfare, NCDs have more severe impacts on impoverishment. Policy wise, government and development partners should put in place a health financing plan entailing health insurance and resource pooling as a mean towards social protection. Key words:  Non-Communicable Diseases (NCD, Catastrophic Health Expenditure, endogeneity Impoverishment

Diagnosis and management of perinatal depression and anxiety in general practice: a meta-synthesis of qualitative studies.

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Ford, Elizabeth; Lee, Suzanne; Shakespeare, Judy; Ayers, Susan

2017-08-01

Up to 20% of women experience anxiety and depression during the perinatal period. In the UK, management of perinatal mental health falls under the remit of GPs. This review aimed at synthesising the available information from qualitative studies on GPs' attitudes, recognition, and management of perinatal anxiety and depression. Meta-synthesis of the available published qualitative evidence on GPs' recognition and management of perinatal anxiety and depression. A systematic search was conducted on Embase, Medline, PsycInfo, Pubmed, Scopus, and Web of Science, and grey literature was searched using Google, Google Scholar, and British Library EThOS. Papers and reports were eligible for inclusion if they reported qualitatively on GPs' diagnosis or treatment of perinatal anxiety or depression. The synthesis was constructed using meta-ethnography. Five themes were established from five eligible papers: labels: diagnosing depression; clinical judgement versus guidelines; care and management; use of medication; and isolation: the role of other professionals. GPs considered perinatal depression to be a psychosocial phenomenon, and were reluctant to label disorders and medicalise distress. GPs relied on their own clinical judgement more than guidelines. They reported helping patients make informed choices about treatment, and inviting them back regularly for GP visits. GPs sometimes felt isolated when dealing with perinatal mental health issues. GPs often do not have timely access to appropriate psychological therapies and use several strategies to mitigate this shortfall. Training must focus on these issues and must be evaluated to consider whether this makes a difference to outcomes for patients. © British Journal of General Practice 2017.

Why babies die in unplanned out-of-institution births: an enquiry into perinatal deaths in Norway 1999-2013.

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Gunnarsson, Björn; Fasting, Sigurd; Skogvoll, Eirik; Smárason, Alexander K; Salvesen, Kjell Å

2017-03-01

The aims were to describe causes of death associated with unplanned out-of-institution births, and to study whether they could be prevented. Retrospective population-based observational study based on data from the Medical Birth Registry of Norway and medical records. Between 1 January 1999 and 31 December 2013, 69 perinatal deaths among 6027 unplanned out-of-institution births, whether unplanned at home, during transportation, or unspecified, were selected for enquiry. Hospital records were investigated and cases classified according to Causes of Death and Associated Conditions. 63 cases were reviewed. There were 25 (40%) antepartum deaths, 10 (16%) intrapartum deaths, and 24 neonatal (38%) deaths. Four cases were in the unknown death category (6%). Both gestational age and birthweight followed a bimodal distribution with modes at 24 and 38 weeks and 750 and 3400 g, respectively. The most common main cause of death was infection (n = 14, 22%), neonatal (n = 14, 22%, nine due to extreme prematurity) and placental (n = 12, 19%, seven placental abruptions). There were 86 associated conditions, most commonly perinatal (n = 32), placental (n = 15) and maternal (n = 14). Further classification revealed that the largest subgroup was associated perinatal conditions/sub-optimal care, involving 25 cases (40%), most commonly due to sub-optimal maternal use of available care (n = 14, 22%). Infections, neonatal, and placental causes accounted for almost two-thirds of perinatal mortality associated with unplanned out-of-institution births in Norway. Sub-optimal maternal use of available care was found in more than one-fifth of cases. © 2016 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).

Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect

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Wallace Dennis

2011-08-01

Full Text Available Abstract Background In many developing countries, the majority of births are attended by traditional birth attendants, who lack formal training in neonatal resuscitation and other essential care required by the newly born infant. In these countries, the major causes of neonatal mortality are birth asphyxia, infection, and low-birth-weight/prematurity. Death from these causes is potentially modifiable using low-cost interventions, including neonatal resuscitation training. The purpose of this study was to evaluate the effect on perinatal mortality of training birth attendants in a rural area of the Democratic Republic of Congo (DRC using two established programs. Methods This study, a secondary analysis of DRC-specific data collected during a multi-country study, was conducted in two phases. The effect of training using the WHO Essential Newborn Care (ENC program was evaluated using an active baseline design, followed by a cluster randomized trial of training using an adaptation of a neonatal resuscitation program (NRP. The perinatal mortality rates before ENC, after ENC training, and after randomization to additional NRP training or continued care were compared. In addition, the influence of time following resuscitation training was investigated by examining change in perinatal mortality during sequential three-month increments following ENC training. Results More than two-thirds of deliveries were attended by traditional birth attendants and occurred in homes; these proportions decreased after ENC training. There was no apparent decline in perinatal mortality when the outcome of all deliveries prior to ENC training was compared to those after ENC but before NRP training. However, there was a gradual but significant decline in perinatal mortality during the year following ENC training (RR 0.73; 95% CI: 0.56-0.96, which was independently associated with time following training. The decline was attributable to a decline in early neonatal mortality

Reduced perinatal mortality following enhanced training of birth attendants in the Democratic Republic of Congo: a time-dependent effect.

Science.gov (United States)

Matendo, Richard; Engmann, Cyril; Ditekemena, John; Gado, Justin; Tshefu, Antoinette; Kinoshita, Rinko; McClure, Elizabeth M; Moore, Janet; Wallace, Dennis; Carlo, Waldemar A; Wright, Linda L; Bose, Carl

2011-08-04

In many developing countries, the majority of births are attended by traditional birth attendants, who lack formal training in neonatal resuscitation and other essential care required by the newly born infant. In these countries, the major causes of neonatal mortality are birth asphyxia, infection, and low-birth-weight/prematurity. Death from these causes is potentially modifiable using low-cost interventions, including neonatal resuscitation training. The purpose of this study was to evaluate the effect on perinatal mortality of training birth attendants in a rural area of the Democratic Republic of Congo (DRC) using two established programs. This study, a secondary analysis of DRC-specific data collected during a multi-country study, was conducted in two phases. The effect of training using the WHO Essential Newborn Care (ENC) program was evaluated using an active baseline design, followed by a cluster randomized trial of training using an adaptation of a neonatal resuscitation program (NRP). The perinatal mortality rates before ENC, after ENC training, and after randomization to additional NRP training or continued care were compared. In addition, the influence of time following resuscitation training was investigated by examining change in perinatal mortality during sequential three-month increments following ENC training. More than two-thirds of deliveries were attended by traditional birth attendants and occurred in homes; these proportions decreased after ENC training. There was no apparent decline in perinatal mortality when the outcome of all deliveries prior to ENC training was compared to those after ENC but before NRP training. However, there was a gradual but significant decline in perinatal mortality during the year following ENC training (RR 0.73; 95% CI: 0.56-0.96), which was independently associated with time following training. The decline was attributable to a decline in early neonatal mortality. NRP training had no demonstrable effect on early

Fertility rates and perinatal outcomes of adolescent pregnancies: a retrospective population-based study

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Maria de Lourdes de Souza

Full Text Available ABSTRACT Objective: analyze trends in fertility rates and associations with perinatal outcomes for adolescents in Santa Catarina, Brazil. Methods: a population-based study covering 2006 to 2013 was carried out to evaluate associations between perinatal outcomes and age groups, using odds ratios, and Chi-squared tests. Results: differences in the fertility rate among female adolescents across regions and time period were observed, ranging from 40.9 to 72.0 per 1,000 in mothers aged 15-19 years. Adolescents had fewer prenatal care appointments than mothers ≥20 years, and a higher proportion had no partner. Mothers aged 15-19 years were more likely to experience preterm birth (OR:1.1; CI:1.08-1.13; p<0.001, have an infant with low birthweight (OR:1.1; CI:1.10-1.15; p<0.001 and low Apgar score at 5 minutes (OR:1.4; CI:1.34-1.45; p<0.001 than mothers ≥20 years, with the odds for adverse outcomes greater for those aged 10-14 years. Conclusion: this study provides evidence of fertility rates among adolescents remaining higher in regions of social and economic deprivation. Adolescent mothers and their infants more likely to experience adverse perinatal outcomes. Nurses, public health practitioners, health and social care professionals and educators need to work collaboratively to better target strategies for adolescents at greater risk; to help reduce fertility rates and improve outcomes.

Health Expenditure Growth under Single-Payer Systems: Comparing South Korea and Taiwan.

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Cheng, Shou-Hsia; Jin, Hyun-Hyo; Yang, Bong-Min; Blank, Robert H

2018-05-03

Achieving universal health coverage has been an important goal for many countries worldwide. However, the rapid growth of health expenditures has challenged all nations, both those with and without such universal coverage. Single-payer systems are considered more efficient for administrative affairs and may be more effective for containing costs than multipayer systems. However, South Korea, which has a typical single-payer scheme, has almost the highest growth rate in health expenditures among industrialized countries. The aim of the present study is to explicate this situation by comparing South Korea with Taiwan. This study analyzed statistical reports published by government departments in South Korea and Taiwan from 2001 to 2015, including population and economic statistics, health statistics, health expenditures, and social health insurance reports. Between 2001 and 2015, the per capita national health expenditure (NHE) in South Korea grew 292%, whereas the corresponding growth of per capita NHE in Taiwan was only 83%. We find that the national health insurance (NHI) global budget cap in Taiwan may have restricted the growth of health expenditures. Less comprehensive benefit coverage for essential diagnosis/treatment services under the South Korean NHI program may have contributed to the growth of out-of-pocket payments. The expansion of insurance coverage for vulnerable individuals may also contribute to higher growth in NHE in South Korea. Explicit regulation of health care resource distribution may also lead to more limited provisioning and utilization of health services in Taiwan. Under analogous single-payer systems, South Korea had a much higher growth in health spending than Taiwan. The annual budget cap for total reimbursement, more comprehensive coverage for essential diagnosis and treatment services, and the regulation of health care resource distribution are important factors associated with the growth of health expenditures. Copyright © 2018

Perinatal mortality and socio-spatial inequalities

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Eunice Francisca Martins

2013-09-01

Full Text Available OBJECTIVE: to analyze the social inequalities in the distribution of perinatal mortality in Belo Horizonte. MATERIAL AND METHODS: the perinatal deaths of residents in Belo Horizonte in the period 2003 to 2007 were studied on the basis of the Information Systems on Mortality and Newborns. The space analysis and the Health Vulnerability Index were used to identify existing inequalities in the sanitary districts regarding coverage and risk, determined by the Odds Ratio and a value p<0.05. The multivariate analysis was used to describe a model for perinatal mortality. RESULTS: there was a proved variation in the numbers of perinatal mortality per one thousand total births in the sanitary districts (12.5 to 19.4, coverage areas (5.3 to 49.4 and areas of risk (13.2 to 20.7. The mortality rate diminished as the maternal schooling increased. The death rates deriving from asphyxia/hypoxia and non-specified fetal death grew with the increase of risk in the area. CONCLUSION: it was verified that the perinatal deaths are distributed in a differentiated form in relation to the space and the social vulnerabilities. The confrontation of this complex problem requires the establishment of intersecting partnerships.

Perinatal Mortality Among Twins In Lagos University Teaching ...

African Journals Online (AJOL)

Background: Perinatal mortality rate is reported to be higher in twins than in singletons. More than two decades ago, Abudu and Agarin reported a twinning rate of 21.1/1000 maternities and perinatal mortality rate of 142.6/1000 among twins in Lagos. Objective: To determine the current perinatal mortality rate and risk factors ...

Maternal and perinatal outcome of eclampsia in tertiary health institution in Southeast Nigeria.

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Adinma, Echendu Dolly

2013-01-01

To evaluate the maternal and perinatal outcome in patients with eclampsia at Nnamdi-Azikiwe-University-Teaching-Hospital (NAUTH), Nnewi, Nigeria. A retrospective study of cases of eclampsia managed at NAUTH over a 10 year period - 1st January, 2000 to 31st December, 2009. Maternal outcome was measured in terms of complications and maternal death. Foetal outcome was assessed in terms of low birth weight, pre-term births, low apgar score, and perinatal deaths. There were 57 cases of eclampsia out of a total of 6,262 deliveries within the study period, giving a prevalence of 0.91%. Majority, 71.7%, had caesarean section. There were 17.4% maternal deaths mainly from pulmonary oedema, 6 (13.0%), acute renal failure, 4 (8.7%), and coagulopathy, 3 (6.5%). Perinatal deaths were 25.5% as a result of prematurity, 42 (82.4%), and low birth weight, 36 (70.6%). Twenty-one (41.2%) of the new born had Apgar score of less than seven at 5 min while 13.0% were severely asphyxiated. Eclampsia was associated with high maternal and perinatal morbidity and mortality in this study. There is need to review existing protocol on eclampsia management with emphasis on appropriate health education of pregnant mothers, good antenatal care, early diagnosis of pre-eclampsia with prompt treatment.

Óbitos perinatais investigados e falhas na assistência hospitalar ao parto Muertes perinatales investigadas y los fracasos en la atención hospitalaria al parto Perinatal deaths investigated and failures in hospital care delivery

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Eunice Francisca Martins

2013-03-01

Full Text Available Objetivou-se analisar as falhas na assistência hospitalar ao parto, o perfil materno e as características do feto e do recém-nascido que evoluíram para óbito perinatal, em Belo Horizonte. MÉTODOS: Estudo transversal, dos óbitos perinatais investigados pelo Comitê de Prevenção de Óbitos de Belo Horizonte, ocorridos entre 2003 e 2007. A fonte dos dados foram as fichas de investigação do Comitê. Os dados foram analisados pela distribuição de frequência das variáveis e análise bivariada utilizando-se o teste de Qui-quadrado de Pearson, considerando o nível de significância de 5% (pAnalizar las deficiencias en la prestación de la atención hospitalaria al parto, el perfil materno y las características del feto y del recién nacido que murió durante el período perinatal, en Belo Horizonte (MG. MÉTODOS: eEstudio transversal de las muertes perinatales investigadas por el Comité para la Prevención de Muertes de Belo Horizonte, que se produjo entre 2003 y 2007. La fuente de datos fueron informes de investigación del Comité. Los datos fueron analizados mediante distribución de frecuencias de las variables y el análisis bivariado se utilizó la prueba de Qui-Quadrado, teniendo en cuenta el nivel de significación del 5% (p To analyze the shortcomings in hospital care delivery, the maternal profile and characteristics of the fetus and newborn that died perinatally, in Belo Horizonte. METHODS: Cross sectional study of perinatal deaths investigated by the Committee for the Prevention of Deaths of Belo Horizonte, which occurred between 2003 and 2007. The data source was the Committee's investigation forms. Data were analyzed by frequency distribution of variables and the bivariate analysis used the chi-square test, considering the significance level of 5% (p <0.05. RESULTS: We studied 253 deaths, most born at term with adequate weight infants. In 65.6% of cases there were gaps in care, mainly related to the monitoring of pregnant

Occupational Therapy in the Neonatal Intensive Care Unit for a Neonate with Perinatal Stroke: A Case Report.

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Roan, Cecilia; Bell, Alison

2017-08-01

This case report describes an occupational therapy intervention based on synactive theory for a neonate born full-term with a diagnosis of perinatal stroke. Occupational therapy was provided 4-5 times a week for 3 weeks. The focus was improving infant state regulation and motor skills to support developmentally appropriate behaviors through environmental modifications, positioning, guided progression of sensory stimulation, and promotion of motor and postural skills. At discharge on day 24, the infant had improved state regulation, behavioral organization, and motor performance. Occupational therapy based on synactive theory was an effective therapeutic approach for improving the behavioral and motor organization of a full term infant diagnosed with perinatal stroke.

Maternal nutritional status & practices & perinatal, neonatal mortality in rural Andhra Pradesh, India.

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Bamji, Mahtab S; V S Murthy, P V; Williams, Livia; Vardhana Rao, M Vishnu

2008-01-01

Despite a vast network of primary health centres and sub-centres, health care outreach in rural parts of India is poor. The Dangoria Charitable Trust (DCT), Hyderabad, has developed a model of health care outreach through trained Village Health and Nutrition Entrepreneur and Mobilisers (HNEMs) in five villages of Medak district in Andhra Pradesh, not serviced by the Integrated Child Development Scheme (ICDS) of the Government of India. Impact of such a link worker on perinatal/ neonatal mortality has been positive. The present study attempts to examine the association of maternal nutrition and related factors with perinatal, and neonatal mortality in these villages. Women from five selected villages who had delivered between June 1998 and September 2003, were identified. Those who had lost a child before one month (28 days), including stillbirths, (group 1- mortality group), who could be contacted and were willing to participate, were compared with those who had not lost a child (group II- no mortality), through a structured questionnaire and physical examination for anthropometric status and signs and symptoms of nutritional deficiency. Categorical data were analysed using Pearson chi square analysis. Continuous data were analysed using Student's t test. Mortality during perinatal, neonatal period was 8.2 per cent of all births. Malnutrition was rampant. Over 90 per cent women had 3 or more antenatal check-ups, had taken tetanus injections and had complied with regular consumption of iron-folic acid tablets. Higher percentage of women in group I (mortality group) tended to have height less than 145 cm (high risk) and signs and symptoms of micronutrient deficiencies. However, differences between groups I and II were not statistically significant. Pre-term delivery, difficult labour (use of forceps), first parity, birth asphyxia (no cry at birth) and day of initiating breastfeeding showed significant association with mortality. Significant association between signs

THE PROGNOSIS OF TOTAL PUBLIC EXPENDITURES AND TYPES OF EXPENDITURES IN ROMANIA

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ANA-PETRINA STANCIU

2012-12-01

Full Text Available The purpose of the paper is to provide a prognosis of total public expenditure and types of expenditures, starting from the evolution in time of total public expenditure and spending on public services, defense, public order and safety, economic affairs, environmental protection, housing and community amenities, health, recreation, culture and religion, education and social protection.

Value of the perinatal autopsy : Critique

NARCIS (Netherlands)

Gordijn, SJ; Erwich, JJHM; Khong, TY

2002-01-01

In consenting to a perinatal autopsy, the primary motive of parents may be to find the exact cause of death. A critical review on the value of perinatal autopsies was performed to see whether parents could be counseled regarding their main motive. A literature search was performed in MEDLINE,

Does health insurance reduce out-of-pocket expenditure? Heterogeneity among China's middle-aged and elderly.

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Zhang, Anwen; Nikoloski, Zlatko; Mossialos, Elias

2017-10-01

China's recent healthcare reforms aim to provide fair and affordable health services for its huge population. In this paper, we investigate the association between China's health insurance and out-of-pocket (OOP) healthcare expenditure. We further explore the heterogeneity in this association. Using data of 32,387 middle-aged and elderly individuals drawn from the 2011 and 2013 waves of China Health and Retirement Longitudinal Study (CHARLS), we report five findings. First, having health insurance increases the likelihood of utilizing healthcare and reduces inpatient OOP expenditure. Second, healthcare benefits are distributed unevenly: while low- and medium-income individuals are the main beneficiaries with reduced OOP expenditure, those faced with very high medical bills are still at risk, owing to limited and shallow coverage in certain aspects. Third, rural migrants hardly benefit from having health insurance, suggesting that institutional barriers are still in place. Fourth, health insurance does not increase patient visits to primary care facilities; hospitals are still the main provider of healthcare. Nonetheless, there is some evidence that patients shift from higher-tier to lower-tier hospitals. Last, OOP spending on pharmaceuticals is reduced for inpatient care but not for outpatient care, suggesting that people rely on inpatient care to obtain reimbursable drugs, putting further pressure on the already overcrowded hospitals. Our findings suggest that China's health insurance system has been effective in boosting healthcare utilization and lowering OOP hospitalization expenditure, but there still remain challenges due to the less generous rural scheme, shallow outpatient care coverage, lack of insurance portability, and an underdeveloped primary healthcare system. Copyright © 2017 Elsevier Ltd. All rights reserved.

Is There a Statistical Relationship between Economic Crises and Changes in Government Health Expenditure Growth? An Analysis of Twenty-Four European Countries

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Cylus, Jonathan; Mladovsky, Philipa; McKee, Martin

2012-01-01

Objective To identify whether, by what means, and the extent to which historically, government health care expenditure growth in Europe has changed following economic crises. Data Sources Organization for Economic Cooperation and Development Health Data 2011. Study Design Cross-country fixed effects multiple regression analysis is used to determine whether statutory health care expenditure growth in the year after economic crises differs from that which would otherwise be predicted by general economic trends. Better understanding of the mechanisms involved is achieved by distinguishing between policy responses which lead to cost-shifting and all others. Findings In the year after an economic downturn, public health care expenditure grows more slowly than would have been expected given the longer term economic climate. Cost-shifting and other policy responses are both associated with these slowdowns. However, while changes in tax-derived expenditure are associated with both cost-shifting and other policy responses following a crisis, changes in expenditure derived from social insurance have been associated only with changes in cost-shifting. Conclusions Disproportionate cuts to the health sector, as well as reliance on cost-shifting to slow growth in health care expenditure, serve as a warning in terms of potentially negative effects on equity, efficiency, and quality of health services and, potentially, health outcomes following economic crises. PMID:22670771

[Tobacco control policies and perinatal health].

Science.gov (United States)

Peelen, M J; Sheikh, A; Kok, M; Hajenius, P; Zimmermann, L J; Kramer, B W; Hukkelhoven, C W; Reiss, I K; Mol, B W; Been, J V

2017-01-01

Study the association between the introduction of tobacco control policies in the Netherlands and changes in perinatal outcomes. National quasi-experimental study. We used Netherlands Perinatal Registry data (now called Perined) for the period 2000-2011. We studied whether the introduction of smoke-free legislation in workplaces plus a tobacco tax increase and mass media campaign in January 2004, and extension of the smoke-free law to the hospitality industry accompanied by another tax increase and media campaign in July 2008, was associated with changes in perinatal outcomes. We studied all singleton births (gestational age: 24+0 to 42+6 weeks). Our primary outcome measures were: perinatal mortality, preterm birth and being small-for-gestational-age (SGA). Interrupted time series logistic regression analyses were performed to investigate changes in these outcomes occurred after the introduction of the aforementioned tobacco control policies (ClinicalTrials.gov: NCT02189265). Among 2,069,695 singleton births, 13,027 (0.6%) perinatal deaths, 116,043 (5.6%) preterm live-births and 187,966 (9.1%) SGA live-births were observed. The policies introduced in January 2004 were not associated with significant changes in any of the primary outcome measures. A -4.4% (95% CI: -6.4 to -2.4; p hospitality industry, a further tax increase and another media campaign. This translates to an estimated over 500 cases of SGA being averted per year. A reduction in SGA births, but not preterm birth or perinatal mortality, was observed in the Netherlands after extension of the smoke-free workplace law to include bars and restaurants, in conjunction with a tax increase and media campaign in 2008.

[Reimbursed health expenditures during the last year of life, in France, in the year 2008].

Science.gov (United States)

Ricci, P; Mezzarobba, M; Blotière, P O; Polton, D

2013-02-01

To measure the reimbursed health expenditures in the last year of life and the proportion it represents in total reimbursement costs in 2008, to analyse the structure of such expenditures and to identify costs by cause of death. Data were obtained from the French national insurance information system (SNIIRAM). Data from the national hospital discharge database were linked to the outpatient reimbursement database for patients covered by the general health insurance scheme (n=49 million persons). The cost of the last year of life was calculated for the exhaustive population (361,328 deaths in 2008). The supposed cause of death was mainly derived from the primary diagnosis of the last hospital stay during which the patient died. The average reimbursed expenses during the last year of life were estimated at 22,000 € per person in 2008, with 12,500 € accounting for public hospital costs. Reimbursed health expenditures varied according to different medical causes of death: 52,300 € for HIV disease and about 40,000 € for tumors. A negative effect of age on the expenditure during the last year of life was observed. Health care spending increased with shorter time before death, the last month of life corresponding to 28% of reimbursed expenditures during the last year of life. Health care use in the last year of life represented 10.5% of the total health expenditures in 2008. This study found results similar to those observed in the past or in other countries. Our results show in particular that the weight of health expenditures during the last year of life on total health expenditures remains stable over the years. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

Qualitative Comparison of Barriers to Antiretroviral Medication Adherence Among Perinatally and Behaviorally HIV-Infected Youth.

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Fields, Errol L; Bogart, Laura M; Thurston, Idia B; Hu, Caroline H; Skeer, Margie R; Safren, Steven A; Mimiaga, Matthew J

2017-07-01

Medication adherence among youth living with HIV (28%-69%) is often insufficient for viral suppression. The psychosocial context of adherence barriers is complex. We sought to qualitatively understand adherence barriers among behaviorally infected and perinatally infected youth and develop an intervention specific to their needs. We conducted in-depth interviews with 30 youth living with HIV (aged 14-24 years) and analyzed transcripts using the constant comparative method. Barriers were influenced by clinical and psychosocial factors. Perinatally infected youth barriers included reactance, complicated regimens, HIV fatigue, and difficulty transitioning to autonomous care. Behaviorally infected youth barriers included HIV-related shame and difficulty initiating medication. Both groups reported low risk perception, medication as a reminder of HIV, and nondisclosure, but described different contexts to these common barriers. Common and unique barriers emerged for behaviorally infected and perinatally infected youth reflecting varying HIV experiences and psychosocial contexts. We developed a customizable intervention addressing identified barriers and their psychosocial antecedents.

Experiences with perinatal loss from the health professionals’ perspective La vivencia de la pérdida perinatal desde la perspectiva de los profesionales de la salud A experiência da perda perinatal a partir da perspectiva dos profissionais de saúde

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Sonia María Pastor Montero

2011-12-01

Full Text Available The purpose of this paper is to know the experience of health professionals in situations of perinatal death and grief and to describe their action strategies in the management of perinatal loss. A qualitative study with a phenomenological approach was carried out through interviews conducted with 19 professionals. Three thematic categories were identified: Healthcare practice, feelings aroused by perinatal loss and meaning and beliefs about perinatal loss and grief. The results revealed that the lack of knowledge and skills to deal with perinatal loss are identified as the main reason behind unsuitable attitudes that are usually adopted in these situations. This generates anxiety, helplessness and frustration that compromise professional competency. The conclusion reached is that the promotion of training programs to acquire knowledge, skills and abilities in management of perinatal bereavement and the development of a clinical practice guideline for perinatal loss are necessary.El objetivo de este artículo es conocer la experiencia vivida por los profesionales de la salud en situaciones de muerte y duelo perinatal y describir las estrategias de actuación ante la pérdida perinatal. Se trata de un estudio cualitativo con un enfoque fenomenológico realizado a 19 profesionales a través de entrevistas. Se identificaron 3 categorías temáticas: la práctica asistencial, los sentimientos que despierta la pérdida perinatal y significado y creencias sobre la pérdida y el duelo perinatal. Los resultados ponen de manifiesto que la falta de conocimientos y de recursos para enfrentar la pérdida perinatal hace que se adopten actitudes poco adecuadas en estas situaciones, generando una sensación de ansiedad, impotencia y frustración que compromete la competencia profesional. Se concluye que es fundamental promover programas de formación para adquirir conocimientos y destrezas sobre el duelo perinatal y elaborar una guía de práctica cl

Low cerebral blood flow in hypotensive perinatal distress

DEFF Research Database (Denmark)

Lou, H C; Lassen, N A; Friis-Hansen, B

1977-01-01

was used for the cerebral blood flow measurements. The study confirmed that perinatal distress may be associated with low arterial blood pressure, and it was shown that cerebral blood flow is very low, 20 ml/100 g/min or less, in hypotensive perinatal distress. It is concluded that cerebral ischaemia plays...... a crucial role in the development of perinatal hypoxic brain injury....

A Systematic Review of the Physical, Mental, Social, and Economic Problems of Immigrant Women in the Perinatal Period in Japan.

Science.gov (United States)

Kita, Sachiko; Minatani, Mariko; Hikita, Naoko; Matsuzaki, Masayo; Shiraishi, Mie; Haruna, Megumi

2015-12-01

The perinatal mortality of immigrants in Japan is higher than that of Japanese women. However, details of the problems of immigrant perinatal women that contribute to worsening of their health are still unknown. This review describes the physical, psychological, social, and economic problems of immigrant women during the perinatal period in Japan. Medline, CINAHL, PsycINFO, and Igaku-Chuo Zasshi were searched and 36 relevant articles were reviewed. The related descriptions were collected and analyzed by using content analysis. The results showed that immigrant perinatal women in Japan experienced the following problems: language barriers, a problematic relationship with a partner, illegal residency, emotional distress, physical distress, adjustment difficulties, lack of utilization of services, social isolation, lack of support, lack of information, low economic status, unsatisfactory health care, and discrimination. These results indicated that multilingual services, strengthening of social and support networks, and political action are necessary to resolve their problems.

Mortes perinatais evitáveis em Belo Horizonte, Minas Gerais, Brasil, 1999 Avoidable perinatal deaths in Belo Horizonte, Minas Gerais, Brazil, 1999

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Sônia Lansky

2002-10-01

Full Text Available Tendo em vista a elevada taxa de mortalidade perinatal em Belo Horizonte, foi realizado estudo dos 826 óbitos perinatais da coorte de nascimentos ocorridos no município em 1999, com análise da possibilidade de sua prevenção, utilizando-se o enfoque de evitabilidade de Wigglesworth. A taxa de mortalidade perinatal observada foi 20,2 por mil e o risco de morte perinatal foi vinte vezes maior para as crianças com baixo peso ao nascer. Cerca de um quarto das crianças tinham peso maior que 2.500g e a asfixia intraparto foi a principal causa de óbito neste grupo. A causa anteparto contribuiu com 30% dos óbitos e 25% destas crianças tinham peso maior que 2.500g. Observou-se ainda a ocorrência de óbitos perinatais fora do hospital e óbitos de crianças cujas mães chegaram à maternidade já em período expulsivo. Cerca de 40% dos óbitos perinatais e 60% dos óbitos neonatais poderiam ter sido evitados. Estas mortes precoces sugerem falhas na assistência à gestante e ao recém-nascido no município, tanto no atendimento clínico como na organização da rede assistencial, sendo necessário avançar na qualificação e responsabilização dos serviços e do sistema de saúde como um todo sobre esta população.The perinatal mortality rate is still high in Belo Horizonte. This study investigated all 826 perinatal deaths taking place in 1999, focusing on the possibility of their prevention, using the Wigglesworth classification. The perinatal mortality rate was 20.2 per one thousand births, and the risk of perinatal death was 20 times higher in children with low birthweight. Some 24.6% of the children weighed more than 2,500g, and the main cause of death in this group was asphyxia during labor. The antepartum cause of death contributed to 30% of all deaths, and 25% of these children weighed more than 2,500g. Some deaths occurred out of hospital, and in some cases the mother arrived at hospital in end-stage labor. About 40% of all perinatal

Economic impact of chikungunya epidemic: out-of-pocket health expenditures during the 2007 outbreak in Kerala, India.

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Vijayakumar, K; George, B; Anish, T S; Rajasi, R S; Teena, M J; Sujina, C M

2013-01-01

The southern state of Kerala, India was seriously affected by a chikungunya epidemic in 2007. As this outbreak was the first of its kind, the morbidity incurred by the epidemic was a challenge to the state's public health system. A cross sectional survey was conducted in five districts of Kerala that were seriously affected by the epidemic, using a two-stage cluster sampling technique to select households, and the patients were identified using a syndromic case definition. We calculated the direct health expenditure of families and checked whether it exceed the margins of catastrophic health expenditure (CHE). The median (IQR) total out-of-pocket (OOP) health expenditure in the study population was USD7.4 (16.7). The OOP health expenditure did not show any significant association with increasing per-capita monthly income.The major share (47.4%) of the costs was utilized for buying medicines, but costs for transportation (17.2%), consultations (16.6%), and diagnoses (9.9%) also contributed significantly to the total OOP health expenditure. The OOP health expenditure was high in private sector facilities, especially in tertiary care hospitals. For more than 15% of the respondents, the OOP was more than double their average monthly family income. The chikungunya outbreak of 2007 had significantly contributed to the OOP expenditure of the affected community in Kerala.The OOP health expenditure incurred was high, irrespective of the level of income. Governments should attempt to ensure comprehensive financial protection by covering the costs of care, along with loss of productivity.

Expenditure Analysis of HIV Testing and Counseling Services Using the Cascade Framework in Vietnam.

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Van Thu Nguyen

Full Text Available Currently, HIV testing and counseling (HTC services in Vietnam are primarily funded by international sources. However, international funders are now planning to withdraw their support and the Government of Vietnam (GVN is seeking to identify domestic funding and generate client fees to continue services. A clear understanding of the cost to sustain current HTC services is becoming increasingly important to facilitate planning that can lead to making HTC and other HIV services more affordable and sustainable in Vietnam. The objectives of this analysis were to provide a snapshot of current program costs to achieve key program outcomes including 1 testing and identifying PLHIV unaware of their HIV status and 2 successfully enrolling HIV (+ clients in care.We reviewed expenditure data reported by 34 HTC sites in nine Vietnamese provinces over a one-year period from October 2012 to September 2013. Data on program outcomes were extracted from the HTC database of 42,390 client records. Analysis was carried out from the service providers' perspective.The mean expenditure for a single client provided HTC services (testing, receiving results and referral for care/treatment was US $7.6. The unit expenditure per PLHIV identified through these services varied widely from US $22.8 to $741.5 (median: $131.8. Excluding repeat tests, the range for expenditure to newly diagnose a PLHIV was even wider (from US $30.8 to $1483.0. The mean expenditure for one successfully referred HIV client to care services was US $466.6. Personnel costs contributed most to the total cost.Our analysis found a wide range of expenditures by site for achieving the same outcomes. Re-designing systems to provide services at the lowest feasible cost is essential to making HIV services more affordable and treatment for prevention programs feasible in Vietnam. The analysis also found that understanding the determinants and reasons for variance in service costs by site is an important

Health care seeking patterns and determinants of out-of-pocket expenditure for malaria for the children under-five in Uganda.

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Nabyonga Orem, Juliet; Mugisha, Frederick; Okui, Albert Peter; Musango, Laurent; Kirigia, Joses Muthuri

2013-05-31

The objectives of this study were to assess the patterns of treatment seeking behaviour for children under five with malaria; and to examine the statistical relationship between out-of-pocket expenditure (OOP) on malaria treatment for under-fives and source of treatment, place of residence, education and wealth characteristics of Uganda households. OOP expenditure on health care is now a development concern due to its negative effect on households' ability to finance consumption of other basic needs. The 2009 Uganda Malaria Indicator Survey was the source of data on treatment seeking behaviour for under-five children with malaria, and patterns and levels of OOP expenditure for malaria treatment. Binomial logit and Log-lin regression models were estimated. In logit model the dependent variable was a dummy (1=incurred some OOP, 0=none incurred) and independent variables were wealth quintiles, rural versus urban, place of treatment, education level, sub-region, and normal duty disruption. The dependent variable in Log-lin model was natural logarithm of OOP and the independent variables were the same as mentioned above. Five key descriptive analysis findings emerge. First, malaria is quite prevalent at 44.7% among children below the age of five. Second, a significant proportion seeks treatment (81.8%). Third, private providers are the preferred option for the under-fives for the treatment of malaria. Fourth, the majority pay about 70.9% for either consultation, medicines, transport or hospitalization but the biggest percent of those who pay, do so for medicines (54.0%). Fifth, hospitalization is the most expensive at an average expenditure of US$7.6 per child, even though only 2.9% of those that seek treatment are hospitalized.The binomial logit model slope coefficients for the variables richest wealth quintile, Private facility as first source of treatment, and sub-regions Central 2, East central, Mid-eastern, Mid-western, and Normal duties disrupted were positive and

Variability in prescription drug expenditures explained by adjusted clinical groups (ACG case-mix: A cross-sectional study of patient electronic records in primary care

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Serrat Josep

2008-03-01

Full Text Available Abstract Background In view of rapidly increasing prescription costs, case-mix adjustment should be considered for effective control of costs. We have estimated the variability in pharmacy costs explained by ACG in centers using patient electronic records, profiled centers and physicians and analyzed the correlation between cost and quality of prescription. Methods We analyzed 65,630 patient records attending five primary care centers in Spain during 2005. Variables explored were age, gender, registered diagnosed episodes of care during 2005, total cost of prescriptions, physician and center. One ACG was assigned to each patient with ACG case-mix software version 7.1. In a two-part model, logistic regression was used to explain the incurrence of drug expenditure at the first stage and a linear mixed model that considered the multilevel structure of data modeled the cost, conditional upon incurring any expense. Risk and efficiency indexes in pharmacy cost adjusted for ACG were obtained for centers and physicians. Spearman rank correlation between physician expenditure, adjusted for ACG, and a prescription quality index was also obtained. Pediatric and adult data were analyzed separately. Results No prescription was recorded for 13% of adults and 39.6% of children. The proportion of variance of the incurrence of expenditure explained by ACGs was 0.29 in adults and 0.21 in children. For adults with prescriptions, the variance of cost explained by ACGs was 35.4%, by physician-center was 1.8% and age 10.5% (residual 52.3%. For children, ACGs explained 22.4% of cost and physician-center 10.9% (residual 66.7%. Center efficiency index for adults ranged 0.58 to 1.22 and for children 0.32 to 2.36. Spearman correlation between expenditure and prescription quality index was -0.36 in family physicians (p = 0.019, N = 41 and -0.52 in pediatricians (p = 0.08, N = 12. Conclusion In our setting, ACG is the variable studied that explains more variability in

[Perinatal sources of stem cells].

Science.gov (United States)

Piskorska-Jasiulewicz, Magdalena Maria; Witkowska-Zimny, Małgorzata

2015-03-08

Recently, stem cell biology has become an interesting topic. Several varieties of human stem cells have been isolated and identified in vivo and in vitro. Successful application of hematopoietic stem cells in hematology has led to the search for other sources of stem cells and expanding the scale of their application. Perinatal stem cells are a versatile cell population, and they are interesting for both scientific and practical objectives. Stem cells from perinatal tissue may be particularly useful in the clinic for autologous transplantation for fetuses and newborns, and after banking in later stages of life, as well as for in utero transplantation in the case of genetic disorders. In this review paper we focus on the extraction and therapeutic potential of stem cells derived from perinatal tissues such as the placenta, the amnion, amniotic fluid, umbilical cord blood and Wharton's jelly.

Medical resource use and expenditure in patients with chronic heart failure: a population-based analysis of 88 195 patients.

Science.gov (United States)

Farré, Nuria; Vela, Emili; Clèries, Montse; Bustins, Montse; Cainzos-Achirica, Miguel; Enjuanes, Cristina; Moliner, Pedro; Ruiz, Sonia; Verdú-Rotellar, Jose Maria; Comín-Colet, Josep

2016-09-01

Heart failure (HF) is one of the diseases with greater healthcare expenditure. However, little is known about the cost of HF at a population level. Hence, our aim was to study the population-level distribution and predictors of healthcare expenditure in patients with HF. This was a population-based longitudinal study including all prevalent HF cases in Catalonia (Spain) on 31 December 2012 (n = 88 195). We evaluated 1-year healthcare resource use and expenditure using the Health Department (CatSalut) surveillance system that collects detailed information on healthcare usage for the entire population. Mean age was 77.4 (12) years; 55% were women. One-year mortality rate was 14%. All-cause emergency department visits and unplanned hospitalizations were required at least once in 53.4% and 30.8% of patients, respectively. During 2013, a total of €536.2 million were spent in the care of HF patients (7.1% of the total healthcare budget). The main source of expenditure was hospitalization (39% of the total) whereas outpatient care represented 20% of the total expenditure. In the general population, outpatient care and hospitalization were the main expenses. In multivariate analysis, younger age, higher presence of co-morbidities, and a recent HF or all-cause hospitalization were independently associated with higher healthcare expenditure. In Catalonia, a large portion of the annual healthcare budget is devoted to HF patients. Unplanned hospitalization represents the main source of healthcare-related expenditure. The knowledge of how expenditure is distributed in a non-selected HF population might allow health providers to plan the distribution of resources in patients with HF. © 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

Recognizing the importance of chronic disease in driving healthcare expenditure in Tanzania: analysis of panel data from 1991 to 2010.

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Counts, Christopher J; Skordis-Worrall, Jolene

2016-05-01

 Despite the growing chronic disease burden in low- and middle-income countries, there are significant gaps in our understanding of the financial impact of these illnesses on households. As countries make progress towards universal health coverage, specific information is needed about how chronic disease care drives health expenditure over time, and how this spending differs from spending on acute disease care.  A 19-year panel dataset was constructed using data from the Kagera Health and Development Surveys. Health expenditure was modelled using multilevel regression for three different sub-populations of households: (1) all households that spent on healthcare, (2) households affected by chronic disease and (3) households affected by acute disease. Explanatory variables were identified from a review of the health expenditure literature, and all variables were analysed descriptively.  Households affected by chronic disease spent 22% more on healthcare than unaffected households. Catastrophic expenditure and zero expenditure are both common in chronic disease-affected households. Expenditure predictors were different between households affected by chronic disease and those unaffected. Expenditure over time is highly heterogeneous and household-dependent.  The financial burden of healthcare is greater for households affected by chronic disease than those unaffected. Households appear unable to sustain high levels of expenditure over time, likely resulting in both irregular chronic disease treatment and impoverishment. The Tanzanian government's current efforts to develop a National Health Financing Strategy present an important opportunity to prioritize policies that promote the long-term financial protection of households by preventing the catastrophic consequences of chronic disease care payments. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh.

Science.gov (United States)

Mahumud, Rashidul Alam; Sarker, Abdur Razzaque; Sultana, Marufa; Islam, Ziaul; Khan, Jahangir; Morton, Alec

2017-03-01

As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

Pediatric Palliative Care: A Personal Story

Medline Plus

Full Text Available ... The story demonstrates how palliative care can positively influence a patient's and family's experience with illness. Category ... Cancer: Palliative Care - Duration: 3:29. American Cancer Society 4,364 views 3:29 Perinatal Palliative Care - ...

Health care inequities in north India: role of public sector in universalizing health care.

Science.gov (United States)

Prinja, Shankar; Kanavos, Panos; Kumar, Rajesh

2012-09-01

Income inequality is associated with poor health. Inequities exist in service utilization and financing for health care. Health care costs push high number of households into poverty in India. We undertook this study to ascertain inequities in health status, service utilization and out-of-pocket (OOP) health expenditures in two States in north India namely, Haryana and Punjab, and Union Territory of Chandigarh. Data from National Sample Survey 60 th Round on Morbidity and Health Care were analyzed by mean consumption expenditure quintiles. Indicators were devised to document inequities in the dimensions of horizontal and vertical inequity; and redistribution of public subsidy. Concentration index (CI), and equity ratio in conjunction with concentration curve were computed to measure inequity. Reporting of morbidity and hospitalization rate had a pro-rich distribution in all three States indicating poor utilization of health services by low income households. Nearly 57 and 60 per cent households from poorest income quintile in Haryana and Punjab, respectively faced catastrophic OOP hospitalization expenditure at 10 per cent threshold. Lower prevalence of catastrophic expenditure was recorded in higher income groups. Public sector also incurred high costs for hospitalization in selected three States. Medicines constituted 19 to 47 per cent of hospitalization expenditure and 59 to 86 per cent OPD expenditure borne OOP by households in public sector. Public sector hospitalizations had a pro-poor distribution in Haryana, Punjab and Chandigarh. Our analysis indicates that public sector health service utilization needs to be improved. OOP health care expenditures at public sector institutions should to be curtailed to improve utilization of poorer segments of population. Greater availability of medicines in public sector and regulation of their prices provide a unique opportunity to reduce public sector OOP expenditure.

Mitochondria, Bioenergetics and Excitotoxicity: New Therapeutic Targets in Perinatal Brain Injury

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Bryan Leaw

2017-07-01

Full Text Available Injury to the fragile immature brain is implicated in the manifestation of long-term neurological disorders, including childhood disability such as cerebral palsy, learning disability and behavioral disorders. Advancements in perinatal practice and improved care mean the majority of infants suffering from perinatal brain injury will survive, with many subtle clinical symptoms going undiagnosed until later in life. Hypoxic-ischemia is the dominant cause of perinatal brain injury, and constitutes a significant socioeconomic burden to both developed and developing countries. Therapeutic hypothermia is the sole validated clinical intervention to perinatal asphyxia; however it is not always neuroprotective and its utility is limited to developed countries. There is an urgent need to better understand the molecular pathways underlying hypoxic-ischemic injury to identify new therapeutic targets in such a small but critical therapeutic window. Mitochondria are highly implicated following ischemic injury due to their roles as the powerhouse and main energy generators of the cell, as well as cell death processes. While the link between impaired mitochondrial bioenergetics and secondary energy failure following loss of high-energy phosphates is well established after hypoxia-ischemia (HI, there is emerging evidence that the roles of mitochondria in disease extend far beyond this. Indeed, mitochondrial turnover, including processes such as mitochondrial biogenesis, fusion, fission and mitophagy, affect recovery of neurons after injury and mitochondria are involved in the regulation of the innate immune response to inflammation. This review article will explore these mitochondrial pathways, and finally will summarize past and current efforts in targeting these pathways after hypoxic-ischemic injury, as a means of identifying new avenues for clinical intervention.

Russia - Public Expenditure Review

OpenAIRE

World Bank

2011-01-01

The primary objective of the Public Expenditure Review (PER) is to assist the Ministry of Finance (MOF) in identifying opportunities for efficiency gains in some key categories of government expenditure. In this context, policy makers face two related fiscal dilemmas. First, how can expenditure efficiency are increased to provide public services with fewer resources? Second, how can the fi...

Socioeconomic differences in perinatal health and disease

DEFF Research Database (Denmark)

Mortensen, Laust Hvas; Andersen, Anne-Marie Nybo; Helweg-Larsen, Karin

2011-01-01

been used to examine the influence of socioeconomic factors on perinatal health. Conclusion: Danish register data is an invaluable source of information on socioeconomic differences in perinatal health. Danish registers continue to provide excellent opportunities for research and surveillance...

Pregnancy outcomes in perinatally HIV-infected young women in Madrid, Spain: 2000-2015.

Science.gov (United States)

Prieto, Luis M; Fernández McPhee, Carolina; Rojas, Patricia; Mazariegos, Diana; Muñoz, Eloy; Mellado, Maria José; Holguín, África; Navarro, María Luisa; González-Tomé, María Isabel; Ramos, José Tomás

2017-01-01

An increasing number of perinatally HIV-infected women (PHIV) are reaching adulthood and becoming pregnant. Most PHIV women have been exposed to a high number of antiretroviral regimens, and they may have difficulties to achieve viral suppression. Psychosocial problems are not uncommon and could be an important barrier for treatment adherence. The effects of chronic HIV infection and long-term exposure to antiretroviral treatment of PHIV women cause concerns on the developing fetus. The aims of this study were to describe the prevention of mother-to-child transmission strategies in PHIV women and the infant outcomes in the Madrid Cohort of HIV-infected mother-infant pairs. All PHIV pregnant women registered in the Cohort that gave birth from 2000 to 2015 were included in the study. Twenty-eight pregnancies in twenty-two perinatally infected women were registered. Most women were Caucasian and heavily treatment-experienced. Nine cases (32.1%) were at high risk of HIV mother-to-child transmission. Maternal HIV-1 viral load was detectable close to delivery in four women (14.3%). The management of these cases was described, and the treatment strategies were discussed. None of the newborns acquired HIV infection. Eight infants (28.6%) were small for gestational age. This study included a large series of pregnancies among PHIV women attended according to a youth-centered care model. The challenges in the management of this population by health-care providers were described. Specific strategies to minimize perinatal transmission risks should be addressed in future collaborative studies.

Financial burden of household out-of pocket health expenditure in Viet Nam: findings from the National Living Standard Survey 2002-2010.

Science.gov (United States)

Van Minh, Hoang; Kim Phuong, Nguyen Thi; Saksena, Priyanka; James, Chris D; Xu, Ke

2013-11-01

In Viet Nam, household direct out-of-pocket (OOP) health expenditure as a share of the total health expenditure has been always high, ranging from 50% to 70%. The high share of OOP expenditure has been linked to different inequity problems such as catastrophic health expenditure (households must reduce their expenditure on other necessities) and impoverishment. This paper aims to examine catastrophic and poverty impacts of household out-of-pocket health expenditure in Viet Nam over time and identify socio-economic indicators associated with them. Data used in this research were obtained from a nationally representative household survey, Viet Nam Living Standard Survey 2002, 2004, 2006, 2008 and 2010. The findings revealed that there were problems in health care financing in Viet Nam - many households encountered catastrophic health expenditure and/or were pushed into poverty due to health care payments. The issues were pervasive over time. Catastrophic expenditure and impoverishment problems were more common among the households who had more elderly people and those located in rural areas. Importantly, the financial protection aspect of the national health insurance schemes was still modest. Given these findings, more attention is needed on developing methods of financial protection in Viet Nam. Copyright © 2012 Elsevier Ltd. All rights reserved.

Financial viability of perinatal centers in the longer term, taking legislative requirements into account. An examination of the cost-revenue structure of a Level I perinatal center.

Science.gov (United States)

Lux, Michael P; Kraml, Florian; Wagner, Stefanie; Hack, Carolin C; Schulze, Christine; Faschingbauer, Florian; Winkler, Mathias; Fasching, Peter A; Beckmann, Matthias W; Hildebrandt, Thomas

2013-01-01

Debate is currently taking place over minimum case numbers for the care of premature infants and neonates in Germany. As a result of the Federal Joint Committee (Gemeinsamer Bundesauschuss, G-BA) guidelines for the quality of structures, processes, and results, requiring high levels of staffing resources, Level I perinatal centers are increasingly becoming the focus for health-economics questions, specifically, debating whether Level I structures are financially viable. Using a multistep contribution margin analysis, the operating results for the Obstetrics Section at the University Perinatal Center of Franconia (Universitäts-Perinatalzentrum Franken) were calculated for the year 2009. Costs arising per diagnosis-related group (DRG) (separated into variable costs and fixed costs) and the corresponding revenue generated were compared for 4,194 in-patients and neonates, as well as for 3,126 patients in the outpatient ultrasound and pregnancy clinics. With a positive operating result of € 374,874.81, a Level I perinatal center on the whole initially appears to be financially viable, from the obstetrics point of view (excluding neonatology), with a high bed occupancy rate and a profitable case mix. By contrast, the costs of prenatal diagnostics, with a negative contribution margin II of € 50,313, cannot be covered. A total of 79.4% of DRG case numbers were distributed to five DRGs, all of which were associated with pregnancies and neonates with the lowest risk profiles. A Level I perinatal center is currently capable of covering its costs. However, the cost-revenue ratio is fragile due to the high requirements for staffing resources and numerous economic, social, and regional influencing factors.

Midwives' perceptions and experiences of engaging fathers in perinatal services.

Science.gov (United States)

Rominov, Holly; Giallo, Rebecca; Pilkington, Pamela D; Whelan, Thomas A

2017-08-01

The active engagement of fathers in maternity care is associated with long-term benefits for the father, their partner, and their child. Midwives are ideally placed to engage fathers, but few studies have explored midwives' experiences of working with men. Therefore, the aim of this study was to describe midwives' perceptions and experiences of engaging fathers in perinatal services. A multi-method approach was utilised. Registered midwives (N=106) providing perinatal services to families in Australia participated in an online survey. Of these, 13 also participated in semi-structured telephone interviews. Descriptive analyses summarised the online survey data. The interview data were coded using semantic thematic analysis. Survey results indicated that midwives unanimously agreed that engaging fathers is part of their role and acknowledged the importance of receiving education to develop knowledge and skills about fathers. Analysis of the telephone interviews led to the identification of a range of strategies, facilitators and barriers to engaging fathers in midwifery services. Some of these were related to characteristics of midwives, factors related specifically to fathers, and several external factors relating to organisational policies. Findings from this study could inform maternity health care policies, as well the development of resources, education and ongoing professional training for midwives to promote father-inclusive practice. Copyright © 2017 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

Pediatric Palliative Care: A Personal Story

Medline Plus

Full Text Available ... The Keeney Family discuss pediatric palliative care - Duration: 12:07. Hospice of the Western Reserve 12,073 views 12:07 Perinatal Palliative Care - The Zimmer Family Story - ...

Physical inactivity of adults and 1-year health care expenditures in Brazil

NARCIS (Netherlands)

Codogno, J.S.; Turi, B.C.; Kemper, H.C.G.; Fernandes, R.A.; Christofaro, D.G.D.; Monteiro, H.L.

2015-01-01

Objectives: To analyze the association between physical inactivity in different domains and direct public healthcare expenditures in adults and to identify whether the clustering of physical inactivity in different domains would contribute to increased public healthcare. Methods: The sample composed

Perinatal sources of stem cells

Directory of Open Access Journals (Sweden)

Magdalena Maria Piskorska-Jasiulewicz

2015-03-01

Full Text Available Recently, stem cell biology has become an interesting topic. Several varieties of human stem cells have been isolated and identified in vivo and in vitro. Successful application of hematopoietic stem cells in hematology has led to the search for other sources of stem cells and expanding the scale of their application. Perinatal stem cells are a versatile cell population, and they are interesting for both scientific and practical objectives. Stem cells from perinatal tissue may be particularly useful in the clinic for autologous transplantation for fetuses and newborns, and after banking in later stages of life, as well as for in utero transplantation in the case of genetic disorders. In this review paper we focus on the extraction and therapeutic potential of stem cells derived from perinatal tissues such as the placenta, the amnion, amniotic fluid, umbilical cord blood and Wharton’s jelly.

Perinatal Mortality Trends in Ethiopia | Berhan | Ethiopian Journal of ...

African Journals Online (AJOL)

BACKGROUND: Although the magnitude of perinatal mortality in Ethiopia was among the highest in Sub Saharan Africa, there was no systematic review done to assess the trend and causes of perinatal death. The objective of this review was to assess the trend of perinatal mortality rate (PMR) and the causes attributed to ...

Impacts of chronic non-communicable diseases on households' out-of-pocket healthcare expenditures in Sri Lanka.

Science.gov (United States)

Pallegedara, Asankha

2018-01-10

This article examines the effects of chronic non-communicable diseases (NCDs) on households' out-of-pocket health expenditures in Sri Lanka. We explore the disease specific impacts on out-of-pocket health care expenses from chronic NCDs such as heart diseases, hypertension, cancer, diabetics and asthma. We use nationwide cross-sectional household income and expenditure survey 2012/2013 data compiled by the department of census and statistics of Sri Lanka. Employing propensity score matching method to account for selectivity bias, we find that chronic NCD affected households appear to spend significantly higher out-of-pocket health care expenditures and encounter grater economic burden than matched control group despite having universal public health care policy in Sri Lanka. The results also suggest that out-of-pocket expenses on medicines and other pharmaceutical products as well as expenses on medical laboratory tests and other ancillary services are particularly higher for households with chronic NCD patients. The findings underline the importance of protecting households against the financial burden due to NCDs.

Preventing Workplace Injuries Among Perinatal Nurses.

Science.gov (United States)

Harolds, Laura; Hurst, Helen

2016-01-01

Many aspects of perinatal nursing put nurses at risk for injuries, including frequent repetitive bending, lifting of clients, and exposure to potentially large amounts of body fluids such as blood and amniotic fluid. Violence is also a potential risk with stressful family situations that may arise around childbirth. Workplace injuries put a health care facility at risk for staff turnover, decreases in the number of skilled nurses, client dissatisfaction, workers' compensation payouts, and employee lawsuits. Through the use of safety equipment, improved safety and violence training programs, "no manual lift" policies, reinforcement of personal protective equipment usage, and diligent staff training to improve awareness, these risks can be minimized. © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses.

Maternal Pseudo-Bartter Syndrome Associated with Severe Perinatal Brain Injury.

Science.gov (United States)

Vora, Shrenik; Ibrahim, Thowfique; Rajadurai, Victor Samuel

2017-09-15

Maternal electrolyte imbalance is rarely reported as causative factor of severe perinatal brain injury. This case outlines a unique maternal and neonatal pseudo-Bartter syndrome presented with metabolic alkalosis and hypochloremia due to maternal severe vomiting. Neonatal MRI brain revealed extensive brain hemorrhages with porencephalic cysts. Subsequent investigation workup points towards maternal severe metabolic alkalosis as its cause. Careful medical attention should be paid to pregnant women with excessive vomiting to ensure a healthy outcome for both the mother and the baby.

Recognition and management of perinatal depression and anxiety by general practitioners: a systematic review.

Science.gov (United States)

Ford, Elizabeth; Shakespeare, Judy; Elias, Fatin; Ayers, Susan

2017-02-01

Perinatal anxiety and depression are widespread, with up to 20% of women affected during pregnancy and after birth. In the UK, management of perinatal mental health falls under the remit of general practitioners (GPs). We reviewed the literature on GPs' routine recognition, diagnosis and management of anxiety and depression in the perinatal period. A systematic search of Embase, Medline, PsycInfo, Pubmed, Scopus and Web of Science was conducted. Studies were eligible if they reported quantitative measures of GPs' or Family Physicians' assessment, recognition and management of anxiety or depression in pregnancy or post-partum. Thirteen papers, reporting 10 studies, were identified from the United States, Australia, UK, Netherlands and Canada. All reported on depression; two included anxiety disorders. Reported awareness and ability to diagnose perinatal depression among GPs was high. GPs knew about and used screening tools in the UK but less so in US settings. Antidepressants were the first line of treatment, with various SSRIs considered safest. Counseling by GPs and referrals to specialists were common in the post-natal period, less so in pregnancy. Treatment choices were determined by resources, attitudes, knowledge and training. Data on GPs' awareness and management of perinatal depression were sparse and unlikely to be generalizable. Future directions for research are proposed; such as exploring the management of anxiety disorders which are largely missing from the literature, and understanding more about barriers to disclosure and recognition in primary care. More standardized training could help to improve recognition and management practices. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Intergenerational enrollment and expenditure changes in Medicaid: trends from 1991 to 2005

Directory of Open Access Journals (Sweden)

Patrick Stephen W

2012-09-01

Full Text Available Abstract Background From its inception, Medicaid was aimed at providing insurance coverage for low income children, elderly, and disabled. Since this time, children have become a smaller proportion of the US population and Medicaid has expanded to additional eligibility groups. We sought to evaluate relative growth in spending in the Medicaid program between children and adults from 1991-2005. We hypothesize that this shifting demographic will result in fewer resources being allocated to children in the Medicaid program. Methods We utilized retrospective enrollment and expenditure data for children, adults and the elderly from 1991 to 2005 for both Medicaid and Children’s Health Insurance Program Medicaid expansion programs. Data were obtained from the Centers for Medicare and Medicaid Services using their Medicaid Statistical Information System. Results From 1991 to 2005, the number of enrollees increased by 83% to 58.7 million. This includes increases of 33% for children, 100% for adults and 50% for the elderly. Concurrently, total expenditures nationwide rose 150% to $273 billion. Expenditures for children increased from $23.4 to $65.7 billion, adults from $46.2 to $123.6 billion, and elderly from $39.2 to $71.3 billion. From 1999 to 2005, Medicaid spending on long-term care increased by 31% to $84.3 billion. Expenditures on the disabled grew by 61% to $119 billion. In total, the disabled account for 43% and long-term care 31%, of the total Medicaid budget. Conclusion Our study did not find an absolute decrease in the overall resources being directed toward children. However, increased spending on adults on a per-capita and absolute basis, particularly disabled adults, is responsible for much of the growth in spending over the past 15 years. Medicaid expenditures have grown faster than inflation and overall national health expenditures. A national strategy is needed to ensure adequate coverage for Medicaid recipients while dealing with the

Medicaid Expenditures for Children Remaining at Home After a First Finding of Child Maltreatment.

Science.gov (United States)

Campbell, Kristine A; Telford, S Russell; Cook, Lawrence J; Waitzman, Norman J; Keenan, Heather T

2016-09-01

Child maltreatment is associated with physical and mental health problems. The objective of this study was to compare Medicaid expenditures based on a first-time finding of child maltreatment by Child Protective Services (CPS). This retrospective cohort study included children aged 0 to 14 years enrolled in Utah Medicaid between January 2007 and December 2009. The exposed group included children enrolled in Medicaid during the month of a first-time CPS finding of maltreatment not resulting in out-of-home placement. The unexposed group included children enrolled in Medicaid in the same months without CPS involvement. Quantile regression was used to describe differences in average nonpharmacy Medicaid expenditures per child-year associated with a first-time CPS finding of maltreatment. A total of 6593 exposed children and 39 181 unexposed children contributed 20 670 and 105 982 child-years to this analysis, respectively. In adjusted quantile regression, exposed children at the 50th percentile of health care spending had annual expenditures $78 (95% confidence interval [CI], 65 to 90) higher than unexposed children. This difference increased to $336 (95% CI, 283 to 389) and $1038 (95% CI, 812 to 1264) at the 75th and 90th percentiles of health care spending. Differences were higher among older children, children with mental health diagnoses, and children with repeated episodes of CPS involvement; differences were lower among children with severe chronic health conditions. Maltreatment is associated with increased health care expenditures, but these costs are not evenly distributed. Better understanding of the reasons for and outcomes associated with differences in health care costs for children with a history of maltreatment is needed. Copyright © 2016 by the American Academy of Pediatrics.