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Pesquisa : N03.219.559 [Categoria DeCS]
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[PMID]:29437565
[Au] Autor:Fu W; Zhao S; Zhang Y; Chai P; Goss J
[Ad] Endereço:China National Health and Development Research Centre, Beijing, China fuwei@nhei.cn.
[Ti] Título:Research in health policy making in China: out-of-pocket payments in Healthy China 2030.
[So] Source:BMJ;360:k234, 2018 02 05.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Honorários e Preços
Financiamento Pessoal
Gastos em Saúde
Política de Saúde
Programas Gente Saudável
Formulação de Políticas
[Mh] Termos MeSH secundário: China
Reforma dos Serviços de Saúde
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180214
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k234


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[PMID]:29389995
[Au] Autor:Dalinjong PA; Wang AY; Homer CSE
[Ad] Endereço:Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.
[Ti] Título:Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana.
[So] Source:PLoS One;13(2):e0184830, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The free maternal health policy was implemented in Ghana in 2008 under the National Health Insurance Scheme (NHIS). The policy sought to eliminate out of pocket (OOP) payments and enhance the utilisation of maternal health services. It is unclear whether the policy had altered OOP payments for services. The study explored views on costs and actual OOP payments during pregnancy. The source of funding for payments was also explored. METHODS: A convergent parallel mixed methods design, involving quantitative and qualitative data collection approaches. The study was set in the Kassena-Nankana municipality, a rural area in Ghana. Women (n = 406) who utilised services during pregnancy were surveyed. Also, 10 focus groups discussions (FGDs) were held with women who used services during pregnancy as well as 28 in-depth interviews (IDIs) with midwives/nurses (n = 25) and insurance managers/directors (n = 3). The survey was analysed using descriptive statistics, focussing on costs from the women's perspective. Qualitative data were audio recorded, transcribed and translated verbatim into English where necessary. The transcripts were read and coded into themes and sub-themes. RESULTS: The NHIS did not cover all expenses in relation to maternal health services. The overall mean for OOP cost during pregnancy was GH¢17.50 (US$8.60). Both FGDs and IDIs showed that women especially paid for drugs and ultrasound scan services. Sixty-five percent of the women used savings, whilst twenty-two percent sold assets to meet the OOP cost. Some women were unable to afford payments due to poverty and had to forgo treatment. Participants called for payments to be eliminated and for the NHIS to absorb the cost of emergency referrals. All participants admitted the benefits of the policy. CONCLUSION: Women needed to make payments despite the policy. Measures should be put in place to eliminate payments to enable all women to receive services and promote universal health coverage.
[Mh] Termos MeSH primário: Pessoal Administrativo/psicologia
Atitude
Financiamento Pessoal
Pessoal de Saúde/psicologia
Serviços de Saúde Materna/economia
Programas Nacionais de Saúde/economia
[Mh] Termos MeSH secundário: Adulto
Antimaláricos/economia
Feminino
Gana
Seres Humanos
Cobertura do Seguro
Gravidez
Inquéritos e Questionários
Ultrassonografia Pré-Natal/economia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antimalarials)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180202
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184830


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[PMID]:29443473
[Au] Autor:Trejos-Castillo E; Davis G; Hipps T
[Ti] Título:Economic Well-Being and Independent Living in FosterYouth: Paving the Road to Effective Transitioning out of Care.
[So] Source:Child Welfare;94(1):53-71, 2015.
[Is] ISSN:0009-4021
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Using a mixed-methods methodological approach, the proposed study examines the associations between economic well-being and independent living experiences in foster youth. Quantitative data were collected from N = 294 in-care foster youth using the Casey Life Skills assessment (α = .79 to α = .95). Qualitative data were collected via focus groups with aged-out foster youth (N =15). Results provide important insights on youth's economic well-being, financial literacy, individual experiences regarding aging out of foster care and independent living. This study provides new insights into the complex dynamics of successfully transitioning out of foster care and the need for supporting economic well-being in foster youth to better prepare them to live independently and develop coping skills for the challenges they might experience once they leave the system.
[Mh] Termos MeSH primário: Comportamento do Consumidor/economia
Financiamento Pessoal
Cuidados no Lar de Adoção
Vida Independente/economia
[Mh] Termos MeSH secundário: Adaptação Psicológica
Adolescente
Bem-Estar da Criança
Feminino
Grupos Focais
Seres Humanos
Masculino
Fatores Socioeconômicos
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, U.S. GOV'T, P.H.S.
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180215
[St] Status:MEDLINE


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[PMID]:28453645
[Au] Autor:Song H; Adamson A; Mostaghimi A
[Ad] Endereço:Harvard Medical School, Boston, Massachusetts.
[Ti] Título:Medicare Part D Payments for Topical Steroids: Rising Costs and Potential Savings.
[So] Source:JAMA Dermatol;153(8):755-759, 2017 Aug 01.
[Is] ISSN:2168-6084
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Rising pharmaceutical costs in the United States are an increasing source of financial burden for payers and patients. Although topical steroids are among the most commonly prescribed medications in dermatology, there are limited data on steroid-related spending and utilization. Objective: To characterize Medicare and patient out-of-pocket costs for topical steroids, and to model potential savings that could result from substitution of the cheapest topical steroid from the corresponding potency class. Design, Setting, and Participants: This study was a retrospective cost analysis of the Medicare Part D Prescriber Public Use File, which details annual drug utilization and spending on both generic and branded drugs from 2011 to 2015 by Medicare Part D participants who filled prescriptions for topical steroids. Main Outcomes and Measures: Total and potential Medicare and out-of-pocket patient spending. Costs were adjusted for inflation and reported in 2015 dollars. Results: Medicare Part D expenditures on topical steroids between 2011 and 2015 were $2.3 billion. Patients' out-of-pocket spending for topical steroids over the same period was $333.7 million. The total annual spending increased from $237.6 million to $775.9 million, an increase of 226.5%. Patients' annual out-of-pocket spending increased from $41.4 million to $101.8 million, an increase of 145.9%. The total number of prescriptions were 7.7 million in 2011 and 10.6 million in 2015, an increase of 37.0%. Generic medication costs accounted for 97.8% of the total spending during this time period. The potential health care savings and out-of-pocket patient savings from substitution of the cheapest topical steroid within the corresponding potency class were $944.8 million and $66.6 million, respectively. Conclusions and Relevance: Most topical steroids prescribed were generic drugs. There has been a sharp increase in Medicare and out-of-pocket spending on topical steroids that is driven by higher costs for generics. Use of clinical decision support tools to enable substitution of the most affordable generic topical steroid from the corresponding potency class may reduce drug expenditures.
[Mh] Termos MeSH primário: Medicamentos Genéricos/administração & dosagem
Financiamento Pessoal/economia
Glucocorticoides/administração & dosagem
Medicare Part D/economia
[Mh] Termos MeSH secundário: Administração Tópica
Custo Compartilhado de Seguro/economia
Custos e Análise de Custo
Sistemas de Apoio a Decisões Clínicas
Dermatologia
Custos de Medicamentos
Medicamentos Genéricos/economia
Glucocorticoides/economia
Seres Humanos
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Drugs, Generic); 0 (Glucocorticoids)
[Em] Mês de entrada:1708
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170429
[St] Status:MEDLINE
[do] DOI:10.1001/jamadermatol.2017.1130


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[PMID]:29351299
[Au] Autor:Lungu EA; Guda Obse A; Darker C; Biesma R
[Ad] Endereço:HIV/AIDS Section, UNICEF Malawi, Lilongwe, Malawi.
[Ti] Título:What influences where they seek care? Caregivers' preferences for under-five child healthcare services in urban slums of Malawi: A discrete choice experiment.
[So] Source:PLoS One;13(1):e0189940, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Access to and utilisation of quality healthcare promotes positive child health outcomes. However, to be optimally utilised, the healthcare system needs to be responsive to the expectations of the population it serves. Health systems in many sub-Saharan African countries, including Malawi, have historically focused on promoting access to health services by the rural poor. However, in the context of increasing urbanisation and consequent proliferation of urban slums, promoting health of children under five years of age in these settings is a public health imperative. We conducted a discrete choice experiment to determine the relative importance of health facility factors in seeking healthcare for childhood illnesses in urban slums of Malawi. Caregivers of children under five years of age were presented with choice cards that depicted two hypothetical health facilities using six health facility attributes: availability of medicines and supplies, thoroughness of physical examination of the child, attitude of health workers, cost, distance, and waiting time. Caregivers were asked to indicate the health facility they would prefer to use. A mixed logit model was used to estimate the relative importance of and willingness to pay (WTP) for health facility attributes. Attributes with greatest influence on choice were: availability of medicines and supplies (ß = 0.842, p<0.001) and thorough examination of the child (ß = 0.479, p <0.001) with WTP of MK3698.32 ($11) (95% CI: $8-$13) and MK2049.13 ($6) (95% CI: $3-$9) respectively. Respondents were willing to pay 1.8 and 2.4 times more for medicine availability over thorough examination and positive attitude of health workers respectively. Therefore, strengthening health service delivery system through investment in sustained availability of essential medicines and supplies, sufficient and competent health workforce with positive attitude and clinical discipline to undertake thorough examination, and reductions in waiting times have the potential to improve child healthcare utilization in the urban slums.
[Mh] Termos MeSH primário: Cuidadores/psicologia
Serviços de Saúde da Criança
Comportamento de Escolha
Pobreza
População Urbana
[Mh] Termos MeSH secundário: Adolescente
Adulto
Serviços de Saúde da Criança/economia
Pré-Escolar
Financiamento Pessoal
Seres Humanos
Lactente
Estudos Longitudinais
Malaui
Inquéritos e Questionários
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0189940


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[PMID]:28468240
[Au] Autor:Alfonso NY; Alonge O; Hoque DME; Baset KU; Hyder AA; Bishai D
[Ad] Endereço:¹Department of Population Family and Reproductive health, International Injury Research Unit, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA. ynalfonso@jhu.edu.
[Ti] Título:Care-Seeking Patterns and Direct Economic Burden of Injuries in Bangladesh.
[So] Source:Int J Environ Res Public Health;14(5), 2017 04 29.
[Is] ISSN:1660-4601
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:This study provides a comprehensive review of the care-seeking patterns and direct economic burden of injuries from the victims' perspective in rural Bangladesh using a 2013 household survey covering 1.17 million people. Descriptive statistics and bivariate analyses were used to derive rates and test the association between variables. An analytic model was used to estimate total injury out-of-pocket (OOP) payments and a multivariate probit regression model assessed the relationship between financial distress and injury type. Results show non-fatal injuries occur to 1 in 5 people in our sample per year. With average household size of 4.5 in Bangladesh--every household has an injury every year. Most non-fatally injured patients sought healthcare from drug sellers. Less than half of fatal injuries sought healthcare and half of those with care were hospitalized. Average OOP payments varied significantly (range: $8-$830) by injury type and outcome (fatal vs. non-fatal). Total injury OOP expenditure was $$355,795 and $5000 for non-fatal and fatal injuries, respectively, per 100,000 people. The majority of household heads with injuries reported financial distress. This study can inform injury prevention advocates on disparities in healthcare usage, OOP costs and financial distress. Reallocation of resources to the most at risk populations can accelerate reduction of preventable injuries and prevent injury related catastrophic payments and impoverishment.
[Mh] Termos MeSH primário: Efeitos Psicossociais da Doença
Assistência à Saúde/economia
Assistência à Saúde/utilização
Ferimentos e Lesões/economia
[Mh] Termos MeSH secundário: Bangladesh
Financiamento Pessoal
Gastos em Saúde
Seres Humanos
Modelos Teóricos
População Rural
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180201
[Lr] Data última revisão:
180201
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170505
[St] Status:MEDLINE


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[PMID]:29304049
[Au] Autor:Subramanian S; Gakunga R; Kibachio J; Gathecha G; Edwards P; Ogola E; Yonga G; Busakhala N; Munyoro E; Chakaya J; Ngugi N; Mwangi N; Von Rege D; Wangari LM; Wata D; Makori R; Mwangi J; Mwanda W; East African Economics and Implementation Group (EAEIG)
[Ad] Endereço:Public Health Research Division, RTI International, Waltham, MA, United States of America.
[Ti] Título:Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors.
[So] Source:PLoS One;13(1):e0190113, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients' ability to pay for the services. METHODS AND FINDINGS: We collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer, and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital, and the Kibera South Health Center-a public outpatient facility, and private sector practitioners and hospitals. We developed detailed treatment frameworks for each NCD and used an itemization cost approach to estimate payments. Patient affordability metrics were derived from Kenyan government surveys and national datasets. Results compare public and private costs in U.S. dollars. NCD screening costs ranged from $4 to $36, while diagnostic procedures, particularly for breast and cervical cancer, were substantially more expensive. Annual hypertension medication costs ranged from $26 to $234 and $418 to $987 in public and private facilities, respectively. Stroke admissions ($1,874 versus $16,711) and dialysis for chronic kidney disease ($5,338 versus $11,024) were among the most expensive treatments. Cervical and breast cancer treatment cost for stage III (curative approach) was about $1,500 in public facilities and more than $7,500 in the private facilities. A large proportion of Kenyans aged 15 to 49 years do not have health insurance, which makes NCD services unaffordable for most people given the overall high cost of services relative to income (average household expenditure per adult is $413 per annum). CONCLUSIONS: There is substantial variation in patient costs between the public and private sectors. Most NCD diagnosis and treatment costs, even in the public sector, represent a substantial economic burden that can result in catastrophic expenditures.
[Mh] Termos MeSH primário: Financiamento Pessoal/economia
Custos de Cuidados de Saúde
Doenças não Transmissíveis
Setor Privado
Setor Público
[Mh] Termos MeSH secundário: Gerenciamento Clínico
Seres Humanos
Quênia
Doenças não Transmissíveis/terapia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180106
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190113


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[PMID]:29236403
[Au] Autor:Mizzen B
[Ti] Título:Canada's long-term care funding crisis.
[So] Source:Can Nurse;112(7):32, 2016 Oct.
[Is] ISSN:0008-4581
[Cp] País de publicação:Canada
[La] Idioma:eng
[Mh] Termos MeSH primário: Financiamento Pessoal
Assistência de Longa Duração/economia
[Mh] Termos MeSH secundário: Canadá
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180118
[Lr] Data última revisão:
180118
[Sb] Subgrupo de revista:IM; N
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29232091
[Au] Autor:Bush DM
[Ti] Título:The Risk of Living Too Long.
[So] Source:J Indiana Dent Assoc;95(3):9-10, 2016.
[Is] ISSN:0019-6568
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Odontólogos
Financiamento Pessoal
Seguro de Assistência de Longo Prazo
Aposentadoria
[Mh] Termos MeSH secundário: Seres Humanos
Indiana
Sociedades Odontológicas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180115
[Lr] Data última revisão:
180115
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:171213
[St] Status:MEDLINE


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[PMID]:29215235
[Au] Autor:Greenwald L; Copeland C; VanDerhei J
[Ti] Título:The 2017 Retirement Confidence Survey: Many Workers Lack Retirement Confidence and Feel Stressed About Retirement Preparations.
[So] Source:EBRI Issue Brief;(431):1-29, 2017 03 21.
[Is] ISSN:0887-137X
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Emprego/estatística & dados numéricos
Aposentadoria/economia
Aposentadoria/psicologia
Autoeficácia
[Mh] Termos MeSH secundário: Adulto
Idoso
Coleta de Dados/métodos
Feminino
Financiamento Pessoal/estatística & dados numéricos
Seres Humanos
Renda/estatística & dados numéricos
Inflação
Entrevistas como Assunto
Investimentos em Saúde/estatística & dados numéricos
Masculino
Meia-Idade
Pensões/estatística & dados numéricos
Previdência Social/estatística & dados numéricos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180108
[Lr] Data última revisão:
180108
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:171208
[St] Status:MEDLINE



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