| 1. |
- Jansson, Sven-Arne, et al.
(författare)
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The economic consequences of asthma among adults in Sweden.
- 2007
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Ingår i: Respiratory medicine. - : Elsevier BV. - 0954-6111 .- 1532-3064. ; 101:11, s. 2263-70
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Asthma is a common disease in most countries. The objective of this study was to estimate the societal costs for subjects with asthma. METHODS: Telephone interviews regarding resource utilization were made in a representative sample of 115 randomly selected subjects with asthma derived from a large population study of obstructive airway diseases. Direct and indirect costs were measured, and the costs were also transformed with the estimated prevalence of asthma in Sweden. RESULTS: Average annual costs were SEK 15919 (USD 1592; EUR 1768) per subject with asthma in the ages between 25 and 56 years. The direct and indirect costs were SEK 4931 (31.0%) and SEK 10988 (69.0%), respectively, and were highly dependent of age and disease severity. Assuming that the prevalence is representative for Sweden as a whole, the asthmatics would amount to 226000 in the ages between 25 and 56 years, corresponding to an overall prevalence in Sweden of 6-7%. The total costs of asthma for the society amounted thus to SEK 3.7 billion in these ages. CONCLUSIONS: The total costs of asthma for the society could be estimated at 3.7 billion SEK in the age range of 25-56 years, and thus approximately twice as high in the whole population of Sweden. The costs were strongly dependent on disease severity and increasing age.
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| 2. |
- Lemma, Hailemariam, et al.
(författare)
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Adherence to a six-dose regimen of artemether-lumefantrine among uncomplicated Plasmodium falciparum patients in the Tigray Region, Ethiopia
- 2011
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Ingår i: Malaria Journal. - : Springer Science and Business Media LLC. - 1475-2875. ; 10, s. 349-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In 2004, Ethiopia switched its first-line treatment of uncomplicated Plasmodium falciparum malaria from sulphadoxine-pyrimethamine to a fixed artemisinin-based combination therapy (ACT), artemether-lumefantrine (AL). Patient adherence to AL regimen is a major determining factor to achieve the desired therapeutic outcome. The aim of this study was to measure patient adherence levels to the six-dose AL regimen for the treatment of uncomplicated P. falciparum malaria and to identify its determinant factors in rural areas of the Tigray region, EthiopiaMETHODS: The study was conducted under routine health service delivery at health posts level. Patients/caregivers were not informed about their home visit and were traced on the day after they finished the AL regimen. By combining the response to a structured questionnaire and the tablet count from the blister, adherence level was classified into three categories: definitely non-adherent, probably non-adherent and probably adherent. Reasons for being definitely non-adherent were also assessed. For the purpose of examine risk factors, definitely non-adherent and probably non-adherent was merged into a non-adherent group. Variables found significantly associated (p < 0.05) with the adherence level on the univariate analysis were fitted into a multivariate logistic regression model.RESULTS: Out of the total initially enrolled 180 patients, 86.1% completed the follow-up. Out of these, 38.7% were classified as probably adherent, 34.8% as probably non-adherent, and 26.5% were definitely non-adherent. The most common reasons that definitely non-adherents gave for not taking the full dose were "too many tablets" (37.3%) and to "felt better before finished the treatment course" (25.5%). The adherence of the patients was associated with the ownership of a radio (adjusted odd ratio, AOR: 3.8; 95% CI: 1.66-8.75), the belief that malaria can be treated traditionally (AOR: 0.09; 95% CI: 0.01-0.78) and a delay of more than one day in seeking treatment after the onset of fever (AOR: 5.39; 95% CI: 1.83-15.88).CONCLUSION: The very low adherence to AL found in this study raises serious concerns for the malaria control in the region. The implementation of a monitoring adherence system is essential to ensure long-term treatment efficacy.
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| 3. |
- Lemma, Hailemariam, et al.
(författare)
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Cost-effectiveness of three malaria treatment strategies in rural Tigray, Ethiopia where both Plasmodium falciparum and Plasmodium vivax co-dominate
- 2011
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Ingår i: Cost Effectiveness and Resource Allocation. - : BioMed Central (BMC). - 1478-7547. ; 9, s. 2-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Malaria transmission in Ethiopia is unstable and the disease is a major public health problem. Both, p.falciparum (60%) and p.vivax (40%) co-dominantly exist. The national guideline recommends three different diagnosis and treatment strategies at health post level: i) the use of a p.falciparum/vivax specific RDT as diagnosis tool and to treat with artemether-lumefantrine (AL), chloroquine (CQ) or referral if the patient was diagnosed with p.falciparum, p.vivax or no malaria, respectively (parascreen pan/pf based strategy); ii) the use of a p.falciparum specific RDT and AL for p.falciparum cases and CQ for the rest (paracheck pf based strategy); and iii) the use of AL for all cases diagnosed presumptively as malaria (presumptive based strategy). This study aimed to assess the cost-effectiveness of the recommended three diagnosis and treatment strategies in the Tigray region of Ethiopia.METHODS: The study was conducted under a routine health service delivery following the national malaria diagnosis and treatment guideline. Every suspected malaria case, who presented to a health extension worker either at a village or health post, was included. Costing, from the provider's perspective, only included diagnosis and antimalarial drugs. Effectiveness was measured by the number of correctly treated cases (CTC) and average and incremental cost-effectiveness calculated. One-way and two-way sensitivity analyses were conducted for selected parameters.RESULTS: In total 2,422 subjects and 35 health posts were enrolled in the study. The average cost-effectiveness ratio showed that the parascreen pan/pf based strategy was more cost-effective (US$1.69/CTC) than both the paracheck pf (US$4.66/CTC) and the presumptive (US$11.08/CTC) based strategies. The incremental cost for the parascreen pan/pf based strategy was US$0.59/CTC to manage 65% more cases. The sensitivity analysis also confirmed parascreen pan/pf based strategy as the most cost-effective.CONCLUSION: This study showed that the parascreen pan/pf based strategy should be the preferred option to be used at health post level in rural Tigray. This finding is relevant nationwide as the entire country's malaria epidemiology is similar to the study area.
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| 4. |
- Lemma, Hailemariam, 1966-
(författare)
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Improving efficiency, access to and quality of the rural health extension programme in Tigray, Ethiopia : the case of malaria diagnosis and treatment
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Ensuring universal access to primary health care (PHC) is a key component of the Ethiopian nationalhealth policy. The policy also emphasises promoting and enhancing national self-reliance in health development bymobilizing and efficiently utilizing resources including community participation. To this end, the government introducedthe accelerated expansion of the PHC strategy through a comprehensive health extension programme (HEP). HEP is afamily and community-based health care delivery system institutionalised at health post level which combines carefullyselected high impact promotive, preventive and basic curative interventions. All HEP interventions are promotive and preventive except the malaria intervention which, in addition, incorporates a curative service. In the country, malaria is a leading disease. Unlike most Sub-Saharan African countries where P. falciparum accounts for almost all malaria infections, in Ethiopia both P. falciparum and P. vivax are co-dominant. Considering this peculiar epidemiological nature, the national guideline recommends alternative diagnosis and treatment strategies. Rationale: The lack of adequate resources and the efficiency with which available resources are being utilised are the main challenges in any health care setting. Therefore, if the HEP which consumes consideral amount of resource desires to reach its intended goal, monitoring and improving its efficiency is of great public heath importance. HEP has been successful in improving access to PHC including the malaria diagnosis and treatment service. Though this is a crucial measure, its quality ought to be considered. For the malaria curative service, studying the cost-effectiveness of the available strategy and patients’ adherence to the treatment regimen can be considered as proxy measures of quality for which local evidence is lacking. However, none of the existing studies in this field of research has addressed the Ethiopian malaria epidemiological context and its diagnosis and treatment guideline. In Tigray, for more than two decades, access to malaria early diagnosis and prompt treatment was facilitated by volunteer community healthworkers (CHWs). However, with the introduction of artemether-lumefantrine (AL) the service was compromised mainly for reasons of cost, safety and logistic. Therefore, it was important to explore the feasibility and the impact of community deployment of AL with rapid diagnostic tests (RDTs). The aim: to explore the overall performance of HEP and particularly the access to and quality of malaria early diagnosis and prompt treatment in the Tigray region of Ethiopia. Methods: Different study designs and populations were used for each of the four specific objectives. Data envelop analysis (DEA) was applied to assess the HEP efficiency. For this, register data for the output variables and primary data for the input and the environmental factors were collected. A health provider perspective cost-effectiveness analysis was used to determine which among the currently available diagnostic and treatment strategies is best for the country. Effectiveness data were generated from a stratified cross-sectional survey and secondary data were used to calculate the cost. For measuring adherence to the six-dose AL regimen, an assessment questionnaire and pill count was employed at patients´ home. To determine whether deploying AL with RDT at community level was feasible and effective, a number of designs were used: longitudinal follow-up, cross-sectional surveys, cost analysis, verbal autopsyquestionnaires and focal group discussions. Main findings: More than three-quarters of the health posts were found to be technically inefficient with an average score of 42%, which implies potentially they could improve their efficiency by 58%. Scale of operation was not a cause of inefficiency. None of the considered environmental factors was associated with efficiency. The Parascreen-based strategy (multispecies RDT-BS) was found to be the most cost-effective strategy, which allowed treating correctly an additional 65% of patients with less cost than the paracheck-BS. Presumptive-BS was highly dominated. Among P.falciparum positive patients to whom AL was prescribed, more than a quarter did not finish their treatment. The main reasons for interrupting the dose were ‘too many tablets’ and ‘felt better before finishing the dose’. The ownership of aradio, the belief that malaria cannot be treated traditionally and a delay of more than one day in seeking treatment after the onset of fever were significantly associated with being adherent. Deploying AL with RDT at community level was demonstrated to be effective and feasible. In the intervention district, almost 60% of suspected cases were managed by CHWs. Malaria transmission was lower at least threefold and malaria mortality risk by around 40% compared to the control district. The use of RDTs reduced cost and possibly the risk of drug resistance development. Conclusion: Though improving access to health care is important, it should be considered a means, not an end. Themore accessible a system is the more people could utilise it to improve their health. Thus, ensuring the access obtainedthrough HEP is maintained, its quality is improved and efficiently utilised to its optimal productivity level is a necessarytask. The DEA study revealed a high level of inefficiency where majority of the health posts needed improvement.This thesis also found parascreen-BS to be the most cost-effective strategy and that there is no epidemiological andeconomical contextual justification to keep both, the presumptive-BS and the RDT-BS specific only to P.falciparum.The high poor adherence levels raises great concern as it leads to recurrent malaria attacks of the patient, speed upthe development and spread of drug resistance strains and reduces the effect of the drug on the transmission. Therefore,providing effective drug alone is not sufficient; assessing and monitoring adherence to the treatment is by faressential. Deployment of AL with RDT through a community-based service has shown an enormous impact in termsof cost, transmission, morbidity and mortality. However, it is worth noting that this results came from an area wherea community-based service has been involved in the PHC system for more than three decades.
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| 5. |
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| 6. |
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| 7. |
- Löfgren, Curt, 1950-
(författare)
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Catastrophic health expenditure in Vietnam : studies of problems and solutions
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In Vietnam, problems of high out-of-pocket payments for health, leading to catastrophic health expenditure and resulting impoverishment for vulnerable groups, has been at focus in the past decades. Since the beginning of the 1990’s, the Vietnamese government has launched a series of social health insurance reforms to increase prepayment in the health sector and thereby better protect the population from the financial consequences of health problems.Objective: The objective of this thesis is to contribute to the discussion in Vietnam on how large the problems of catastrophic health expenditure are in the population as a whole and in a special subgroup; the elderly households, and to assess important aspects on health insurance as a means to reduce the problems.Methods: Catastrophic health expenditure has been estimated, using an established and common method, from two different data sources; the Epidemiological Field Laboratory for Health Systems Research (FilaBavi) in the Bavi district, and Vietnam Household Living Standards Survey (VHLSS) 2010. Results from two cross-sectional analyses and a panel study have been compared, to gain information on whether the estimates of catastrophic health spending may be overestimated when using cross-sectional data. Then, the size of the problem for one group, the elderly households; hypothesized to be particularly vulnerable in this context, has been estimated. The question of to what extent a health insurance reform; the Health Care Funds for the Poor (HCFP), has offered protection for the insured against health spending is being assessed in another study over the period 2001 – 2007, using propensity score matching. The value that households attach to health insurance has also been explored through a willingness to pay (WTP) study.Results: Comparing results from two cross-sectional studies with a panel study over a full year in which the respondents were interviewed once every month, the estimates of catastrophic spending vary largely. The monthly estimates in the panels study are half as large as the cross-sectional estimates; the latter also having a recall period of one month. Among the elderly households, catastrophic health spending and impoverishment are found to be problems three times as large as for the whole population. However, household health care expenditure as a percentage of total household expenditure was affected by the HCFP, and significantly reduced for the insured. In the study of household WTP for health insurance, it was iiifound that households attach a low value to this insurance form; WTP being only half of household health expenditure.Conclusions: Cross-sectional studies of catastrophic spending with a monthly recall period are likely to be affected by recall bias leading to overestimations through respondents including expenditure in the period preceding the recall period. However, such problems should not deter researchers form studying this phenomenon. If using the same method, estimates of catastrophic spending and impoverishment can be compared between different groups – as for the elderly households – and over time; e.g. studying the protective capacity of health insurance. It should be used more, not less. The VHLSS rounds offer the Vietnamese a possibility to regularly study this. The HCFP were found to be partly protective but important problems remain to be solved, e.g. the fact that people are reluctant to use their health insurance because of e.g. quality problems and possible discrimination of the insured. The findings of a low WTP for health insurance may be another reflection of this.
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| 8. |
- Löfgren, Curt, et al.
(författare)
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Is cardiac consultation with remote-controlled real-time echocardiography a wise use of resources?
- 2009
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Ingår i: Telemedicine journal and e-health. - : Mary Ann Liebert Inc. - 1530-5627 .- 1556-3669. ; 15:5, s. 431-438
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Tidskriftsartikel (refereegranskat)abstract
- Northern Sweden is a sparsely populated area with six hospitals and about 50 healthcare centers. The elderly population is a large proportion of the total of population, and the incidence of cardiovascular disease is high. The objective of this research was to analyze the costs and benefits of cardiac consultation in healthcare centers involving long-distance, remote-controlled, real-time echocardiography. The distance diagnostics were developed and tested in two healthcare centers. Experiences of the feasibility of this approach were used as a basis for an economic analysis with regard to heart failure. The societal costs for two different systems were calculated, namely, traditional hospital diagnosis versus distance diagnosis using the new system. The potential prime gainers were the patients. Their traveling time, and thereby their time costs, were significantly reduced. The quality of care may also have been improved. From the health authorities' perspective, the costs of the two systems were approximately equal. Since county council costs are not greatly affected, the large reduction in patient travel time and the improved quality of care ought to be a sufficient incentive for large-scale tests.
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| 9. |
- Löfgren, Curt, et al.
(författare)
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People's willingness to pay for health insurance in rural Vietnam
- 2008
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Ingår i: Cost Effectiveness and Resource Allocation. - : BioMed Central (BMC). - 1478-7547. ; 6, s. 16-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The inequity caused by health financing in Vietnam, which mainly relies on out-of-pocket payments, has put pre-payment reform high on the political agenda. This paper reports on a study of the willingness to pay for health insurance among a rural population in northern Vietnam, exploring whether the Vietnamese are willing to pay enough to sufficiently finance a health insurance system.METHODS: Using the Epidemiological Field Laboratory for Health Systems Research in the Bavi district (FilaBavi), 2070 households were randomly selected for the study. Existing FilaBavi interviewers were trained especially for this study. The interview questionnaire was developed through a pilot study followed by focus group discussions among interviewers. Determinants of households' willingness to pay were studied through interval regression by which problems such as zero answers, skewness, outliers and the heaping effect may be solved.RESULTS: Households' average willingness to pay (WTP) is higher than their costs for public health care and self-treatment. For 70-80% of the respondents, average WTP is also sufficient to pay the lower range of premiums in existing health insurance programmes. However, the average WTP would only be sufficient to finance about half of total household public, as well as private, health care costs. Variables that reflect income, health care need, age and educational level were significant determinants of households' willingness to pay. Contrary to expectations, age was negatively related to willingness to pay.CONCLUSION: Since WTP is sufficient to cover household costs for public health care, it depends to what extent households would substitute private for public care and increase utilization as to whether WTP would also be sufficient enough to finance health insurance. This study highlights potential for public information schemes that may change the negative attitude towards health insurance, which this study has uncovered. A key task for policy makers is to win the trust of the population in relation to a health insurance system, particularly among the old and those with relatively low education.
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| 10. |
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| 11. |
- Löfgren, Curt, et al.
(författare)
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What determines when undergraduates complete their theses? : Evidence from two economics departments
- 1999
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Ingår i: Economics of Education Review. - 0272-7757 .- 1873-7382. ; 18:1, s. 79-88
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Tidskriftsartikel (refereegranskat)abstract
- Most economics students at Uppsala and Umeå do not complete their undergraduate thesis within the intended time. We find that coauthoring, compared to writing alone, increases the probability of completing a thesis. A second thesis is less likely to be completed than a first. The two departments also differ in completion time. The probability of completing decreases over time. There is also some weaker evidence that students with high grades are more likely to complete and that women take a longer time to complete their theses.
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| 12. |
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| 13. |
- Munkholm, Michaela, 1967-
(författare)
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Occupational performance in school settings : evaluation and intervention using the school AMPS
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: This thesis is was designed to evaluate aspects of reliability and validity of the School Version of the Assessment of Motor and Process Skills (School AMPS) (Fisher, Bryze, Hume, & Griswold, 2007), an observation-based evaluation of quality of occupational performance when children perform schoolwork tasks in school settings. The long term goal was to contribute to knowledge about children at risk or with mild disabilities who experience difficulties with occupational performance in school settings, and describe how the School AMPS can be used when a true top−down process of planning and implementing school-based occupational therapy services is implemented in a Swedish context. Methods: In Study I, two different split-half methods and were used to estimate reliability of the School AMPS measures. These were cross-validated using Rasch equivalent of Cronbach’s alpha. The standard error of measurement (m) was also calculated. In Studies II and III, many-facet Rasch analyses and/or relevant inferential statistics (e.g., ANOVA, tests) were used to examine for evidence of validity based on (1) internal structure related to differential item functioning (DIF), (2) relations to other variables (sensitivity) in terms of comparing groups (typically-developing children vs. children with mild disabilities), and (3) consequences of testing (benefits of testing) in terms of test fairness. In Study IV, ANOVA and tests were used to examine relations to other variables in terms of sensitivity of the School AMPS measures for detecting change based on repeated School AMPS evaluations pre- and post-interventions. Results: The three methods for estimating reliability of the School AMPS measures yielded high reliability coefficient estimates (≥0.73) and low ms. Minimal DIF was identified, and despite minimal DIF, the School AMPS measures were found to be free of differential test functioning. The School AMPS measures were sensitive enough to detect differences between groups as well as changes following consultative occupational therapy services provided in natural school settings. Conclusions: The results support the reliability and validity of the School AMPS scales and measures when used to evaluate quality of occupational performance in school settings. The results are also of clinical importance as they provide evidence that occupational therapists can have confidence in the School AMPS measures when they are used in the process of making decisions about individual students, planning interventions, and later perform follow-up evaluations to measure the outcomes. We also have objective evidence that children with mild disabilities demonstrate diminished quality of "doing" when performing schoolwork tasks. The potential long term benefits of such evidence may be to support or justify the need for children with mild disabilities to receive occupational therapy services within school settings in Sweden; and through collaboration with teachers, plan and implement better targeted and more effective interventions.
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| 14. |
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| 15. |
- Norström, Fredrik, et al.
(författare)
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Parents' willingness to pay for coeliac disease screening of their child.
- 2011
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Ingår i: Journal of Pediatric Gastroenterology and Nutrition - Jpgn. - 1536-4801 .- 0277-2116. ; 52:4, s. 452-459
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: : The aim of this study is to determine Swedish parents' willingness to pay (WTP) for coeliac disease (CD) screening of their child. SUBJECTS AND METHODS: : CD screening was undertaken involving 10,041 12-year-old children, with 7567 (75%) agreeing to participate. Blood samples from the children were analysed for CD serological markers. Parents received a questionnaire including a scenario describing the health-related risks of having CD and screening and diagnostic procedures. Parents were also asked whether they were willing to pay for CD screening, should this not be offered free of charge, and, if so, what their maximum WTP would be. Their WTP was compared with the average cost per child for the screening and case ascertainment procedures. RESULTS: : The questionnaire was answered by 6524 parents, and of 6057 valid responses 63% stated that they were willing to pay something. The mean WTP was 79 EUR and the median 10 EUR. The average cost per child for the screening and case ascertainment procedures was 47 EUR, which 23% of the parents stated they were willing to pay. Parents' WTP increased with higher education and income, and with child symptoms that may indicate CD. CONCLUSIONS: : Swedish parents' WTP for school-based CD screening of their child was higher than the average cost per child; however, only a minority of the parents were willing to pay that amount.
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| 16. |
- Sahlen, Klas-Göran, 1957-, et al.
(författare)
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Measuring the value of older people's production : a diary study
- 2012
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963.
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Tidskriftsartikel (refereegranskat)abstract
- Background: The productive capacity of retired people is usually not valued. However, some retirees produce much more than we might expect. This diary-based study identifies the activities of older people, and suggests some value mechanisms. One question raised is whether it is possible to scale up this diary study into a larger representative study.Methods: Diaries kept for one week were collected among 23 older people in the north of Sweden. The texts were analysed with a grounded theory approach; an interplay between ideas and empirical data.Results: Some productive activities of older people must be valued as the opportunity cost of time or according to the market value, and others must be valued with the replacement cost. In order to make the choice between these methods, it is important to consider the societal entitlement. When there is no societal entitlement, the first or second method must be used; and when it exists, the third must be used.Conclusions: An explicit investigation of the content of the entitlement is needed to justify the choice of valuation method for each activity. In a questionnaire addressing older people's production, each question must be adjusted to the type of production. In order to fully understand this production, it is important to consider the degree of free choice to conduct an activity, as well as health-related quality of life.
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| 17. |
- Sahlen, Klas Göran, 1957-, et al.
(författare)
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Preventive home visits to older people are cost-effective
- 2008
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Ingår i: Scandinavian Journal of Public Health. - : SAGE. - 1403-4948 .- 1651-1905. ; 36, s. 265-271
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Tidskriftsartikel (refereegranskat)abstract
- Aims: There is ongoing debate over the effectiveness of preventive home visits (PHVs) for the elderly. A municipality in the north of Sweden carried out a controlled trial of such visits. Healthy seniors aged 75 years and over received two PHVs per year over 2 years. The aim of this study was to do a cost utility analysis of the intervention. Methods: The intervention group (n=196) was compared with a control group (n=346), and a cost utility analysis was performed. The analysis was carried out with three different time perspectives. Data were sourced from official documents and medical and social records. Results: From a societal perspective, using a time period of 4 years, the analysis of PHVs to healthy seniors showed net savings. When including estimated future costs for health and elderly care during gained life years, the result changed from a net saving to a cost of Euro 200,000. A lifetime perspective also resulted in net savings if the costs of future health and elderly care were not included in the analysis. In this case, the total costs rose to approximately Euro 900,000. The cost could also be expressed as Euro 14,200 per quality-adjusted life year gained if future costs for elderly care and healthcare were included. Conclusions: PHVs represent a cost-effective intervention in this setting. The costs are justified by the outcomes.
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| 18. |
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| 19. |
- Thanh, Nguyen Xuan, et al.
(författare)
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An assessment of the implementation of the Health Care Funds for the Poor policy in rural Vietnam.
- 2010
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Ingår i: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 98:1, s. 58-64
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Tidskriftsartikel (refereegranskat)abstract
- User fees at public health care facilities and out-of-pocket payments for health care services are major health financing problems in Vietnam. In 2002, the Government launched the Health Care Funds for the Poor (HCFP) policy which offered free public health care services to help the poor access public health services and reduce their health care expenditure (HCE). This paper is an assessment of the implementation of the HCFP in a rural district of Vietnam. The impacts of HCFP on household HCE as a percentage of total expenditure and health care utilization were assessed by a double-difference propensity score matching method using panel data of 10,711 households in 2001, 2003, 2005 and 2007. The results showed that the HCFP significantly reduced the HCE as a percentage of total expenditure and increased the use of the local public health care among the poor. However, the impacts of HCFP on the use of the higher levels of public health care and the use of go-to-pharmacies were not significant. In conclusion, this assessment indicates that the HCFP has met its objectives by reducing HCE for the poor and increasing their use of the local public health care services. However, further efforts are needed to help them access higher levels of public health care. Pharmacists should be better regulated and incorporated with primary health care to improve efficiency of the system.
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| 20. |
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| 21. |
- Thuan, Nguyen Thi Bich, et al.
(författare)
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Are the estimates of catastrophic health expenditure among rural poopulation too high? A comparison of studies in Vietnam.
- 2008
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Ingår i: Open Public Health Journal. - : Bentham Open. - 1874-9445. ; 1, s. 25-31
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To describe the proportion of the households that experienced catastrophic health expenditure and to compare the magnitude of catastrophic health expenditure that is estimated from three different data sets in Vietnam.Methods: The study we are comparing with is based on data from the Vietnam Living Standard Survey (VLSS) 1997/98. We have used data from the 2001 re-survey. The FilaBavi sample consists of 11,089 households. We have also conducted a special survey from July 2001 to June 2002. The sample is smaller, 629 households, but they have been followed for an entire year with monthly interviews. For VLSS and FilaBavi, re-census survey households were interviewed once with a recall period of one month.Findings: In the VLSS data and in the FilaBavi re-census survey it was found that 9%-10% of the households experienced catastrophic healthcare spending. But, only 5% (average per month) and 1% (for the whole year) of the households in the special survey report catastrophic spending.Conclusions: We suggest that the major reason for the difference in the estimates is the different data collection methods. When doing a cross sectional study with a relatively short recall period there is a risk that households will tend to overestimate non-recurrent large expenditures as that for health.
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| 22. |
- Thuan, Nguyen Thi Bich, et al.
(författare)
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Choice of healthcare provider following reform in Vietnam
- 2008
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 8, s. 162-
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Vietnam, the health-sector reforms since 1989 have lead to a rapid increase in out-of-pocket expenses. This paper examines the choice of medical provider and household healthcare expenditure for different providers in a rural district of Vietnam following healthcare reform.Methods: The study consisted of twelve monthly follow-up interviews of 621 randomly selected households. The households are part of the FilaBavi project sample – Health System Research Project. The heads of household were interviewed at monthly intervals from July 2001 to June 2002.Results: The use of private health providers and self-treatment are quite common for both episodes (60% and 23% of all illness episodes) and expenditure (60% and 12.8% of healthcare expenditure) The poor tend to use self-treatment more frequently than wealthier members of the community (31% vs. 14.5% of illness episodes respectively). All patients in this study often use private services before public ones. The poor use less public care and less care at higher levels than the rich do (8% vs.13% of total illness episodes, which decomposes into 3% vs. 7% at district level, and 1% vs. 3% at the provincial or central level, respectively). The education of the patients significantly affects healthcare decisions. Those with higher education tend to choose healthcare providers rather than self-treatment. Women tend to use drugs or healthcare services more often than men do. Patients in two highest quintiles use health services more than in the lowest quintile. Moreover, seriously ill patients frequently use more drugs, healthcare services, public care than those with less severe illness.Conclusion: The results are useful for policy makers and healthcare professionals to (i) formulate healthcare policies-of foremost importance are methods used to reduce self-treatment and no treatment; (ii) the management of private practices and maintaining public healthcare providers at all levels, particularly at the basic levels (district, commune) where the poor more easily can access healthcare services, is also important, as is the management of private practices and (iii) provide a background for further studies on both short and long-term health service strategies.
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