| 1. |
- Johansson, Pia M, 1963-, et al.
(författare)
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Statistical modelling needed to find the effects from a community-based elderly safety promotion program.
- 2009
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 19:1, s. 100-105
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Tidskriftsartikel (refereegranskat)abstract
- Background: Multiple control areas and time-series analyses have been recommended for effect evaluations of community-based health promotion. Large fluctuations, maybe due to chance, among the areas and over the years might obscure the intervention effect. Methods: A quasi-experimental time-series analysis with several control areas was performed as an effect evaluation of a community-based elderly safety promotion program. The program was implemented during 199599 in a community in the Stockholm Metropolitan area (population 65 years: 5500; number of first hip fractures in 1995: 60). Four control areas were selected based on similar hip fracture-related characteristics as the intervention community, complemented with two larger control areas. The time series covered 6 years pre-intervention (199095) and 6 years post-intervention (19962001). The study population was divided into two age groups and gender, resulting in 28 panels. The first hip fracture incidence was obtained from the Swedish national in-patient register. Results: The time series revealed no discernible pattern, and conventional analyses showed no conclusive results. A multivariate analysis, examining the time trends by employing the intra-annual and intra-panel variance, revealed the underlying trends in hip fracture rates. Comparisons between predicted numbers of hip fractures in the intervention and control areas was enabled, which resulted in 14 less hip fractures in the intervention community than expected from the control communities. If one extreme value was altered, the result changed considerably. Conclusion: Effect evaluations of community-based health promotion programs using time-series from small communities might give faulty results, if statistical modelling is not employed.
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| 2. |
- Johansson, Pia, et al.
(författare)
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Participation, resource mobilisation and financial incentives in community-based health promotion - an economic evaluation perspective from Sweden.
- 2009
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Ingår i: Health Promotion International. - : Oxford University Press (OUP). - 0957-4824 .- 1460-2245. ; 24:2, s. 177-184
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Tidskriftsartikel (refereegranskat)abstract
- Local community participation is an important objective for many health promotion interventions, but it hinges on the incentives for local organizations to participate. Both aspects might be explored with information obtained from economic evaluations, illustrated in this study with data from a cost-effectiveness analysis of an elderly safety promotion programme implemented in Sweden. Previously, resource mobilization has been used as a process indicator for successful community participation. We propose that resource mobilization can be measured as the proportion of total intervention costs paid by collaborators. In the case presented here, local collaborators contributed 50 per cent of the total intervention costs (SEK 6.45 million, in Swedish krona 2004; 1 USD = 7.35 SEK), while participants, i.e. the elderly in the intervention area, contributed 13 per cent and the remainder, 37 per cent, was paid by project funds. In a subsector financial analysis, the distribution of costs and financial benefits from interventions among different sectors in society is described. The estimated financial benefits in the case were divided between the health-care system (SEK 2.5 million), the local authority (SEK 3.7 million) and the elderly and their relatives (SEK 0.3 million). The only net beneficiary was the local authority. In the case presented here, the health promotion objective of local community participation was achieved as half of the total costs was mobilized from local collaborators. The local community participation objective was supported by financial incentives for at least one key collaborator.
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| 3. |
- Dong, Hengjin, et al.
(författare)
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A description of outpatient drug use in rural China : evidence of differences due to insurance coverage
- 1999
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Ingår i: International Journal of Health Planning and Management. - 0749-6753 .- 1099-1751. ; 14:1, s. 41-56
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes the effects of health financing systems (insurance) on outpatient drug use in rural China. 1320 outpatients were interviewed (exit interview) in the randomly selected county, township and village health care facilities in five counties in three provinces of central China. The interview was face to face. Questions were asked by a trained interviewer and were answered by patient him/herself. The main finding was that health insurance appeared to influence drug use in outpatient services. The average number of drugs per visit was 2.56 and drug expenditures per visit was 16.9 yuan. Between insured and uninsured (out-of-pocket) groups, there were significant differences in the number of drugs and drug expenditures per visit. The insured had a lower number of drugs and a higher drug expenditure per visit than the uninsured, implying the use of more expensive drugs per visit than the uninsured. There were also significant differences in the number of drugs and drug expenditures per visit between the types of insurance. One third of the drugs were anti-infectives, most of which were penicillin, gentamycin, and sulfonamides. The results imply that uninsured patients do not receive the same care as the insured do even if they have the same needs. The fee-for-service financing for hospitals and health insurance have changed health providers' and consumers' behaviour and resulted in the increase of medical expenditure.
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| 4. |
- Dong, Hengjin, et al.
(författare)
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Association between health insurance and antibiotics prescribing in four counties in rural China
- 1999
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Ingår i: Health Policy. - 0168-8510 .- 1872-6054. ; 48:1, s. 29-45
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Tidskriftsartikel (refereegranskat)abstract
- A cross-sectional study was carried out at county, township and village health care facilities in four counties in rural China in order to describe and compare the effects of health financing systems on antibiotic prescribing in outpatient care. A total of 1232 outpatients at the health care facilities was selected by multi-stage random sampling and were interviewed over 2 weeks. The results showed that health financing systems appeared to influence antibiotic prescribing in outpatient care, both in terms of frequency and of the types prescribed. The insured group had lower prescribing of antibiotics at township and village health care facilities, and for respiratory tract infections, but had higher prescribing of newer antibiotics at county and village health care facilities, for respiratory tract and g-i infections. Because there was a high patient compliance rate (94.3%) in this study the prescribing of antibiotics (supply side behavior) reflected the use of antibiotics (demand side behavior) to a great extent. Thus the results imply that antibiotics prescribing and using might be biased by the patient's health financing systems and antibiotic prescribing was the result of the interaction between physicians and patients.
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| 5. |
- Dong, Hengjin, et al.
(författare)
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Drug policy in China : pharmaceutical distribution in rural areas.
- 1999
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Ingår i: Social Science and Medicine. - : Elsevier. - 0277-9536 .- 1873-5347. ; 48:6, s. 777-786
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Tidskriftsartikel (refereegranskat)abstract
- In 1978, China decided to reform its economy and since then has gradually opened up to the world. The economy has grown rapidly at an average of 9.8% per year from 1978 to 1994. Medical expenditure, especially for drugs, has grown even more rapidly. The increase in medical expenditure can be attributed to changing disease patterns, a higher proportion of older people in the population and fee-for-service incentives for hospitals. Due to the changing economic system and higher cost of health care, the Chinese government has reformed its health care system, including its health and drug policy. The drug policy reform has led to more comprehensive policy elements, including registration, production, distribution, utilization and administration. As a part of drug policy reform, the drug distribution network has also been changed, from a centrally controlled supply system (push system) to a market-oriented demand system (pull system). Hospitals can now purchase drugs directly from drug companies, factories and retailers, leading to increased price competition. Patients have easier access to drugs as more drugs are available on the market. At the same time, this has also entailed negative effects. The old drug administrative system is not suitable for the new drug distribution network. It is easy for people to get drugs on the market and this can lead to overuse and misuse. Marketing factors have influenced drug distribution so strongly that there is a risk of fake or low quality drugs being distributed. The government has taken some measures to fight these negative effects. This paper describes the drug policy reform in China, particularly the distribution of drugs to health care facilities.
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