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Introduction: Maternal health is essential to ensure the good health of the mother as well as children and by extension, the whole family. Despite the various measures launched by the government to enhance maternal care services, the utilization remains at large. Method: A community-based face to face interview was conducted using a pre-tested structured survey questionnaire to find out maternal health service utilization among mothers in Mahankal Rural Municipality, Lalitpur, Nepal, during Feb-Jun 2020. A probability simple random sampling was used to select mothers having children aged between 1 to 3 y. A score of ≥mean was considered good utilization and below it a poor utilization. The study was approved by the ethical committee. The SPSS 16 was used for descriptive (frequency, mean) and comparative analysis by chi square between demographics and health service utilization. Result: There were a total of 178 mothers surveyed, the mean age of 25.9±4.4 y, 77(43.3%) had completed elementary school, and 147(82.6%) were farmers. Good utilization of maternal health service 98(55%) and poor utilization 80(45%). The majority 153(86%) had ≥4 Antenatal checkups, 55(30.9%) had delivered at home despite the government incentive for institutional delivery, 105(59%) had postnatal visits ≥1, and 18(10%) had 3 postnatal visits. Conclusion: The study revealed that slightly more than half (55%) of mothers surveyed had good utilization of maternal health services. Keywords: maternal health services, mothers, utilization

Although the positive developmental effects of infrastructure provisioning are well documented, research on the potential role of governance in the improvement of infrastructure performance and individual-level service utilization is lacking. I explore the effect of infrastructure provisioning on individual-level health service utilization, paying close attention to whether governance at different levels shapes people's access to health care. The different geographical levels of infrastructure provisioning, governance, and health service utilization require a multilevel analysis, which I perform using Afrobarometer Round 5 survey data on 34 African countries in a three-stage mixed-effects modeling. Results show that the presence of health infrastructure is crucial for enhancing people's health service utilization. However, people encounter certain problems when receiving services at their local health clinics or hospitals, and these problems are directly linked with governance in the health sector as well as overall governance at the country level. Improvements in people's health service utilization therefore require both better infrastructure provisioning and better governance at different levels, as the former does not guarantee the latter. Development scholars need to widen their focus beyond national-level governance and help policy makers identify at which level state interventions are most needed for removing barriers to development.

Abstract
Background and Purpose: Chronic diseases and associated co-morbidities are highly prevalent among elderly and are associated with an increase in health services utilization which in turn raises health care expenditures throughout industrialized societies. However, health care utilization in elderly is still inadequately understood, particularly regarding the differences among European jurisdictions. In our article, we use dataset of Wave 5 of SHARE survey to study the utilization of health care in older Europeans in 15 European countries.
Design/Methodology/Approach: We investigate relationships between factors such as age, gender, income, education and health variables and the utilization of various types of health services. We apply regression modeling to study the determinants of health utilization (different socioeconomic and health variables) of older people.
Results: We show some significant differences between determinants of health utilization in terms of probability and frequency of usage. We also explore patterns between welfare regimes, taking Eastern European jurisdictions as a reference category. Finally, we show that in a simple causal model the provision of formal and/or informal homecare serves as a complement to utilization of health care services.
Conclusion: Results of our article are important for the management of health care facilities in terms of health care usage by older people, and can be of value to health care providers and policy makers in the field.

Aim: Youth unemployment is associated with increased levels of anxiety, depression, alcohol abuse, reduced self-esteem and satisfaction with life. Up to date data based on standardized psychiatric diagnostic assessments in adolescent or young adult unemployment is very scarce. To our knowledge, this study has, for the first time, assessed both Axis-I (non-personality) and Axis-II (personality) psychiatric disorders and related constructs in a preselected sample of unemployed individuals. Subjects and methods: Subjects were aged 16–24 and lived in the large urban region of Essen, Germany. They were referred by case managers of the vocational services centre to the on-site psychiatric out-patient unit. SCID-I and II were administered to assess DSM-IV diagnoses. Symptom Checklist 90 R, Beck Depression Inventory and Client Sociodemographic Service Receipt Inventory were used to measure severity of psychopathology and health service utilization. Results: In all, 98% of the unemployed young adults suffered from mental disorders. Mood and anxiety disorders were the most common Axis-I disorders (47.9 and 33.4%). Altogether, 58.2% of probands met diagnostic criteria for a personality disorder; a borderline personality disorder accounted for one half of these disorders. Despite a 49% rate of Axis-I and II comorbidity and severe psychopathology, the majority of subjects were untreated and mental health service utilization in general was low. The diagnosis of a personality disorder was related to a 2.7-fold risk of dropping out of job reintegration programmes. Conclusion: Unemployed young adults referred for a psychiatric assessment have a high rate of both Axis-I and II disorders, which need to be considered upon planning individual-based vocational rehabilitation programs.

Although there is no paucity of theoretical frameworks for explaining people's health service utilization (HSU), theoretical frameworks designed to account for variations in immigrants' HSU remain underdeveloped. Building on influential theories or models for explaining HSU and especially Andersen's widely used health behavior model, this article proposes a theoretical framework for explaining disparities in immigrant HSU. The proposed framework explains disparities in immigrant HSU by the health care need, resources, and predisposing factors of immigrants, and macrostructural/contextual conditions at both the general and immigrant-specific levels, as well as the mediating relationships among some of these factors. It is believed that this new framework can offer a fuller understanding of the determination process of immigrant HSU.

To form a notion of the relative magnitude of health services utilization in Curaçao, patterns of use were compared with those in the Netherlands. Dutch reference data were chosen because of the strong political and historical ties between Curaçao and the Netherlands. Most care providers in Curaçao have received their vocational training in the Netherlands. Also, in many aspects the health care systems in Curaçao and the Netherlands are comparable. For example, in both systems the GP functions as gatekeeper to secondary care. . Zie: Summary.

AbstractWe estimate the causal effects of retirement on health services utilization in Vietnam. Using authorized retirement ages as instruments for exogenous changes in retirement, we find positive and strong effects of retirement on outpatient health services in the public health sector. Retirement increases the probability of an outpatient visit by 51 percentage points for males and 36 percentage points for females, and the frequency of outpatient visits by 1.4 times for males and 2 times for females. However, we find no effect on the use of public inpatient services as well as private health services.

Using data from the China Health and Retirement Longitudinal Survey, we employed counterfactual propensity score matching to examine the association between income and health service utilization and expenditure of the elderly in China. The results demonstrated that income did not differentiate whether the poor elderly in China visited a doctor when suffering an illness, but their expenditure on medical treatment was significantly associated with income. Subgroup analysis further indicated that the medical demands of female, older, and rural elderly were more likely to be reduced by their income compared with their counterparts.

BACKGROUND: Major depression is prevalent, impactful, and treatable in military populations, but not all depressed personnel seek professional care in a given year. Care-seeking patterns (including the use of primary vs. specialty care) and factors associated with the likelihood of mental health service utilization in depressed military personnel are poorly understood. METHODS: Our sample included 520 Regular Force respondents to the 2013 Canadian Forces Mental Health Survey. All study participants had past-year major depression. Subjects reported whether they had spoken about their mental health with at least one health professional in the past 12 months. We used multivariate Poisson regression to explore factors associated with past-year mental health service use. RESULTS: Three-quarters of Canadian military personnel with past-year depression had sought mental health care in the previous 12 months. Among care-seeking personnel, 70% had seen a psychologist or psychiatrist, while 5% had exclusively received care from a primary care physician. Belief in the effectiveness of mental health care was the factor most strongly associated with care seeking. Female gender, functional impairments, and psychiatric comorbidities were also associated with care seeking. Surprisingly, stigma perceptions had no independent association with care seeking. CONCLUSIONS: The proportion of depressed Canadian Armed Forces personnel who seek professional care and who access specialty mental health care is higher than in most other populations. However, an important minority of patients are not accessing health services. Efforts to further increase mental health service utilization in the Canadian military should continue to target beliefs about the effectiveness of mental health care.