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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.

Objectives: To systematically assess barriers delaying home respiratory equipment requisition and to evaluate for temporal correlation between delays and emergency room or hospitalization episodes.Background: Initiation of home respiratory treatments is delayed because of delays in delivery of durable medical equipment (DME). This study assesses root causes of such delays from a system perspective. We also describe clinical consequences by measuring emergency room visits and hospitalization days for temporal correlations.Methods: We conducted a retrospective review of DME ordering records from April 2011 to March of 2012.Settings: Outpatient DME records in Pediatric Pulmonary Division.Results: Of 164 available orders studied, deliveries were made as followed: 31 (19%) within 24 hr: 18 (59%) oxygen orders and 10 (32%) nebulizer orders 50 (30%) within 1 week: 25 (50%) nebulizer orders and 10 (20%) oxygen orders Delays: 45 (27%) delivered > 1 month: Bilevel positive airway pressure (BPAP) = 16 (36%) Oxygen = 12 (26%) Cough assist device = 7 (16%) Nebulizer = 5 (11%) Miscellaneous devices = 5 (11%) Analysis of barriers includes (a) type of insurance, (b) human error, (c) communication barrier, (d) deficit in training or knowledge, (e) no clear policy, (f) differences in clinical policy/ standard, (g) no DME benefit, (h) no clinical justification, and (i) error in communication/record keeping. Six patients with 7 emergency department (ED) visits and 4 inpatient admissions, totaling 24 hospital days, were temporally associated with delays in delivery of equipment over 30 days.Conclusion: One half of commonly used DMEs were delivered within the first week. One quarter of more expensive required more steps for approval. Twenty-nine ED/hospital days with respiratory morbidities were temporally associated with delays.

Population aging has become an important issue mostly discussed in many countries in the world. The proportion of the older population is getting better in both developed and developing countries. Elderly tend to need more health care as they are more susceptible to chronic diseases. The purpose of this study was to determine the factors affecting outpatient visit among elderly in Indonesia. This study employed a cross-sectional study design with a sample of ≥60-year-old individual with a total sample of 5,325 elderly. The data used to be analyzed were from the Indonesian Family Life Survey 2014 representing 83% of the population in Indonesia. The theory used was Andersen health service utilization model. In analyzing the data, bivariate analysis were used, with Chi-square and multivariate test using multiple logistic regression test prediction model. Elderly who utilize health service for outpatient was 18.6%. Variables that have significant relationships with outpatient utilization on elderly were female, high education, formal job, Java and Bali, urban, health insurance ownership, economic status, the perception of ill, smoking habit, history of chronic disease, fat, and obesity. Predictor for the most dominant outpatient utilization is influenced by chronic disesase after controlled by other variables. Chronic disesase greatly affect the elderly in utilizing health services for outpatient. To overcome this, the government is expected to provide policies on health facilities to better emphasize promotive and preventive efforts among the elderly.

Funding of healthcare services has recently become a hot topic among economists, thus is attracting new econo­mists with various backgrounds and experiences. The aim of this article is to find exogenous variables which influence the demand for outpatient care services and provide a depoliticized and clear outpatient service fund­ing index model. This is done by analysing the findings of other authors and forming of a possible conceptual model. The goal is to refocus outpatient care payments from being a political decision to a decision based on the market demands, that is – exogenous factors and provide a transparent and more representative funding model. The application of the Index for the years 2010–2015, has showed that in order to maintain the same level of quality of outpatient care services as in the year 2010, additional 130.30 million Euros were needed. ; Sveikatos priežiūros paslaugų finansavimas pastaruoju metu tapo populiaria tema tarp ekonomistų, todėl pritraukia vis daugiau turinčių skirtingą patirtį ir šia tema galinčių suteikti skirtingų įžvalgų. Šio straipsnio tikslas – rasti išorinius kintamuosius, darančius įtaką ambulatorinės priežiūros paslaugų paklausai, ir pateik­ti depolitizuotą, objektyvų, lengvai pamatuojamą šių paslaugų finansavimo modelį. Tam analizuojami kitų autorių darbai ir formuojamas galimas koncepcinis ambulatorinių sveikatos priežiūros paslaugų finansavimo modelis. Pagrindinis šio straipsnio uždavinys – perorientuoti ambulatorinės sveikatos priežiūros išmokas nuo politinio sprendimo į pamatuojamą, rinkos dinamika grįstą rinkos modelį. 2010–2015 m. taikytas indekso modelis parodė, jog tokiam pat ambulatorinės priežiūros paslaugų lygiui ir kokybei išlaikyti kaip ir 2010 m. reikėjo papildomų 130,30 mln. eurų.

Abstract Background The burden of chronic conditions is on the rise in India, necessitating long-term support from healthcare services. Healthcare, in India, is primarily financed through out-of-pocket payments by households. Considering scarce evidence available from India, our study investigates whether and how out-of-pocket payments for outpatient care affect individuals with chronic conditions. Methods A large census covering 9299 households was conducted in Bangalore, India. Of these, 3202 households that reported presence of chronic condition were further analysed. Data was collected using a structured household-level questionnaire. Out-of-pocket payments, catastrophic healthcare expenditure, and the resultant impoverishment were measured using a standard technique. Results The response rate for the census was 98.5%. Overall, 69.6% (95%CI=68.0-71.2) of households made out-of-pocket payments for outpatient care spending a median of 3.2% (95%CI=3.0-3.4) of their total income. Overall, 16% (95%CI=14.8-17.3) of households suffered financial catastrophe by spending more than 10% of household income on outpatient care. Occurrence and intensity of financial catastrophe were inequitably high among poor. Low household income, use of referral hospitals as place for consultation, and small household size were associated with a greater likelihood of incurring financial catastrophe. The out-of-pocket spending on chronic conditions doubled the number of people living below the poverty line in one month, with further deepening of their poverty. In order to cope, households borrowed money (4.2% instances), and sold or mortgaged their assets (0.4% instances). Conclusions This study provides evidence from India that the out-of-pocket payment for chronic conditions, even for outpatient care, pushes people into poverty. Our findings suggest that improving availability of affordable medications and diagnostics for chronic conditions, as well as strengthening the gate keeping function of the primary care services are important measures to enhance financial protection for urban poor. Our findings call for inclusion of outpatient care for chronic conditions in existing government-initiated health insurance schemes.

Outpatient health care provision plays an important role in the identification and treatment of health problems. Data are needed on the utilisation of health care services and their determinants to enable health policy decision-making and needs-based care provision. The analyses set out in this article are based on current data on the utilisation of outpatient health care services. The data stem from the German Health Update (GEDA 2019/2020-EHIS), a nationwide cross-sectional survey of the resident population in Germany that is undertaken as part of the health monitoring conducted at the Robert Koch Institute. Around 80% of the population aged 18 or over were treated at least once within twelve months by a general practitioner, 60% by a specialist, and 10% received psychiatric or psychotherapeutic treatment. Less than half of those eligible had had a stool test during the past two years, and just over half had had a colonoscopy in the past ten years. Around 80% of women and 70% of men had had their blood pressure checked within the last year, and 60% had had their blood cholesterol or blood sugar levels monitored. Over 50% reported that they had taken medically prescribed drugs in the past two weeks. In general, most of the indicators under study suggest that utilisation increases with age and that utilisation is higher among women than men, with the exception of psychiatric and psychotherapeutic services, among others.

The Indonesian Social Safety Net health card program was implemented in response to the economic crisis that hit Indonesia in 1997, to preserve access to health care services for the poor. Health cards were allocated to poor households, entitling them to subsidized care from public health care providers. The providers received budgetary support to compensate for the extra demand. This article focuses on the effect of the program on primary outpatient health care use, disentangling the direct effect of allocating health cards from the indirect effect of government transfers to health care facilities. For poor health card owners the program resulted in a net increase in use of outpatient care, while for nonpoor health card owners the program resulted mainly in a substitution from private to public health care. The largest effect of the program seems to have come from a general increase in the supply of public services resulting from the budgetary support to public providers. These benefits seem to have been captured mainly by the nonpoor. As a result, most of the benefits of the health card program went to the nonpoor, even though distribution of the health cards was propoor. The results suggest that had the program, in addition to targeting the poor, established a closer link between provision of services to the target groups and funding, the overall results would have been more propoor.

OBJECTIVE: In October 2013, the South Korean government introduced an incentive programme to increase the availability of Saturday treatment at clinics, hoping to increase the role of primary care providers as gatekeepers to medical care. To the best of our knowledge, no one has yet investigated this programme's effect on overall outpatient care. Our study aims to analyse the change in Saturday outpatient volume and billings in clinics that adopted the Saturday incentive programme. SETTING: Our study used 3 types of data from the period October 2012 to March 2014: National Health Insurance Service (NHIS) claims data, hospital evaluation data and medical institution data. PARTICIPANTS: These data consisted of 66��825��881 outpatient cases from 2837 clinics. INTERVENTIONS: Introducing the Saturday incentive programme. OUTCOME MEASURE: We performed a multilevel analysis that adjusted for clinic-level and outpatient-level variables to examine the difference in the percentage of Saturday outpatient volume and billings after introducing the Saturday incentive programme. RESULTS: The percentages of Saturday outpatient volume and billings were higher after introducing the programme (outpatient volume: 棺=2.065, p<0.001; outpatient billings: 棺=3.518, p<0.001). In addition, outpatient volume and billings on Friday and Saturday increased after introducing the programme, while those on weekdays, excluding Friday, decreased. CONCLUSIONS: Our findings suggest that the Saturday incentive programme has affected clinic outpatient care and is a worthwhile health policy in terms of promoting primary care. Thus, it may improve healthcare accessibility and quality of care, and prevent inappropriate usage such as emergency room visits by providing patients with weekend clinic hours. ; open

Background: Pathways to care studies in Singapore are of high interest given the cultural diversity and various sources of help available for those with mental illnesses, ranging from the more traditional to tertiary-level mental health care services. Aim: The current study aimed to explore the associations of patients' socio-demographic characteristics with pathways to first contact and duration of untreated mental illness. Method: A total of 402 participants were recruited through convenience sampling. A pathway to care form was used to gather systematic information about the sources of care utilized by participants before approaching a mental health professional. Data were analysed using multinomial logistic regression and multiple linear regression models to assess the associations. Results: Majority of participants reported primary care (36.0%) as their first point of contact, followed by non-formal sources of help (33.8%), specialist care (21.8%), police/court (4.0%), websites/media (3.3%) and religious/traditional treatment (1.3%). Those belonging to Malay and Indian ethnicity (vs Chinese) were more likely to make first contact with non-formal sources of help than primary care. Those who received a diagnosis of any mood or anxiety disorder (vs schizophrenia and related psychoses) were less likely to make first contact with specialist care or non-formal sources of help than primary care. Those who were separated/divorced/widowed were significantly associated with higher duration of untreated illness compared to those who were single. Participants whose family/relative initiated the first contact were significantly associated with a shorter duration of untreated illness compared to those who initiated first contact on their own. Conclusion: Findings suggest the determinants of the pathways to first contact and duration of untreated illness included diagnosis, ethnicity, marital status and family initiating the first contact. The pathways adopted by these participants need to be kept in mind for planning mental health programmes.

Objective: To know women's health behavior and their reason to seek for care in an emergency service.
Methods: Descriptive, exploratory and qualitative study done with 18 women who were attended in a
municipal emergency unit in the northwest of Paraná. These data were collected in November of 2015 with
a semi-structured interview and subjected to content analysis, in thematic modality. Results: Two empirical
categories were identified: "Women behaviors before health complications" shows that the initial conduct of
women in situations of illness is self-medication and postponement to seek health services; and "reasons to seek
emergency care service", which shows that the demand for this level of service is driven by the perception of
better resolution, effectiveness and agility, as well as proximity to home. Conclusion: It is common for women
to delay seeking treatment because of gender-related responsibilities, and when they do it, they prefer to choose
more resolute services.