Suchergebnisse

International audience ; Background: Since 2012, Senegal has conducted a national program to cover renal therapy (dialysis) expenses in public hospitals and social security-approved centers. Given the increasing demand for dialysis, national guidelines recommend explicit rationing through waiting lists, and hospitals have committees to determine whom to enroll. While national recommendations are known, criteria applied in hospitals to register patients remain unclear. Our study analyzes social justice principles used to ration renal therapy in government-owned centers and highlights inequalities caused by low access to treatment. Methods: We conduct a multivariate logit regression analysis using data collected from patients in public and private centers to identify which socioeconomic or sociodemographic factors determine enrollment. Based on the average marginal effects of these factors on program enrollment, we hypothesize the justice principles applied (or not) in hospitals. Results: We find that the duration of illness, insurance distribution, age, education, and involvement in patient associations influence program access. The duration of illness is the most robust predictor regardless of socioeconomic factors, which suggests the predominant application of egalitarian principles, notably the first-come-first-served rule. However, our findings indicate that the most impoverished patients do not have access to free dialysis. Conclusions: Although the national dialysis program aims to improve access to costly life-sustaining treatment, the first-come-first-served strategy is designed to suit patients who live longer, that is, those who can seek dialysis care in a private center. The program does not address inequalities in access, especially for the most impoverished patients recently diagnosed with end-stage kidney disease.

International audience ; Background: Since 2012, Senegal has conducted a national program to cover renal therapy (dialysis) expenses in public hospitals and social security-approved centers. Given the increasing demand for dialysis, national guidelines recommend explicit rationing through waiting lists, and hospitals have committees to determine whom to enroll. While national recommendations are known, criteria applied in hospitals to register patients remain unclear. Our study analyzes social justice principles used to ration renal therapy in government-owned centers and highlights inequalities caused by low access to treatment. Methods: We conduct a multivariate logit regression analysis using data collected from patients in public and private centers to identify which socioeconomic or sociodemographic factors determine enrollment. Based on the average marginal effects of these factors on program enrollment, we hypothesize the justice principles applied (or not) in hospitals. Results: We find that the duration of illness, insurance distribution, age, education, and involvement in patient associations influence program access. The duration of illness is the most robust predictor regardless of socioeconomic factors, which suggests the predominant application of egalitarian principles, notably the first-come-first-served rule. However, our findings indicate that the most impoverished patients do not have access to free dialysis. Conclusions: Although the national dialysis program aims to improve access to costly life-sustaining treatment, the first-come-first-served strategy is designed to suit patients who live longer, that is, those who can seek dialysis care in a private center. The program does not address inequalities in access, especially for the most impoverished patients recently diagnosed with end-stage kidney disease.

International audience ; Background: Since 2012, Senegal has conducted a national program to cover renal therapy (dialysis) expenses in public hospitals and social security-approved centers. Given the increasing demand for dialysis, national guidelines recommend explicit rationing through waiting lists, and hospitals have committees to determine whom to enroll. While national recommendations are known, criteria applied in hospitals to register patients remain unclear. Our study analyzes social justice principles used to ration renal therapy in government-owned centers and highlights inequalities caused by low access to treatment. Methods: We conduct a multivariate logit regression analysis using data collected from patients in public and private centers to identify which socioeconomic or sociodemographic factors determine enrollment. Based on the average marginal effects of these factors on program enrollment, we hypothesize the justice principles applied (or not) in hospitals. Results: We find that the duration of illness, insurance distribution, age, education, and involvement in patient associations influence program access. The duration of illness is the most robust predictor regardless of socioeconomic factors, which suggests the predominant application of egalitarian principles, notably the first-come-first-served rule. However, our findings indicate that the most impoverished patients do not have access to free dialysis. Conclusions: Although the national dialysis program aims to improve access to costly life-sustaining treatment, the first-come-first-served strategy is designed to suit patients who live longer, that is, those who can seek dialysis care in a private center. The program does not address inequalities in access, especially for the most impoverished patients recently diagnosed with end-stage kidney disease.

Very soon after the first cases of Covid appeared on the African continent, governments adopted a series of measures to limit its spread. To be effective, these measures require that they be widely accepted and respected by the population, notwithstanding their various costs to the individual. Compliance depends on numerous individual and collective cultural, socio-economic, institutional and environmental factors, as well as on the perception of the risks involved and the severity of the protean consequences that the pandemic may generate.We examine these various issues based on data from a survey conducted in Burkina Faso in May-June 2020. The results show that the measures adopted by the authorities to limit the spread of the pandemic are generally fairly well respected. The vast majority of respondents take the epidemic very seriously and consider that the health consequences, and even more so the economic consequences, will be serious. The survey also shows that a large proportion of respondents are concerned about the consequences of the epidemic on the deepening of inequalities and the increase in violence and insecurity. The results highlight both common features and great heterogeneity in perception and behavioral response at the individual and regional levels, thus providing useful information for Burkina Faso's decision-makers to better calibrate the prevention strategies to be implemented as the pandemic accelerates in Burkina as in other African countries and the prospect of broad immunization coverage remains both distant and highly uncertain ; Très rapidement après l'apparition des premiers cas de Covid sur le continent africain, les gouvernements ont adopté une série de mesures visant à en limiter la propagation. Pour être efficaces, ces mesures exigent qu'elles soient très largement acceptées et respectées par la population nonobstant les coûts de diverses natures qui en résultent pour chacun. Or l'observance des dispositions dépend de nombreux facteurs individuels et collectifs d'ordre ...

Very soon after the first cases of Covid appeared on the African continent, governments adopted a series of measures to limit its spread. To be effective, these measures require that they be widely accepted and respected by the population, notwithstanding their various costs to the individual. Compliance depends on numerous individual and collective cultural, socio-economic, institutional and environmental factors, as well as on the perception of the risks involved and the severity of the protean consequences that the pandemic may generate.We examine these various issues based on data from a survey conducted in Burkina Faso in May-June 2020. The results show that the measures adopted by the authorities to limit the spread of the pandemic are generally fairly well respected. The vast majority of respondents take the epidemic very seriously and consider that the health consequences, and even more so the economic consequences, will be serious. The survey also shows that a large proportion of respondents are concerned about the consequences of the epidemic on the deepening of inequalities and the increase in violence and insecurity. The results highlight both common features and great heterogeneity in perception and behavioral response at the individual and regional levels, thus providing useful information for Burkina Faso's decision-makers to better calibrate the prevention strategies to be implemented as the pandemic accelerates in Burkina as in other African countries and the prospect of broad immunization coverage remains both distant and highly uncertain ; Très rapidement après l'apparition des premiers cas de Covid sur le continent africain, les gouvernements ont adopté une série de mesures visant à en limiter la propagation. Pour être efficaces, ces mesures exigent qu'elles soient très largement acceptées et respectées par la population nonobstant les coûts de diverses natures qui en résultent pour chacun. Or l'observance des dispositions dépend de nombreux facteurs individuels et collectifs d'ordre ...

Very soon after the first cases of Covid appeared on the African continent, governments adopted a series of measures to limit its spread. To be effective, these measures require that they be widely accepted and respected by the population, notwithstanding their various costs to the individual. Compliance depends on numerous individual and collective cultural, socio-economic, institutional and environmental factors, as well as on the perception of the risks involved and the severity of the protean consequences that the pandemic may generate.We examine these various issues based on data from a survey conducted in Burkina Faso in May-June 2020. The results show that the measures adopted by the authorities to limit the spread of the pandemic are generally fairly well respected. The vast majority of respondents take the epidemic very seriously and consider that the health consequences, and even more so the economic consequences, will be serious. The survey also shows that a large proportion of respondents are concerned about the consequences of the epidemic on the deepening of inequalities and the increase in violence and insecurity. The results highlight both common features and great heterogeneity in perception and behavioral response at the individual and regional levels, thus providing useful information for Burkina Faso's decision-makers to better calibrate the prevention strategies to be implemented as the pandemic accelerates in Burkina as in other African countries and the prospect of broad immunization coverage remains both distant and highly uncertain ; Très rapidement après l'apparition des premiers cas de Covid sur le continent africain, les gouvernements ont adopté une série de mesures visant à en limiter la propagation. Pour être efficaces, ces mesures exigent qu'elles soient très largement acceptées et respectées par la population nonobstant les coûts de diverses natures qui en résultent pour chacun. Or l'observance des dispositions dépend de nombreux facteurs individuels et collectifs d'ordre ...

In this study, the varying nature of catastrophic threshold for out-of-pocket health expenditures of Turkish households has been investigated by the help of Household Budget Surveys compiled by TurkStat (2002-2016). Two methods have been used in the calculation of catastrophic health expenditures: (i) The fixed (same) catastrophic thresholds and (ii) variable thresholds based on different socio-economic groups (quintile) have been calculated and compared. Also, catastrophic health expenditures risk factors have been analysed by using binary logistic regression models. Unlike previous studies, poor households have been found more likely to experience catastrophic health expenditure in Turkey. Thus, the result indicates that analyses using the same threshold level for all socio-economic groups of a society might lead policymakers to misleading conclusions.

We estimate the evolution of healthcare demand under the influence of income growth and population aging with two samples of patients surveyed in the same regions, but with an interval of 18 years in rural China and with mixed logit to deal with heterogeneity. In accordance with theoretical and inductive inferences, it is found that healthcare price effects decreased and became more heterogeneous. Aging impact overweighed income growth impact, resulting in increasing distance effect and patients' preference to proximity. In the face of this demand change, the adjustment of governmental supply should be to promote small and middle-sized healthcare providers. However during this period to cope with urbanization, the Chinese policy consisted of privileging large hospitals. This has led to a higher share of patients, especially the aging patients, to choose self-care and a higher share of poorer patients to suffer from catastrophic health expenditures. This finding carries broad implications for rural health policy-making on, along with income growth, population aging and urbanization, how to provide better coverage of rural areas by enough qualified and multifunctional small and middle-sized healthcare providers in the developing world.

We estimate the evolution of healthcare demand under the influence of income growth and population aging with two samples of patients surveyed in the same regions, but with an interval of 18 years in rural China and with mixed logit to deal with heterogeneity. In accordance with theoretical and inductive inferences, it is found that healthcare price effects decreased and became more heterogeneous. Aging impact overweighed income growth impact, resulting in increasing distance effect and patients' preference to proximity. In the face of this demand change, the adjustment of governmental supply should be to promote small and middle-sized healthcare providers. However during this period to cope with urbanization, the Chinese policy consisted of privileging large hospitals. This has led to a higher share of patients, especially the aging patients, to choose self-care and a higher share of poorer patients to suffer from catastrophic health expenditures. This finding carries broad implications for rural health policy-making on, along with income growth, population aging and urbanization, how to provide better coverage of rural areas by enough qualified and multifunctional small and middle-sized healthcare providers in the developing world.