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PubMed2006

Financing mental health services in low- and middle-income countries.

Mental disorders account for a significant and growing proportion of the global burden of disease and yet remain a low priority for public financing in health systems globally. In many low-income countries, formal mental health services are paid for directly by patients out-of-pocket and in middle-income countries undergoing transition there has been a decline in coverage. The paper explores the impact of health care financing arrangements on the efficient and equitable utilization of mental health services. Through a review of the literature and a number of country case studies, the paper examines the impact of financing mental health services from out-of-pocket payments, private health insurance, social health insurance and taxation. The implications for the development of financing systems in low- and middle-income countries are discussed. International evidence suggests that charging patients for mental health services results in levels of use which are below socially efficient levels as the benefits of the services are distributed according to ability to pay, resulting in inequitable access to care. Private health insurance poses three main problems for mental health service users: exclusion of mental health benefits, limited access to those without employment and refusal to insure pre-existing conditions. Social health insurance may offer protection to those with mental health problems. However, in many low- and middle-income countries, eligibility is based on contributions and limited to those in formal employment (therefore excluding many with mental health problems). Tax-funded systems provide universal coverage in theory. However, the quality and distribution of publicly financed health care services makes access difficult in practice, particularly for rural poor communities.

Developing Countries↗
PubMed2003

Food stamp program participation is positively related to obesity in low income women.

This study examined the relationship between Food Stamp Program (FSP) participation and the obesity of low income individuals using data from the National Longitudinal Survey of Youth 1979. Obesity was defined as body mass index >or= 30 kg/m(2). The data were arranged as a panel with multiple observations per individual, and the models of obesity included current and long-term FSP participation, additional demographic, socioeconomic and environment characteristics and individual fixed effects. Individual fixed effects were used to take into account unobserved differences across individuals that did not vary over time. In ordinary least squares models, current and long-term FSP participation were significantly related to the obesity of low income women (P < 0.05), but not of low income men. For low income women, current participation in the FSP was associated with a 9.1% increase in the predicted probability of current obesity. Participation in the FSP in each of the previous five years compared to no participation over that time period was associated with approximately a 20.5% increase in the predicted probability of current obesity. These models did not control for food insecurity, and this omission potentially complicates the interpretation of the FSP participation variables.

Adolescent↗
PubMed2003

Food insecurity and low income in an English inner city.

BACKGROUND: Low incomes may not provide the minimum requirements for healthy living. We evaluated experiences of food insecurity in relation to income in inner London. METHODS: Subjects attending 10 general medical practices completed a short self-administered questionnaire, including the short form Household Food Security Scale and a short food frequency questionnaire. RESULTS: Responses were obtained from 431/495 (87 per cent) subjects. Overall 87 (20 per cent) of subjects were classified as food insecure. Food insecurity was negatively associated with household income (p = 0.004). University-educated subjects (8 per cent) were less often food insecure than all others (26 per cent). Subjects who were food insecure were less likely to report eating fruit daily (food secure 48 per cent, food insecure 33 per cent, p = 0.017) or vegetables or salads daily (food secure 56 per cent, food insecure 34 per cent, p = 0.002). CONCLUSIONS: Experiences of food insecurity may be common in households with incomes at the level of the UK national minimum wage or lower.

Adolescent↗
PubMed1997

Incentives to disability in federal disability insurance and supplemental security income.

Between 1989 and 1994, Disability Insurance and Supplemental Security Income, the 2 federal programs that provide disability benefits, expanded rapidly. The largest growth has been among recipients with mental disorders in the Disability Insurance program and among children with learning disabilities in the Supplemental Security Income program. The expansion was partly due to changes in eligibility rules and partly to other factors including outreach efforts by the Social Security Administration and a lack of funds to review and terminate cases. Factors that keep many of the disabled from seeking work include a fear of being unable to obtain health insurance, which is provided to beneficiaries under Disability Insurance and Social Security Insurance, and the fear of being unable to obtain and keep stable employment. Although children's Supplemental Security Income benefits have reduced poverty in families with disabled children, there is some evidence that parents are encouraging their children to behave poorly so they can qualify. Replacing present welfare and disability programs with national health insurance and a guaranteed annual income would eliminate the work disincentives, but such dramatic restructuring is unlikely in the context of present political debates.

Eligibility Determination↗
PubMed1997

DSM-III-R disorders in preschool children from low-income families.

OBJECTIVE: To generate rates of DSM-III-R disorders in a sample of preschool children from low-income families, examine impairment ratings for preschool children meeting criteria for DSM-III-R disorders, and compare rates of psychopathology using DSM-III-R criteria with rates generated by the Child Behavior Checklist (CBCL). METHOD: As part of an ongoing longitudinal study of 104 mother-child dyads from low-income families, data were gathered when children were 5 years of age. DSM-III-R disorders were diagnosed through the administration of the Schedule for Affective Disorders and Schizophrenia for School-Age Children to the mothers, and mothers competed the CBCL. RESULTS: Rates of DSM-III-R disorders among preschool children from low-income families were higher than those reported in community samples, but comparable with rates for low-income school-age children and adolescents. Children meeting criteria for DSM-III-R disorders were rated as significantly impaired. The prevalence of behavioral and emotional problems was similar by both DSM-III-R criteria and the CBCL. There was some evidence, however, that the two systems identified different children. CONCLUSIONS: DSM-III-R criteria appear to adequately identify preschool children with serious behavioral and emotional problems. Longitudinal studies are needed to explore further the relative utility of the DSM and CBCL in the identification of psychopathology in preschool children.

Chi-Square Distribution↗
PubMed2001

Does managed care enable more low income persons to identify a usual source of care? Implications for access to care.

BACKGROUND: By requiring or encouraging enrollees to obtain a usual source of care, managed care programs hope to improve access to care without incurring higher costs. OBJECTIVES: (1) To examine the effects of managed care on the likelihood of low-income persons having a usual source of care and a usual physician, and; (2) To examine the association between usual source of care and access. RESEARCH DESIGN: Cross-sectional survey of households conducted during 1996 and 1997. SUBJECTS: A nationally representative sample of 14,271 low-income persons. MEASURES: Usual source of care, usual physician, managed care enrollment, managed care penetration. RESULTS: High managed care penetration in the community is associated with a lower likelihood of having a usual source of care for uninsured persons (54.8% vs. 62.2% in low penetration areas) as well as a lower likelihood of having a usual physician (60% vs. 72.8%). Managed care has only marginal effects on the likelihood of having a usual source of care for privately insured and Medicaid beneficiaries. Having a usual physician substantially reduces unmet medical needs for the insured but less so for the uninsured. CONCLUSIONS: Having a usual physician can be an effective tool in improving access to care for low-income populations, although it is most effective when combined with insurance coverage. However, the effectiveness of managed care in linking more low-income persons to a medical home is uncertain, and may have unintended consequences for uninsured persons.

Adult↗
PubMed1996

A model for describing low-income African American women's participation in breast and cervical cancer early detection and screening.

The article reports on data derived from two investigations. In one study, focus groups were used with low-income African American women to pilot test a teaching module developed to support the inclusion of culturally relevant content on breast and cervical health in teaching low-income African American women. A second study using individual interviews was undertaken to illuminate the lived experience of low-income African American women who participated in breast and cervical cancer early detection and screening services. Data analysis of group and individual interviews were performed using phenomenology as a methodological approach. Findings from the two studies, combined with information identified in the theoretical and literary contexts, supported the development of an Afrocentric model that describes the lived experience and decision making practices of low-income African American women's participation in breast and cervical cancer early detection and screening services.

Adolescent↗
PubMed2003

Use of the SF-36 in low-income Chinese American primary care patients.

BACKGROUND: Measures of health status have been increasingly utilized but most research in the United States has been conducted on middle-class, English-speaking white persons. Although Asians reportedly often have a better health status than white persons, previously surveyed samples may not be representative of low-income non-English-speaking Asian immigrant populations. MATERIALS AND METHODS: This cross-sectional study surveyed a convenience sample of low-income Chinese patients attending a community health center in Chinatown (New York City). We sought to evaluate the known-groups validity of self-administered Chinese and English versions of the Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey (SF-36) and to determine if scores differed from a community-based sample of Chinese Americans and the United States general population. RESULTS: Eight hundred fifty-six persons were approached and data were obtained from 523 participants (61%); 90% completed the questionnaire in Chinese and 74% earned less than 15,000 US dollars. Known-group comparisons based upon differences in age, gender, and number of medical problems yielded support for the validity of the SF-36 in this sample. The sample's SF-36 subscale scores were lower than scores from the community-based sample of Chinese Americans and tended to be lower than scores from the United States general population. Mean scores were lowest for persons reporting depression, anxiety, or an emotional problem. CONCLUSIONS: The SF-36 demonstrated known-groups validity in this low-income Chinese sample. Collecting data in the primary care setting enables both a better understanding of the relative burden of disease in low-income Chinese and targeted program planning for preventive interventions.

Adolescent↗
PubMed2007

Risk factors and prevalence of HIV and sexually transmitted infections among low-income female commercial sex workers in Mongolia.

BACKGROUND: Mongolia has very low HIV prevalence despite high rates of sexually transmitted infections (STIs). Low-income female sex workers (FSWs) may be at high risk for acquiring and spreading the disease in Mongolia. GOAL: The goal of this study was to assess the prevalence and risk factors associated with the acquisition of HIV, syphilis, gonorrhea, and trichomoniasis among low-income female commercial sex workers in 3 urban centers in Mongolia. STUDY DESIGN: One hundred seventy-nine low-income FSWs were tested for HIV (enzyme immunoassay) and 132 were tested for syphilis (Treponema pallidum hemagglutination-confirmed), gonorrhea (Gram stain and culture), and trichomoniasis (wet mount microscopy). Questionnaires detailing socioeconomic characteristics, sexual behaviors, drug and alcohol use, general health, and STI/HIV knowledge were completed by 149 women. RESULTS: No HIV infections were found in 179 women. Of 132 women, 57 (43%), 18 (14%), and 37 (28%) tested positive for syphilis, gonorrhea, and trichomonas, respectively; 88 (67%) tested positive for one or more STIs and 22 (17%) were multiply infected. Socioeconomic factors were correlated to reported condom use and infection status. CONCLUSIONS: Low-income FSWs in Mongolia represent a unique population of very high-risk individuals with very low rates of HIV infection. Interventions targeting this population represent a unique opportunity to prevent a potentially rapid increase of HIV infection in urban Mongolia.

Adolescent↗
PubMed2005

Depressive symptomatology among Turkish older adults with low incomes in a rural community sample.

AIMS AND OBJECTIVES: To identify the characteristics that are associated with depressive symptomatology among Turkish older adults with low income. BACKGROUND: Depression is a major threat to mental health in older people, but little is known about older adults with low income at risk for depressive symptomatology in Turkey. DESIGN: This was a cross-sectional study, based in one area of Istanbul. METHODS: The sample included 132 older adults in a rural setting living in Istanbul, Turkey. The participants were 55 years of age or older and chosen from among older adults with low income. Data were collected through a structured interview conducted in the homes of the participants. RESULTS: High depressive symptoms (Geriatric Depression Scale > or =11) were reported by 50% of the participants. Compared with non-depressed individuals, those with depressive symptomatology were more likely to be women, widowed, lack health insurance and to live alone. Depressed participants significantly more often reported chronic health conditions compared to non-depressed participants (OR = 4.11, 95% CI = 1.35, 12.57). Overall well-being scores were significantly higher in men and in the non-depressed group. The result of the Pearson correlation provided support for the association between depression scores and overall well-being scores (r = -0.60). CONCLUSIONS: Depressive symptomatology is prevalent within Turkish older adults with low income. Further research is needed to examine potential risk factors associated with depressive symptomatology for this population. RELEVANCE TO CLINICAL PRACTICE: Findings may assist health care professionals in assessing high-risk older people who could benefit from interventions aimed at minimizing depressive symptoms.

Aged↗
PubMed1999

Self-reported health status of low-income mothers.

PURPOSE: To determine the self-reported health status of low-income mothers before major health and welfare policy reform in the state of Ohio, to compare the health status of this group with the general population age-based norms, and to examine differences in health status among insurance and racial subgroups. Policy makers and others have a need for key health-status information about low-income mothers, a topic for which little empirical data currently exist. DESIGN: Descriptive using a cross-sectional survey with convenience sampling; 502 women were interviewed at intake sites in four countries in central Ohio, 1995 to 1996. METHODS: Health status was measured using the general health status index developed by J. E. Ware and colleagues (1995). Two summary measures, one indicating physical health and one indicating mental health, were used and compared with published norms. Multivariate logistic models were examined for depression and physical health status. FINDINGS: A significant level of depression in the population of low-income mothers was found as were differences in physical health scores by insurance group. People insured privately had the highest physical health scores, while those enrolled in fee-for-service Medicaid had scores indicating the poorest health. No significant difference was found between racial groups in self-reported health status. CONCLUSIONS: Self-reported mental health status is low among some low-income female populations. Physical health is worse for the Medicaid-enrolled group compared to both uninsured and privately insured groups. This poor state of health will likely diminish the success of welfare reform to improve the economic self-sufficiency of these women unless comprehensive health services are available.

Adult↗
PubMed2004

Physical activity in low-income postpartum women.

PURPOSE: To validate the 7-day physical activity recall (PAR), including alternative PAR scoring algorithms, using pedometer readings with low-income postpartum women, and to describe physical activity patterns of a low-income population of postpartum women. METHODS: Forty-four women (13 African American, 19 Hispanic, and 12 White) from the Austin New Mothers Study (ANMS) were interviewed at 3 months postpartum. Data were scored alternatively according to the Blair (sitting treated as light activity) and Welk (sitting excluded from light activity and treated as rest) algorithms. Step counts based on 3 days of wearing pedometers served as the validation measure. FINDINGS: Using the Welk algorithm, PAR components significantly correlated with step counts were: minutes spent in light activity, total activity (sum of light to very hard activity), and energy expenditure. Minutes spent in sitting were negatively correlated with step counts. No PAR component activities derived with the Blair algorithm were significantly related to step counts. The largest amount of active time was spent in light activity: 384.4 minutes with the Welk algorithm. Mothers averaged fewer than 16 minutes per day in moderate or high intensity activity. Step counts measured by pedometers averaged 6,262 (SD = 2,712) per day. CONCLUSIONS: The findings indicate support for the validity of the PAR as a measure of physical activity with low-income postpartum mothers when scored according to the Welk algorithm. On average, low-income postpartum women in this study did not meet recommendations for amount of moderate or high intensity physical activity.

Activities of Daily Living↗
PubMedDate not supplied

Effects of social support on prenatal care and health behaviors of low-income women.

OBJECTIVE: To determine the relationship of social support from partners and others to the adequacy of prenatal care and to the prenatal health behaviors of low-income women. DESIGN: Descriptive, correlational study using self-reports and medical record review. SETTING: Data were collected in five metropolitan prenatal clinics serving low-income women. PARTICIPANTS: Ethnically diverse, primarily single, low-income pregnant women (N = 101) between 28 and 40 weeks of pregnancy. MAIN OUTCOME MEASURES: Subjects completed the Norbeck Social Support Questionnaire, the Prenatal Health Questionnaire, and the Demographic/Pregnancy Questionnaire. RESULTS: Social support provided by the partner correlated positively with adequacy of prenatal care, whereas social support from others (excluding partner relationships) correlated positively with prenatal health behaviors. Professionals such as health care providers and counselors were not considered sources of social support by women. CONCLUSIONS: Nurses who work with low-income pregnant women in a variety of settings should assist partners in recognizing their potential positive contributions, teach women to communicate their expectations to their partners, acknowledge the importance of other family members as providers of social support, and when needed, refer women to programs that increase available social support.

Adolescent↗
PubMed2026

Costs of surgeries in low- and middle-income countries: a systematic literature review.

BACKGROUND: Surgical care is essential for achieving global health equity, yet low- and middle-income countries (LMICs) face major gaps in access and planning, partly due to limited evidence on the costs and resource requirements of surgical interventions. Understanding these costs is vital for designing efficient and equitable health systems. METHODS: We conducted a systematic literature review (covering MEDLINE, EMBASE, Global Health, EconLit and grey literature) to identify studies reporting the costs of surgeries in LMICs from January 2000 to June 2023. Minor and major surgical procedures were considered, focusing on therapeutic procedures (excluding diagnostic interventions). Studies that clearly identified, quantified and costed hospital resources and services deployed in the provision of surgical care, and included at least two of the surgical production factors (ie, consumables, diagnostics, personnel, infrastructure and overhead) in the costing were included. Costs were standardised to 2023 International dollars (I$) for comparability. RESULTS: A total of 74 studies from 29 countries met the inclusion criteria, with 210 cost estimates across 65 procedure groups. Costs varied widely: from I$1.54 for a caesarean section in Tanzania to I$618 098 for paediatric cataract surgery in Zambia. Full costing studies reported higher estimates than partial costing studies. Most studies (60%) originated from upper-middle-income countries, with limited data (10%) from low-income settings. CONCLUSION: This review provides a reference list of surgical procedure costs across LMICs, highlighting considerable cost variation by procedure, specialty and country. The findings underscore the need for better-quality, standardised cost data-especially from low-income countries-to inform national surgical plans, universal health coverage benefit packages and reimbursement policies.

Developing Countries↗
PubMed2004

Low-Income workers with employer-sponsored insurance: who's at risk when employer coverage is no longer an option?

A firm's decision to drop the offer of employer-sponsored insurance (ESI), reduce eligibility for ESI, or significantly increase employee costs would have serious implications for the health insurance status of currently covered low-income workers. The authors find that at least a third of currently covered low-income workers do not have affordable insurance options outside of the group market. Furthermore, a simulation analysis shows that 54 percent of those workers would become uninsured if their employers were to drop ESI. This would result in an additional 1 million uninsured adults if 10 percent of low-income workers lost their ESI offer, and at least 350,000 uninsured adults if 10 percent of workers in firms with fewer than 100 employees (the firms most likely to drop coverage) lost their ESI. The authors also find that expanding public programs to cover low-income workers would reduce the high uninsurance rate by half, but substantial minorities would remain uninsured.

Adult↗
PubMed2005

Modifying physical activity in a multiethnic sample of low-income women: one-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project.

BACKGROUND: Ethnic minorities or those with low socioeconomic status (SES) are at increased risk of cardiovascular disease, type 2 diabetes, and all-cause mortality, compared to higher SES Whites. National surveys also indicate that low-income, ethnic minority women have the highest rates of inactivity in the United States. PURPOSE: This study (the Increasing Motivation for Physical ACTivity or IMPACT study) promoted adoption and maintenance of physical activity (PA) in sedentary, low-income women participating in federally funded job training programs. METHODS: The study consisted of 2 months of weekly 1-hr classes, then random assignment to 10 months of either home-based telephone counseling for PA plus information and feedback via mailed newsletters (Phone + Mail Counseling condition) or just the mailed newsletters (Mail Support condition). The IMPACT intervention included behavior change strategies for PA as well as discussions related to motivational readiness for PA change. Participants completed surveys and physiological assessments at baseline after the classes ended (i.e., at 10 weeks) and at 6 and 12 months postbaseline. Seventy-three percent of randomized participants (n = 72) were Latina, with a mean age of 32 +/- 10 years. More than half the women had not completed high school, and 73% had an annual income less than 20,000 dollars. RESULTS: After 10 months of a home-based intervention, women in the phone + mail counseling condition had significantly greater increases in estimated total energy expenditure compared to women in the mail support condition (p < .05). CONCLUSIONS: Regular PA counseling delivered via the telephone and through the mail appears effective for encouraging regular PA among low-income women transitioning from welfare or job training to the workforce.

Adolescent↗
PubMed2005

A study of the level of knowledge about diabetes management of low-income persons with diabetes.

Diabetes education has proven to be an effective intervention for the management of diabetes. Persons with lower education levels, the majority of whom have low incomes, receive less diabetes self-management education (DSME) than their peers. This study compared the diabetes knowledge level of low-income adults who did not have a high school diploma or general equivalency diploma with those who did. We conducted a survey among residents of 4 low-income neighborhoods in Cincinnati, Ohio, using a cross-sectional descriptive design. Surveys included information related to diabetes self-management and level of education. The only questions for which there was a significant difference between the 2 groups were those pertaining to the causes and treatment of hypoglycemia. Survey results were used to validate the need for a DSME program for low-income adults in Cincinnati, Ohio. A DSME program was developed specifically for persons with low literacy.

Adult↗
PubMed2003

Break-even analysis revisited: the need to adjust for profitability, the collection rate and autonomous income.

This paper modifies traditional break-even analysis and develops a model that reflects the influence of variation in payer mix, the collection rate, profitability and autonomous income on the desired volume alternative. The augmented model indicates that a failure to adjust for uncollectibles and the net surplus results in a systematic understatement of the desired volume alternative. Conversely, a failure to adjust for autonomous income derived from the operation of cafeterias, gift shops or an organization's investment in marketable securities produces an overstatement of the desired volume. In addition, this paper uses Microsoft Excel to develop a spreadsheet that constructs a pro forma income statement, expressed in terms of the contribution margin. The spreadsheet also relies on the percentage of sales or revenue approach to prepare a balance sheet from which indicators of fiscal performance are calculated. Hence, the analysis enables the organization to perform a sensitivity analysis of potential changes in the desired volume, the operating margin, the current ratio, the debt: equity ratio and the amount of cash derived from operations that are associated with expected variation in payer mix, the collection rate, grouped by payer, the net surplus and autonomous income.

Accounts Payable and Receivable↗