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PubMedDate not supplied

Burns as a result of assault: associated risk factors, injury characteristics, and outcomes.

The purpose of this study was to identify specific premorbid factors and injury characteristics associated with intentional burn injuries and to compare outcomes for individuals injured by assault and those with unintentional injuries. Participants sustaining major burns from May 1994 to August 2005 and consenting to a multisite, prospective, longitudinal outcome study were included. Etiology of the injury was classified as intentional (i.e., assault) or unintentional. Subjects <18 years old or with self-inflicted burns were excluded. Statistical analysis was performed with t-tests, chi2 tests, and analysis of variance. Eighty patients sustained intentional burn injuries and 1982 subjects sustained nonintentional burn injuries. Compared to patients with nonintentional burns, those with burns related to assault were more likely to be female, black, and unemployed and to have higher rates of premorbid substance use. Between the groups, there were no significant differences in preinjury living situation, education level, history of psychiatric treatment, or hospital length of stay. The intentional-burn group had larger burns and a greater in-hospital mortality rate, and these patients were less likely to be discharged to home. They also demonstrated significantly greater levels of psychological distress during the acute hospitalization but not at follow-up. Understanding the unique characteristics and needs of patients with intentional burn injuries is important because these individuals are less likely to have a steady income and more likely to rely on community social services. Affordable and accessible community-based health services are necessary in order to improve their outcomes.

Accidents↗
PubMed1998

Willingness of families caring for victims of dementia to pay for nursing home care: results of a pilot study in Taiwan.

In order to examine the value family caregivers attach to the benefits associated with nursing home services, this contingent survey was designed to investigate the willingness of family caregivers of dementia victims to pay for nursing home care. A total of 136 members of families of dementia patients from the department of neurology and psychiatry of four medical centers in Taiwan were interviewed by phone. These family members provided in-home care for dementia victims and had expressed the need for nursing home placement. These family caregivers were asked to explicitly state the maximum amount of family income per month they are able to give up to receive nursing home services. The willingness to pay (WTP) for nursing home care ranged from US$185 to $2,407 per month, and 37.5 percent of the family caregivers interviewed indicated a willingness to pay at least 50 percent of the monthly family income for nursing home placement. The amount of monthly family income was strongly associated with the WTP for nursing home care in dollars. Age and education of the caregiver, and accessibility of nursing home care were significantly associated with WTP in both cost range and percentage of monthly family income. Interviewees who were older than 65 years (odds ratio is 3.52), and educated equal to or above senior high school (odds ratio is 5.57) were inclined to pay at least 50 percent of monthly family income for nursing home placement. As other variables were adjusted, respondents older than 65 years were willing to pay US$208.4 per month more than those younger than 65 years for nursing home placement; and the educated equal to or above senior high school were inclined to pay US$171.9 per month more than those with less than a senior high school education. The easier it was to find nursing home agencies near the residence, the more willing the family was to pay at least 50 percent of their monthly family income for nursing home services; with an odds ratio of 16.51. The families with the higher accessibility to nursing home agencies were willing to pay US$174.3 per month more than caregivers with lower accessibility. Family caregivers, who were older than 65 years, educated above the senior high school level, with a higher family income, and easier accessibility to nursing home services, were likely to attach higher economic values to nursing home placement.

Aged↗
PubMed1997

Medical rationing as a health strategy.

Notes the problem of rising health care costs in the USA. Considers a highly controversial solution to this problem, which is to consider health care as a scarce resource and to ration access to it. Whether rationing is done by age, ability to pay, or a cost-benefit analysis, the very concept contradicts the US belief in the right to health care. Other industrialized countries currently ration health care through a National Health Insurance Plan. Points out that, in the USA, individual states are beginning to consider health care rationing to combat shrinking budgets and increasing demand for services.

Adult↗
PubMed2004

Managing finances for a fulfilled Canadian retirement.

Finances play an important, if not pivotal, role in a healthy retirement. Managing money, knowing where one stands financially, forecasting needs for the lifestyle of choice, are all necessary activities to leading a fulfilling happy retirement. Until the basic needs of life are met, the greater joys of socializing, esteem, and fulfillment cannot be achieved. In Canada there are pensions for seniors available according to certain requirements. Knowledge of these pensions is essential before retiring. Knowing how to evaluate one's worth and forecast future needs is necessary to achieve the anticipated retirement so frequently cherished. By planning early and managing decisions and actions effectively, an individual can ensure the best possible retirement.

Aged↗
PubMed2005

Measuring preferences for delivery services in rural Vietnam.

BACKGROUND: The relatively low use of maternity services at the primary health care level in Vietnam has highlighted the need for economic evaluations of the current maternal health delivery network. This study measured willingness-to-pay for obstetric delivery preferences in rural Vietnam. METHODS: An interviewer-administered survey was conducted among 200 postpartum and 196 pregnant women, and 196 men in Quang Xuong district, Thanh Hoa province of Vietnam, using the payment card technique. RESULTS: A kappa score of 0.98 showed very good agreement between the two interviewers administering the survey. An association was found between willingness-to-pay and satisfaction with the quality of maternity services. No significant differences were found in willingness-to-pay values between prenatal and postpartum groups, and between male and female participants. CONCLUSIONS: The study demonstrates that the willingness-to-pay instrument is a feasible tool, and is relatively reliable to measure the benefit of different alternatives of delivery services in rural Vietnam. For wider application of the instrument, its validity should be investigated further. Meanwhile, health care managers and decision makers should be encouraged to apply the instrument in the evaluation of maternal health programs.

Adult↗
PubMedDate not supplied

Complementary therapy use among older rural adults.

OBJECTIVE: Explore use, cost, and satisfaction with the quality and effectiveness of complementary therapy among older rural adults. DESIGN: Descriptive survey. SAMPLE: A random sample of 325 older adults from rural communities throughout Montana and North Dakota. MEASUREMENTS: Participants were interviewed by telephone. RESULTS: Only 57 participants (17.5%) had used complementary providers and most sought this care for chronic problems, heard about providers through word-of-mouth information, and were satisfied with the care. A total of 35.7% (116) used self-directed complementary practices and most used these practices for health promotion, heard about them through informal sources, and found them to be at least somewhat helpful. Of the 325 participants, 45.2% (147) used some form of complementary care, e.g., providers, self-directed practices, or both. Participants used as much complementary care as is found in national studies. Most spent relatively little out-of-pocket for complementary care. CONCLUSIONS: Understanding the health care choices that older rural residents make, including complementary health care, is paramount for a comprehensive approach to meeting their health care needs.

Aged↗
PubMed2004

Willingness to pay for on-demand and prophylactic treatment for severe haemophilia in Sweden.

The objective of the present paper was to provide an estimate of the benefits of on-demand and prophylaxis treatment strategies for severe haemophilia in monetary terms. Using the contingent-valuation method, which simulates a missing market by asking people about their willingness to pay (WTP), we asked a representative sample (n = 609) of the Swedish population if they would be willing to pay a specific amount (bid) so that patients with severe haemophilia could receive on-demand treatment and another bid for prophylactic treatment. Different respondents were offered different bids and the bid vector ranged from 71 Euro cents to EUR 130. The order of the bid questions was randomized so that half of the respondents were asked first about their WTP for on-demand treatment, and then about their WTP for prophylaxis, while the order was reversed for the other half of the respondents. The mean estimated WTP (year 2002) was EUR 39 (95% CI 31-47) for on-demand and EUR 65 (95% CI 55-73) for prophylaxis. Our sensitivity analysis showed that the ranking of the two treatment alternatives was robust in that the WTP was greater for prophylaxis in all possible subsets. The point estimates of WTP varied somewhat in subsets defined by individual characteristics, but confidence intervals always overlapped that of the main results. The WTP for on-demand and prophylaxis exceeded the calculated cost of treatment per taxpayer of providing on-demand and prophylactic treatment, respectively, based on our previous results.

Adult↗
PubMed2005

Using discrete choice experiments to go beyond clinical outcomes when evaluating clinical practice.

BACKGROUND: This study builds on the results of a randomized controlled trial concerned with examining the effect of reducing waiting times on the health status of patients referred for non-urgent rheumatology opinion. No difference in clinical outcomes was found between a 'fast-track' and 'ordinary' appointment system. This suggests that rationing by waiting times is not detrimental to health. However, such an approach ignores the value patients attach to reducing waiting time. OBJECTIVES: To estimate the monetary value of reducing waiting time, as well as changes in duration of appointment and the introduction of a pain management service, in the provision of rheumatology services. METHODS: Discrete choice experiment (DCE). SETTING: The main outpatient clinic of the rheumatology service for the Lothian and Borders region. SUBJECTS: 262 patients who had received a specialist rheumatology opinion--73 had received fast-track treatment, 65 standard care and 124 were non-trial patients. RESULTS: A response rate of 71% was achieved. Patients valued a 9-week reduction in waiting time at 131 pounds sterling. However, the introduction of a pain management service was valued at 209 pounds sterling. Thus, the latter is of more value to respondents. Evidence was also found of the internal consistency and theoretical validity of the DCE approach. CONCLUSIONS: The reduction of waiting times is a central plank of NHS policy. Whilst a reduction in waiting time is of value, a pain management service is of more benefit than a 9-week reduction in waiting time. DCE were shown to be a potentially useful technique for valuing different aspects of health care interventions.

Clinical Medicine↗
PubMed2005

The relationships among three factors affecting the financial decision-making abilities of adults with mild intellectual disabilities.

BACKGROUND: Among adults with intellectual disabilities (IDs), there is a need not only to assess financial decision-making capacity, but also to understand how it can be maximized. Although increased financial independence is a goal for many people, it is essential that individuals' decision-making abilities are sufficient, and many factors may affect the development of such abilities. METHOD: As part of a wider project on financial decision-making, we analysed previous data from a group of 30 adults with mild IDs, identifying correlations among four variables: (i) financial decision-making abilities; (ii) intellectual ability; (iii) understanding of some basic concepts relevant to finance; and (iv) decision-making opportunities in everyday life. RESULTS: The analysis indicated a direct relationship between ID and basic financial understanding. Strong relationships of a potentially reciprocal nature were identified between basic financial understanding and everyday decision-making opportunities, and between such opportunities and financial decision-making abilities. CONCLUSIONS: The findings suggest that the role of intellectual ability in determining financial decision-making abilities is only indirect, and that access to both basic skills education and everyday decision-making opportunities is crucial for maximizing capacity. The implications of this are discussed.

Adolescent↗
PubMed2006

Stress, debt and undergraduate medical student performance.

INTRODUCTION: Against the background of current debate over university funding and widening access, we aimed to examine the relationships between student debt, mental health and academic performance. METHODS: We carried out an electronic survey of all medical undergraduate students at the University of Aberdeen during May-June 2004. The questionnaire contained items about demographics, debt, income and stress. Students were also asked for consent to access their examination results, which were correlated with their answers. Statistical analyses of the relationships between debt, performance and stress were performed. RESULTS: The median total outstanding debt was pound 7300 (interquartile range 2000-14 762.50). Students from lower socioeconomic backgrounds and postgraduate students had higher debts. There was no direct correlation between debt, class ranking or General Health Questionnaire (GHQ) score; however, a subgroup of 125 students (37.7%), who said that worrying about money affected their studies, did have higher debt and were ranked lower in their classes. Some of these students were also cases on the GHQ-12. Overall, however, cases on the GHQ had lower levels of debt and lower class ranking, suggesting that financial worries are only 1 cause of mental health difficulties. DISCUSSION: Students' perceptions of their own levels of debt rather than level of debt per se relates to performance. Students who worry about money have higher debts and perform less well than their peers in degree examinations. Some students in this subgroup were also identified by the GHQ and may have mental health problems. The relationships between debt, mental health and performance in undergraduate medical students are complex but need to be appreciated by medical education policy makers.

Clinical Competence↗
PubMed2006

Fever treatment and household wealth: the challenge posed for rolling out combination therapy for malaria.

OBJECTIVE: To investigate the variation in malaria parasitaemia, reported fever, care seeking, antimalarials obtained and household expenditure by socio-economic status (SES), and to assess the implications for ensuring equitable and appropriate use of antimalarial combination therapy. METHODS: A total of 2,500 households were surveyed in three rural districts in southern Tanzania in mid-2001. Blood samples and data on SES were collected from all households. Half the households completed a detailed questionnaire on care seeking and treatment costs. Households were categorised into SES thirds based on an index of household wealth derived using principal components analysis. RESULTS: Of individuals completing the detailed survey, 16% reported a fever episode in the previous 2 weeks. People from the better-off stratum were significantly less likely to be parasitaemic, and significantly more likely to obtain antimalarials than those in the middle or poor stratum. The better treatment obtained by the better off led them to spend two to three times more than the middle and poor third spent. This reflected greater use of non-governmental organisation (NGO) facilities, which were the most expensive source of care, and higher expenditure at NGO facilities and drug stores. CONCLUSION: The coverage of appropriate malaria treatment was low in all SES groups, but the two poorer groups were particularly disadvantaged. As countries switch to antimalarial combination therapy, distribution must be targeted to ensure that the poorest groups fully benefit from these new and highly effective medicines.

Adolescent↗
PubMed2007

Patients' willingness to pay for anti-emetic treatment.

BACKGROUND: Post-operative nausea and vomiting (PONV) is a common complication of anaesthesia. This study was conducted in 100 German and 100 Turkish patients scheduled for elective surgery under general anaesthesia to assess the amount patients were willing to pay for an anti-emetic that completely prevented PONV. METHODS: Post-operatively, using Dixon's up and down method, patients completed an interactive computer questionnaire with a random starting point to determine how much of their own money they were willing to pay for a totally effective anti-emetic treatment. RESULTS: On average, participants were willing to pay 65 euro in Germany and 68 euro in Turkey to avoid PONV. However, patients who actually experienced PONV were willing to pay larger amounts: 96 euro in Germany and 99 euro in Turkey. The amount patients were willing to pay was related to female sex, history of motion sickness, non-smoking status and better education. CONCLUSIONS: Despite differences in political and cultural origin, health care system and financial background, the amount patients were willing to pay for an effective anti-emetic was similar in both Germany and Turkey to that reported previously for the USA.

Adult↗
PubMed2006

Parents' willingness to pay for diminishing children's pain during blood sampling.

BACKGROUND: Blood sampling is a frequent medical procedure, very often considered as a stressful experience by children. Local anesthetics have been developed, but are expensive and not reimbursed by insurance companies in our country. We wanted to assess parents' willingness to pay (WTP) for this kind of drug. PATIENTS AND METHODS: Over 6 months, all parents of children presenting for general (GV) or specialized visit (SV) with blood sampling. WTP was assessed through three scenarios [avoiding blood sampling (ABS), using the drug on prescription (PD), or over the counter (OTC)], with a payment card system randomized to ascending or descending order of prices (AO or DO). RESULTS: Fifty-six responses were collected (34 GV, 22 SV, 27 AO and 29 DO), response rate 40%. Response distribution was wide, with median WTP of 40 for ABS, 25 for PD, 10 for OTC, which is close to the drug's real price. Responses were similar for GV and SV. Median WTP amounted to 0.71, 0.67, 0.20% of respondents' monthly income for the three scenarios, respectively, with a maximum at 10%. CONCLUSIONS: Assessing parents' WTP in an outpatient setting is difficult, with wide result distribution, but median WTP is close to the real drug price. This finding could be used to promote insurance coverage for this drug.

Adolescent↗
PubMed1998

The short-term financial costs of abnormal Pap smears to women and government in Australia.

Using data collected from a private Canberra colposcopy service, we examined the direct costs, to women and government, of the gynaecological care of women with cervical cytological abnormalities and determine the potential savings of implementing the Commonwealth recommendations for the clinical care of women with screen-detected abnormalities. We performed a case note audit of 502 women who first attended a gynaecologist because of an abnormal Pap smear between 1 January 1989 and 30 April 1990. The smear resulting in their referral--their presenting smear--was categorised as No CIN (showing no evidence of cervical intraepithelial neoplasia), CIN 1, CIN 2 and CIN 3. The average costs to government (p for trend < 0.001) and women (p for trend = 0.006) increase as the presenting smear increases in severity; the median costs to government (p for trend < 0.001) and women (p for trend < 0.001) also rose with increasing cytological severity. Treatment of CIN 1 and No CIN accounted for half the costs incurred by government and women. Although costs increase with increasing severity of cytological abnormality, adherence to new Australian guidelines for the gynaecological care of women with screen-detected cervical abnormalities could result in substantial short-term savings to government and women.

Adult↗