Health Care and Social Service Access and Utilization

Introduction: The health services in higher institutions are to aid in providing treatment, information and education about health. Unfortunately, services available are not being utilized appropriately. Assessment of utilization is a main approach to understand the functioning of the health services. This study aimed to know the behavioural pattern and factors that influence the utilization of available health services among undergraduates. Method: This was a cross sectional descriptive study of 250 undergraduates selected using random sampling technique from four faculties out of thirteen faculties in the institution. Self-administered pre-tested questionnaires were used to gather information from the participants. Results: Majority, 177(70.8%) were males, 190 (76%) had registered with the health centre and those who did not, 67.4% were of the opinion that registration procedure is clumsy. Among 142 students who were ill, 45.8% utilized the health centre. Of those that sought alternative means of treatment, 70.7% used self-medication (over-the-counter), while 15.2% visited private hospitals, 41.8% believed that alternative means were prompt in response to their health needs while 24.6% believed drugs were not usually available in the health centre. Conclusion: Factors that influence utilization of university health centre are income, course of study, registration with health centre and perceived severity of illness. These factors identified among undergraduates in this study are amenable to policy change in order to improve utilization.

An important determinant of students’ morbidity and mortal-
ity rate is the access to and use of quality healthcare services. The provision of quality health care is an increasingly dif
-
ficult task. Globally, universities do have health centres to pro
-
vide  quality  and  affordable  health  care  to  students  of  the  in-
stitution. Access to quality health services provided by the
university  management  is  crucial  to  having  a  reduced  rate  of 
students’  morbidity  and  mortality.  Attitude  towards  utiliza
-
tionof health services will be related to the availability of drugs,
health care providers, equipment and accessibility. The World
Health Assembly mandated sound health for all people in the
-
year 2000 because it was necessary for socially productive life. In low resource countries, the hospital bed-population and
doctor-population ratio was about 0.4 and 0.2 per 1,000 popu-
lation respectively, while the corresponding figures for the de
-
veloped countries are 6 and 3 per thousand population.

Ensuring equitable access to high-quality healthcare constitutes a key challenge for health systems throughout Europe. Despite differences in health system size, structure and financing, evidence suggests that across Europe particular sections of the population are disproportionately affected by barriers to
accessing healthcare. Studies have also shown that difficulties in accessing healthcare are compounded by poverty and social exclusion, and that poverty and social exclusion compound difficulties in accessing healthcare.

At an EU level, access to healthcare is also a key issue. Listed as one of the common values for EU Member States agreed in June 2006 (Council of the European Union, 2006b), access for all to adequate healthcare and long-term care and tackling of inequities in access has also been proposed as a priority
objective for the new streamlined EU Open Method of Coordination for Social Protection and Social Inclusion. The Social Inclusion Strategy (European Commission 2006b) also emphasises a strong focus on reducing poverty and social exclusion for EU citizens.

Against this background, the European Commission (DG Employment, Social Affairs and Equal Opportunity) commissioned the European Health Management Association to undertake a study on “Quality in and Equality of
Access to Healthcare Services: HealthQUEST”. The study has had two key aims. The first has been to identify and analyse barriers to accessing healthcare, particularly for vulnerable people at risk of social exclusion. The study therefore looks at barriers to access at the supply side, problems experienced in this respect by certain groups of the population (demand side)
and also at the interplay between the two. The second aim has been to review policy initiatives taken by Member States to realise the objective of equitable access for all. This has included analysing evidence of the effectiveness of
policy initiatives and highlighting good practice.

This study is based on detailed analysis provided by studies on the situation of the following eight countries: Finland, Germany, Greece, the Netherlands, Poland, Romania, Spain, and the United Kingdom, - countries that represent different ways of organising and funding of health care across Europe. This was
complemented with findings from the literature, in particular recent European comparative studies.
The report falls into three principle parts. The first outlines the policy context and methodology of the project. The second looks at the specific barriers focused on in the study, including coverage, cost-sharing, health literacy and supply-side responsiveness. The third part moves on to analyse the specific problems affecting selected groups at particular risk of social exclusion. In each,
underlying factors have been analysed and policy initiatives and good practice identified.

Three groups at particular risk of social exclusion and where there are important gaps in research (and sometimes also in policy action) were chosen for in-depth study:
− Migrants (including asylum seekers and illegal immigrants);
− Older people with functional limitations;
− People with mental disorders (studied as a special case study under the project).
For these groups the study looked across the eight countries to find out what issues they face and the interaction between the difficulties they experience. An in depth review in the form of a case study was undertaken on the access of people with mental health problems on access to mainstream (somatic) healthcare services."

Background
A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.

Methods
Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.

Findings
In 2016, HAQ Index performance spanned from a high of 97·1 (95% UI 95·8–98·1) in Iceland, followed by 96·6 (94·9–97·9) in Norway and 96·1 (94·5–97·3) in the Netherlands, to values as low as 18·6 (13·1–24·4) in the Central African Republic, 19·0 (14·3–23·7) in Somalia, and 23·4 (20·2–26·8) in Guinea-Bissau. The pace of progress achieved between 1990 and 2016 varied, with markedly faster improvements occurring between 2000 and 2016 for many countries in sub-Saharan Africa and southeast Asia, whereas several countries in Latin America and elsewhere saw progress stagnate after experiencing considerable advances in the HAQ Index between 1990 and 2000. Striking subnational disparities emerged in personal health-care access and quality, with China and India having particularly large gaps between locations with the highest and lowest scores in 2016. In China, performance ranged from 91·5 (89·1–93·6) in Beijing to 48·0 (43·4–53·2) in Tibet (a 43·5-point difference), while India saw a 30·8-point disparity, from 64·8 (59·6–68·8) in Goa to 34·0 (30·3–38·1) in Assam. Japan recorded the smallest range in subnational HAQ performance in 2016 (a 4·8-point difference), whereas differences between subnational locations with the highest and lowest HAQ Index values were more than two times as high for the USA and three times as high for England. State-level gaps in the HAQ Index in Mexico somewhat narrowed from 1990 to 2016 (from a 20·9-point to 17·0-point difference), whereas in Brazil, disparities slightly increased across states during this time (a 17·2-point to 20·4-point difference). Performance on the HAQ Index showed strong linkages to overall development, with high and high-middle SDI countries generally having higher scores and faster gains for non-communicable diseases. Nonetheless, countries across the development spectrum saw substantial gains in some key health service areas from 2000 to 2016, most notably vaccine-preventable diseases. Overall, national performance on the HAQ Index was positively associated with higher levels of total health spending per capita, as well as health systems inputs, but these relationships were quite heterogeneous, particularly among low-to-middle SDI countries.

Interpretation
GBD 2016 provides a more detailed understanding of past success and current challenges in improving personal health-care access and quality worldwide. Despite substantial gains since 2000, many low-SDI and middle-SDI countries face considerable challenges unless heightened policy action and investments focus on advancing access to and quality of health care across key health services, especially non-communicable diseases. Stagnating or minimal improvements experienced by several low-middle to high-middle SDI countries could reflect the complexities of re-orienting both primary and secondary health-care services beyond the more limited foci of the Millennium Development Goals. Alongside initiatives to strengthen public health programmes, the pursuit of universal health coverage hinges upon improving both access and quality worldwide, and thus requires adopting a more comprehensive view—and subsequent provision—of quality health care for all populations.

My dissertation focusses on the relevance of applying an inclusive social protection framework for the reduction of maternal mortality among pastoralists in Kenya. I will discuss this using the case study of the Free Maternity Services program introduced in Kenya in 2013 which aims at providing access to free maternal health services to the poor and economically disadvantaged sections of its population. Using evidence from reports on the implementation of the program, I will provide a detailed analysis of applying an inclusive approach to this intervention in order to make it more equitable and accessible to the pastoralist communities in the region.

OBJECTIVE: While trucking in industrialized nations is linked with driver health afflictions, the role of trucking in U.S. truckers' health remains largely unknown. This paper sheds light on links between the trucking work environment and drivers' physical health. METHODS: Using a cross-sectional design, 316 truckers were enrolled in the Healthy Trucker Survey. Questions included work history, physical and mental health, and healthcare access. PASW 18 was used to examine patterns among factors. PARTICIPANTS: 316 truckers participated. RESULTS: Respondents were mainly full-time, long-haul drivers with over 5 years of experience, and who spent over 17 days on the road per month. While almost 75% described their health as good, 83.4% were overweight/obese, 57.9% had sleeping disturbances, 56.3% fatigue, 42.3% musculoskeletal disorders, and about 40% cardiovascular disease concerns. About 33% had no health insurance, 70% had no regular healthcare visits, 24.4% could not afford insurance, and 42.1% took over-the-counter drugs when sick, while 20.1% waited to reach home for medical care. Exercise facilities were unavailable in over 70% of trucking worksites and 70% of drivers did not exercise regularly. CONCLUSIONS: The trucking occupation places drivers at high risk for poor health outcomes. Prospective studies are needed to delve into how continued exposure to trucking influences the progression of disease burden.

Health and social care profession is one of the most common professions in contemporary Britain. The health and social care industry is currently one of UK\'s largest employers. Over the years, there have been developments in the profession with more recognition to its status and more people getting into the work force. One major change to the profession is the creation of professional organizations which seems to protect and add more value to the profession. These professional organizations lay down ethical standards that professionals have to abide to in order to practice ethically. Some approaches to the ethical standards are normative (that is, they present standard of right or good action), others are descriptive (that is, they report what people believe and how they act), and still others analyze the concepts and methods of ethics (Beauchamp and Childress 1994). The morally prescribed behavior (i.e., the “right” thing to do) would be a person’s ethical duty, or moral obligation, in that situation. A theory of obligation is also a normative ethical theory because it presents rules of right and wrong conducts that apply to everyone.

Introduction: Patients and the public are beginning
to use digital health tools to assist in managing
chronic illness, support independent living and
self-care, and remain connected to health and care
providers. However, engaging with and enrolling in
digital health interventions, such as telehealth
systems, mobile health applications, patient portals
and personal health records, in order to use them
varies considerably. Many factors affect people’s
ability to engage with and sign up to digital health
platforms.
Objectives: The primary aim is to identify the
barriers and facilitators patients and the public
experience to engagement and recruitment to digital
health interventions. The secondary aim is to identify
engagement and enrolment strategies, leading if
possible to a taxonomy of such approaches, and a
conceptual framework of digital health engagement
and recruitment processes.
Methods: A systematic review of qualitative studies
will be conducted by searching six databases:
MEDLINE, CINAHL, PubMed, EMBASE, Scopus and
the ACM Digital Library for papers published between
2000 and 2015. Titles and abstracts along with
full-text papers will be screened by two independent
reviewers against predetermined inclusion and
exclusion criteria. A data extraction form will be used
to provide details of the included studies. Quality
assessment will be conducted using the Consolidated
Criteria for Reporting Qualitative Research checklist.
Any disagreements will be resolved through
discussion with an independent third reviewer.
Analysis will be guided by framework synthesis and
informed by normalization process theory and
burden of treatment theory, to aid conceptualisation
of digital health engagement and recruitment
processes.
Discussion: This systematic review of qualitative
studies will explore factors affecting engagement and
enrolment in digital health interventions. It will
advance our understanding of readiness for digital
health by examining the complex factors that affect
patients’ and the public’s ability to take part.

Increasing medical expenditures is a major economic challenge for the United States.  From 1990 to 2009, total per capita health care expenditures increased 284% and are expected to exceed $12,000 per capita by 2020. Although previous research has tested the impact of a single health behavior on medical expenditures, no empirical studies have examined the link between patterns of health-related behavior and medical expenditures.  The current research was grounded in typological methods, complex systems, dynamic systems, and complex adaptive systems theories.  The research question assessed the predictive validity of an individual case’s probabilistic distance from patterns of health-related behavior at the center of cluster groups identified typologically on medical expenditures while controlling for the predictive effects of a case’s probabilistic distance from remaining central patterns of health-related behavior, age, and sex. A random sample of 3,955 adults was taken from a 2003 Florida commercial health plan database. Participant probabilistic distance from patterns of health-related behavior was assessed using posterior probabilities derived from discriminant function analysis. Multiple regression analysis was used to analyze the research question and results supported the positive predictive effects of patterns of health-related behavior on medical expenditures as participants emulated the patterns with increasing acuteness.  This research supports positive social change by demonstrating the need for policy development to address health behavior pattern contributions to increasing expenditures at national, regional, community, and individual levels.  This research expands the predictive effects of single health-related behaviors on medical expenditures to multiple health-related behaviors.

The legal discipline of social services occupies a central position with regard to the transformations which have affected and continue to affect national welfare systems in Europe. In fact, while at national level subnational authorities continue to play a relevant role in providing said services, at supranational level a gradual “infiltration” of EU Antitrust law has taken place. Nevertheless, said “infiltration”, affecting only organizational aspects relating to social services, does not appear to be able to undermine the “social sovereignty” of Member States, which is provided by art. 106, par. 2, of the TFEU and by some sectoral regulations. Nevertheless it could be important to start an harmonization process at European level in this field, in order to encourage virtuous reforms in the Member States and, so on, reduce inefficiencies and inequalities which still characterize several national welfare systems.

Background: Developing countries, including India, face similar problems in implementation of health programs and thus have shown poor progress on the Millennium Development Goals. Many of these countries are also facing epidemiological transition and facing a dual disease pattern, which leads to increasing burden on the limited resources, leading to program failure. This review is undertaken to look at the possible reasons for program failure focusing on India.

Background: Begging is a last resort of coping mechanisms of poverty, disability and various political, social
and environmental crises. It is practiced to obtain from others. Objective: This study is attempted to investigate the
demographic and socio-economic determinants of begging at Bahir Dar. Methods: case-control study design was used with
a total population of 204 (102 cases[ beggars] and 102 controls[ non- beggars] ). Semi-structured questionnaire were used
and entered in to SPSS for Windows version 15.0 for analysis. Result: reasons for beggar’s engagement in begging were,
Poverty (98%) unemployment (78%) and physical handicap (54%) were identified. As to the background characteristics of
respondents, the result of the binary logistic regression indicates that there was significant relation between begging and
literacy status. The odds of begging decreases by 25% for literate respondents than their illiterate counterparts. In this study,
beggaring was found increasing as age level increases. The logistic regression results also indicate that the odds of begging
is 10.76 times higher for cases in the age group 25-34 years than younger cohorts (15-24 years). Annual household income
also showed an association to be beggars between the groups. Conclusion and Recommendation: illiteracy, migration, old
age and low annual household income were significantly associated with being beggar. Reducing rural urban migration and
establishing an old age security system may solve the problem.

Economic improvement in Palu City has an impact on changes in the structure and general view of transportation facilities, by technological advances, as well as engineering in the field of transportation, so that the public's need for transportation can provide maximum service. This study aims to analyze the degree of saturation and identify the use of land use, as well as to analyze the influence of land use development along the National Road Corridor Jalan Jenderal Sudirman – Pelabuhan Pantoloan? The results of the study show that the development of land use will cause attraction and generation from an area, increasing accessibility and intensity of traffic flow using this road corridor with the largest degree of saturation in Segment 3 - Jl. Yos Sudarso is 0.65 and Segment 5 - Kebonsari – Tawaeli is 0.63. It is found that the generation of movement, residential areas, gives a figure of 1737 smp/hour. As for the pull of movement, it is strongly influenced by the trade and service area with 2041 smp/hour. In the Office Area for attraction of movement of 838 junior high school/hour, Education Area of 22 junior high school/hour and Health Area of 26 junior high school/hour. Almost all of these interactions are carried out with trips that will result in traffic flow, thus causing a problem with increasing traffic volume along the road which causes the performance of the road segment to decrease.

Health care sector grows tremendously in last few decades. The health care sector has generated huge amounts of data that has huge volume, enormous velocity and vast variety. Also it comes from a variety of new sources as hospitals are now tend to implemented electronic health record (EHR) systems. These sources have strained the existing capabilities of existing conventional relational database management systems. In such scenario, Big data solutions offer to harness these massive, heterogeneous and complex data sets to obtain more meaningful and knowledgeable information. This paper basically studies the impact of implementing the big data solutions on the healthcare sector, the potential opportunities, challenges and available platform and tools to implement Big data analytics in health care sector.

Uniform distribution of any service or facility is always a challenging job as the physical and cultural factors are not homogeneous. Providing Health care facility to a large population which is distributed in variety of landforms or physical region is not easy task. Study of health care services is one of the major aspects of Health Geography. Many studies have been made in recent time at macro or micro level. Akhtar (1978) 1 have been examined the spatial distribution and growth of healthcare services in Rajasthan. In Maharashtra, socio economic abstract were publishes regularly (yearly) for every district, which provide important statistics of health facilities. By its study one can understand the spatio-temporal changes in the development of health care facilities. In present paper an attempt has been made to understand the development of government health care facilities in the span of 40 years i.e. 1971 to 2010. Tahsil has been taken as a study unit. All 15 tahsil were grouped in to tribal and non-tribal tahsil on the basis of tribal population percentage. By using composite score method all tahsil were categorized in to 3 levels of development. It is found that initially Government health facilities are not distributed well in tribal part but after 40 years tribal tahsil shows remarkable increase in this field. Few tahsil have yet to develop fully in this manner. The norms suggested for medical facilities by Bhore committee or National health plan 1983 should be implemented in near future.

Grid computing has emerged from category of distributed and parallel computing where the heterogeneous resources from different network are used simultaneously to solve a particular problem that need huge amount of resources. Potential of Grid computing depends on my issues such as security of resources, heterogeneity of resources, fault tolerance & resource discovery and job scheduling. Scheduling is one of the core steps to efficiently exploit the capabilities of heterogeneous distributed computing resources and is an NP-complete problem. To achieve the promising potential of grid computing, an effective and efficient job scheduling algorithm is proposed, which will optimized two important criteria to improve the performance of resources i.e. makespan time & resource utilization. With this, we have classified various tasks scheduling heuristic in grid on the basis of their characteristics.

Network on chip (NOC) is used to connect Multiple Cores in a tiled multicore Processor. Here each core is connected to L1 cache where LLC (L2) is shared by the entire core. The data in the Last Level Cache slices can be accessed by multiple cores simultaneously and results in congestion at the LLC and increases the access time .So in order to find a solution to this problem, Propose a congestion management Technique in the LLC that contains NOC Router with small storage (Router Buffer Cache) to keep a copy of heavily shared cache blocks. The simulation of the Multicore system can be done by Gem5 tool and evaluate its effectiveness by running a set of parallel benchmarks , Thereby Reducing the LLC access Time "

Introduction: Immigrants are among the most vulnerable population groups in North America; they face multidimensional hurdles to obtain proper healthcare. Such barriers result in increased risk of developing acute and chronic conditions. Subsequently a great deal of burden is placed on the healthcare system. Community navigator programs are designed to provide culturally sensitive guidance to vulnerable populations in order to overcome barriers to accessing healthcare. Navigators are healthcare workers who support patients to obtain appropriate healthcare. This scoping review systematically searches and summarizes the literature on community navigators to help immigrant and ethnic minority groups in Canada and the United States overcome barriers to healthcare.

This paper describes the way in which a mixed methods approach might provide a knowledge base to understand some of the factors involved in access to paediatric healthcare. The paper addresses the potential for this approach to start to build an evidence-informed understanding of a public policy issue.  Our research tracked the increase in paediatric presentations at the Woman’s and Children’s Health Service Emergency Department in South Australia for illness events that might more appropriately have been dealt with through primary care services such as general practice. The mixed methods used the Hospital Admission Status(HAS), Paediatric ED data, analysis of the South Australian Social Health Atlas for demographic and epidemiological data, and triage priority information. This quantitative analysis informed the use of interviews with parents, community health providers and emergency health professionals. Sequencing allowed the researcher to integrate the question over time and revealed policy deficits in health access in Australia.

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]). 
Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.
Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 visits were reviewed. The PMHNP was more likely to care for younger patients while the MD cared for more older patients (p<.001). The PMHNPs cared for a more diverse gender spectrum than the MD (p = .031). The MD was more likely to care for Caucasian patients; whereas, the PHMNPs cared for a more diverse racial or ethnic population (p <.001). The MD was more likely to care for the self-pay patient than the PMHNP who cared for those with a larger range of payor types (p< .001). The rate of emergency department (ED) visits and hospitalizations between providers was essentially the same (p=0.40) and (p=0.31) respectively.
Implications: No determination could be made in the key outcome measures of ED visits or hospitalizations between the PMHNPs and MD due to lack of documentation in the record. However, 450 more patients per month were treated for mental healthcare needs when PMHNPs were utilized.

Restrictive U.S. immigration policies and enforcement have led to concerns among providers about how these changes affect service utilization among Latinx and immigrant communities. This study outlines perceptions from twenty service providers in health care, mental health, legal affairs, and immigrant advocacy in El Paso, Texas. Nearly all respondents stated that their work has been negatively affected by immigration enforcement policies under the current federal administration. Most reported changes in utilization among undocumented immigrants and families of mixed immigration status, as well as legal permanent and temporary residents, refugees or asylum seekers, and U.S. citizens. Negative effects were related to immigration-related fear and uncertainty in the community, a need for public education about policies and individu-als' rights, and changes in immigration policy enforcement. Further research about the impacts of immigration enforcement policies on service utilization is needed. To protect the well-being of immigrant communities, policy makers should be aware of the human rights implications of immigration enforcement policies with regard to service utilization. In a global environment of increasing nationalism and xenophobia, nations must carefully consider the implications of harsh anti-immigrant narratives and strict immigration enforcement on the well-being of minority and immigrant populations.

Mandated public reporting on health care performance at the level of individual health care institutions and providers has been in place in most Western countries for at least three decades. The capacity to evaluate and report on quality of care is widely regarded as critical for system-wide improvement of health care delivery and patient health outcomes. However, evidence from the literature indicates that evaluation of the effectiveness of public reporting is scant. The purpose of this research is to propose an approach to evaluate the impact of third-party  public reporting on improving quality of health care in the province of Ontario, Canada.  Starting with the research question ‘How can we evaluate and enhance the impact of third-party public reporting on quality improvement for health care’, the researcher used an explanatory sequential mixed-methods design to assess the current state of public reporting in Ontario and identify opportunities to improve its effectiveness for quality improvement. Through analysis of provincial-level publicly-reported measures, the researcher found that performance results are improving for about one-third of the measures; however, where public reporting is combined with other accountability mechanisms, such as funding agreements or legislation, there is greater indication of improvement and/or sustained improvement over time. The researcher concluded that there is insufficient evidence that public reporting improves health care quality; however, public reporting can be effective when bundled with other improvement mechanisms. The researcher identified a number of opportunities to improve the effectiveness of public reporting in Ontario based on literature evidence and the research findings. The findings may be applicable to Canada as a whole and to other countries that have nationalized health care or any large-scale health system.

Background: In recent years, the delivery of early intensive behavioral intervention (EIBI) for children with autism spectrum disorder (ASD) in the United States has significantly changed. More children with ASD than ever before are eligible to use publicly funded EIBI. Yet, the challenges to large-scale implementation of EIBI remain unclear. Specific Aims: We examined parent perceived challenges to treatment utilization, predictors of increased challenges to treatment utilization, and parent recommendations for increasing utilization in a statewide EIBI program. Method: Using a cross-sectional design, we surveyed parents of children with ASD receiving EIBI through South Carolina's Pervasive Developmental Disorder Program (N = 145). To examine the contributions of parent demographic characteristics, parent social support, and child challenging behaviors to perceived challenges to utilization, we used multiple linear regression. Parent recommendations were collected using a single open-ended question. Findings: The most frequently endorsed challenges included the child's school schedule (62.1%) and the child being overburdened with other treatment demands (65.2%). Greater child challenging behaviors were associated with a greater degree of perceived challenges, and social support was associated with a lesser degree of perceived challenges. Discussion: Parents perceived various challenges to utilization, and child and family characteristics may increase the risk for experiencing challenges to utilization. As the delivery of EIBI continues to evolve in the United States and elsewhere, these findings have implications for policy, programming, and future research.

Background: The Indonesian National Health Insurance (JKN) was commenced in early 2014. BPJS Kesehatan (parastatal organization appointed as JKN management entity) and the primary health centers (PHCs) are dealing with challenges and bottlenecks in providing quality health service to JKN beneficiaries. One of the challenges is the management and utilization of the capitation fund, which is used as the payment model for PHC. The monitoring and evaluation of the capitation fund are imperative to improve the attainment of universal health coverage through JKN program.

Objective: To analyze the management and utilization of capitation fund in PHC including the bottlenecks and to generate solutions in the implementation of JKN.

Method: This is a descriptive study using quantitative and qualitative approaches. A total of 384 PHCs in 7 regionals and 20 districts were selected using random sampling. Primary data were collected through series of interviews and FGDs using a standardized questionnaire. Secondary data on capitation fund and health care services (2014-mid 2015) were collected from primary health centers and BPJS Kesehatan database. Qualitative data were analyzed using thematic approach and quantitative data were descriptively analyzed to show the capitation fund and health care utilization trend at PHC level.

Result: Although an increase in overall income from capitation fund was observed in the majority of PHCs, there was a higher increase in patient utilization leading to lower actual capitation income generated by PHCs. Such finding is applicable morely to Private GP Practice (Dokter Praktik Perorangan) and Private Primary Clinic (Klinik Pratama). Quantitative findings show that most private PHCs experienced deficit. Most Puskesmas used Head of District decree/district regulation as the main legal basis for capitation fund management and utilization. However, many of the local regulations are not completely in line with central-level mainly because of the rapid changes at the central-level. Such disconnection of policies between levels of government has led to confusion at the PHC level in fund management and use. As the sole purchaser, BPJS Kesehatan is considered to be not yet well involved in district capitation fund planning and budgeting. Such practices were perceived to be even less condusive in the monitoring and evaluation of capitation fund usage.

Conclusion: To ensure the quality of care and the sustainability of PHCs as JKN providers, capitation fund should be increased. Local government needs to support JKN implementation by issuing clear guidelines that follow central policies on how PHCs should plan and manage capitation fund. Continuous monitoring and evaluation of capitation fund is important to ensure that JKN program targets are achieved at the primary care level.

Keywords: capitation, management, utilization

There is no doubt that existing health care delivery system is very
poor  in  rural  India  especially  in  the  localities  of  backward,
marginalized  tribal,  and  under-privileged  communities  due  to
several  apparent  infrastructural  lacune,  constraints,  limitations,
and excuses. Added to these adversaries, are the ample prevalence
of birth defects/genetic disorders among these poverty stricken
vulnerable  communities.  There  were  705  scheduled  tribes  and
subtribes, and 75 Primitive Tribal Groups in India as per 2011
Census, which constituted about half of the indigenous people of
the world! A huge mass of dwindling people has virtually no
access to genetic services, available only to a few in big cities at
exorbitant  cost,  and  utterly  lacking  in  rural  India.  This
epidemiological  review  related  to  public  health  genetics,
highlights the genetic burden/magnitude of hemoglobinopathies
having  glimpses  of  reproductive  and  child  health,  and
neonatal/infant mortality in afflicted couples in the three states of
India, namely, Chhattisgarh, Madhya Pradesh, and Odisha. With
over  emphasis  laid  on  bringing  awareness  and  imparting
genetic/marriage counseling, carrier detection and establishment
of prenatal diagnostic facilities at least in the vicinity of at risk
communities.  Cost  of  establishment  of  such  infrastructural
facilities is still lower than the potential benefits to the people.
Therefore, it is high time to introduce the genetic services in the
existing health systems approach.

This paper presents some preliminary results of a study investigating the effect of telecare on the length of stay in hospital using linked administrative health and social care data in Scotland.  We make various assumptions about the probability distribution of the outcome measure and formulate three Negative Binomial Models to that effect i.e. a basic Negative Binomial Model, a zero-inflated Negative Binomial Model and a zero-truncated Negative Binomial Model.  We then bring the models to data and estimate them using a strategy that controls for the effects of confounding variables and unobservable factors.  These models provide an alternative to the Propensity Score Matching technique used by the previous studies.  The empirical results show that telecare users are expected to spend a shorter time in hospital than non-users, holding other factors constant.  The results also show that older individuals, males, rural residents and individuals with comorbidities have a longer length of stay in hospital, on average, than their counterparts, all things equal.  Future research will involve conducting a sub-group analysis, investigating the effectiveness of various telecare devices and determining the impact of telecare on admission to hospital.

Background: The Indonesian National Health Insurance (JKN) was commenced in early 2014. BPJS Kesehatan (parastatal organization appointed as JKN management entity) and the primary health centers (PHCs) are dealing with challenges and bottlenecks in providing quality health service to JKN beneficiaries. One of the challenges is the management and utilization of the capitation fund, which is used as the payment model for PHC. The monitoring and evaluation of the capitation fund are imperative to improve the attainment of universal health coverage through JKN program.

Objective: To analyze the management and utilization of capitation fund in PHC including the bottlenecks and to generate solutions in the implementation of JKN.

Method: This is a descriptive study using quantitative and qualitative approaches. A total of 384 PHCs in 7 regionals and 20 districts were selected using random sampling. Primary data were collected through series of interviews and FGDs using a standardized questionnaire. Secondary data on capitation fund and health care services (2014-mid 2015) were collected from primary health centers and BPJS Kesehatan database. Qualitative data were analyzed using thematic approach and quantitative data were descriptively analyzed to show the capitation fund and health care utilization trend at PHC level.

Result: Although an increase in overall income from capitation fund was observed in the majority of PHCs, there was a higher increase in patient utilization leading to lower actual capitation income generated by PHCs. Such finding is applicable morely to Private GP Practice (Dokter Praktik Perorangan) and Private Primary Clinic (Klinik Pratama). Quantitative findings show that most private PHCs experienced deficit. Most Puskesmas used Head of District decree/district regulation as the main legal basis for capitation fund management and utilization. However, many of the local regulations are not completely in line with central-level mainly because of the rapid changes at the central-level. Such disconnection of policies between levels of government has led to confusion at the PHC level in fund management and use. As the sole purchaser, BPJS Kesehatan is considered to be not yet well involved in district capitation fund planning and budgeting. Such practices were perceived to be even less condusive in the monitoring and evaluation of capitation fund usage.

Conclusion: To ensure the quality of care and the sustainability of PHCs as JKN providers, capitation fund should be increased. Local government needs to support JKN implementation by issuing clear guidelines that follow central policies on how PHCs should plan and manage capitation fund. Continuous monitoring and evaluation of capitation fund is important to ensure that JKN program targets are achieved at the primary care level.

Keywords: capitation, management, utilization

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016. Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths ...

Co-authors: Dassieu L, Heino A, Develay E, Kaboré JL, Pagé MG, Moor G, Hudspith M, Choinière M

Background: The opioid overdose epidemic has led health care providers to increased vigilance for opioid-related risks in the treatment of chronic non-cancer pain (CNCP). Media have conveyed stigmatizing representations of opioid analgesics.
Aims: This study aimed to understand how the opioid overdose epidemic has impacted health care experiences among people living with CNCP in two Canadian provinces (British Columbia, Quebec).
Methods: This qualitative study proceeded through 22 semi-structured interviews conducted in 2019. Participants were recruited from a cross-sectional survey examining the effects of the opioid overdose epidemic on individuals with CNCP. We collected in-depth narratives that we analyzed using a thematic framework. The sample included 12 women and 10 men aged 20 to 70 years, with 11 from each province.
Results: Several participants described increased difficulty in accessing medical services for pain since the onset of the opioid overdose epidemic. They reported that some physicians urged them to taper opioids regardless of their pain severity and functional limitations. Some participants reported facing discrimination and care denials as they were labeled “drug-seeking,” especially in hospital. Depending on their educational resources, they were unequally able to counter providers’ stigmatizing behaviors. However, participants described empathetic relationships with providers with whom they had a long term relationship. Some participants drew distinctions between themselves and the stigmatized status of “addict” in ways that reinforced stigma toward people who are dependent on opioids.
Conclusions: Health policies and provider education programs aimed at reducing opioid-related stigma are needed to counter detrimental consequences of the opioid overdose epidemic for people living with CNCP.

At the first stage of the project "Területi közszolgáltatások szabályozásai“ [Regulatory Tools for Local Public Services] (2012 -2016) concept papers have been completed which relate to different public function/public service delivery fields covered by the research. This conceptualisation part of the work resulted in the volume T.M. Horváth (ed.) (2013) "Kilengések. Közszolgáltatási változások" [Swings. Changes in Public Service Delivery]. Budapest: Dialóg Campus. The research group continued the exploration with international comparative researches in order to identify the basic patterns for different fields of local public services (public utilities, public education, administrative services etc). The findings have been published in the volume T.M. Horváth (ed.) (2013) "Külön utak. Közfeladatok megoldásai" [Distinct Roads. Models for Public Service Delivery]., Budapest–Pécs: Dialóg Campus Kiadó (2014).
From 2012 to the end of 2014, based (fully or partly) on researches in the project, more than 70 papers have been published in academic journals or as a part of academic volumes (including those two mentioned above). The present collection contains the majority of abstracts of these works.

The most basic long-standing method of citizen engagement in public sector decision making is the opportunity to vote at elections although at local level this sometimes only occurs once every four years. However, this mechanism is not enough either for citizens to communicate their wishes to the local authority or to hold the local authority to account. In the last two decades, many other mechanisms have emerged to allow citizens to engage with public sector organisations (Leach et al., 2005).

This policy paper explores the innovative methods used by some local authorities for engaging and communicating with their local electorate and stakeholders. It focuses in particular on efforts to move beyond engagement and participation to more intensive processes – including those labelled ‘co-production’ - where the public have a direct influence over policy and service delivery. It provides a theoretical and conceptual framework for understanding the importance of this shift in the relationship between the public and the public sector.

The paper draws upon three types of evidence; research conducted by the various Communities and Local Government (CLG) funded evaluations of policies associated with the 1998 and 2001 Local Government White Papers; primary research by the meta-evaluation team and a wide range of literature on public engagement and co-production. It complements the recent meta-evaluation reports on the ‘State of Governance of Places’ (Sullivan, 2008) and the ‘State of Local Democracy’ (Cowell et al, 2008).

This policy paper therefore:

• Explores the need for innovation by local authorities and local partners in engaging and communicating with local citizens.
• Provides a theoretical and conceptual framework for understanding the role of co-production in public services
• Identifies some negative and unintended impacts of increased involvement of users and other citizens.
• Highlights the scope for more innovative methods based upon current experience.
• Considers the learning opportunities from co-production (drawing upon national and international practice).
• Highlights some illustrative examples of good practice which can be disseminated across local government and local strategic partnerships.
• Draws out the lessons for policy makers.