Shalini Nagaratnam, Nader Ale Ebrahim, M. Habibullah
The systematic literature search on the fertility rate was performed on articles from the Web of Science compiled by the Institute of Scientific Information (ISI) to provide major publication characteristics. All articles related to Fertility from year 1980 to 2011 were analyzed with the bibliometric approach using non-parametrics techniques. Total Citation, Citation per year and Cited References were significantly different between the 80’s, 90’s and 2000’s, with more than a 100% increase in the number of publication. The association between number of authors and citation per year were significantly weak. Number of publication in a journal posed a poor negative association with the citation per year. Similarity between Authors Keyword and KeyWords Plus® do not promote the increase in citation per year. The author’s affiliation and country of publication would be an interesting exploration for future fertility research. The bibiliometric analyses on Fertility is rather new and vital, as the key finding will provide researchers guidance in the literature search and future publication.
对科学信息研究所(ISI)编辑的Web of Science上的文章进行了关于生育率的系统文献检索，以提供主要的出版物特征。采用文献计量学方法，采用非参数技术对1980 - 2011年与生育率相关的所有文章进行分析。总引文数、年引文数和引用文献数在80年代、90年代和2000年代之间存在显著差异，发表次数增加了100%以上。作者数与年引用数之间的相关性显著弱。在期刊上发表的次数与每年被引用的次数呈负相关。作者关键字与KeyWords Plus®之间的相似性并不能促进引用量的逐年增加。作者所属单位和发表国将是未来生育研究的一个有趣的探索。关于生育的文献计量学分析是一项非常新颖和重要的研究，其关键发现将为研究人员的文献检索和未来的出版提供指导。
{"title":"A Bibliometric Analysis on 'Fertility Rate' Research Trends","authors":"Shalini Nagaratnam, Nader Ale Ebrahim, M. Habibullah","doi":"10.5281/ZENODO.58318","DOIUrl":"https://doi.org/10.5281/ZENODO.58318","url":null,"abstract":"The systematic literature search on the fertility rate was performed on articles from the Web of Science compiled by the Institute of Scientific Information (ISI) to provide major publication characteristics. All articles related to Fertility from year 1980 to 2011 were analyzed with the bibliometric approach using non-parametrics techniques. Total Citation, Citation per year and Cited References were significantly different between the 80’s, 90’s and 2000’s, with more than a 100% increase in the number of publication. The association between number of authors and citation per year were significantly weak. Number of publication in a journal posed a poor negative association with the citation per year. Similarity between Authors Keyword and KeyWords Plus® do not promote the increase in citation per year. The author’s affiliation and country of publication would be an interesting exploration for future fertility research. The bibiliometric analyses on Fertility is rather new and vital, as the key finding will provide researchers guidance in the literature search and future publication.","PeriodicalId":11036,"journal":{"name":"Demand & Supply in Health Economics eJournal","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84895566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Existing studies estimate health insurance-induced increases in medical care expenditure by examining medical care decisions that are aggregated to the annual level. Using employer-employee matched data from the Medical Expenditure Panel Survey, I quantify the moral hazard effect of insurance on medical care expenditure by estimating a dynamic model of within-year medical care consumption that allows for insurance selection, endogenous health transitions, and individual uncertainty about medical care prices in an environment where insurance has non-linear cost-sharing features. The results suggest that the additional consumption induced by moral hazard amounts to 53.1 percent, on average, of total annual medical care expenditure when insured. In order to understand the relationship between the dynamic features of the model and the estimated moral hazard effects, I estimate a second model that is representative of the annual decision-making models found in the literature. The within-year decision-making model produces a moral hazard effect that is significantly different, and generally larger, than the alternative model. To illustrate the importance of the within-year decision-making model, I quantify the welfare and spending implications of health insurance alternative sets with more and less generous options.
{"title":"Insurance-Induced Moral Hazard: A Dynamic Model of Within-Year Medical Care Decision Making Under Uncertainty","authors":"Christopher J. Cronin","doi":"10.2139/ssrn.2706185","DOIUrl":"https://doi.org/10.2139/ssrn.2706185","url":null,"abstract":"Existing studies estimate health insurance-induced increases in medical care expenditure by examining medical care decisions that are aggregated to the annual level. Using employer-employee matched data from the Medical Expenditure Panel Survey, I quantify the moral hazard effect of insurance on medical care expenditure by estimating a dynamic model of within-year medical care consumption that allows for insurance selection, endogenous health transitions, and individual uncertainty about medical care prices in an environment where insurance has non-linear cost-sharing features. The results suggest that the additional consumption induced by moral hazard amounts to 53.1 percent, on average, of total annual medical care expenditure when insured. In order to understand the relationship between the dynamic features of the model and the estimated moral hazard effects, I estimate a second model that is representative of the annual decision-making models found in the literature. The within-year decision-making model produces a moral hazard effect that is significantly different, and generally larger, than the alternative model. To illustrate the importance of the within-year decision-making model, I quantify the welfare and spending implications of health insurance alternative sets with more and less generous options.","PeriodicalId":11036,"journal":{"name":"Demand & Supply in Health Economics eJournal","volume":"101 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77358902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Advertising is often criticized for presenting only partial or selective information about products. This criticism is particularly pronounced for health products, where large asymmetries in information may exist between consumers and firms. This paper explores how government restrictions designed to prevent selective advertising affect the types of information to which consumers are exposed. We exploit a natural experiment in the form of a U.S. Food and Drug Administration (FDA) crackdown that prevented pharmaceutical companies from using selectively chosen information in their Internet search ads. Because companies could not adequately document side effects within the advertising space allowed, they removed their ads. Our results suggest that, after the ads were removed, consumers were more likely to seek information from websites based on user-generated content or websites that focused on medical treatments not regulated by the FDA, such as Canadian pharmacies and sites promoting herbal remedies. This paper was accepted by Matthew Shum, marketing.
{"title":"How Do Restrictions on Advertising Affect Consumer Search?","authors":"Lesley Chiou, Catherine Tucker","doi":"10.2139/ssrn.1542934","DOIUrl":"https://doi.org/10.2139/ssrn.1542934","url":null,"abstract":"Advertising is often criticized for presenting only partial or selective information about products. This criticism is particularly pronounced for health products, where large asymmetries in information may exist between consumers and firms. This paper explores how government restrictions designed to prevent selective advertising affect the types of information to which consumers are exposed. We exploit a natural experiment in the form of a U.S. Food and Drug Administration (FDA) crackdown that prevented pharmaceutical companies from using selectively chosen information in their Internet search ads. Because companies could not adequately document side effects within the advertising space allowed, they removed their ads. Our results suggest that, after the ads were removed, consumers were more likely to seek information from websites based on user-generated content or websites that focused on medical treatments not regulated by the FDA, such as Canadian pharmacies and sites promoting herbal remedies. This paper was accepted by Matthew Shum, marketing.","PeriodicalId":11036,"journal":{"name":"Demand & Supply in Health Economics eJournal","volume":"76 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86703856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Motivated by a collaborative study with one of the most comprehensive ocular imaging programs in the United States, we investigate the underlying three-way trade-off among operational, clinical, and financial considerations in physicians' decisions about ordering imaging tests. Laboratory tests may be processed in parallel and thus have a limited effect on patients' waiting times; imaging tests, by contrast, require patient presence and thus directly influence patients' waiting times. We use a strategic queueing framework to model a physician's decision of ordering imaging tests and show that insurance coverage is the key driver of overtesting. Our further analysis reveals the following: i Whereas existing studies hold that lower out-of-pocket expenses lead to higher consumption levels, we refine this statement by showing the copayment and the coinsurance rate drive the consumption in different directions. Thus, simply expanding patient cost sharing is not the solution to overtesting. ii Setting a low reimbursement ceiling alone cannot eliminate overtesting. iii The joint effect of misdiagnosis concerns and insurance coverage can lead to both overtesting and undertesting even when no reimbursement ceiling exists. These and other results continue to hold under more general conditions and are therefore robust. We enrich our model along two extensions: one with patient heterogeneity in diagnostic precision, and the other with disparities in health insurance coverage. Our findings have implications for other healthcare settings with similar trade-offs.
{"title":"Imaging Room and Beyond: The Underlying Economics Behind Physicians' Test-Ordering Behavior in Outpatient Services","authors":"Tinglong Dai, Mustafa Akan, S. Tayur","doi":"10.1287/MSOM.2016.0594","DOIUrl":"https://doi.org/10.1287/MSOM.2016.0594","url":null,"abstract":"Motivated by a collaborative study with one of the most comprehensive ocular imaging programs in the United States, we investigate the underlying three-way trade-off among operational, clinical, and financial considerations in physicians' decisions about ordering imaging tests. Laboratory tests may be processed in parallel and thus have a limited effect on patients' waiting times; imaging tests, by contrast, require patient presence and thus directly influence patients' waiting times. We use a strategic queueing framework to model a physician's decision of ordering imaging tests and show that insurance coverage is the key driver of overtesting. Our further analysis reveals the following: i Whereas existing studies hold that lower out-of-pocket expenses lead to higher consumption levels, we refine this statement by showing the copayment and the coinsurance rate drive the consumption in different directions. Thus, simply expanding patient cost sharing is not the solution to overtesting. ii Setting a low reimbursement ceiling alone cannot eliminate overtesting. iii The joint effect of misdiagnosis concerns and insurance coverage can lead to both overtesting and undertesting even when no reimbursement ceiling exists. These and other results continue to hold under more general conditions and are therefore robust. We enrich our model along two extensions: one with patient heterogeneity in diagnostic precision, and the other with disparities in health insurance coverage. Our findings have implications for other healthcare settings with similar trade-offs.","PeriodicalId":11036,"journal":{"name":"Demand & Supply in Health Economics eJournal","volume":"133 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84014311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
We derive optimal rules for paying hospitals in a public health care system in which providers can choose quality and random patient demand is rationed by waiting time. Since waiting time imposes real costs on patients hospital payment rules should take account of their e¤ect on waiting time as well as on quality and the number of patients treated. We develop a general stochastic model of rationing by waiting and use it to derive welfare maximising payment to hospitals linked to output, expected waiting times, quality, hospital capacity and length of stay. We show that, although prospective output pricing gives hospitals an incentive to attract patients by raising quality and reducing waiting times, it must be supplemented by prices attached to other hospital decisions and outcomes except under very strong assumptions about the welfare function, patient preferences, and whether patients lose income whilst waiting.
{"title":"Optimal Hospital Payment Rules Under Rationing by Random Waiting","authors":"H. Gravelle, F. Schroyen","doi":"10.2139/ssrn.2783315","DOIUrl":"https://doi.org/10.2139/ssrn.2783315","url":null,"abstract":"We derive optimal rules for paying hospitals in a public health care system in which providers can choose quality and random patient demand is rationed by waiting time. Since waiting time imposes real costs on patients hospital payment rules should take account of their e¤ect on waiting time as well as on quality and the number of patients treated. We develop a general stochastic model of rationing by waiting and use it to derive welfare maximising payment to hospitals linked to output, expected waiting times, quality, hospital capacity and length of stay. We show that, although prospective output pricing gives hospitals an incentive to attract patients by raising quality and reducing waiting times, it must be supplemented by prices attached to other hospital decisions and outcomes except under very strong assumptions about the welfare function, patient preferences, and whether patients lose income whilst waiting.","PeriodicalId":11036,"journal":{"name":"Demand & Supply in Health Economics eJournal","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79737537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Physicians’ generic pharmaceutical adoption involves not only patients’ and insurance payers’ cost, but also their own interests. This study examines this double agency problem for physicians by using Taiwanese data because two of its institutional features: First, patients and physicians in a universal health care system did not self-select their insurance plans. Second, physicians in Taiwan respond to strong financial incentives because they are allowed to both prescribe and dispense drugs. The empirical results show that a larger price difference between brand-name and generic drugs increases physicians’ likelihood for prescribing generic prescriptions. However, this effect decreases as the payer’s cost share percentage increases. These results indicate that physicians’ prescriptions decision internalize patients’ cost but not the payer’s ones. This study also demonstrates that physicians who are more responsive to profits prescribed more generic drugs, including owners of hospitals and clinics, and physicians in clinics and private institutions. However, this effect decreases as the number of competitors in the drug market increases.
{"title":"Physicians as Double Agents in a Universal Health Care System: Evidence from Generic Pharmaceutical Adoption in Taiwan","authors":"M. Tang","doi":"10.2139/ssrn.2736754","DOIUrl":"https://doi.org/10.2139/ssrn.2736754","url":null,"abstract":"Physicians’ generic pharmaceutical adoption involves not only patients’ and insurance payers’ cost, but also their own interests. This study examines this double agency problem for physicians by using Taiwanese data because two of its institutional features: First, patients and physicians in a universal health care system did not self-select their insurance plans. Second, physicians in Taiwan respond to strong financial incentives because they are allowed to both prescribe and dispense drugs. The empirical results show that a larger price difference between brand-name and generic drugs increases physicians’ likelihood for prescribing generic prescriptions. However, this effect decreases as the payer’s cost share percentage increases. These results indicate that physicians’ prescriptions decision internalize patients’ cost but not the payer’s ones. This study also demonstrates that physicians who are more responsive to profits prescribed more generic drugs, including owners of hospitals and clinics, and physicians in clinics and private institutions. However, this effect decreases as the number of competitors in the drug market increases.","PeriodicalId":11036,"journal":{"name":"Demand & Supply in Health Economics eJournal","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88254191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This study employs a Structural Equation Modelling (SEM) to understand the effect of the costs related to health conditions of people on their standard of living (SoL)using the data from the cross-sectional Household Budget Survey (HBS) for the period 2002-2013 and the panel Income and Living Conditions Survey (ILCS) in Turkey during the period 2009-2012. Using HBS, it is tested whether out-of-pocket health expenditures (OOPEs), which is directly affected by the health conditions of people, contribute to the standard of living in a negative way. Using ILCS, it is examined the effect of labor market outcomes (wages and hours of work loss due to bad health conditions) on SoL. A Structural Equation model allows us to investigate all these concerns simultaneously. Referring health conditions, two different health-condition indices are constructed using two different datasets since they have various questions representing health status of people. Using HBS a health condition index is created regarding questions related to the mental and physical limitations (disability) of people. The second health condition index is created using ILCS that includes questions both related to disability and chronic diseases. The study extends the previous research by several ways. First, the application of a structural equation modelling (SEM) accounts for the measurement error both in the SoL and health-condition indices and it allows for the simultaneous estimation of the link between health condition costs and SoL through out-of-pocket expenditures as well as labor market outcomes using structural equations. Second, it will contribute to existing literature by analysing not only the impact of health condition costs but also the impact of health insurance types on OOPEs and therefore SoL. Third, using a propensity score matching, it creates comparable groups. Finally, the impact of disability and relevant OOPEs on transportation expenditures is analysed and their association with SoL is investigated. The results show that OOPEs and disability have a significant and negative impact on SoL. The disability related costs consist of the 24-30 per cent of the household income corresponding to monetary values ranging between 4,200-4,600 Turkish Liras (TL) per annum, while the respective values in terms of wages range between 1,000-1,200 TL. OOPEs costs are estimated at 2.5 per cent of the household income, which are equal at 540 TL per annum and OOPEs consist of 10 per cent of the non-wage household income corresponding to 870 TL per year. Moreover, the disability leads to significant increases of transportation expenditures and the associated costs are estimated at roughly 470 TL per year. However, when the households with members that have been disabled during the survey are compared with the non-disabled households, the disability costs reach 8,500 TL.
{"title":"The Link between Health Condition Costs and Standard of Living Through Out-of-Pocket Health Expenditures and Labour Market Outcomes in Turkey: A Structural Equation Modelling","authors":"Oznur Ozdamar, Eleftherios Giovanis","doi":"10.2139/ssrn.2784949","DOIUrl":"https://doi.org/10.2139/ssrn.2784949","url":null,"abstract":"This study employs a Structural Equation Modelling (SEM) to understand the effect of the costs related to health conditions of people on their standard of living (SoL)using the data from the cross-sectional Household Budget Survey (HBS) for the period 2002-2013 and the panel Income and Living Conditions Survey (ILCS) in Turkey during the period 2009-2012. Using HBS, it is tested whether out-of-pocket health expenditures (OOPEs), which is directly affected by the health conditions of people, contribute to the standard of living in a negative way. Using ILCS, it is examined the effect of labor market outcomes (wages and hours of work loss due to bad health conditions) on SoL. A Structural Equation model allows us to investigate all these concerns simultaneously. Referring health conditions, two different health-condition indices are constructed using two different datasets since they have various questions representing health status of people. Using HBS a health condition index is created regarding questions related to the mental and physical limitations (disability) of people. The second health condition index is created using ILCS that includes questions both related to disability and chronic diseases. The study extends the previous research by several ways. First, the application of a structural equation modelling (SEM) accounts for the measurement error both in the SoL and health-condition indices and it allows for the simultaneous estimation of the link between health condition costs and SoL through out-of-pocket expenditures as well as labor market outcomes using structural equations. Second, it will contribute to existing literature by analysing not only the impact of health condition costs but also the impact of health insurance types on OOPEs and therefore SoL. Third, using a propensity score matching, it creates comparable groups. Finally, the impact of disability and relevant OOPEs on transportation expenditures is analysed and their association with SoL is investigated. The results show that OOPEs and disability have a significant and negative impact on SoL. The disability related costs consist of the 24-30 per cent of the household income corresponding to monetary values ranging between 4,200-4,600 Turkish Liras (TL) per annum, while the respective values in terms of wages range between 1,000-1,200 TL. OOPEs costs are estimated at 2.5 per cent of the household income, which are equal at 540 TL per annum and OOPEs consist of 10 per cent of the non-wage household income corresponding to 870 TL per year. Moreover, the disability leads to significant increases of transportation expenditures and the associated costs are estimated at roughly 470 TL per year. However, when the households with members that have been disabled during the survey are compared with the non-disabled households, the disability costs reach 8,500 TL.","PeriodicalId":11036,"journal":{"name":"Demand & Supply in Health Economics eJournal","volume":"120 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87746566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Higher educated individuals are healthier and live longer than their lower educated peers. One reason is that lower educated individuals engage more often in unhealthy behaviors, including consumption of a poor diet, but it is not clear why they do so. In this paper, we design a Discrete Choice Experiment, based upon an economic model of unhealthy consumption, to understand the relationship between education and diet. Our results show that differences in dietary knowledge are responsible for the greatest part of the education disparity in diet. However, even when faced with the most explicit information regarding components of a healthy diet, lower educated individuals still state choices that imply a lower concern for negative health consequences. This is consistent with the model’s prediction that part of the education differences across health behaviors is driven by a higher “value of health” among the higher educated.
{"title":"Thought for Food: Understanding Educational Disparities in Diet","authors":"H. Koç, H. van Kippersluis","doi":"10.2139/ssrn.2724915","DOIUrl":"https://doi.org/10.2139/ssrn.2724915","url":null,"abstract":"Higher educated individuals are healthier and live longer than their lower educated peers. One reason is that lower educated individuals engage more often in unhealthy behaviors, including consumption of a poor diet, but it is not clear why they do so. In this paper, we design a Discrete Choice Experiment, based upon an economic model of unhealthy consumption, to understand the relationship between education and diet. Our results show that differences in dietary knowledge are responsible for the greatest part of the education disparity in diet. However, even when faced with the most explicit information regarding components of a healthy diet, lower educated individuals still state choices that imply a lower concern for negative health consequences. This is consistent with the model’s prediction that part of the education differences across health behaviors is driven by a higher “value of health” among the higher educated.","PeriodicalId":11036,"journal":{"name":"Demand & Supply in Health Economics eJournal","volume":"109 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89505970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nasiri Maryam, M. Karamouzian, Kamali Kianoush, Nabipour Amir Reza, M. Ahmad, Nikaeen Roja, Razzaghi Alireza, Mirzazadeh Ali, M. Baneshi, A. Haghdoost
BACKGROUND Understanding the prevalence of symptoms associated with sexually transmitted infections (STIs) and how care is sought for those symptoms are important components of STIs control and prevention. People's preference between public and private service providers is another important part of developing a well-functioning STIs surveillance system. METHODS This cross-sectional survey was carried out in spring 2011, using a nonrandom quota sample of 1190 participants (52% female) in 4 densely-populated cities of Tehran, Kerman, Shiraz, and Babol. Two predictive logistic regression models were constructed to assess the association between the socio-demographic determinants (independent variables) and the dependent variables of history of STIs-associated symptom and seeking care. RESULTS Around 57% (677 out of 1190; men: 29.70% and women: 81.80%) had experienced at least one STIs-associated symptom during the previous year. History of experiencing STIs-associated symptoms among men, was negatively significantly associated with older age (adjusted odds ratio [AOR] = 0.34, CI 95%: 0.17-0.67). Women who were married, in older ages, and had higher educations were more likely to report a recent (past year) STIs symptom, however all were statistically insignificant in both bivariate and multivariable models. Among those who have had STIs-associated symptoms in the last year, 31.15% did nothing to improve their symptoms, 8.03% attempted self-treatment by over-the-counter (OTC) medications or traditional remedies, and 60.93% sought care in health facilities. In both bivariate and multivariable analyses, care seeking among men was insignificantly associated with any of the collected demographic variables. Care seeking among women was positively significantly associated with being married (AOR = 2.48, 95% CI: 1.60-3.84). CONCLUSION The reported prevalence of STIs-associated symptoms among our participants is concerning. A considerable number of participants had delayed seeking care and treatment or self-medicated. People should be informed about their sexual health and the consequences of delaying or avoiding seeking care for STIs. Participants preferred seeking care at private sectors which calls for engaging both public and private health sectors for reporting and following up STIs cases.
{"title":"Care Seeking Patterns of STIs-Associated Symptoms in Iran: Findings of a Population-Based Survey","authors":"Nasiri Maryam, M. Karamouzian, Kamali Kianoush, Nabipour Amir Reza, M. Ahmad, Nikaeen Roja, Razzaghi Alireza, Mirzazadeh Ali, M. Baneshi, A. Haghdoost","doi":"10.15171/ijhpm.2015.146","DOIUrl":"https://doi.org/10.15171/ijhpm.2015.146","url":null,"abstract":"BACKGROUND\u0000Understanding the prevalence of symptoms associated with sexually transmitted infections (STIs) and how care is sought for those symptoms are important components of STIs control and prevention. People's preference between public and private service providers is another important part of developing a well-functioning STIs surveillance system.\u0000\u0000\u0000METHODS\u0000This cross-sectional survey was carried out in spring 2011, using a nonrandom quota sample of 1190 participants (52% female) in 4 densely-populated cities of Tehran, Kerman, Shiraz, and Babol. Two predictive logistic regression models were constructed to assess the association between the socio-demographic determinants (independent variables) and the dependent variables of history of STIs-associated symptom and seeking care.\u0000\u0000\u0000RESULTS\u0000Around 57% (677 out of 1190; men: 29.70% and women: 81.80%) had experienced at least one STIs-associated symptom during the previous year. History of experiencing STIs-associated symptoms among men, was negatively significantly associated with older age (adjusted odds ratio [AOR] = 0.34, CI 95%: 0.17-0.67). Women who were married, in older ages, and had higher educations were more likely to report a recent (past year) STIs symptom, however all were statistically insignificant in both bivariate and multivariable models. Among those who have had STIs-associated symptoms in the last year, 31.15% did nothing to improve their symptoms, 8.03% attempted self-treatment by over-the-counter (OTC) medications or traditional remedies, and 60.93% sought care in health facilities. In both bivariate and multivariable analyses, care seeking among men was insignificantly associated with any of the collected demographic variables. Care seeking among women was positively significantly associated with being married (AOR = 2.48, 95% CI: 1.60-3.84).\u0000\u0000\u0000CONCLUSION\u0000The reported prevalence of STIs-associated symptoms among our participants is concerning. A considerable number of participants had delayed seeking care and treatment or self-medicated. People should be informed about their sexual health and the consequences of delaying or avoiding seeking care for STIs. Participants preferred seeking care at private sectors which calls for engaging both public and private health sectors for reporting and following up STIs cases.","PeriodicalId":11036,"journal":{"name":"Demand & Supply in Health Economics eJournal","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81444802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Existing literature analyzing the choice of received long-term care by frail elderly (65+ years) predominantly focuses on physical and psychological conditions of elderly people as factors that influence the decision for a particular type of care. Until now, however, the regional in-patient long-term care supply has been neglected as influential factor in the individual's decision-making process. In this study, we analyze the choice of received long-term care by explicitly taking the regional supply of nursing homes into account. When estimating a discrete choice model, we distinguish between four different types of formal and informal care provision. We find that the decision for long-term in-patient care is significantly correlated with the regional supply of nursing home places, while controlling for physical and psychological conditions of the individual.
{"title":"Choice of Received Long-Term Care – Individual Responses to Regional Nursing Home Provisions","authors":"Adam Pilny, M. A. Stroka","doi":"10.2139/ssrn.2566240","DOIUrl":"https://doi.org/10.2139/ssrn.2566240","url":null,"abstract":"Existing literature analyzing the choice of received long-term care by frail elderly (65+ years) predominantly focuses on physical and psychological conditions of elderly people as factors that influence the decision for a particular type of care. Until now, however, the regional in-patient long-term care supply has been neglected as influential factor in the individual's decision-making process. In this study, we analyze the choice of received long-term care by explicitly taking the regional supply of nursing homes into account. When estimating a discrete choice model, we distinguish between four different types of formal and informal care provision. We find that the decision for long-term in-patient care is significantly correlated with the regional supply of nursing home places, while controlling for physical and psychological conditions of the individual.","PeriodicalId":11036,"journal":{"name":"Demand & Supply in Health Economics eJournal","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2015-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73161457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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