BMC Health Services Research最新文献

Background: Domestic violence (DV) is a global public health issue with far-reaching physical, psychological, and social consequences. Although prior reviews have identified barriers to DV disclosure in healthcare settings, these have predominantly focused on female victims in Western contexts. This scoping review builds on the work of Heron and Eisma (2021) by including male victims, along with females, and studies from Asian countries, along with western countries, offering a more inclusive and culturally diverse understanding of disclosure barriers.

Methods: A thorough search of four databases: PubMed, Scopus, Embase, and the Cochrane Database, was conducted to identify relevant studies published between January 2018 and April 2023. Studies were included if they examined barriers to DV disclosure in healthcare settings from the perspectives of either victims or healthcare professionals (HCPs). Title and abstract screening, full-text review, and data extraction were performed independently by two reviewers. A thematic analysis was conducted to synthesise victim- and HCP-related barriers.

Results: Fifteen studies met the inclusion criteria. Victim-reported barriers included fear of retaliation, social stigma, low self-esteem, mental health challenges, and lack of privacy during healthcare encounters. Male victims highlighted societal disbelief and stigma around male victimhood. In Asian countries, cultural norms around family honour and obedience were particularly influential in discouraging disclosure. Practical barriers, such as the presence of abusers and limited access to services, were common in both high-income and low- and middle-income settings. HCP-reported barriers included inadequate training, absence of standardised protocols, time constraints, and a lack of culturally sensitive tools.

Conclusion: This review identifies complex, context-specific barriers to DV disclosure, especially for male victims and individuals in non-Western healthcare systems. Addressing these barriers requires gender-sensitive training, culturally appropriate interventions, and systemic improvements to healthcare delivery. These findings call for inclusive, evidence-based strategies to support disclosure and improve care for all DV survivors in healthcare settings.

Background: The prevalence of obesity worldwide has reached pandemic levels and is anticipated to escalate swiftly in developing nations. Given the substantial surge in obesity rates observed over the last three decades, assessing obesity-related costs is imperative for informing policy decisions.

Objectives: This study aimed to estimate direct medical and non-medical costs, along with indirect costs associated with laparoscopic sleeve gastrectomy (LSG), laparoscopic Roux-en-Y bypass (LRYGB), and pharmacotherapy for obesity in adult populations in Iran.

Methods: An economic analysis was conducted to evaluate the costs of pharmacological and surgical obesity treatments over a one-year period in 2023 from a societal perspective. This analysis incorporated direct medical costs (e.g., medications, counseling, hospitalization), direct non-medical costs (e.g., transportation), and indirect costs (e.g., lost productivity). Cost components and resource use were identified through literature reviews and expert validation. Medical tariffs and hospital bills informed medical cost estimations, while patient self-report questionnaires were utilized for non-medical and indirect cost calculations. The analysis followed established reporting guidelines and employed a micro-costing approach to ensure a comprehensive evaluation.

Results: The total costs were highest for LSG (2,294.98 USD), followed by LRYGB (2,266.85 USD), and pharmacotherapy (402.67 USD). Direct medical costs represented the largest proportion of total costs for all interventions, followed by direct non-medical costs and then indirect costs. Direct non-medical costs were notably higher for LSG and LRYGB compared to pharmacotherapy, with no statistically significant difference observed between LSG and LRYGB. Indirect costs were significantly greater for surgical interventions compared to pharmacotherapy, while no significant difference was noted between LSG and LRYGB.

Conclusion: Surgical interventions incurred higher total costs than pharmacotherapy, primarily due to substantial direct medical costs associated with LSG. Pharmacotherapy exhibited relatively higher direct non-medical costs, and indirect costs were a notable contributor across all interventions. These findings shed light on the economic burden of obesity and advocate for further exploration of costs related to lifestyle modifications and long-term assessments. The data supports future cost-effectiveness studies, aiding decision-making in obesity management.

Switzerland's statutory health insurance system is compulsory, but offers consumers a choice between different deductible levels. Faced with a steady growth of healthcare expenditure (HCE), both chambers of the national parliament recently voted in favour of increasing the minimum deductible from CHF 300 to CHF 500. In this study, we use claims data from the largest Swiss health insurer to compare the per capita HCE of adults who voluntarily chose different deductible levels. Specifically, we focus on individuals with the minimum deductible (CHF 300), the proposed new minimum (CHF 500), and the maximum deductible (CHF 2500). Applying matching and regression analysis, we find an 11% and 27% reduction in HCE, respectively, of the higher deductibles. The effects are stronger for outpatient care and drugs and weaker for inpatient and long-term care. If the minimum deductible increases to CHF 500 and insurers pass through the estimated CHF 900 reduction in per capita HCE, the average consumer will benefit by CHF 772. No consumer will lose because the maximum additional copayment is capped at CHF 200.