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      Factors Associated with Utilization of Primary and Specialist Healthcare Services by Elderly Cardiovascular Patients in the Republic of Serbia: A Cross-Sectional Study from the National Health Survey 2013

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          Abstract

          The European Health Interview Survey (EHIS) is run every 5 years to examine how people experience and rank their health, how they care about their health, and to what extent they use the healthcare services. We identified the sub-population of special interest, i.e., cardiovascular disease (CVD) patients older than 65 years, in this cross-sectional study from the Serbian national survey of population health (2568 persons from a total of 15,999 subjects surveyed). We performed univariable and multivariable logistic regression analysis to assess the correlation between the healthcare system utilization and identified demographic, geographic, socio-economic, and self-rated factors. The most important factor for the utilization of the primary and the specialist healthcare services by elderly CVD patients is the region where one lives (Southern and Eastern Serbia OR = 2.44, 95% CI = 1.58–3.77/Belgrade OR = 1.75, 95% CI = 1.32–2.30). Age is another factor, where the 65 to 74 years old CVD patients utilize healthcare services the most. Higher education (OR = 1.80, 95% CI = 1.31–2.47), being a part of the highest Wealth Index group (OR = 1.62, 95% CI = 1.10–2.40), having very poor health status (OR = 3.02, 95% CI = 1.41–6.47), and presence of long-term illness (OR = 1.49, 95% CI = 1.16–1.92), play an important role in the utilization of the specialist care only.

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          Most cited references 39

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          Access to medical care for low-income persons: how do communities make a difference?

          This paper considers the impact of community-level variables over and above the effects of individual characteristics on healthcare access of low-income children and adults residing in large metropolitan statistical areas (MSAs). Further, we rank MSAs' performance in promoting healthcare access for their low-income populations. The individual-level data come from the 1995 and 1996 National Health Interview Survey (NHIS). The community-level variables are derived from multiple public-use data sources. The outcome variable is whether low-income individuals received a physician visit in the past twelve months. The proportion receiving a visit by MSA varied from 63% to 99% for children and from 62% to 83% for adults. Access was better for individuals with health insurance and a regular source of care and for those living in communities with more federally-funded health centers. Children residing in MSA.
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            Catastrophic and impoverishing effects of health expenditure: new evidence from the Western Balkans.

            This paper investigates the effect of health-related expenditure on household welfare in Albania, Bosnia and Herzegovina, Montenegro, Serbia and Kosovo, all of which have undertaken major health sector reform. Two methodologies are used: (i) the incidence and intensity of 'catastrophic' health care expenditure, and (ii) the effect of out-of-pocket payments on poverty headcount and poverty gap measures. Data are drawn from the most recent Living Standards and Measurement Surveys, 2000-05. While our analyses are not without their limitations, and the lack of comparability across instruments precludes a direct comparison across countries, there is no doubt that health expenditure contributes substantially to the impoverishment of households-increasing the incidence of poverty and pushing poor households into deeper poverty-in each country. Both the catastrophic and the impoverishing effects of health expenditures are particularly severe in Albania and Kosovo. Transportation expenditure accounts for a large share of total health expenditures, especially in Albania and Serbia. Informal payments are substantial in all countries, and are particularly high in Albania. As countries in the sub-region continue the process of health system reform, an important policy question should be how to protect vulnerable groups from the catastrophic and impoverishing effects of health care expenditure.
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              Socioeconomic inequalities in health care utilisation in Norway: the population-based HUNT3 survey

              Background In this study we investigated the distribution of self-reported health care utilisation by education and household income in a county population in Norway, in a universal public health care system based on ideals of equal access for all according to need, and not according to wealth. Methods The study included 24,147 women and 20,608 men aged 20 years and above in the third Nord-Trøndelag Health Survey (HUNT 3) of 2006–2008. Income-related horizontal inequity was estimated through concentration indexes, and inequity by both education and income was estimated as risk ratios through conventional regression. Results We found no overall pro-rich or pro-educated socioeconomic gradient in needs-adjusted utilisation of general practitioner or inpatient care. However, we found overall pro-rich and pro-educated inequity in utilisation of both private medical specialists and hospital outpatient care. For these services there were large differences in levels of inequity between younger and older men and women. Conclusion In contrast with recent studies from Norway, we found pro-rich and pro-educated social inequalities in utilisation of hospital outpatient services and not only private medical specialists. Utilisation of general practitioner and inpatient services, which have low access threshold or are free of charge, we found to be equitable.
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                Author and article information

                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                10 April 2020
                April 2020
                : 17
                : 7
                Affiliations
                [1 ]Contract Research Organization for Medical Devices & Services, 1204 Geneva, Switzerland
                [2 ]School of Public Health and Health Management, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; aleksandra.jovic-vranes@ 123456med.bg.ac.rs
                [3 ]Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
                [4 ]Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; ivan.soldatovic@ 123456med.bg.ac.rs
                [5 ]The Rippel Foundation, Morristown, NJ 07960, USA; predrag.stojicic@ 123456gmail.com
                [6 ]ReThink Health, Cambridge, MA 02139, USA
                [7 ]Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1014 Copenhagen, Denmark; zorana.andersen@ 123456sund.ku.dk
                [8 ]Nykøbing F Hospital, Centre for Epidemiological Research, 4800 Nykøbing F, Denmark
                Author notes
                Article
                ijerph-17-02602
                10.3390/ijerph17072602
                7177605
                32290147
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                Categories
                Article

                Public health

                cardiovascular diseases, healthcare utilization, logistic regression, serbia

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