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The hidden cost of 'free' maternity care in Dhaka, Bangladesh

HEALTH POLICY AND PLANNING 1998年第4期13卷 417-422页

作者： Nahar, S Costello, A Inst Child Hlth Ctr Int Child Hlth London WC1N 1EH England Natl Inst Prevent & Social Med Dhaka Bangladesh

We studied the cost and affordability of 'free' maternity services at government facilities in Dhaka, Bangladesh, to assess whether economic factors may contribute to low utilization. We conducted a questionnaire survey and in-depth interviews among 220 post-partum mothers and their husbands, selected from four government maternity facilities (three referral hospitals and one Mother and Child Health hospital) in Dhaka. Mothers with serious complications were excluded. Information was collected on the costs of maternity care, household income, the sources of finance used to cover the costs, and the family's willingness to pay for maternity services. The mean cost for normal delivery was 1275 taka (US$31.9) and for caesarean section 4703 taka (US$117.5). Average monthly household income was 4933 taka (US$123). Twenty-one per cent of families were spending 51-100% of monthly income, and 27% of families 2-8 times their monthly income for maternity care. Overall, 51 % of the families (and 74% of those having a caesarean delivery) did not have enough money to pay;of these, 79% had to borrow from a money lender or relative. Surprisingly, 72 % of the families said they were willing to pay a government-levied user charge, though this was less popular among low-income families (61%). 'Free' maternity care in Bangladesh involves considerable hidden costs which may be a major contributor to low utilization of maternity services, especially among low-income groups. To increase utilization of safer motherhood services, policy-makers might consider introducing fixed user charges with clear exemption guidelines, or greater subsidies for existing services, especially caesarean section.

关键词：孟加拉国接生产科/经济学发展中国家/经济学费用和收费筹资个人/统计学和数值数据卫生保健费用/统计学和数值数据卫生保健调查收入产妇卫生保健服务/经济学青少年成年人女(雌)性人类妊娠

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Household health expenditures in Nepal: implications for health care financing reform

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HEALTH POLICY AND PLANNING 1998年第4期13卷 371-383页

作者： Hotchkiss, DR Rous, JJ Karmacharya, K Sangraula, P Tulane Univ Sch Publ Hlth & Trop Med Dept Int Hlth & Dev New Orleans LA 70012 USA Univ N Texas Dept Econ Denton TX 76203 USA

His Majesty's Government of Nepal has embarked on an ambitious social welfare programme of increasing the accessibility of primary education and health care services in rural communities. The implications on the financing of health care services are substantial, as the number of health posts has increased twelve-fold from 1992 to 1996, from 200 to 2597. To strengthen health care financing, government policy-makers are considering a number of financing strategies that are likely to have a substantial impact on household health care expenditures. However, more needs to be known about the role of households in the current structure of the health economy before the government designs and implements policies that affect household welfare. This paper uses the Nepal Living Standards Survey, a rich, nationally-representative sample of households from 1996, to investigate the level and distribution of household out-of-pocket health expenditures. Utilization and expenditures for different types of providers are presented by urban/rural status and by socioeconomic status. In addition, the sources of health sector funds are analyzed by contrasting household out-of-pocket expenditures with expenditures by the government and donors. The results indicate that households spend about 5.5% of total household expenditures on health care and that households account for 74% of the total level of funds used to finance the health economy. In addition, rural households are found to spend more on health care than urban households, after controlling for income status. Distributing health care expenditures by type of care utilized indicates that the wealthy, as well as the poor, rely heavily on services provided by the public sector. The results of this analysis are used to discuss the feasibility of implementing alternative health care financing policies.

关键词：发展中国家/经济学筹资政府/方法筹资个人/统计学和数值数据卫生保健改革/经济学卫生经费支出/统计学和数值数据卫生服务易得程度卫生服务研究尼泊尔乡村卫生服务/经济学乡村卫生服务/组织和管理农村人口市区人口

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Dental services: Use, expenditures and sources of payment, 1987

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JOURNAL OF THE AMERICAN DENTAL ASSOCIATION 1999年第4期130卷 500-508页

作者： Manski, RJ Moeller, JF Maas, WR Univ Maryland Sch Dent Dept Oral Hlth Care Delivery Baltimore MD 21201 USA

Background This article pro rides per capita estimates of dental care utilization, expenditures mix of services and sources of payment for each of several socioeconomic and demographic categories. Methods. The focus of the analyses presented here is on dental cafe utilization by the U.S, population during 1987. Specifically, national estimates are provided for dental visits, expenditures, sources of payment and procedure type for each of several socioeconomic and demographic categories using household data from the 1987 National Medical Expenditure Survey, or NMES. Results. During 1987, less that 50 percent of Americans visited a dental office. Americans made approximately 292 million dental visits and received approximately $30 billion worth of dental care, of which $10 billion was paid by insurers, $17 billion was paid out of pocket and $1.6 billion was not reimbursed. Conclusions. These analyses establish the magnitude of the dental care market and the amounts paid by individual patients, private insurance companies and Medicaid. They also reveal that the type of care received varies among people in distinct socioeconomic and demographic groups. Practice Implications. Although the dental care market is substantial, many Americans do not visit a dentist. By understanding these analyses. practitioners will be better positioned to meet the dental needs of all Americans.

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A comparison of complementary therapy use between breast cancer patients and patients with other primary tumor sites

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AMERICAN JOURNAL OF SURGERY 2000年第5期179卷 407-411页

作者： Morris, KT Johnson, N Homer, L Walts, D Oregon Hlth Sci Univ Dept Surg Portland OR 97201 USA Legacy Hlth Syst Portland OR USA

BACKGROUND: interest in complementary therapies in the United States is rising. We sought to characterize the use of complementary therapies among our cancer patients in our community and analyze differences in use between patients with breast versus those with other primary tumor sites. METHODS: A survey of 1,935 randomly selected patients from the tumor registry was performed. A questionnaire was mailed to 935 breast cancer patients and 1,000 patients with other primary site diagnoses. RESULTS: There were 617 responses (288 breast, 329 other). Seventy-five patients (75%) reported use of a complementary modality. Top therapies used were nutrition (63%), massage (53%), and healing herbs (44%). The most common reason for use, immune modulation (73%), was similar in both groups. Therapy was used consistently by 84% of breast patients versus 66% of others (P = 0.003). CONCLUSION: A significant number of cancer patients are using complementary therapies. Breast cancer patients are far more likely to be consistent users compared with other tumor sites. (C) 2000 by Excerpta Medica, Inc.

关键词：乳腺肿瘤/心理学乳腺肿瘤/治疗补充疗法/经济学补充疗法/统计学和数值数据补充疗法/利用药物信息机构药物相互作用筹资个人/统计学和数值数据目的卫生保健调查健康知识态度实践收入/统计学和数值数据肿瘤/心理学肿瘤/治疗病人接受卫生保健的程度/心理学病人接受卫生保健的程度/统计学和数值数据问卷调查美国青少年成年人老年人女(雌)性人类男(雄)性中年人

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WILLINGNESS TO PAY FOR ANTIHYPERTENSIVE THERAPY - FURTHER RESULTS

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JOURNAL OF HEALTH ECONOMICS 1993年第1期12卷 95-108页

作者： JOHANNESSON, M JOHANSSON, PO KRISTROM, B GERDTHAM, UG STOCKHOLM SCH ECON DEPT ECONSTOCKHOLMSWEDEN

A measurement experiment regarding willingness to pay for antihypertensive therapy is reported. A new type of binary willingness to pay question is used, that allows for different degrees of certainty with respect to the responses. Mean willingness to pay is derived from a simple expected utility model and estimated using maximum likelihood methods. The estimated parameters are highly significant, with predicted signs, and imply a mean willingness to pay of about SEK 800 ($130) per month. The explanatory power of the equation that only includes 'certain' yes/no responses is, as expected, much higher than that of the equation where only 'uncertain' responses are included.

关键词：健康态度评价研究(主题) 费用医疗/统计学和数值数据筹资个人/统计学和数值数据卫生服务研究/方法高血压/经济学高血压/治疗 Logistic模型比值比病人接受卫生保健的程度/统计学和数值数据回归分析社会经济因素瑞典意志人类

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Elders’ out-of-pocket payment for community-based long-term care

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Home Health Care Services Quarterly 1994年第4期14卷 87-103页

作者： Hays, Antoinette M. Branch, Laurence G. Division of Nursing Weston MA 02193 United States Associates and Boston University School of Medicine Wayland MA 01778 United States

This research describes characteristics of community living elders aged 71 and older with long-term care (LTC) needs who pay out-of-pocket for community-based LTC. Community living elders with higher incomes, more friends and non-child relatives outside the home, and greater ADL or IADL needs are more likely to purchase LTC than those without these characteristics. Also the lack of sufficient numbers of children outside the home to provide assistance tended to result in the use of out-of-pocket paid services. Paying for LTC is not associated with the extent of disability experienced. This study clarifies the characteristics of those in need who currently pay out-of-pocket for community LTC as a basis for examining the inadequacies of current LTC financing. © 1994 Taylor & Francis Group, LLC.

关键词：日常生活活动数据收集人口统计学筹资个人/统计学和数值数据虚弱老人/统计学和数值数据卫生经费支出/统计学和数值数据卫生服务需求/统计学和数值数据家庭医疗保健服务/经济学家庭医疗保健服务/统计学和数值数据 Logistic模型长期医疗/经济学长期医疗/统计学和数值数据马萨诸塞多元分析亲子关系社会经济因素老年人老年人 80以上女(雌)性人类男(雄)性

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WILLINGNESS TO PAY FOR PUBLICLY-PROVIDED GOODS - A POSSIBLE MEASURE OF BENEFIT

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JOURNAL OF HEALTH ECONOMICS 1990年第1期9卷 103-118页

作者： DONALDSON, C UNIV NEWCASTLE UPON TYNE NEWCASTLE TYNE NE2 4AAENGLAND

The results presented in this paper arise from a U.K.-based study aimed at determining peoples' willingness to pay for two publicly-provided goods, namely continuing-care for elderly people in either hospital or National Health Service (NHS) nursing homes. Seventy-one per cent of respondents provided evaluations which could contribute to the analysis which showed that the group which preferred NHS nursing-home care could potentially compensate the group which preferred hospital care and still remain better off, thus rendering NHS nursing-home care the efficient option to undertake. No variable could be found which discriminated between those who could place a value on both types of care and those who could not. The willingness-to-pay methodology is very experimental in this context and should be investigated thoroughly before its widespread adoption in the evaluation of health care techniques.

关键词：健康态度用户参与/经济学费用效益分析/方法数据收集评价研究家庭/心理学筹资政府/统计学和数值数据筹资个人/统计学和数值数据大不列颠住院/经济学模型统计学医护疗养所/经济学公费医疗老年人人类

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Willingness to pay for district hospital services in rural Tanzania

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HEALTH POLICY AND PLANNING 1996年第4期11卷 428-437页

作者： Walraven, G MRC FARAFENNIGAMBIA

This paper describes a study undertaken to investigate the willingness of patients and households to pay for rural district hospital services in north-western Tanzania. The surveys undertaken included interviews with 500 outpatients and 293 inpatients at three district level hospitals, interviews with 1500 households and discussions with 22 focus groups within the catchment areas of the primary health care programmes of these hospitals. Information was collected on willingness to pay fees for certain hospital services, willingness to become a member of a local insurance system, and exemptions for cost-sharing. The willingness to pay for district hospital services was large. Furthermore, most respondents favoured a local insurance system above user fee systems, a finding which applied at all places and in ail the surveys. More female respondents were in favour of a local insurance scheme. The conditions needed for the introduction of a local insurance system are discussed.

关键词：健康态度数据收集人口统计学筹资个人/统计学和数值数据卫生保健调查卫生经费支出/统计学和数值数据医院区/经济学住院病人保险健康门诊病人初级卫生保健/经济学乡村卫生服务/经济学坦桑尼亚女(雌)性人类男(雄)性

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Out of pocket expenditures by family caregivers of dementia patients residing in the community

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Home Health Care Services Quarterly 1992年第4期12卷 29-43页

作者： Collins, Clare Stommel, Manfred Clare Collins is affiliated with the College of Nursing Michigan State University MI 48824 United States College of Nursing Michigan State University Research Associate of the Sovial Science Research Bureau at Michigan State University MI 48824 United States

Out of pocket expenditures by families (N = 182) of relatives with dementia residing in the community were examined. Average expenditures for a three month period were $1,149. The relationship between illness variable... 详细信息

关键词：阿尔茨海默病/经济学医疗护理提供者/经济学社区卫生服务/经济学数据收集家庭筹资个人/统计学和数值数据卫生经费支出/统计学和数值数据家庭护理(非专业)/经济学密执安女(雌)性人类男(雄)性

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The costs and financing of dental education.

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Journal of dental education 1999年第12期63卷 873-881页

作者： Hardigan, J. School of Dentistry Virginia Commonwealth University Richmond 23298-0566 USA.

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