Erlyana

Expanding health insurance to increase health care utilization: will it have different effects in rural vs. urban areas?

OBJECTIVES This study investigates the importance of medical fee and distance to health care provider on individuals decision to seek care in developing countries. METHODS The estimation method used a mixed logit model applied to data from the third wave of the Indonesian family life survey (2000). The key variables of interest include medical fee and distance to different types of health care provider and individual characteristic variables. RESULTS Urban dwellers decision to choose health care providers are sensitive to the monetary cost of medical care as measured by medical fee but they are not sensitive to distance. For those who reside in rural area, they are sensitive to the non-medical component cost of care as measured by travel distance but they are not sensitive to medical fee. CONCLUSIONS As a result of those findings, policy makers should consider different sets of policy instruments when attempting to expand health services usage in urban and rural areas of Indonesia. To increase access in urban areas, we recommend expansion of health insurance coverage in order to lower out-of-pocket medical expenditures. As for rural areas, expansion of medical infrastructures to reduce commuting distance and costs will be needed to increase utilization.

Comparison of Rapid Point-of-Care Tests for Detection of Antibodies to Hepatitis C Virus

OraSure had the highest sensitivity at 92.7% followed closely by Chembios three blood tests. False results were associated with HIV, and hepatitis B core antibody. The OraSure and Chembio blood tests have good performance characteristics.

Hepatitis C Infection Among Hispanics in California

Hispanics in California are more likely to be infected with hepatitis C, and those infected have had their infection detected later. A total of 1,567 Hispanic and Caucasian individuals were tested for antibodies to hepatitis C from 2000 through 2013. Interviewers administered the Risk Behavior Assessment. Hepatitis C-infected Hispanics were incarcerated longer than hepatitis C-infected Caucasians, and they used marijuana less and illicit methadone more. They were more likely to use crack, heroin, speedballs, and to have been in methadone treatment. Hispanics need hepatitis C testing linked to methadone treatment and written information in Spanish and English.

Emergency room use after being released from incarceration

BackgroundThis study investigates opiate use in mediating the impact of history of incarceration on emergency department (ED) use.MethodData were collected from 1,341 clients who underwent HIV and STI screening in an outpatient care center in Long Beach, California. The Risk Behavior Assessment (RBA, baseline) and Risk Behavior Follow-Up Assessment (RBFA, follow-up) were administered to each client with at least a three months interval between assessments.ResultsOf 1341 participants in the study, 931 (69.43%) reported previous incarceration. Having a history of incarceration was significantly associated with emergency room use as well as a history of sexually transmitted infections (STIs), injection drug use, opiate use, and survival sex trading, defined as sex for money or drugs. The relationship between previous incarceration and ED use was mediated by opiate use for men but not for women. The findings suggested that the effect of history of incarceration on ED use was exacerbated when the individuals were male and opiate users.ConclusionsTargeted interventions in treatment and rehabilitation programs could help prevent unnecessary ED use and reduce the use of EDs through drug treatment during incarceration and after release.