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1.
Int J Environ Res Public Health ; 18(20)2021 10 17.
Article in English | MEDLINE | ID: covidwho-1470874

ABSTRACT

Confronted with a global pandemic, public healthcare systems are under pressure, making access to healthcare services difficult for patients. This provides fertile ground for using illegal practices such as informal payments to gain access. This paper aims to evaluate the use of informal payments by patients during the COVID-19 pandemic and the institutions that affect the prevalence of this practice. Various measurements of formal and informal institutions are here investigated, namely the acceptability of corruption, the level of trust, transparency, and performance of the healthcare system. To do so, a logistic regression of 10,859 interviews with patients conducted across 11 Central and Eastern Europe countries in October-December 2020 is employed. The finding is that there are large disparities between countries in the prevalence of informal payments, and that the practice is more likely to occur where there are poorer formal and informal institutions, namely higher acceptability of corruption, lower trust in authorities, lower perceived transparency in handling the COVID-19 pandemic, difficult access to, and poor quality of, healthcare services, and higher mortality rates due to the COVID-19 pandemic. These findings suggest that policy measures for tackling informal payments need to address the current state of the institutional environment.


Subject(s)
COVID-19 , Pandemics , Europe, Eastern , Financing, Personal , Health Expenditures , Humans , SARS-CoV-2
3.
Sci Rep ; 11(1): 18759, 2021 09 21.
Article in English | MEDLINE | ID: covidwho-1434154

ABSTRACT

Repayment failures of borrowers have greatly affected the sustainable development of the peer-to-peer (P2P) lending industry. The latest literature reveals that existing risk evaluation systems may ignore important signals and risk factors affecting P2P repayment. In our study, we applied four machine learning methods (random forest (RF), extreme gradient boosting tree (XGBT), gradient boosting model (GBM), and neural network (NN)) to predict important factors affecting repayment by utilizing data from Renrendai.com in China from Thursday, January 1, 2015, to Tuesday, June 30, 2015. The results showed that borrowers who have passed video, mobile phone, job, residence or education level verification are more likely to default on loan repayment, whereas those who have passed identity and asset certification are less likely to default on loans. The accuracy and kappa value of the four methods all exceed 90%, and RF is superior to the other classification models. Our findings demonstrate important techniques for borrower screening by P2P companies and risk regulation by regulatory agencies. Our methodology and findings will help regulators, banks and creditors combat current financial disasters caused by the coronavirus disease 2019 (COVID-19) pandemic by addressing various financial risks and translating credit scoring improvements.


Subject(s)
Financing, Personal/economics , Machine Learning , COVID-19/epidemiology , COVID-19/virology , China/epidemiology , Financial Management , Financing, Personal/standards , Humans , Internet , Pandemics , Risk Factors , SARS-CoV-2/isolation & purification
4.
JAMA ; 326(3): 250-256, 2021 07 20.
Article in English | MEDLINE | ID: covidwho-1338163

ABSTRACT

Importance: Medical debt is an increasing concern in the US, yet there is limited understanding of the amount and distribution of medical debt, and its association with health care policies. Objective: To measure the amount of medical debt nationally and by geographic region and income group and its association with Medicaid expansion under the Affordable Care Act. Design, Setting, and Participants: Data on medical debt in collections were obtained from a nationally representative 10% panel of consumer credit reports between January 2009 and June 2020 (reflecting care provided prior to the COVID-19 pandemic). Income data were obtained from the 2014-2018 American Community Survey. The sample consisted of 4.1 billion person-month observations (nearly 40 million unique individuals). These data were used to estimate the amount of medical debt (nationally and by geographic region and zip code income decile) and to examine the association between Medicaid expansion and medical debt (overall and by income group). Exposures: Geographic region (US Census region), income group (zip code income decile), and state Medicaid expansion status. Main Outcomes and Measures: The stock (all unpaid debt listed on credit reports) and flow (new debt listed on credit reports during the preceding 12 months) of medical debt in collections that can be collected on by debt collectors. Results: In June 2020, an estimated 17.8% of individuals had medical debt (13.0% accrued debt during the prior year), and the mean amount was $429 ($311 accrued during the prior year). The mean stock of medical debt was highest in the South and lowest in the Northeast ($616 vs $167; difference, $448 [95% CI, $435-$462]) and higher in poor than in rich zip code income deciles ($677 vs $126; difference, $551 [95% CI, $520-$581]). Between 2013 and 2020, the states that expanded Medicaid in 2014 experienced a decline in the mean flow of medical debt that was 34.0 percentage points (95% CI, 18.5-49.4 percentage points) greater (from $330 to $175) than the states that did not expand Medicaid (from $613 to $550). In the expansion states, the gap in the mean flow of medical debt between the lowest and highest zip code income deciles decreased by $145 (95% CI, $95-$194) while the gap increased by $218 (95% CI, $163-$273) in the nonexpansion states. Conclusions and Relevance: This study provides an estimate of the amount of medical debt in collections in the US based on consumer credit reports from January 2009 to June 2020, reflecting care delivered prior to the COVID-19 pandemic, and suggests that the amount of medical debt was highest among individuals living in the South and in lower-income communities. However, further study is needed regarding debt related to COVID-19.


Subject(s)
Financing, Personal/economics , Health Expenditures/statistics & numerical data , Healthcare Disparities/economics , Humans , Income , Insurance, Health/economics , Medicaid/economics , Medically Uninsured , Social Determinants of Health , United States
5.
JAMA Netw Open ; 4(7): e2118223, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1321668

ABSTRACT

Importance: Methadone access may be uniquely vulnerable to disruption during COVID-19, and even short delays in access are associated with decreased medication initiation and increased illicit opioid use and overdose death. Relative to Canada, US methadone provision is more restricted and limited to specialized opioid treatment programs. Objective: To compare timely access to methadone initiation in the US and Canada during COVID-19. Design, Setting, and Participants: This cross-sectional study was conducted from May to June 2020. Participating clinics provided methadone for opioid use disorder in 14 US states and territories and 3 Canadian provinces with the highest opioid overdose death rates. Statistical analysis was performed from July 2020 to January 2021. Exposures: Nation and type of health insurance (US Medicaid and US self-pay vs Canadian provincial). Main Outcomes and Measures: Proportion of clinics accepting new patients and days to first appointment. Results: Among 268 of 298 US clinics contacted as a patient with Medicaid (90%), 271 of 301 US clinics contacted as a self-pay patient (90%), and 237 of 288 Canadian clinics contacted as a patient with provincial insurance (82%), new patients were accepted for methadone at 231 clinics (86%) during US Medicaid contacts, 230 clinics (85%) during US self-pay contacts, and at 210 clinics (89%) during Canadian contacts. Among clinics not accepting new patients, at least 44% of 27 clinics reported that the COVID-19 pandemic was the reason. The mean wait for first appointment was greater among US Medicaid contacts (3.5 days [95% CI, 2.9-4.2 days]) and US self-pay contacts (4.1 days [95% CI, 3.4-4.8 days]) than Canadian contacts (1.9 days [95% CI, 1.7-2.1 days]) (P < .001). Open-access model (walk-in hours for new patients without an appointment) utilization was reported by 57 Medicaid (30%), 57 self-pay (30%), and 115 Canadian (59%) contacts offering an appointment. Conclusions and Relevance: In this cross-sectional study of 2 nations, more than 1 in 10 methadone clinics were not accepting new patients. Canadian clinics offered more timely methadone access than US opioid treatment programs. These results suggest that the methadone access shortage was exacerbated by COVID-19 and that changes to the US opioid treatment program model are needed to improve the timeliness of access. Increased open-access model adoption may increase timely access.


Subject(s)
COVID-19 , Health Services Accessibility , Methadone/therapeutic use , Opiate Substitution Treatment , Opioid-Related Disorders/therapy , Pandemics , Waiting Lists , Ambulatory Care Facilities , Analgesics, Opioid , Canada , Cross-Sectional Studies , Financing, Personal , Health Services , Insurance, Health , Medicaid , United States
6.
Asian Pac J Cancer Prev ; 22(3): 793-800, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1155073

ABSTRACT

BACKGROUND: Cancer treatment during nationwide lockdown due to the COVID-19 pandemic has posed several challenges in the delivery of cancer care and carries tremendous potential sequel of impoverishing the households. This study aims to examine the economic distress faced by breast cancer patients receiving treatment at Tata Memorial Center (TMC) Mumbai, India during the nationwide lockdown initiated in March 2020 following the outbreak of COVID-19. METHODS: A total of 138 non-metastatic breast cancer patients who were accrued in this study at TMC before imposing of lockdown, and their treatment was impacted because of the COVID-19 outbreak, were interviewed. Telephonic interviews were conducted using a structured schedule which contained information on household and demographic characteristics of the patients, knowledge about COVID-19, their daily expenditure for treatment, difficulties faced during lockdown and how they met expenditures. Descriptive statistics and logistic regression were used in the analyses. RESULTS: The average monthly expenditure of cancer patients had increased by 32% during the COVID-19 period while the mean monthly household income was reduced by a quarter. More than two-thirds of the patients had no income during the lockdown. More than half of the patients met their expenditure by borrowing money, 30% of the patients used their savings, 28% got charity and 25% used household income. About 81% of the patients had reported shortage of money, 32%  reported shortage of food and 28% reported shortage of medicine. The distress financing was significantly higher among patients receiving treatment in Mumbai compared to those receiving treatment at their native cities (67% vs. 46%), patients under 40 years of age, illiterate, currently married, Muslim and staying at a rented house. CONCLUSION: The incremental expenditure coupled with reduced or no income due to the closure of economic activities in the country imposed severe financial stress on breast cancer patients.


Subject(s)
Breast Neoplasms/economics , COVID-19 , Cost of Illness , Financial Stress , Financing, Personal , Health Expenditures , Adult , Age Factors , Breast Neoplasms/therapy , Cohort Studies , Communicable Disease Control , Female , Geography , Humans , Income , India , Literacy , Marital Status , Middle Aged , Religion , SARS-CoV-2
7.
Appl Health Econ Health Policy ; 19(3): 343-351, 2021 05.
Article in English | MEDLINE | ID: covidwho-1095758

ABSTRACT

BACKGROUND: The coronavirus disease (COVID-19) pandemic has considerably affected the lives of people worldwide, impacting their health and economic welfare, and changing the behavior of our society significantly. This situation may lead to a strong incentive for people to buy a vaccine. Therefore, a relevant study to assess individuals' choices and the value of change in welfare from a COVID-19 vaccine is essential. OBJECTIVE: This study aimed to estimate the willingness-to-pay (WTP) value for a vaccine for COVID-19. We also identify the variables that influence individual vaccination decisions, which could be used in the design of vaccination promotion strategies. METHODS: We use the contingent valuation method in its double-bounded dichotomous choice format. The estimation coefficients are calculated according to the maximum likelihood method under the assumption of a probit distribution. The sample consisted of 531 individuals, mainly from middle- and high-income socioeconomic groups from Chile between enrolled between 10 July and 10 August 2020. RESULTS: The results show a high WTP for the COVID-19 vaccine, with a value up to US$232. Income and education levels and having family members with COVID-19 increased the likelihood of persons paying for a vaccine. There is also a greater fear as the pandemic progresses that people will get sick from COVID-19. CONCLUSIONS: The high WTP value creates an opportunity for formulating public health policy. The results of this study suggest that governments can provide the vaccine free to low-income groups and allow those with higher incomes to acquire the vaccine through the private sector by paying. This will be useful especially for countries with economic difficulties.


Subject(s)
COVID-19 Vaccines/economics , COVID-19/prevention & control , Financing, Personal , Adolescent , Adult , Female , Humans , Male , Middle Aged , Models, Econometric , Pandemics , Patient Acceptance of Health Care , SARS-CoV-2 , Surveys and Questionnaires , Young Adult
8.
BMC Pregnancy Childbirth ; 21(1): 38, 2021 Jan 08.
Article in English | MEDLINE | ID: covidwho-1035146

ABSTRACT

BACKGROUND: The complexity of fetal medicine (FM) referrals that can be managed within obstetric units is dependent on the availability of specialist ultrasound expertise. Telemedicine can effectively transfer real-time ultrasound images via video-conferencing. We report the successful introduction of a fetal ultrasound telemedicine service linking a specialist fetal medicine (FM) centre and a remote obstetric unit. METHODS: Over a four-year period from October 2015, all women referred for FM consultation from the obstetric unit were seen via telemedicine, excluding cases where invasive testing, intrauterine therapy or cardiac anomalies were anticipated. The outcomes measured included the indication for FM referral; scan duration and image and sound quality during the consultation. Women's perceptions of the telemedicine consultation and estimated costs to attend the FM centre were measured by a structured questionnaire completed following the first telemedicine appointment during the Phase 1 of the project. RESULTS: Overall, 297 women had a telemedicine consultation during Phase 1 (pilot and evaluation) and Phase 2 (embedding and adoption) of the project, which covered a 4 year period 34 women completed questionnaires during the Phase 1 of the study. Travel to the telemedicine consultation took a median (range) time of 20 min (4150), in comparison to an estimated journey of 230 min (120,450) to the FM centre. On average, women would have spent approximately £28 to travel to the FM centre per visit. The overall costs for the woman and her partner/ friend to attend the FM centre was estimated to be £439. Women were generally satisfied with the service and valued the opportunity to have a FM consultation locally. CONCLUSIONS: We have demonstrated that a fetal ultrasound telemedicine service can be successfully introduced to provide FM ultrasound of sufficient quality to allow fetal diagnosis and specialist consultation with parents. Furthermore, the service is acceptable to parents, has shown a reduction in family costs and journey times.


Subject(s)
Pregnant Women/psychology , Telemedicine/organization & administration , Ultrasonography, Prenatal/methods , Adolescent , Adult , Costs and Cost Analysis , Female , Financing, Personal/economics , Health Services Accessibility/economics , Health Services Accessibility/statistics & numerical data , Humans , Outcome Assessment, Health Care , Patient Satisfaction , Pregnancy , Referral and Consultation/statistics & numerical data , Telemedicine/economics , Telemedicine/standards , Telemedicine/statistics & numerical data , Time Factors , Ultrasonography, Prenatal/economics , Ultrasonography, Prenatal/standards , Ultrasonography, Prenatal/statistics & numerical data , United Kingdom , Young Adult
9.
J Health Serv Res Policy ; 26(3): 189-197, 2021 07.
Article in English | MEDLINE | ID: covidwho-992317

ABSTRACT

OBJECTIVE: To describe the disruptions in care experienced by persons with Multiple Sclerosis in Italy due to the COVID-19 pandemic and the self-reported impact on their health and wellbeing. METHODS: A cross-sectional online survey was completed by 2722 persons with Multiple Sclerosis, after Italy instituted a national lockdown in response to the pandemic. RESULTS: Persons with Multiple Sclerosis reported that the pandemic caused broad disruptions to usual health and social care services, which impacted on their health and wellbeing. Disruptions in care were consistently associated with negative self-reported impacts on the expected progression of the disease, on out-of-pocket expenditure and on carer's stress. Psychological consequences were associated with interruption to usual psychological support, and concerns about the safety of care delivered in person. CONCLUSIONS: The quality of life of persons with Multiple Sclerosis depends greatly on prompt access to a broad range of health and care services. Negative psychological impacts reported by persons with Multiple Sclerosis with less severe disabilities show that accessible integrated services are crucial for maintenance of their wellbeing. Most persons with Multiple Sclerosis with more severe disability experienced negative impacts on perceived health. Their carers compensating for lack of social input resulted in care overburden. As continuity of care is crucial for persons with Multiple Sclerosis, as well as for persons with chronic conditions in general, strategies must be in place to ensure it is included in future pandemic response plans.


Subject(s)
COVID-19/epidemiology , Continuity of Patient Care/organization & administration , Multiple Sclerosis/epidemiology , Multiple Sclerosis/psychology , Adult , Caregiver Burden/epidemiology , Cross-Sectional Studies , Delivery of Health Care/organization & administration , Disabled Persons/psychology , Female , Financing, Personal , Health Status , Humans , Italy , Male , Mental Health , Middle Aged , Pandemics , Quality of Life , SARS-CoV-2 , Self Report , Severity of Illness Index , Social Work/organization & administration , Stress, Psychological/epidemiology
10.
J Am Coll Radiol ; 18(1 Pt A): 103-107, 2021 01.
Article in English | MEDLINE | ID: covidwho-813662

ABSTRACT

Today's female physicians face a "triple whammy" of structural discrimination, rigid work expectations, and increasing educational debt. Coronavirus disease 2019 is disproportionately amplifying these forces on women. The burden of these forces on women, the likely long-term consequences, and some preliminary solutions are discussed.


Subject(s)
COVID-19/epidemiology , Mothers , Physicians, Women , Radiologists/economics , Radiologists/education , Adult , Education, Medical/economics , Female , Financing, Personal/statistics & numerical data , Humans , SARS-CoV-2 , Sexism , Training Support/economics , Workload
14.
Lancet ; 395(10227): 912-920, 2020 03 14.
Article in English | MEDLINE | ID: covidwho-2354

ABSTRACT

The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.


Subject(s)
Coronavirus Infections/prevention & control , Pneumonia, Viral/prevention & control , Quarantine , Stress, Psychological , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Financing, Personal , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Public Health , Quarantine/economics , Quarantine/psychology , Social Conditions , Social Stigma , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/prevention & control
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