A Multilevel Logit Estimation on the Determinants of Utilization of Preventive Health Care and Healthy Lifestyle Practice in China.

The purpose of this study is to provide policy implications by estimating the individual and community level determinants of preventive health-care utilization in China based upon data from the China Health and Nutrition Survey. Two different frameworks, a human capital model and a psychological-behavioral model, are tested using a multilevel logit estimation. The results demonstrate different patterns for medical and nonmedical preventive activities. There is a strong correlation between having medical insurance and utilizing preventive health services. For the usage of medical-related preventive health care (MP), age, gender, education, urban residence, and medical insurance are strong predictors. High income did not provide much of an increase in the usage level of MP, but the lack of income was a huge obstacle for low-income people to overcome. Community variation in number of facilities accounted for about one third of the total variation in the utilization of MP. The utilization of MP in China remains dependent upon the individual's social-economic conditions.

Self-rated health and social capital in transitional countries: Multilevel analysis of comparative surveys in Armenia, Azerbaijan, and Georgia.

The objective of this study is to analyze the effect of social capital on self-rated health in transitional countries of the South Caucasus region. The study is based on recent, 2009, cross-sectional nationally-representative surveys of 2082 respondents in Armenia, 2014 in Azerbaijan, and 1837 in Georgia with response rate of 78-80%. Two-level random-coefficient ordered logistic regression, modeling individual and community variations in subjective health was estimated to account for the hierarchical structure of the data set which includes individuals nested within communities. The results allow several interesting conclusions to be drawn. First, a proportion of the total variation in self-rated health explained at the community level is 0.23 for Azerbaijan, 0.10 for Georgia, and 0.08 for Armenia. These findings highlight the importance of more decentralized community-based healthcare interventions in the region. Second, human capital covariates remained significant predictors of health status even after controlling for social capital both at individual and community levels. Likewise, social capital variables are significant predictors of health status when used alone and when they are controlled by human capital covariates. These findings suggest that human capital and social capital influence health status independently of each other. Finally, this study sheds light on whether social capital collectively benefits members of a community in transitional countries beyond the individual benefits. In Armenia and Azerbaijan, community level differences in health status are rooted in "compositional" differences between social capital of individuals in the communities rather than at the community "contextual" level. In Georgia, by contrast, the beneficial effect of social capital can be simultaneously observed at the individual "compositional", and community "contextual" levels. These findings suggest that neither "compositional" nor "contextual" models of the social capital effect of health status can apply to all transitional societies universally.

Does prenatal healthcare improve child birthweight outcomes in Azerbaijan? Results of the national Demographic and Health Survey.

This paper evaluates the effectiveness of prenatal healthcare in Azerbaijan on improving child birthweight using the 2006 Azerbaijan Demographic and Health Survey, a nationally representative survey of reproductive aged women. Two measures of prenatal health utilization are used to measure healthcare input-the number of prenatal visits and the quality index of health care. Endogeneity in prenatal healthcare utilization is controlled by 2SLS regression. Selection bias of probability of child being weighed is controlled by a binomial probit regression. We found that prenatal healthcare does improve child birthweight. The results of the 2SLS suggest that an additional prenatal visit increases birthweight by about 26g, or approximately 0.8% of the raw mean of birthweight in the country. Likewise, a unit increase in quality of prenatal healthcare increases birthweight by 21g or by approximately 1.3% of the birthweight. In general, the magnitude of prenatal care impact in Azerbaijan is comparable with that in other countries.

The inequity in out-of-pocket expenditures for healthcare in Tajikistan: evidence and implications from a nationally representative survey.

OBJECTIVE: Out-of-pocket expenditures (OPE) for healthcare are a widespread and enduring phenomenon in post-communist countries. However, evidence regarding their effect on health equity is limited, especially in the low-income countries of Central Asia. With this in mind, the current paper presents the results of an analysis of the impact of OPE on equity in Tajikistan, one of the poorest transitional countries. METHODS: Utilizing a sample from a nationally representative household survey, this paper presents a systematic examination of the effect of OPE on equity using concentration curve, quintile analysis and concentration indices. The impact was disaggregated by inpatient and outpatient services, and medication purchase. Further disaggregation was performed according to spatial dimensions, by types of providers, condition or disease, by place of medication purchase, and by type of facility and treatment received. RESULTS: Overall, OPE in Tajikistan are equally distributed across the population, with the poorest and the wealthiest, in most cases, bearing a similar level of burden. However, the poor bear the heaviest burden in terms of expenditures for medication and other supplies in inpatient services. There is considerable spatial variation in the expenditures burden, with regional variation being more substantial than rural-urban variation. More importantly, the poor experience a larger proportion of burden with regard to expenditures in vital areas such as those of infectious diseases and maternal health. CONCLUSIONS: While current economic constraints and the ongoing health sector reform in Tajikistan promote OPE for healthcare utilization, the lack of financial protection against the risk of these conditions should be of major concern to policy-makers. In particular, the problems of OPE, which have been found to place a higher burden on the poor, should be taken into consideration during healthcare reform in Tajikistan.

On the socio-economic determinants of antenatal care utilization in Azerbaijan: evidence and policy implications for reforms.

Azerbaijan is a country with one of the highest child mortality rates in the regions of Eastern Europe and the former Soviet Union. Drawing on the nationally representative Demographic and Health Survey, this study examines the utilization of antenatal care in Azerbaijan to identify the socio-economic determinants of the usage, and its frequency, timing and quality. Consequently, binomial logit, two ordered logit and negative binomial regression models are specified to estimate the effect of various socio-economic characteristics on the likelihood of utilization. Place of living is an important determinant of antenatal healthcare utilization in Azerbaijan. It is important in determining the likelihood of utilization, its timing and quality of care received, whereas it is not significant in the model predicting the frequency of antenatal utilization. Women's education is also significant in three models out of four. Education is important in explaining the frequency and timing of utilization as well as the quality of services received, but it is not significant in predicting the likelihood of utilization. Wealth gradient is another important determinant of antenatal care utilization in Azerbaijan inasmuch as it is significant in explaining the likelihood of prenatal care utilization and its frequency. In addition, two variables, birth order and desirability of the last child or current pregnancy, are significant only in explaining the likelihood of utilization. Therefore, we confirm the findings of previous studies, which reported that the utilization of prenatal health care is a multistage process in which decisions are sequential. Although the same set of factors may affect decision-making at all stages, the effect of these factors is different at different stages. Implications for reforms in the healthcare sector to improve antenatal care utilization in Azerbaijan are provided and discussed.

Comparing and contrasting poverty reduction performance of social welfare programs across jurisdictions in Canada using Data Envelopment Analysis (DEA): an exploratory study of the era of devolution.

In the mid-1990s, the responsibilities to design, implement, and evaluate social welfare programs were transferred from federal to local jurisdictions in many countries of North America and Europe through devolution processes. Devolution has caused the need for a technique to measure and compare the performances of social welfare programs across multiple jurisdictions. This paper utilizes Data Envelopment Analysis (DEA) for a comparison of poverty reduction performances of jurisdictional social welfare programs across Canadian provinces. From the theoretical perspective, findings of this paper demonstrates that DEA is a promising method to evaluate, compare, and benchmark poverty reduction performance across multiple jurisdictions using multiple inputs and outputs. This paper demonstrates that DEA generates easy to comprehend composite rankings of provincial performances, identifies appropriate benchmarks for each inefficient province, and estimates sources and amounts of improvement needed to make the provinces efficient. From a practical perspective the empirical results presented in this paper indicate that Newfoundland, Prince Edwards Island, and Alberta achieve better efficiency in poverty reduction than other provinces. Policy makers and social administrators of the ineffective provinces across Canada may find benefit in selecting one of the effective provinces as a benchmark for improving their own performance based on similar size and structure of population, size of the budget for social programs, and traditions with administering particular types of social programs.

Determinants of maternity health care utilization in Tajikistan: learning from a national living standards survey.

This study examines the demographic, economic, social, and geographic factors that help explain maternity health care utilization in Tajikistan, a low-income transitional country in Central Asia, based on a newly available nationally representative living standard survey. Two regression models, namely, a binomial logit model and a zero-inflated negative binomial (ZINB) model are estimated. The estimations of the two models show strikingly consistent results--the year of last childbirth, educational attainment, and the availability of public infrastructure are important predictors of maternity health care utilization. The results also signify an urgent need to overturn the current negative trend in maternity health care utilization. The findings also suggest that many determinants of maternity health care are outside the direct sphere of health care policies, indicating the need of cross-sectional policies in addressing maternity health care utilization, for example, policies and strategies that include contributions from other sectors.

Modelling prenatal health care utilization in Tajikistan using a two-stage approach: implications for policy and research.

Since the transition from a centrally planned to a market economy, Tajikistan has witnessed a high rate of child and maternal mortality, a decline in the birth rate and a significant drop in public expenditures on health care. Against this backdrop, this paper analyses the determinants of prenatal health care utilization using Andersen's behavioural model, which has been modified to the context of Tajikistan. We applied a two-stage sequential model to data drawn from a nationally representative survey. Binary logit regression is used to predict and explain the probability of using prenatal health care services, while negative binomial regression is used to predict and explain the frequency of using these services. Findings suggest that higher educational attainment increases the utilization of prenatal care. Conversely, poverty, limited knowledge about matters related to sex, low quality of health care service, lack of public infrastructure, as well as absence of or long distance of travel to the nearest health facility, all reduce the utilization of prenatal health care. Health policy and research implications are presented and discussed.