Co-payments for emergency department visits: a quasi-experimental study.

OBJECTIVES: Financial recession in Cyprus has led to health reforms to promote efficiency and reduce public expenditure. In this context, a co-payment fee was introduced in 2013 for all emergency department (ED) visits, with the aim of reducing potentially avoidable visits. The objective of this study was to assess the short-term intended and unintended impacts of introducing these co-payments. STUDY DESIGN: The study design is an interrupted time series analysis. METHODS: We used an autoregressive integrated moving average model for interrupted time series analysis of data on ED visits over 42 consecutive months, from 2013 to 2015 in a regional hospital in Cyprus. The ED visits have been classified to non-avoidable and potentially avoidable visits. RESULTS: The introduction of co-payment had no effect on non-avoidable visits (4% [95% confidence interval {CI}: 4.3-11.08] P = 0.694). However, it had the immediate and sustained effect of reducing potentially avoidable visits, an effect that was statistically significant from the first month onwards (29.8% [95% CI: 22.6-34.1] P < 0.00001). CONCLUSIONS: Co-payments can be a valuable tool for reducing potentially avoidable emergency department visits, without adversely impacting non-avoidable visits. This is a particularly significant finding for countries experiencing financial pressures and struggling to reduce waste in health expenditure. However, the long-term impact of this policy must be assessed, including potential negative effects on public health, to make sure it does not create barriers in obtaining necessary health care that might actually increase expenses in the long run. In particular, timely access to primary care services must be safeguarded.

The concept of "intercultural opening": the development of an assessment tool for the appraisal of its current implementation in the mental health care system.

The German concept of "intercultural opening" is an approach to facilitating migrants' access to the health care system and improving the care they receive. No data exist concerning the current status of the implementation of this approach in Germany, and the concept has never been analysed in practice. To assess the status of "intercultural opening" in the German mental health care system and to further analyse the concept, we developed a tool by combining pre-existing instruments. In order to review the preliminary tool we combined experts' knowledge by carrying out a consensusoriented, expert-based Delphi process with actual practice by piloting the instrument in each type of institution to be assessed. The assessment tool thus developed(1) is the first one to evaluate the current status of "intercultural opening" in the community mental health care system in Germany from a broad perspective. This paper is intended to present the development process of our assessment tool for demonstrating the benefits of this approach and as a model for future studies, as well as to increase transparency in relation to the current German approach to health care structures in dealing with migrants.

Effects of war and organized violence on children: a study of Bosnian refugees in Sweden.

Data from 99 school-aged Bosnian refugee children living in Sweden were analyzed to reveal the patterns of war stress experienced and the relation between these stressors and current psychological problems. A significant pattern of associations emerged. When children had experienced much stress, talking about their experiences seemed to exacerbate their negative effects.