Search Results (372)

This study investigates the impact of the COVID-19 pandemic on clinically diagnosed depression in South Korea, focusing on gender disparities and structural risk factors such as job loss and childcare burden. Although mental health inequalities have received growing attention during the pandemic, most existing research relies on self-reported survey data with inherent limitations. To address this gap, we utilized administrative health data from a 2% stratified random sample of the total population (N = 297,368) in the National Health Insurance Database, focusing on employed individuals without a prior history of depression. Multivariable Cox proportional hazard regression revealed that women had significantly higher risks of depression than men, particularly among those in their 20s to 40s, those who experienced job loss, those who had children aged 7–9, and those who belonged to high-income groups. These findings suggest that the intersection of employment instability and caregiving responsibilities disproportionately affected women’s mental health during the pandemic. The results underscore the urgent need for gender-sensitive public health policies that expand childcare support, institutionalize flexible work arrangements such as telecommuting, and enhance access to targeted mental health services to reduce pandemic-induced gender disparities in mental health. Full article

Although organizational resilience is well established, refining the systematic quantitative evaluation of health systems resilience (HSR) remains an ongoing opportunity for advancement. Research either focuses on individual HSR indicators, such as social welfare policy, public expenditure, health insurance, healthcare quality, and technology, or broadly examines socio-economic factors, highlighting the need for a more comprehensive methodological approach. This study employed the Slacks-Based Measure (SBM) within Data Envelopment Analysis (DEA) to analyze efficiency by maximizing outputs. It systematically examined key HSR factors across countries, providing insights for improved policymaking and resource allocation. Taking a five-year (2016–2020) dataset that covered 55 to 56 countries and evaluating 17 indicators across governance, health systems, and economic aspects, the paper presents that all sixteen top-ranked countries with a perfect efficiency score of 1 belonged to the high-income group, with ten in Europe, highlighting regional HSR differences. This paper concludes that adequate economic resources form the foundation of HSR and ensure stability and sustained progress. A properly supported healthcare workforce is essential for significantly enhancing health systems and delivering quality care. Last, effective governance and the equitable allocation of resources are crucial for fostering sustainable development and strengthening HSR. Full article

Introduction: Low medication adherence and low hypertension control are a public health challenge, particularly in low- and middle-income countries (LMICs). Healthcare system- and patient-related barriers hinder the successful management of hypertension. This study aimed to identify the perceptions of barriers and facilitators to hypertension management among health system stakeholders in Santander, Colombia. Materials and Methods: We conducted a qualitative, phenomenological, and interpretative study, comprising five focus groups, to explore the barriers and facilitators to managing people with hypertension. Each focus group was formed by stakeholders from territorial entities, healthcare insurers, or healthcare providers. Meetings were held between December 2022 and February 2023. The sessions were recorded and transcribed using NVivo Transcription and analyzed using NVivo version 1.6.1. Results: Seven categories of barriers and facilitators were identified: strategies, resources, access, risk assessment, cross-sector collaboration, articulation, and stewardship. Of these categories, articulation and stewardship emerged as the main barriers, as revealed through axial coding and cluster analysis, which highlighted deficiencies in stewardship practices, a lack of clear objectives, and misalignment with public policy frameworks. Conclusions: Multisectoral actions extending beyond healthcare providers and aimed at improving coordination and intersectoral collaboration are essential for enhancing hypertension control in LMICs, such as Colombia. Addressing social determinants and strengthening primary healthcare through community-based strategies are critical, making stewardship and improved access key priorities. Full article

Background: The objective of this study is to investigate the prevalence and epidemiological changes of major sexually transmitted infections (STIs) in Korea over the past decade. Methods: From 2010 to 2021, patients diagnosed with STIs based on ICD-10 codes were analyzed using Korean Health insurance data. The analysis included the number of patients, prevalence, and age-specific prevalence (in 5-year intervals) over this period. We examined changes in disease patterns over time by analyzing the annual trends and age-specific prevalence of bacterial STIs such as chlamydia, mycoplasma, gonorrhea, and syphilis; viral STIs such as genital herpes, human papillomavirus (HPV), and human immunodeficiency virus (HIV); and other infections including scabies, pubic lice, and trichomoniasis. Results: In 2010, the STI with the highest prevalence due to an infectious pathogen was trichomoniasis (256.65/100,000), while latent syphilis had the lowest prevalence (5.29/100,000). In 2021, the STI with the highest prevalence was genital herpes (254.54 per 100,000 persons), and latent syphilis continued to have the lowest prevalence. Bacterial STIs showed a decreasing trend. Viral STIs showed a continuous increase throughout the study period, with anogenital warts (AGW) having the highest rate of increase. Other infections showed a decreasing trend. HIV and AGW in men showed a rapid increase. Gender differences varied depending on the disease. Conclusions: While bacterial STIs have gradually declined, viral STIs have continued to increase during last decade. The characteristics of each pathogen vary according to age and gender, necessitating the establishment of risk groups for each pathogen and the development of prevention policies accordingly. Full article

Healthcare cost acceleration and resource allocation issues have worsened across European health systems, where a small group of patients drives excessive healthcare spending. The prediction of high-cost utilization patterns is important for the sustainable management of healthcare and focused intervention measures. The aim of our study was to derive and validate machine learning algorithms for high-cost healthcare utilization prediction based on detailed administrative data and by comparing three algorithmic methods for the best risk stratification performance. The research analyzed extensive insurance beneficiary records which compile data from health group collective funds operated by non-life insurers across EU countries, across multiple service classes. The definition of high utilization was equivalent to the upper quintile of overall health expenditure using a moderate cost threshold. The research applied three machine learning algorithms, namely logistic regression using elastic net regularization, the random forest, and support vector machines. The models used a comprehensive set of predictor variables including demographics, policy profiles, and patterns of service utilization across multiple domains of healthcare. The performance of the models was evaluated using the standard train–test methodology and rigorous cross-validation procedures. All three models demonstrated outstanding discriminative ability by achieving area under the curve values at near-perfect levels. The random forest achieved the best test performance with exceptional metrics, closely followed by logistic regression with comparable exceptional performance. Service diversity proved to be the strongest predictor across all models, while dentistry services produced an extraordinarily high odds ratio with robust confidence intervals. The group of high utilizers comprised approximately one-fifth of the sample but demonstrated significantly higher utilization across all service classes. Machine learning algorithms are capable of classifying patients eligible for the high utilization of healthcare services with nearly perfect discriminative ability. The findings justify the application of predictive analytics for proactive case management, resource planning, and focused intervention measures across private group health insurance providers in EU countries. Full article

Medicaid is a vital public health program, serving over 70 million Americans from many backgrounds. Understanding how Medicaid spending varies by political leadership and demographic factors can inform policy discussions and advocacy efforts. We conducted a cross-sectional descriptive analysis of state Medicaid spending using publicly available data. Our findings show that individuals identifying as White comprise the largest single racial group of Medicaid beneficiaries both nationally and in most states. While the 2020 Census Diversity Index correlated strongly with total Medicaid spending, no significant association was found with per enrollee spending or the federal share of Medicaid funding. States led by Democrats had higher total Medicaid spending when compared to Republican-led states. However, Republican-led states received a larger proportion of federal Medicaid funding. Among political leadership levels, Senate representation showed the strongest relationship with Medicaid spending trends compared to gubernatorial leadership and presidential voting history. In conclusion, we demonstrate that Medicaid spending impacts all racial groups and both major political parties. However, funding structures and political representation reflect distinct spending patterns. Given the evolving demographic and political landscape, ongoing policy discussions should ensure that Medicaid remains a public health program that remains effective at safeguarding human health. Full article

The Affordable Care Act (ACA), implemented in 2010, aimed to expand healthcare access, reduce costs, and address long-standing disparities in the U.S. healthcare system, particularly among racial and ethnic minorities. This paper reviews the ACA’s impact on healthcare utilization for these populations, with a focus on insurance coverage, preventive services, and health outcomes. While Medicaid expansion significantly reduced uninsured rates and increased access to care in states that adopted the expansion, millions of low-income individuals, many of whom are racial and ethnic minorities, remain uninsured in non-expansion states. The elimination of cost-sharing for preventive services under the ACA contributed to increased utilization of cancer screenings, vaccinations, and other preventive measures among minority groups. However, challenges persist, including affordability barriers, geographic disparities, and cultural and linguistic obstacles. This review also highlights the ongoing need for policy interventions, such as nationwide Medicaid expansion, and future research on the long-term effects of the ACA on health outcomes for minority populations. Full article

Neglecting preventive healthcare policies has contributed to the global surge in chronic diseases, increased hospitalizations, declining quality of care, and escalating costs. Non-communicable diseases (NCDs)—notably cardiovascular conditions, diabetes, and cancer—consume over 80% of healthcare expenditure and account for more than 60% of global deaths, which are projected to exceed 75% by 2030. Poor diets, sedentary lifestyles, regulatory loopholes, and underfunded public health initiatives are driving this crisis. Compounding the issue are flawed policies, congressional lobbying, and conflicts of interest that prioritize costly, hospital-based, symptom-driven care over identifying and treating to eliminate root causes and disease prevention. Regulatory agencies are failing to deliver their intended functions. For instance, the U.S. Food and Drug Administration’s (FDA) broad oversight across drugs, devices, food, and supplements has resulted in inefficiencies, reduced transparency, and public safety risks. This broad mandate has allowed the release of unsafe drugs, food additives, and supplements, contributing to the rising childhood diseases, the burden of chronic illness, and over-medicalization. The author proposes separating oversight responsibilities: transferring authority over food, supplements, and OTC products to a new Food and Nutraceutical Agency (FNA), allowing the FDA to be restructured as the Drug and Device Agency (DDA), to refocus on pharmaceuticals and medical devices. While complete reform requires Congressional action, interim policy shifts are urgently needed to improve public health. Broader structural changes—including overhauling the Affordable Care Act, eliminating waste and fraud, redesigning regulatory and insurance systems, and eliminating intermediaries are essential to reducing costs, improving care, and transforming national and global health outcomes. The information provided herein can serve as a White Paper to help reform health agencies and healthcare systems for greater efficiency and lower costs in the USA and globally. Full article

The Brazilian population in the United States is growing, and many Brazilian workers are employed in settings that may lack occupational health and safety (OHS) protections. In this study, we examined two domains of OHS (measured by the Occupational Health and Safety Vulnerability Survey), namely, Workplace Hazards (potential dangers that may result in injury or illness) and Workplace Vulnerability (inadequate occupational health and safety resources), and described health and demographic characteristics associated with these conditions. Eligible participants were women aged 18 and over, born in Brazil, currently residing in the United States, and employed. A cross-sectional online survey was conducted between July and August 2020. Recruitment occurred through community partnerships and social media. Multivariable models among n = 191 women revealed that greater exposure to Workplace Hazards was associated with employment in private household settings, including childcare and housecleaning (p < 0.001). The association between Workplace Vulnerability and jobs in private household services approached statistical significance (p = 0.07). Both Workplace Hazards and Workplace Vulnerability were associated with lower incomes and educational attainment, as well as having public insurance. Our findings suggest the need for stronger OHS protections and policies, particularly among those working in private household services, to ensure safer working conditions for Brazilian immigrant women. Full article

Background: Health inequality is seen as a challenge for implementing the Healthy China Strategy. This study analyzes the income-related health inequality among urban–rural resident basic medical insurance (URRBMI) participants. Methods: This study utilized data from the 2019 China Household Finance Survey (CHFS), and the concentration index (CI) was employed to estimate the effects of income-related health inequality on participants. Results: Our findings provide clear evidence that health inequality among participants has fluctuated—narrowing, widening, and then narrowing again—in the areas of the contribution, medical treatment, and reimbursement of URRBMI, respectively. Overall, the analysis indicates a widening of health inequality post-reimbursement, with results remaining consistent. A heterogeneity analysis shows that health inequality is most pronounced among women and those with less than a middle school education. Finally, our study reveals a pro-rich trend in the actual utilization of medical services among participants, with persistent disparities in outpatient and inpatient service usage even after standardization, further exacerbating income-related health inequality. Conclusions: We recommend that the URRBMI design take participants’ income levels into account, with policies favoring disadvantaged individuals to enhance their medical security, improve access to healthcare services, and ultimately reduce health inequality. Full article

The increasingly observable financial vulnerability of households in emerging market countries makes it imperative to investigate the factors influencing it. Considering that China stands as a representative of emerging market economies, analyzing the factors influencing household financial vulnerability in China presents great reference significance for the sustainable development of households in emerging market countries. Using data from the China Household Finance Survey (CHFS) household samples, this paper presents the regional distribution of households with financial vulnerability in China. Utilizing machine learning (ML), this research examines the factors that influence household financial vulnerability in China and determines the most significant ones. The results reveal that households with financial vulnerability in China takes up a proportion of more than 63%, and household financial vulnerability is lower in economically developed coastal regions than in medium and small-sized cities in the central and western parts of China. The analysis results of the SHAP method show that the debt leverage ratio of a household is the most significant feature variable in predicting financial vulnerability. The ALE plots demonstrate that, in a household, the debt leverage ratio, the age of household head, health condition, economic development and literacy level are significantly nonlinearly related to financial vulnerability. Heterogeneity analysis reveals that, except for household debt leverage and insurance participation, the key characteristic variables exerting the most pronounced effect on financial fragility differ between urban and rural households: household head age for urban families and physical health status for rural families. Furthermore, digital financial inclusion and social security exert distinct impacts on financial vulnerability, showing significantly stronger effects in high per capita GDP regions and low per capita GDP regions, respectively. These findings offer valuable insights for policymakers in emerging economies to formulate targeted financial risk mitigation strategies—such as developing household debt relief and prevention mechanisms and strengthening rural health security systems—and optimize policies for household financial health. Full article

Flourishing in children is an indicator of positive development in the areas of emotional, social, and cognitive development. Using a recent dataset from the US National Survey of Children’s Health, this study investigates the association between access to a quality healthcare system and flourishing indicators in school-aged children with autism. The outcome variable describes the proportion of children aged 6–17 with autism meeting the flourishing criteria, which include measures related to learning, resilience, and self-regulation. The main independent variable includes six core indicators for school-aged children and adolescents, which assess whether the family feels like a partner in their child’s care, the child has a medical home, receives regular medical and dental preventive care, has adequate insurance, has no unmet needs or barriers to accessing services, and has prepared for transition to adult healthcare. Multivariable logistic regression models were used to examine the relationships between various independent variables and the outcome of interest. The results show that children with autism who receive comprehensive and coordinated care are more likely to flourish compared to those without such care for five of these six indicators, while controlling for sex, race, parental education, household income, self-reported autism severity, general health status, and the number of adverse childhood experiences. Children with autism are more likely to flourish when their families and healthcare providers work together effectively. Addressing gaps in the quality care system is essential for developing holistic approaches that empower children with autism to thrive and reach their full potential. Supportive health policies and effective coordination between families and healthcare providers are crucial for fostering the flourishing of children with autism, ensuring comprehensive, individualized, and continuous care. Full article

Healthcare disparities in cancer care remain pervasive, driven by intersecting socioeconomic, racial, and insurance-related inequities. These disparities manifest in various forms such as limited access to medical resources, underrepresentation in clinical trials, and worse cancer outcomes for marginalized groups, including low-income individuals, racial minorities, and those with inadequate insurance coverage, who face significant barriers in accessing comprehensive cancer care. This manuscript explores the multifaceted nature of these disparities, examining the roles of socioeconomic status, race, ethnicity, and insurance status in influencing cancer care access and outcomes. Historical and contemporary data highlight that minority racial status correlates with reduced clinical trial participation and increased cancer-related mortality. Barriers such as insurance coverage, health literacy, and language further hinder access to cancer treatments. Addressing these disparities requires a systemic approach that includes regulatory reforms, policy changes, educational initiatives, and innovative trial and treatment designs. This manuscript emphasizes the need for comprehensive interventions targeting biomedicine, socio-demographics, and social characteristics to mitigate these inequities. By understanding the underlying causes and implementing targeted strategies, we can work towards a more equitable healthcare system. This involves improving access to high-quality care, increasing participation in research, and addressing social determinants of health. This manuscript concludes with policy recommendations and future directions to achieve health equity in cancer care, ensuring optimal outcomes for all patients. Full article

Background/Objectives: The workplace represents an ideal context for applying policies to foster a healthy lifestyle, guaranteeing advantages both to the individual and the company. Nevertheless, motivation to change one’s lifestyle remains an issue. This study aimed to determine subjects’ most valued intentions toward lifestyle changes and the target actions to improve lifestyles that they would be willing to invest in economically, information which might help design effective intervention programs. Methods: Classification trees were applied to 2762 employees/ex-employees (55.09 ± 13.80 years; 1107 females and 1655 males) of several Italian companies who voluntarily filled out an anonymous questionnaire on lifestyles (inquiring about, e.g., exercise, nutrition, smoking, and stress) to unveil specific subject typologies that are more likely associated with, e.g., manifesting a specific intention toward lifestyle changes and choosing the two most popular target actions resulting from the survey. Results: The main lifestyle aspect that respondents desired to improve was to become more physically active, and the most preferred tools chosen to improve their lifestyle were the possibility of having a medical specialist consultant to prescribe a tailored lifestyle program and buying a gym/swimming pool membership. Conclusions: This observational study might help tailor worksite health promotion and insurance services offered to employees, initiatives that may play an important role in fostering health/well-being and preventing chronic diseases in the more general population, especially in healthy or young subjects who are more prone to change their behavior if immediate benefits are seen instead of only advantages in the future. Full article