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Objective: To estimate and compare unmet health care needs of persons with spinal cord injury (SCI) across countries, the causes of these shortfalls, and the role of income. Data Sources: We analyzed cross-sectional data of 20 countries from the International Spinal Cord Injury (InSCI) survey, a compendium of comparable data on the living situation of persons with SCI. Data included information on high-, middle-, and low-income countries. The survey comprises information on 12,095 participants. Study Design: We used logit regressions to estimate the probability of unmet health care needs of persons with SCI and its causes. We adjusted the results by the individuals' characteristics and countries' fixed effects. We disaggregated the results by income decile of individuals in each country. Data Collection/Extraction Methods: The inclusion criteria for the InSCI survey were adults aged 18 years and older with SCI living in the community, who were able to respond to the survey and who provided informed consent. Principal Findings: Unmet health care needs are significant for people with long-term conditions like SCI, where people in low-income groups tend to be more affected. Among the barriers to meeting health care needs, the foremost is health care cost (in 11 of the 20 countries), followed by transportation and service availability. Persons with SCI in Morocco reported the highest probability of unmet health care needs in the sample, 0.54 (CI: 047-0.59), followed well behind by South Africa, 0.27 (CI: 0.20-0.33), and Brazil, 0.26 (CI: 0.20-0.33). In contrast, persons with SCI in Spain, 0.06 (CI: 0.04-0.08), reported the lowest probability of unmet health care needs, closely followed by Norway, 0.07 (CI: 0.05-0.09), Thailand, 0.08 (CI: 0.05-0.11), France, 0.08 (CI: 0.06-0.11), and Switzerland, 0.09 (CI: 0.07-0.10). Conclusions: SCI is a long-term, irreversible health condition characterized by physical impairment and a series of chronic illness. This makes SCI a high-need, high-cost group that faces significant unmet health care needs, which are mainly explained by the costs of health services, transportation, and services availability. This situation is prevalent in low-, middle-, and high-income countries, where persons in lower income groups are disproportionately affected. To improve the situation, a combination of measures from the health and social systems are required. KEYWORDS health care access, income inequality, out-of-pocket expenditure, spinal cord injury, unmelt health care needs What is known on this topic * Unmet health care needs are a prevalent issue even in countries purporting to have universal health care. * Affordability is the main reason for unmet health care needs, closely followed by transportation. * In general, lower income groups are more likely to have unmet health care needs. What this study adds * We compared unmet health care needs of high-need, high-cost persons among 20 countries. * The main barriers to get health care are the costs, transportation, and service availability. * The cross-country comparison helps to identify target areas for improvement in each country., 1 | INTRODUCTION Population dynamics forecast a shift in the health care needs transitioning from infectious diseases to noncommunicable diseases and injuries where low- and middle-income countries will bear the [...]

The National Association for Quality Development in Hospitals and Clinics (ANQ) has conducted patient satisfaction measurements in the inpatient sector in Switzerland since 2009. Specifically designed for this measurement, an instrument consisting of five questions was evaluated on an 11-point rating scale. Nevertheless, the instrument showed substantial ceiling effects, which did not allow for hospital discrimination. Therefore, ANQ initiated a revision testing different scales in a pilot study. The results showed that a 5-point verbal scale displayed good psychometric properties. Compared to the 7- or 11-point scales, the 5-point verbal scale exhibited reduced ceiling effects, which was more appropriate to compare hospitals. For the national public reporting of hospitals and clinics, risk adjustment by age and self-reported health status was recommended, which was not the case for gender, principal diagnosis, type of admission and insurance status.

Income and health are related in a bi-directional manner, whereby level of income affects health and vice versa. People in poorer households tend to experience worse health status and higher mortality rates than people in wealthier households, and, at the same time, having poor health could restrict workability leading to less income. This gap exists in almost every country, and it is more pronounced in more unequal countries and in vulnerable populations, such as people experiencing disability. The goal of this paper is to estimate the health income gap in people with a Spinal Cord Injury (SCI), which is a chronic health condition often associated with multiple comorbidities that leads to disability. As data on mortality is inexistent, to estimate the health-income gap for persons with SCI, this paper uses two health outcomes: the number of years a person has lived with the injury, and a comorbidity index. Data was obtained from the International Spinal Cord Injury survey (InSCI), which is the first worldwide survey on community-dwelling persons with SCI. To compare across countries, the health outcomes were adjusted through hierarchical models, accounting for country fixed-effects, individual characteristics such as age and gender, and injury characteristics (cause, type and degree). Our results suggest that for the years living with SCI, the gap varies from 1 to 6 years between the lowest and the highest income groups. The main driver of such a difference is the cause of injury, where injuries caused by work accidents showed the biggest gap. Similarly, for the comorbidity index, persons with SCI in poorer deciles reported significantly more comorbidities, forty times more, than people in richer deciles.