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Background: During the COVID-19 pandemic, patients with Alzheimer's disease and related dementias (ADRD) were especially vulnerable, and modes of medical care delivery shifted rapidly. This study assessed the impact of the pandemic on care for people with ADRD, examining the use of primary, emergency, and long-term care, as well as deaths due to COVID and to other causes. Methods: Among 4.2 million beneficiaries aged 66 and older with ADRD in traditional Medicare, monthly deaths and claims for routine care (doctors' office and telehealth visits), inpatient/emergency department (ED) visits, and long-term care facility use from March or June 2020 through December 2022 are compared to monthly rates predicted from January–December 2019 using OLS and logistic/negative binomial regression. Correlation analyses examine the association between excess deaths — due to COVID and non-COVID causes — and changes in care use in the beneficiary's state of residence. Results: Increased telehealth visits more than offset reduced office visits, with primary care visits increasing overall (by 9 percent from June 2020 onward relative to the predicted rate from 2019, p <.001). Emergency/inpatient visits declined (by 9 percent, p <.001) and long-term care facility use declined, remaining 14% below the 2019 trend from June 2020 onward (p <.001). Both COVID and non-COVID deaths rose, with 231,000 excess deaths (16% above the prediction from 2019), over 80 percent of which were attributable to COVID. Excess deaths were higher among women, non-White patients, those in rural and isolated zip codes, and those with higher social deprivation index scores. States with the largest increases in primary care visits had the lowest excess deaths (correlation -0.49). Conclusions: Older adults with ADRD had substantial deaths above pre-pandemic projections during the COVID-19 pandemic, 80 percent of which were attributed to COVID-19. Routine care increased overall due to a dramatic increase in telehealth visits, but this was uneven across states, and mortality rates were significantly lower in states with higher than pre-pandemic visits. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the role of gender in determining healthcare usage among Asian Americans, with specific attention to preventive care and early intervention through doctor visits during COVID-19. The authors used retrospective data from the 2021 California Health Interview Survey (CHIS) by selecting 3,962 Asian Americans who resided in California during the pandemic. The logistic regression analysis found several predictors of healthcare usage. The study concluded that Asian American women are more likely to use both preventive care and doctor visits than Asian American men. In addition, married and older Asian residents are significantly more likely to use both preventive care and doctor visits than their married and younger counterparts. Having health difficulties increases the likelihood of using both preventive care and doctor visits. Interestingly, being employed decreased the likelihood of using preventive care. Lack of use of health care services by Asians with specific backgrounds warrants appropriate health interventions. [ABSTRACT FROM AUTHOR]

We study the effect of a 12-week maternity leave extension in Chile on the health of infants between 6 and 12 months old. Using unique administrative sick leave data for working women enrolled in the private health insurance system who gave birth between 2011 and 2013, we estimate the effect of this extension on the number of paid sick days taken by the mother due to her child being ill. We find that extending maternity leave improved infant health and decreased the number of sick days by 6.43 (0.18 SD) days on average. Additionally, we show that mothers with extended maternity leave take their infant to the pediatrician less often than mothers without the extended leave. Our results are consistent with a decrease in daycare attendance, which decreases exposure to communicable diseases. [ABSTRACT FROM AUTHOR]

Background and Objectives Despite limited analgesic benefits, long-term opioid therapy (L-TOT) is common among older adults with chronic pain. Extended opioid use poses a threat to older adults as aging metabolisms retain opioids for longer, increasing the risk of injury, overdose, and other negative health outcomes. In contrast to predictors of general opioid use, predictors of L-TOT in older adults are not well documented. We aimed to identify such predictors using all available data on self-reported opioid use in the Health and Retirement Study. Research Design and Methods Using 5 waves of data, respondents (N = 10,713) aged 51 and older were identified as reporting no opioid use (n = 8,621), a single wave of use (n = 1,410), or multiple waves of use (n = 682). We conducted a multinomial logistic regression to predict both single- and multiwave opioid use relative to no use. Demographic, socioeconomic, geographic, health, and health care–related factors were included in our model. Results Multivariable findings show that, relative to nonusers, both single- and multiwave users were significantly more likely to be younger (relative risk ratio [RRR] = 1.33; RRR = 2.88); report lower household wealth (RRR = 1.47; RRR = 2.88); live in the U.S. Midwest (RRR = 1.29; RRR = 1.56), South (RRR = 1.34; RRR = 1.58), or West (RRR = 1.46; RRR = 2.34); experience interfering pain (RRR = 1.59; RRR = 3.39), back pain (RRR = 1.35; RRR = 1.53), or arthritic pain (RRR = 1.46; RRR = 2.32); and see the doctor frequently (RRR = 1.50; RRR = 2.02). Multiwave users were less likely to be Black (RRR = 0.69) or Hispanic (RRR = 0.45), and less likely to be never married (RRR = 0.52). Discussion and Implications We identified demographic, socioeconomic, geographic, and health care-related predictors of chronic multiyear opioid use. Our focus on individuals taking opioids for this extended duration is novel. Differences in opioid use by geographic region and frequency of doctor visits particularly warrant attention from policy-makers and researchers. We make additional recommendations based on a sensitivity analysis limited to 2016–2020 data. [ABSTRACT FROM AUTHOR]

Subjective well‐being is associated with many positive health outcomes. However, little is known about whether these favourable outcomes translate into a reduction in the number of doctor visits. Using large‐scale panel data from Australia, we find that individuals with high life satisfaction need fewer visits to their family doctor or general practitioner. We also present evidence on the pathways underlying this relationship, showing it is significantly explained by a person's diet. These findings remain after correcting for sample selection bias using Heckman's approach as well as controlling for various confounding factors. [ABSTRACT FROM AUTHOR]

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Abstract Background During the COVID-19 Pandemic, adults in the United States reported delaying medical care, which may be tied risk of infection and local policies limiting appointment. Some populations may have been more likely to delay care than others, leading to other forms of health inequality during this period. To-date there is little research on delayed care among U.S. older adult. We determine the prevalence of delayed medical care among older adults and investigate sociodemographic and health status inequalities in delaying health care. Method We used data from the first public release of the nationally representative Health and Retirement Study COVID-19 Subsample (N = 3006). Using logistic regression, we assessed whether differences in delaying health care varied by age, sex, race/ethnicity, education, self-rated health (SRH), and having any Activity of Daily Living (ADL) limitation. We also conducted additional analysis that evaluated differences in delaying care by two care subtypes: doctor and dental care visits. Results About 30% of U.S. older adults reported delaying care with the most common types of delayed care being dental or doctor visits. Adults ages 75 and older were less likely to delay care, while women, college educated, and those with poor SRH, and any ADL limitations were more likely to delay care. Conclusions Nearly one-third of older adults delayed care during the COVID-19 pandemic. The increased likelihood of delayed care among people with worse health suggests that there may be longer-term impacts on the health care system and population health from the COVID-19 pandemic, and may contribute to health inequalities in the near future.

Abstract Background Although universal free healthcare is available for all Sri Lankan citizens, older adults face somewhat unique obstacles when utilizing available healthcare services. The aim of this study was to examine some vital predisposing, enabling, and need factors associated with doctor visits made by urban-dwelling older adults in Sri Lanka. Methods A representative sample of 880 urban-dwelling older adults (aged 60 years and above) was surveyed using an interviewer-administered questionnaire. Number of doctor visits, self-rated health, physical activity, and socio-demographic and self-report health conditions were collected. The data were analyzed using chi-squared tests and multinomial logistic regression. Results Participants’ mean age was 70.01 (± 6.02) years. The majority was women (75.0%). The mean number of doctor visits was 6.77 (± 5.92) per year. Nearly half of the participants (47.0%) had made, on average, at least one doctor visit per month. Older men and those of aged 80 years and above were the least likely to make frequent doctor visits. Participants who were physically active and who rated their health as poor were more likely to make frequent doctor visits after adjustment for age, gender, and educational level. Conclusions Doctor visits made by Sri Lankan older adults are satisfactory. The factors that best explain high frequency of doctor visits by older adults are female gender, younger age, higher physical activity and poor self-rated health. Attention should be paid to examine possible accessible and affordable issues related to doctor visits by bedridden or physically dependent older adults in advanced age categories.

Background: During the COVID-19 Pandemic, adults in the United States reported delaying medical care, which may be tied risk of infection and local policies limiting appointment. Some populations may have been more likely to delay care than others, leading to other forms of health inequality during this period. To-date there is little research on delayed care among U.S. older adult. We determine the prevalence of delayed medical care among older adults and investigate sociodemographic and health status inequalities in delaying health care.Method: We used data from the first public release of the nationally representative Health and Retirement Study COVID-19 Subsample (N = 3006). Using logistic regression, we assessed whether differences in delaying health care varied by age, sex, race/ethnicity, education, self-rated health (SRH), and having any Activity of Daily Living (ADL) limitation. We also conducted additional analysis that evaluated differences in delaying care by two care subtypes: doctor and dental care visits.Results: About 30% of U.S. older adults reported delaying care with the most common types of delayed care being dental or doctor visits. Adults ages 75 and older were less likely to delay care, while women, college educated, and those with poor SRH, and any ADL limitations were more likely to delay care.Conclusions: Nearly one-third of older adults delayed care during the COVID-19 pandemic. The increased likelihood of delayed care among people with worse health suggests that there may be longer-term impacts on the health care system and population health from the COVID-19 pandemic, and may contribute to health inequalities in the near future. [ABSTRACT FROM AUTHOR]

Inefficient health service utilisation puts pressure on health systems and may cause such negative individual consequences as over-medicalisation or exacerbation of health problems. While previous research has considered the key relevance of health literacy (HL) for efficient use of health services, the results of that research have been somewhat inconclusive. Possible reasons for diverging results of prior research may be grounded in different measurement concepts of HL and the disregarding of age-specific effects. This paper analyses the association between individuals' HL typology based on a two-dimensional concept and indicators of health service utilisation measured by registered data covering the number of doctor visits and medication costs. Our results confirm a significant interaction effect between age and HL typology. The age-related increase in health service utilisation is strongest for individuals with the combination of high subjective HL but low health-related knowledge, while the smallest increase is for individuals with the constellation of high subjective HL combined with high health-related knowledge. Individuals with specific constellations of HL (that is, individuals with high subjective HL but low health-related knowledge) are associated with reduced service utilisation in younger ages but higher service utilisation in later stages of life, compared to other groups. These results are likely to be attributed to a higher external health-related locus of control and more traditional paternalistic role expectations in such groups. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND: Patients with low back pain frequently undergo a variety of diagnostic and therapeutic interventions, but some of these have uncertain effectiveness. This highlights the importance of the association of healthcare services and therapeutic measures relating to disability. OBJECTIVE: To analyze the use of healthcare services and therapeutic measures among Brazilian older adults with disability-related low back pain. DESIGN AND SETTING: Observational cross-sectional study on baseline assessment data from the Back Complaints in the Elders - Brazil (BACE-B) cohort. METHODS: The main analyses were based on a consecutive sample of 602 older adult participants in BACE-B (60 years of age and over). The main outcome measurement for disability-related low back pain was defined as a score of 14 points or more in the Roland Morris Questionnaire. RESULTS: Visits to doctors in the previous six weeks (odds ratio, OR = 1.82; 95% confidence interval, CI 1.22-2.71) and use of analgesics in the previous three months (OR = 1.57; 95% CI 1.07-2.31) showed statistically significant associations with disability-related low back pain. The probability of disability-related low back pain had an additive effect to the combination of use of healthcare services and therapeutic measures (OR = 2.57; 95% CI 1.52-4.36). The analyses showed that this association was significant among women, but not among men. CONCLUSIONS: Occurrence of the combined of consultations and medication use was correlated with higher chance of severe disability among these elderly people with nonspecific low back pain. This suggested that overuse and “crowding-in” effects were present in medical services for elderly people.

Abstract:: How do people change their healthcare behavior when a public health crisis occurs? Within a year of its emergence, coronavirus disease 2019 (COVID-19) has gradually infiltrated our lives and altered our lifestyles, including our healthcare behaviors. In Japan, which faces China across the East China Sea and accepted 924,800 Chinese tourists in January 2020, the emergence and spread of COVID-19 provides a unique opportunity to study people's reactions and adaptations to a pandemic.Patients with chronic illnesses who require regular doctor visits are particularly affected by such crises. We focused on diabetic patients whose delay in routine healthcare invites life-threatening complications and examined how their patterns of doctor visits changed and how demographic, socioeconomic, and vital factors disparately affected this process. We relied on the insurance claims data of a health insurance association in Tokyo. By using panel data of diabetic patients from April 2018 to September 2020, we performed visual investigations and conditional logistic regressions controlling for all time-invariant individual characteristics.Contrary to the general notion that the change in healthcare behavior correlates with the actual spread of the pandemic, the graphical and statistical results both showed that diabetic patients started reducing their doctor visits during the early stage of the pandemic. Furthermore, a substantial decrease in doctor visits was observed in women, and large to moderate reductions were seen in patients who take insulin and are of advanced age, who are at high risk of developing severe COVID-19. By contrast, no differentiated effect was found in terms of income status. We further investigated why a change in pattern occurred for each subgroup.The patterns of routine healthcare revealed by this study can contribute to the improvement of communication with the target population, the delivery of necessary healthcare resources, and the provision of appropriate responses to future pandemics. (299 words).

Many applied settings in empirical economics require estimation of a large number of individual effects, like teacher effects or location effects; in health economics, prominent examples include patient effects, doctor effects or hospital effects. Increasingly, these effects are the object of interest of the estimation, and predicted effects are often used for further descriptive and regression analyses. To avoid imposing distributional assumptions on these effects, they are typically estimated via fixed effects methods. In short panels, the conventional maximum likelihood estimator for fixed effects binary response models provides poor estimates of these individual effects since the finite sample bias is typically substantial. We present a bias‐reduced fixed effects estimator that provides better estimates of the individual effects in these models by removing the first‐order asymptotic bias. An additional, practical advantage of the estimator is that it provides finite predictions for all individual effects in the sample, including those for which the corresponding dependent variable has identical outcomes in all time periods over time (either all zeros or ones); for these, the maximum likelihood prediction is infinite. We illustrate the approach in simulation experiments and in an application to health care utilization. [ABSTRACT FROM AUTHOR]

Background: The purpose was to investigate the impact of sociodemographic factors on healthcare utilization among adults with different cognition levels (normal and impairment/dementia)., Methods: We used cross-sectional data from the Health and Retirement Study (N=17,698) to assess healthcare utilization: hospital stay, nursing home stay, hospice care, and doctor visits., Results: A cohort comparison between normal and dementia/impaired cognition groups revealed significant differences. The dementia/impaired group had lower education levels, higher single/widowed status, and more racial and ethnic minorities. They experienced longer hospital and nursing home stays, varied doctor visit frequencies, and had higher mean age, greater loneliness scores, and lower family social support scores. Differences in hospitalization, nursing home, hospice care, and doctor visits were influenced by factors such as race, age, marital status, education, and rurality., Conclusion: There were disparities in healthcare utilization based on participants' characteristics and cognition levels, especially in terms of race/ethnicity, education, and rural location., Competing Interests: Conflicts of Interest declaration The authors declare no conflicts of interest.

Abstract Background Health literacy is of increasing importance in public health research. It is a necessary pre-condition for the involvement in decisions about health and health care and related to health outcomes. Knowledge about limited health literacy in different age groups is crucial to better target public health interventions for subgroups of the population. However, little is known about health literacy in Germany. The study therefore assesses the prevalence of limited health literacy and associated factors among different age groups. Methods The Health Literacy Survey Germany is a cross-sectional study with 2,000 participants aged 15 years or older in private households. Perceived health literacy was assessed via computer-assisted personal interviews using the HLS-EU-Q-47 questionnaire. Descriptive analyses, chi-square tests and odds ratios were performed stratified for different age groups. Results The population affected by limited perceived health literacy increases by age. Of the respondents aged 15–29 years, 47.3 % had limited perceived health literacy and 47.2 % of those aged 30–45 years, whereas 55.2 % of the respondents aged 46–64 years and 66.4 % aged 65 years and older showed limited perceived health literacy. In all age groups, limited perceived health literacy was associated with limited functional health literacy, low social status, and a high frequency of doctor visits. Conclusions The results suggest a need to further investigate perceived health literacy in all phases of the life-course. Particular attention should be devoted to persons with lower social status, limited functional health literacy and/or a high number of doctor visits in all age groups.

In health economics, the use of patient recall of health care utilisation information is common, including in national health surveys. However, the types and magnitude of measurement error that relate to different recall periods are not well understood. This study assessed the accuracy of recalled doctor visits over 2-week, 3-month, and 12-month periods by comparing self-report with routine administrative Australian Medicare data. Approximately 5,000 patients enrolled in an Australian study were pseudo-randomised using birth dates to report visits to a doctor over three separate recall periods. When comparing patient recall with visits recorded in administrative information from Medicare Australia, both bias and variance were minimised for the 12-month recall period. This may reflect telescoping that occurs with shorter recall periods (participants pulling in important events that fall outside the period). Using shorter recall periods scaled to represent longer periods is likely to bias results. There were associations between recall error and patient characteristics. The impact of recall error is demonstrated with a cost-effectiveness analysis using costs of doctor visits and a regression example predicting number of doctor visits. The findings have important implications for surveying health service utilisation for use in economic evaluation, econometric analyses, and routine national health surveys. [ABSTRACT FROM AUTHOR]

In this paper, we consider a switching regression model with count data outcomes, where the possible outcome differs across two alternate states and individuals endogenously select one of the states. We assume lognormal latent heterogeneity. Building on the switching regression model, we derive estimators of various treatment effects: the average treatment effect, the average treatment effect on the treated, the local average treatment effect, and the marginal treatment effect. We illustrate an application that examines the effects of public insurance on the number of doctor visits using the data employed by previous studies. [ABSTRACT FROM AUTHOR]

This paper explores the role of physician gender in the expenditures for ambulatory care as a potential source of practice style variation. We exploit a large doctor-patient panel dataset based on insurance-claims data from Switzerland to estimate the effect of physician gender on health care expenditures. We find considerable heterogeneity across specialties. In primary care, female doctors are found to produce similar overall expenditures per visit as their male colleagues, but significantly smaller prescribing costs and significantly higher laboratory costs. In secondary-care specialties, we find that women generate lower overall expenditures, which is mainly driven by consultation costs. These findings provide evidence for the existence of sex-specific practice styles that translate into different overall expenditures as well as different compositions of these expenditures. [ABSTRACT FROM AUTHOR]

This paper assesses the impact of eligibility for a free means-tested complementary health insurance plan, called Couverture Maladie Universelle Complémentaire (CMUC), on doctor visits. We use information on the selection rule to qualify for the plan to identify the effect of eligibility and adopt a regression discontinuity approach. Our sample consists of low-income individuals enrolled in the Health Insurance Fund and recipients of social benefits from the Family Allowance Fund of an urban area in Northern France. Our findings do not show significant impacts of the CMUC threshold on the number of doctor visits within the full sample. Among the subsample of adults under 30 years old, however, eligible individuals are more likely to see a specialist and have, on average, significantly more specialist visits than non-eligible individuals. This specific impact of the CMUC cut-off point among young adults may be explained by the fact that young adults are less likely to be covered by a complementary health insurance plan when they are not recipients of the CMUC plan. © 2017 The Authors. Health Economics Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To examine the role of internal and external locus of control (LOC) in the frequency of physician visits longitudinally.Design: A nationally representative, longitudinal cohort study of German households. Data were used from the years 2005 and 2010.Methods: Data were gathered from the German Socio-Economic Panel (GSOEP). The ten internal and external LOC items in the SOEP are based on a scale by Krampen. The number of physician visits in the last 3 months was used as outcome variable. According to Andersen's behavioural model, predisposing characteristics, enabling resources, and need factors were included as control variables.Results: Fixed-effects Poisson regressions showed that physician visits increased with increasing external LOC, whereas changes in internal LOC were not associated with changes in physician visits. Furthermore, physician visits increased with need factors (decreased self-rated health; onset of disability), whereas predisposing characteristics and the enabling resources were not associated with physician visits.Conclusions: Our findings emphasize the meaning of changes in external LOC for physician visits. As there is evidence that interventions can change the LOC, efforts to modify external LOC might be beneficial for the health care system. Statement of contribution What is already known on this subject? A few cross-sectional studies have investigated the association between locus of control (LOC) and health care use. Longitudinal studies are needed to get a deeper understanding of the causal relationship between these factors. What does this study add? Our longitudinal study provides insights into the impact of general internal and external LOC on physician visits. This is the first study examining the long-term relation in Germany using a population-based sample. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have suggested that the high rates of unmet need for mental health services in China among depressed people are related to a cultural tendency to deny mental and emotional symptoms and instead express them somatically. Such somatization may lead a sufferer to a consultation with a healthcare professional but rarely leads to appropriate mental health treatment. This study aimed to elucidate the relationships of depression, sleep quality and perceived physical pain with doctor visits among community-based adults in China, and thus to help guide the development of clinical practices aimed at reducing unmet mental health service need. Study design: Cross-sectional study. Methods: In total, 7602 north-west Chinese adults aged >40 years were included in the survey. The Center for Epidemiologic Studies Depression Scale-Chinese Edition was used to assess depressive symptoms. Subjective sleep quality was evaluated using the Pittsburgh Sleep Quality Index. The Brief Pain Inventory-Chinese Version was used to measure pain severity and pain interference. Results: In this study, 16.2% of people reported physical pain, and 20.0% of those who reported poor sleep quality had seen a doctor in the past month. Only 14.4% of those with depression had seen a doctor. The results of the logistic regression analyses indicated that subjects with pain were significantly more likely to have seen a doctor than subjects without pain (odds ratio [OR] 1.61; 95% confidence interval [CI] 1.32-1.97). Poor sleep quality was significantly associated with doctor visits (OR 1.76, 95% CI 1.40-2.21). Depression was not associated with doctor visits after adjusting for pain, sleep quality and potentially confounding factors. Conclusion: When attempting to screen for depression and risk of depression in middle-aged and older adults in China, mental health professionals should focus on perceived physical pain and poor sleep quality. [ABSTRACT FROM AUTHOR]

Determining factors that affect healthcare utilization by the elderly is vital for the health system to be more responsive in providing care to this vulnerable group. The main objective of this paper is to identify the effect of the predisposing, enabling, and need factors on doctor visits and in-patient care for the elderly residing in the northern region of Malaysia. A multistage cluster sampling was used in selecting the sample for the study. A total of 1414 respondents aged 60 and over were interviewed face-to-face using a structured questionnaire. A probit model was used in estimating the utilization equations. At a significance level of 0.05, except for age, all predisposing and enabling factors were not statistically significant in affecting the doctor visits. On the other hand, being a male, smoker, medical insurance holder or had not actively involved in social interaction within the reference period increases the likelihood of being in-patient. Health-related variables remain the most significant factors that determine healthcare utilization, including both doctor visits and in-patient stays, in the area of study, which suggests that government policies to improve population health may influence the level of healthcare use in the future. [ABSTRACT FROM AUTHOR]

The researchers analyzed how different regions in the USA, family structure, ethnicity, and family income levels influenced the selection and utilization of medical care programs and services by American children. To prevent any possible bias in the analysis and to produce reliable results, an endogenous switching model was utilized in the study. The researchers found no statistically significant differences in the number of doctor visits and hospital stays between children with insurance and children without insurance. However, significant differences were determined regarding family structure, family income, geographic regions, and ethnicity. Children from single-parent families with insurance coverage (private, Medicaid, or SCHIP) had statistically higher rates of doctor visits and hospital stays than children from two-parent families with insurance coverage. Family income, region, and ethnicity variables all had significant impacts on the type of health insurance coverage that was reported for children.

Objective Cumulative lifetime exposure to potentially traumatic events and serious life stressors has been linked with both mental and physical health problems; however, less is known about the association between exposure to potentially traumatic events and serious life stressors with health care use. We investigated whether a higher number of potentially traumatic events and serious life stressors were prospectively associated with an increased number of doctor visits and nights spent in the hospital. Methods Participants were drawn from the Health and Retirement Study, a prospective and nationally representative study of adults aged 50+ in the United States (n=7168). We analyzed the data using a generalized linear model with a gamma distribution and log link. Results A higher number of potentially traumatic events and serious life stressors were associated with an increased number of doctor visits and nights spent in the hospital. On a 10-point scale, each additional potentially traumatic event or serious life stressor was associated with an 8% increase in doctor visits after controlling for sociodemographic factors (RR=1.08, 95% CI=1.06-1.11; p<.001). Each additional potentially traumatic event or serious life stressor was also associated with an 18% increase in the number of nights spent in the hospital after controlling for sociodemographic factors (RR=1.18, 95% CI=1.10-1.27; p<.001). Conclusion Exposure to potentially traumatic events and serious life stressors is associated with increased doctor visits and nights spent in the hospital, which may have important implications for the current standard of care. [ABSTRACT FROM AUTHOR]

Background: Although universal free healthcare is available for all Sri Lankan citizens, older adults face somewhat unique obstacles when utilizing available healthcare services. The aim of this study was to examine some vital predisposing, enabling, and need factors associated with doctor visits made by urban-dwelling older adults in Sri Lanka.Methods: A representative sample of 880 urban-dwelling older adults (aged 60 years and above) was surveyed using an interviewer-administered questionnaire. Number of doctor visits, self-rated health, physical activity, and socio-demographic and self-report health conditions were collected. The data were analyzed using chi-squared tests and multinomial logistic regression.Results: Participants' mean age was 70.01 (± 6.02) years. The majority was women (75.0%). The mean number of doctor visits was 6.77 (± 5.92) per year. Nearly half of the participants (47.0%) had made, on average, at least one doctor visit per month. Older men and those of aged 80 years and above were the least likely to make frequent doctor visits. Participants who were physically active and who rated their health as poor were more likely to make frequent doctor visits after adjustment for age, gender, and educational level.Conclusions: Doctor visits made by Sri Lankan older adults are satisfactory. The factors that best explain high frequency of doctor visits by older adults are female gender, younger age, higher physical activity and poor self-rated health. Attention should be paid to examine possible accessible and affordable issues related to doctor visits by bedridden or physically dependent older adults in advanced age categories. [ABSTRACT FROM AUTHOR]

ABSTRACT This research note analyzes differences in the number of absent working days and doctor visits and in their cyclicality between private sector, public sector and self-employed workers. For this purpose, I used large-scale German survey data for the years 1995 to 2007 to estimate random effects negative binomial (count data) models. The main findings are as follows. (i) Public sector workers have on average more absent working days than private sector and self-employed workers. Self-employed workers have fewer absent working days and doctor visits than dependent employed workers. (ii) The regional unemployment rate is on average negatively correlated with the number of absent working days among private and public sector workers as well as among self-employed men. The correlations between regional unemployment rate and doctor visits are only significantly negative among private sector workers. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: While it is well documented that economic expansions provide widespread and immediate financial benefits, the evidence on how an economic downturn affects individual''s health behaviors is surprisingly mixed. In this paper, we take a structural approach to investigate the effects of wages and working hours on health behaviors of low-educated persons using variations in wages and hours caused by changes in local economic activity. In the empirical analysis, we adopt a two-sample instrumental variables approach to combine the data on individual health behaviors from the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS) with the data on individual employment from the Current Population Survey (CPS). The total sample size of the combined CPS-BRFSS data for the time period of 1984–2005 is 967,594, while that of the combined CPS-NHIS data for the time period of 1976–2001 is 364,078. We find that increases in wages caused by economic expansions are associated with greater consumption of cigarettes in the United States. We also find that increases in hours of work caused by economic expansions are associated with more cigarette consumption, but less physical activity and physician visits. More importantly, the evidence suggests that most of such effects associated with changes in hours of work can be attributed to the changes at the extensive margin of employment, meaning the changes in employment status, rather than the changes at the intensive margin, meaning changes in hours of work conditional on being employed. These findings imply that changes in employment may have heterogeneous impacts on time-intensive and less time-intensive health behaviors and also provide additional evidence on the importance of time in health production, particularly for time-intensive activities. [Copyright &y& Elsevier]

Despite guidelines recommending that women aged 40 years and older undergo screening mammography at least biennially, reports find that many women do not adhere to these recommendations. The authors’ objective was to investigate the factors associated with undergoing a screening mammography. Eligible women were enrolled in Medicare during 2004 and 2005 and resided in North or South Carolina. Information on morbidities, demographics, and physician visits were assessed as predictors for whether a woman underwent a screening mammography. Approximately 50% of the women included in the study had undergone a screening mammography during the study period. An increasing number of physician visits was positively associated with having a screening mammography. Women making at least 1 visit to a gynecologist were more likely to be screened compared with women who saw only a primary care physician and/or a medical specialist. Older age, having certain morbidities, and Medicaid eligibility were inversely related to being screened. [ABSTRACT FROM PUBLISHER]

The German and Australian longitudinal surveys analysed here are the first national representative surveys to show that (1) people who continuously own a pet are the healthiest group and (2) people who cease to have a pet or never had one are less healthy. Most previous studies which have claimed that pets confer health benefits were cross-sectional. So they were open to the objection that owners may have been healthier in the first place, rather than becoming healthier due to owning a pet. In both countries the data show that pet owners make about 15% fewer annual doctor visits than non-owners. The relationship remains statistically significant after controlling for gender, age, marital status, income and other variables associated with health. The German data come from the German Socio-Economic Panel in which respondents have been interviewed every year since 1984 ( N = 9723). Australian data come from the Australian National Social Science Survey 2001 ( N = 1246). [ABSTRACT FROM AUTHOR]

Observed differences in medical utilization between the privately insured and uninsured reflect the combined effects of self-selection and insurance incentives (moral hazard). This article provides a Bayesian framework for decomposing the disparity into incentive and selection components. The effect of self- selection in private insurance on the number of doctor visits is estimated using a multiyear sample of the U.S. adult non-Medicare population obtained from the Medical Expenditure Panel Survey. We use a flexible econometric framework based on the "Roy model" and develop a Markov chain Monte Carlo algorithm. We estimate the distribution of treatment effects and find strong evidence indicating selection, which accounts, on average, for 50% or more of the observed disparity in doctor visits. [ABSTRACT FROM AUTHOR]

Chronic pain is a frequent condition in society. Besides the patients' suffering, chronic pain leads to high costs in the form of compensation for absence due to illness and production loss, but also for health care utilisation. The responsibility of primary health care for treatment and rehabilitation of patients chronic pain have increased in the last decade. Rehabilitation programmes for these patients using multidisciplinary, behavioural-orientated treatment has mostly taken place in pain centres or pain clinics. The clear effects of those are well documented in several studies. There is a lack of data in similar programmes conducted in primary health care. The principal aim of this work was to study the gains of a biopsychosocial programme in primary health care for chronic pain patients. The intervention programme was based on ego-strengthening psychotherapy and the salutogenetic model. An occupational therapist and a physiotherapist led the intervention. The gains were to be regarded from the perspective of the patient, the treatment and society. Three sub-studies were included in the study. The first sub-study, using a descriptive, qualitative design, investigated how ten patients with fibromyalgia conceived their health after taking part in the programme. The patients were interviewed and data were analysed by the phenomenographic method. The patients gave words for received confirmation, distance to things, gained insight and gained control. Those factors had a positive impact on the patient's meaningfulness, comprehensibility and manageability, which led to improved health. The second sub-study, including 70 chronic pain patients, used a non-randomised longitudinal, evaluative design in order to measure the gains of the programme in terms of ego-resources as well as, personality, physical and cognitive factors (=PPC factors). The sub-study was was performed by Visual Analogue Scale (VAS) and a PPC questionnaire as well as statistically analysed. The programme led to the patients describing significant (p= <0.01 - <0.001) changes compared with before the intervention, in the form of reduced perception of complaints, increased general well-being and ability to manage pain. The third sub-study evaluated follow-up effects of the programme on the patients visits to the doctor, frequency of sick-listing and the level of disability. Ninety-four chronic pain patients were divided into an intervention group with 70 patients, and a non-intervention group with 24 patients. A longitudinal, prospective, cross-over design was used in a non-randomised study conducted over a three-year period. The programme was effective in decreasing doctor visits but not concerning return to work. Instead there was a change from sick-listing to disability pension or temporary disability pension for the intervention group (p=0.009) as well as for the non-intervention group (p=0.046). The study shows that biopsychosocial rehabilitation programme for chronic pain patients in primary health care resulted in gains from the perspective of the patient, the treatment as well as society. The programme gave the patients better health as well as methods for the patients to mange the pain and the pain situation herself/himself. It also informed the health care professionals how to establish an effective treatment, even in small health care units and finally it seems to stop the chronic pain patient's journeys around the health care system by decreasing the need of doctor visits. [ABSTRACT FROM AUTHOR]