Search

Background Progress in hernia surgery in Nigeria is hampered by poor health-seeking behavior, poverty, and ignorance. The disparity in the quality of health care deliveries between urban and rural areas led to the greater proportions of rural dwellers being grossly underserved. Medical aid programs offer ample opportunities to reduce the burden of hernias in Nigeria. This study aimed to analyze the early outcomes of elective hernia repairs performed during medical outreach programs. Methods This is a retrospective study of 186 patients who had hernia repair between September and November 2019. Patients were recruited from six consecutive medical aid programs held in Niger Delta (Southern) region of Nigeria. Results Overall, 186 patients were evaluated: 159 (855%) males and 27 (14.5%) females. Approximately three-fourths (141, 75.8%) harbored inguinal hernia. Nylon-darn was utilized to repair all inguinal hernias while a simple closure technique was used for all midline hernias. Majority (180, 96.8%) were discharged within 24 h of repair. Spinal anesthesia accounted for 51.6% of all anesthetic techniques used. The overall postoperative complication rate was 17.2%. The most common postoperative morbidity was scrotal edema (8.1%) followed by seroma (4.3%). Age >64 years (P < 0.001), large hernias >3 cm defect (P < 0.001), lower cadre of surgeon (P < 0.001), local anesthesia (P < 0.001) and comorbidity (P < 0.001) were significantly associated with raised morbidity. No mortality was recorded. All complications were managed conservatively. Conclusion Majority of the hernias were of inguinal origin. Scrotal edema was the most frequent postoperative complication, followed by seroma. Advanced age, large hernias, lower cadre of surgeon, comorbidity and local anesthesia were associated with raised morbidity rates.

This study empirically tests the effects of the introduction of copayments on healthcare utilization in the Korea's medical aid program (MAP). Due to a growing concern about overutilization of public healthcare and government's financial burden, the Korean government reformed the MAP in 2007 and introduced copayments for outpatient care of Type 1 enrollees who had borne no medical treatment cost until the reform. Exploiting the natural experiment of 2007 reform, we perform a difference-in-differences (DID) analysis with propensity score matching and conclude that the introduction of copayments reduces healthcare utilization in the short-run through heterogeneous effect on the outpatient services consumption distribution, but this effect rapidly disappears over time. [ABSTRACT FROM AUTHOR]

Community-based case management for medical aid beneficiaries was implemented in Korea to promote the rational use of medical care and stabilize the financial system. This study investigated the economic impact of community-based case management on reductions in healthcare utilization and costs. This was a program study using a national database to evaluate the effectiveness of community-based case management in changing not only healthcare utilization and costs but also client-centered outcomes using the NHI database and 198 regional databases. A total of 1741 case management clients were included in this study. The case management clients were categorized into three targeted groups and were provided individualized services according to the groups. Client-centered outcomes, such as health-related quality of life (QOL), self-care ability, and having a support system, increased after case management. Healthcare utilization and costs decreased significantly after case management. However, there was no significant difference in the decrease between the groups. An increase in healthcare utilization among medical aid beneficiaries has been observed due to the aging population and an increase in the number of recipients. To reduce healthcare utilization and costs while maintaining the health status of the beneficiaries, it is necessary to expand targeted case management.