Health Trends
Inter-states Disparity on Utilization of Public Healthcare Facilities for Hospitalization Care in India
Paper Presentation in a Themed Session Anjali Dash
The aim of this paper is to examine trends and patterns of hospitalization rates at public health facilities, inequality on healthcare utilization across the states of India over time, and to identify the factors associated with healthcare utilization. Bi variate, multivariate analysis, Concentration Index and Concentration Curve were used with the help of nationwide data on health survey of two round 60th (2004) and 71st (2014) by National Sample Survey Organisation, Government of India. Hospitalization rates in public health facilities was high for the poorer states in India. Hospitalization rates in public health facilities has increased over a decade in poorer states like Bihar 15% in 2004 to about 40% in 2014. Hospitalization episodes in public health facilities were highest due to non-communicable diseases. Though, economically weaker population were more likely to hospitalize at public healthcare facilities, the result being a wide gap between rich and poor on utilization of public healthcare facilities. Relative health spending also varied over the time period across socio-economic status of households in states of India. Health spending is an important indicator of the utilization of public healthcare facilities. Out-of-pocket expenditure of poorer states like Bihar was 6 times higher from Tamil Nadu during 2004 and relatively high even in 2014. However, a large share of health expenditure is borne by households’ income/saving or from borrowing which may reflect on equality in healthcare utilization, as well as relative spending on in-patients care which needs to be taken care of through states specific health insurance schemes.
Exploring the Association between Multimorbidity and Elderly Abuse or Neglect in India
Paper Presentation in a Themed Session Sathya Thennavan
The prevalence of multimorbidity is increasing mainly as a result of a changing age structure along with rapid urbanization and health risk factors. However, to our knowledge, no previous study examined the association between multimorbidity and elder abuse or maltreatment in India. The aim of the study is to assess the impact of chronic multimorbidity conditions on elder abuse using nationally representative data. Cross-sectional data from the United Nations Population Fund (UNFPA) survey “Building Knowledge Base on Population Aging in India” (BKPAI- 2011) was used. The data consists of a sample of 9589 elderly aged 60 and above in seven states of India. Bivariate analysis multivariate logistic regression was used. The overall prevalence of elder abuse in the study population is 10.1% with significant variation across the states. The prevalence of elder abuse among older adults with no chronic diseases is 6.01% and increases to 22.7% among older adults with 4+ chronic diseases. Furthermore, results from multivariate logistic regression suggested a close association between multimorbidity and elder abuse. Older adults with 2, 3, 4+ chronic diseases are 2.91 (95% Confidence Interval (CI): 2.32- 3.66, p <.000), 3.96 (95% CI: 3.00-5.22, p <.000), 5.74 (95% CI: 4.24- 7.77, p <.000) times more likely to experience elder abuse/neglect than older adults with no chronic diseases, respectively. Our finding suggests that multimorbidity conditions play a significant role in determining the high prevalence of elder abuse. Therefore, any measure to prevent chronic diseases will have significant implications in preventing elder abuse in India.
Regional Cost and Clinical Comparison of Total Knee Arthroplasty in the US from 2008-2010
Paper Presentation in a Themed Session Jia Yu, Alexandra Ball
The purpose of this research is to evaluate the clinical and cost effectiveness of total knee replacement surgery (TKA) for adults hospitalized in the United States from 2008-2010. Using the National Hospital Discharge Survey (NHDS), a data bank of hospital discharges from acute care hospitals in the United States, this study seeks to identify which U.S. region renders the highest quality patient care as measured by impact on patient discharge disposition, hospital length of stay, and adverse outcomes during a three-year span of 2008-2010. Cost data, abstracted from inpatient insurance claims over a 46-month period, is utilized to evaluate cost-efficiency of the surgery in the regions of the United States. Multivariate regression analyses are used to explore the relation of hospital costs as it impacts hospital length of stay and discharges disposition throughout the United States. The results of this study indicate that in a US representative sample of hospitalized patients, the average length of stay for all regions is less than four days with the lowest lengths of stay are noted in the West and Midwest. Demographic characteristics of age, race, and marital are associated with shorter lengths of stay, however, discharge status is only significantly impacted by age. The results of this study reveal that the West has the highest patient outcomes (as measured by the length of stay and discharge disposition) and had the highest expenditure related to this surgery revealing opportunity to study these systems for patient outcome data and cost containment strategies.
