Judith Bom

With population aging, countries worldwide are facing a growing demand for long-term care (LTC), defined as assistance or medical support provided to individuals who require care for a longer perio...

Background: Globally, non-communicable diseases (NCDs) are the leading cause of mortality and morbidity placing a huge burden on individuals, families and health systems, especially in low- and middle-income countries (LMICs). This rising disease burden calls for policy responses that engage the entire health care system. This study aims to synthesize evidence on how people with NCDs choose their healthcare providers in LMICs, and the outcomes of these choices, with a focus on private sector delivery.Methods: A systematic search for literature following PRISMA guidelines was conducted. We extracted and synthesised data on the determinants and outcomes of private health care utilisation for NCDs in LMICs. A quality and risk of bias assessment was performed using the Mixed Methods Appraisal Tool (MMAT).Results: We identified 115 studies for inclusion. Findings on determinants and outcomes were heterogenous, often based on a particular country context, disease, and provider. The most reported determinants of seeking private NCD care were patients having a higher socioeconomic status; greater availability of services, staff and medicines; convenience including proximity and opening hours; shorter waiting times and perceived quality. Transitioning between public and private facilities is common. Costs to patients were usually far higher in the private sector for both inpatient and outpatient settings. The quality of NCD care seems mixed depending on the disease, facility size and location, as well as the aspect of quality assessed.Conclusion: Given the limited, mixed and context specific evidence currently available, adapting health service delivery models to respond to NCDs remains a challenge in LMICs. More robust research on health seeking behaviours and outcomes, especially through large multi-country surveys, is needed to inform the effective design of mixed health care systems that effectively engage both public and private providers.Trial registration: PROSPERO registration numberCRD42022340059.

It’s increasingly recognized that the evaluative space of economic evaluations in health and social care needs to be broadened and instruments measuring well-being are required. A generic measure of well-being comprehensively capturing all relevant domains of well-being in the adult population is not available. The aim is to describe the development of such an instrument, the 10-item Well-being instrument (WiX), and to report the findings from a content validation study. A draft version of the instrument was based on available instruments pursuing the same aim, a comprehensive theoretical framework of the domains of well-being, and recent empirical evidence from the general population about the constituents of well-being. Content validation was conducted following COSMIN methodology and investigated relevance, comprehensiveness, and comprehensibility. In the qualitative content validation, semi-structured interviews were conducted with experts and members of the general population. During quantitative content validation, a representative sample (n = 501) from the general population completed an online survey. The qualitative validation showed the relevance and comprehensiveness of the WiX were adequate, but several changes were made to consecutive draft versions of the items and their descriptions and response levels to improve comprehensibility. The quantitative validation confirmed these findings and resulted in some additional, minor changes. A new instrument aiming to capture overall (or general) quality-of-life in terms of subjective well-being by measuring how satisfied people are on ten important domains of life in the adult general population was developed. The content validation results are encouraging, but further validation and valuation steps are necessary before the WiX can be used in (economic) evaluation studies of interventions with impacts broader than health.

Introduction The burden of non-communicable diseases (NCDs) has increased substantially in low- and middle-income countries (LMICs), and adapting health service delivery models to address this remains a challenge. Many patients with NCD seek private care at different points in their encounters with the health system, but the determinants and outcomes of these choices are insufficiently understood. The proposed systematic review will help inform the governance of mixed health systems towards achieving the goal of universal health coverage. This protocol details our intended methodological and analytical approaches, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Methods and analysis Following the PRISMA approach, this systematic review will develop a descriptive synthesis of the determinants and outcomes of private healthcare utilisation for NCDs in LMICs. The databases Embase, Medline, Web of Science Core Collection, EconLit, Global Index Medicus and Google Scholar will be searched for relevant studies published in English between period 1 January 2010 and 30 June 2022 with additional searching of reference lists. The study selection process will involve a title-abstract and full-text review, guided by clearly defined inclusion and exclusion criteria. A quality and risk of bias assessment will be done for each study using the Mixed Methods Appraisal Tool. Ethics and dissemination Ethical approval is not required because this review is based on data collected from publicly available materials. The results will be published in a peer-reviewed journal and presented at related scientific events. PROSPERO registration number CRD42022340059

Permanent nursing home (NH) admissions are a frequent and major life event aimed at maintaining quality of life in old age. Yet, insights into the impact of a NH admission on well‐being are scarce and inconclusive. We evaluate the effect of a NH admission on domains of well‐being among those who are admitted using event study methodology for cross‐sections combined with inverse probability weighting. We apply this doubly robust approach to Dutch survey data on well‐being linked to extensive administrative data on NH admissions, health, and socio‐economic status. We find that a NH admission leads to a temporary increase in loneliness, the risk of anxiety and depression, and a loss of control over one's life. However, these scores revert to pre‐admission levels after 6 months. These findings may contribute to better‐informed individual‐level and policy decisions about potential NH entry and aging in place policies.

Objective: Informal care, the provision of unpaid care to dependent friends or family members, is often associated with physical and mental health effects. As some individuals are more likely to provide caregiving tasks than others, estimating the causal impact of caregiving is difficult. This systematic literature review provides an overview of all studies aimed at estimating the causal effect of informal caregiving on the health of various subgroups of caregivers. Methodology: A structured literature search, following PRISMA guidelines, was conducted in 4 databases. Three independent researchers assessed studies for eligibility based on predefined criteria. Results from the studies included in the review were summarized in a predefined extraction form and synthesized narratively. Results: The systematic search yielded a total of 1,331 articles of which 15 are included for synthesis. The studies under review show that there is evidence of a negative impact of caregiving on the mental and physical health of the informal caregiver. The presence and intensity of these health effects strongly differ per subgroup of caregivers. Especially female, and married caregivers, and those providing intensive care appear to incur negative health effects from caregiving. Conclusion: The findings emphasize the need for targeted interventions aimed at reducing the negative impact of caregiving among different subgroups. As the strength and presence of the caregiving effect differ between subgroups of caregivers, policymakers should specifically target those caregivers that experience the largest health effect of informal caregiving.