BackgroundConditional cash transfer (CCT) programs provide poor families with cash conditional on investments in health and education. Brazil’s Bolsa Família program began in 2003 and is currently the largest CCT program in the world. This community-based study examines the impact of Bolsa Família on child health in a slum community in a large urban center.MethodsIn 2010, detailed household surveys were conducted with randomly selected Bolsa Família beneficiaries and non-beneficiaries in a Brazilian slum community of approximately 14,000 inhabitants in a large urban center. 567 families (with 1,266 children) were interviewed. Propensity score methods were used to control for differences between beneficiary and non-beneficiary children to estimate program impacts on health care utilization and health outcomes.ResultsBolsa Família has increased the odds of children’s visits to the health post for preventive services. In children under age seven, Bolsa Família was associated with increased odds for growth monitoring (OR = 3.1; 95% CI 1.9-5.1), vaccinations (OR = 2.8; 95% CI 1.4-5.4), and checkups (OR = 1.6; 95% CI 0.98-2.5), and with the number of growth monitoring visits (β = 0.6; p = 0.049) and checkups (β = 0.2; p = 0.068). There were positive spillover effects on older siblings (ages 7-17) no longer required to meet the health conditionalities. Bolsa Família increased their odds for growth monitoring (OR = 2.5; 95% CI 1.3-4.9) and checkups (OR = 1.7; 95% CI 0.9-3.2) and improved psychosocial health (β = 2.6; p = 0.007).ConclusionsBolsa Família has improved health care utilization, especially for services related to the health conditionalites, and there were positive spillover effects on older siblings. The findings of this study are promising, but they also suggest that further improvements in health may depend on the quality of health care services provided, the scope of services linked to the health conditionalities, and coordination with other social safety net programs.
Conditional cash transfer programs are innovative social safety-net programs that aim to relieve poverty. They provide a regular source of income to poor families and are "conditional" in that they require poor families to invest in the health and education of their children through greater use of educational and preventive health services. Brazil's Bolsa Família conditional cash transfer program, created in 2003, is the world's largest program of its kind. During the first five years of the program, it was associated with a significant 9.3 percent reduction in overall infant mortality rates, with greater declines in postneonatal mortality rates than in mortality rates at an earlier age and in municipalities with many users of Brazil's Family Health Program than in those with lower use rates. There were also larger effects in municipalities with higher infant mortality rates at baseline. Programs like Bolsa Família can improve child health and reduce long-standing health inequalities. Policy makers should review the adequacy of basic health services to ensure that the services can respond to the increased demand created by such programs. Programs should also target vulnerable groups at greatest risk and include careful monitoring and evaluation.
BackgroundOpioid abuse and dependence is problematic across many age groups, including the working-age population and their dependents. Little is known, however, about the economic costs of opioid abuse/dependence imposed on employers, who pay for a substantial portion of healthcare costs through their contributions to employer-sponsored health insurance and are also affected by indirect costs such as those due to disability and workplace absenteeism.ObjectiveTo provide a comprehensive, current estimate of the economic burden of prescription opioid abuse/dependence to employers.MethodsAdministrative claims from beneficiaries covered by large self-insured companies throughout the USA were used to identify patients, including employees and dependents, who were diagnosed with opioid abuse and/or dependence (‘abusers’) between 2006 and 2012. Healthcare and work-loss costs for abusers were assessed over a 12-month period and compared with those for patients not diagnosed with abuse (‘comparison patients’), using propensity score matching.Results7,658 matched pairs of abusers and comparison patients were analysed. Relative to comparison patients, abusers had significantly higher annual healthcare resource utilization, leading to US$10,627 in per-patient incremental annual healthcare costs. Additionally, abusers had US$1,244 in excess annual work-loss costs. Together, this implies an employer burden for diagnosed abuse of US$1.71 per member per month.ConclusionOpioid abuse/dependence impose a substantial economic burden on employers.
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