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Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026–0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. The P4P scheme in Rwanda had the greatest effect on those services that had the highest payment rates and needed the least effort from the service provider. P4P financial performance incentives can improve both the use and quality of maternal and child health services, and could be a useful intervention to accelerate progress towards Millennium Development Goals for maternal and child health. World Bank's Bank-Netherlands Partnership Program and Spanish Impact Evaluation Fund, the British Economic and Social Research Council, Government of Rwanda, and Global Development Network.

Background Healthcare in China has significantly improved, meanwhile many  socio-economic risk factors and health conditions factors affect accessibility and utilization of health services in rural areas. Inequity of health service in China needs to  be estimated and reduced. Andersen behavioral model is useful to assess the association of health service utilization with predisposing, enabling, and need factors. Methods A survey was conducted among 4634 residents of 897 households in 2012. Logistic regression analysis was performed to explore the association of predisposing (age, gender, marital status, ethnicity and family size), enabling (education level, travel time to the nearest health facility, medical expense per capita, and health insurance coverage), and need factors (chronic disease) with the utilization of health services (i.e. physician visit and hospitalization). Results We observed a significant association between need factor (chronic diseases) and health service unitization, after adjusting for all predisposing and enabling factors (physician visits: odds ratio (OR) = 5.87, 95 % confidence interval (CI) = 4.71–7.32; hospitalization: OR = 4.04, 95 % CI = 2.90–5.61, respectively). In addition, age, gender, marital status, family size and education level were significant predictors of health service utilization. The travel time to the nearest health facility was associated with the utilization of physician visits, and expenditure on healthcare was a hindering factor of hospitalization. Conclusions The predisposing and enabling factors had a minor impact on health service utilization, while the need factor was a dominant predictor of health service utilization among rural residents in China.

Using data from multiple health systems (2009–2010) and the largest sample to date, this study compares health services use among youth with and without an autism spectrum disorder (ASD)—including preventive services not previously studied. To examine these differences, we estimated logistic and count data models, controlling for demographic characteristics, comorbid physical health, and mental health conditions. Results indicated that youth with an ASD had greater health care use in many categories, but were less likely to receive important preventive services including flu shots and other vaccinations. An improved understanding of the overall patterns of health care use among this population could enable health systems to facilitate the receipt of appropriate and effective health care.

Objective: Little is known about mental health service use among Canadian children and youth. Our objective was to examine temporal trends in mental health service use across different sectors of the health care system among children and youth living in Ontario. Methods: We conducted a population-based, repeated annual cross-sectional study of mental health service use, including mental health- and addictions-related emergency department (ED) visits, psychiatric hospitalizations, and mental health-related outpatient physician visits using linked health administrative databases. Subjects included Ontario residents between 10 and 24 years of age. We tested temporal trends between 2006 and 2011 using linear regression models. Results: Between 2006 and 2011, the relative increase in rates of mental health-related ED visits and hospitalizations were 32.5% and 53.7%, respectively. The absolute increase in anxiety disorders, the most common reason for ED visits, was 2.2 per 1000 population (P < 0.001) while mood and affective disorders, the most common reason for hospitalizations, showed an increase of 0.6 per 1000 population (P < 0.01). The overall relative increase in rates of outpatient visits was 15.8%, with the largest absolute increase found among family physician visits (28.7 per 1000 population, P = 0.01). Conclusions: Mental health care use for children and youth is increasing over time in all sectors, but appears to be increasing at a greater rate in the acute care sector. Further research is required to understand whether the observed differences reflect difficulty with access to outpatient care.

This review summarizes the epidemiology of posttraumatic stress disorder (PTSD) and related mental health problems among persons who served in the armed forces during the Iraq and Afghanistan conflicts, as reflected in the literature published between 2009 and 2014. One-hundred and sixteen research studies are reviewed, most of which are among non-treatment-seeking US service members or treatment-seeking US veterans. Evidence is provided for demographic, military, and deployment-related risk factors for PTSD, though most derive from cross-sectional studies and few control for combat exposure, which is a primary risk factor for mental health problems in this cohort. Evidence is also provided linking PTSD with outcomes in the following domains: physical health, suicide, housing and homelessness, employment and economic well-being, social well-being, and aggression, violence, and criminality. Also included is evidence about the prevalence of mental health service use in this cohort. In many instances, the current suite of studies replicates findings observed in civilian samples, but new findings emerge of relevance to both military and civilian populations, such as the link between PTSD and suicide. Future research should make effort to control for combat exposure and use longitudinal study designs; promising areas for investigation are in non-treatment-seeking samples of US veterans and the role of social support in preventing or mitigating mental health problems in this group.

Although researchers have identified a multitude of factors that contribute to family participation in mental health services, few studies have examined them specifically for Latino youth and their families in the U.S., a population that continues to experience significant disparities related to the availability, accessibility, and quality of mental health services. Latino youth and their families are at greater risk of dropping out of treatment prematurely and demonstrating poor treatment engagement, both of which have subsequent negative effects on treatment response outcomes. In order to help to guide efforts to improve the accessibility and quality of mental health services for Latino youth and their families, the current paper integrates modern conceptualization of family participation in youth mental health services and provides a summary of contextual factors within an ecological framework (Bronfenbrenner in The ecology of human development: experiments by nature and design, Harvard University Press, Cambridge, 1979 ). The current review aims to integrate empirical research on the impact of various contextual factors across multiple levels (i.e., culture, community, mental health system, family, parent/caregiver, and child/adolescent) on Latino family participation in youth mental health services, including treatment retention, engagement, and response. Clinical implications will be discussed, and an integrated, conceptual model will be presented. Not only does this model help to demonstrate the way in which existing literature is conceptually linked, but it also helps to highlight factors and underlying processes that health care providers, administrators, and policy makers must consider in working to improve mental health services for Latino youth and their families living in the U.S.

Difficulty engaging families in mental health treatment is seen as an underlying reason for the disparity between child mental health need and service use. Interpretation of the literature on how best to engage families is complicated by a diversity of operational definitions of engagement outcomes and related interventions. Thus, we sought to review studies of engagement interventions using a structured methodology allowing for an aggregate summary of the most common practices associated with effective engagement interventions. We identified 344 articles through a combination of database search methods and recommendations from engagement research experts; 38 articles describing 40 studies met our inclusion criteria. Following coding methods described by Chorpita and Daleiden (J Consul Clin Psychol 77(3):566–579, 2009 , doi: 10.1037/a0014565 ), we identified 22 engagement practice elements from 89 study groups that examined or implemented family engagement strategies. Most frequently identified engagement practice elements included assessment , accessibility promotion , psychoeducation about services , homework assignment , and appointment reminders . Assessment and accessibility promotion were two practice elements present in at least 50 % of treatment groups that outperformed a control group in a randomized controlled trial. With the exception of appointment reminders , these frequently identified engagement practice elements had a high likelihood of being associated with winning treatments when they were used. This approach offers a novel way of summarizing the engagement literature and provides the foundation for enhancing clinical decision-making around treatment engagement.

Background Studies comparing the access to health care of rural and urban populations have been contradictory and inconclusive. These studies are complicated by the influence of other factor which have been shown to be related to access and utilization. This study assesses the equity of access to health care services across the rural-urban continuum in Canada before and after taking other determinants of access into account. Methods This is a cross-sectional study of the population of the 10 provinces of Canada using data from the Canadian Community Health Survey (CCHS 2.1). Five different measures of access and utilization are compared across the continuum of rural-urban. Known determinants of utilization are taken into account according to Andersen's Health Behaviour Model (HBM); location of residence at the levels of province, health region, and community is also controlled for. Results This study found that residents of small cities not adjacent to major centres, had the highest reported utilisation rates of influenza vaccines and family physician services, were most likely to have a regular medical doctor, and were most likely to report unmet need. Among the rural categories there was a gradient with the most rural being least likely to have had a flu shot, use specialist physicians services, or have a regular medical doctor. Residents of the most urban centres were more likely to report using specialist physician services. Many of these differences are diminished or eliminated once other factors are accounted for. After adjusting for other factors those living in the most urban areas were more likely to have seen a specialist physician. Those in rural communities had a lower odds of receiving a flu shot and having a regular medical doctor. People residing in the most urban and most rural communities were less likely to have a regular medical doctor. Those in any of the rural categories were less likely to report unmet need. Conclusion Inequities in access to care along the rural-urban continuum exist and can be masked when evaluation is done at a very large scale with gross indicators of rural-urban. Understanding the relationship between rural-urban and other determinants will help policy makers to target interventions appropriately: to specific demographic, provincial, community, or rural categories.

Background Despite the pro-poor health policies in Ethiopia, the utilization of maternal, neonatal, and child health services remains a challenge for the country. Health equity became central in the post-2015 Sustainable Development Goals globally and is a priority for Ethiopia. The aim of this study was to assess equity in utilization of a range of maternal and child health services by applying absolute and relative equity indices. Methods Data on maternal and child health utilization emanated from a baseline survey conducted for a large project ‘Optimizing the Health Extension Program from December 2016 to February 2017 in four regions of Ethiopia. The utilization of four or more antenatal care visits; skilled birth attendance; postnatal care within 2 days after childbirth; immunization with BCG, polio 3, pentavalent 3, measles and full immunization of children aged 12–23 months; and vitamin A supplementation for 6–23 months old children were stratified by wealth quintiles. The socioeconomic status of the household was assessed by household assets and measured by constructing a wealth index using principal component analysis. Equity was assessed by applying two absolute inequity indices (Wealth index [quintile 5- quintile 1] and slope index of inequality) and two relative inequity indices (Wealth index [quintile5: quintile1] and concentration index). Results The maternal health services utilization was low and inequitably distributed favoring the better-off women. About 44, 71, and 18% of women from the better-off households had four or more antenatal visits, utilized skilled birth attendance and postnatal care within two days compared to 20, 29, and 8% of women from the poorest households, respectively. Skilled birth attendance was the most inequitably distributed maternal health service. All basic immunizations: BCG, polio 3, pentavalent 3, measles, and full immunization in children aged 12–23 months and vitamin A supplementation were equitably distributed. Conclusion Utilization of maternal health services was low, inequitable, and skewed against women from the poorest households. In contrast, preventive child health services were equitably distributed. Efforts to increase utilization and reinforcement of pro-poor and pro-rural strategies for maternal, newborn and immunization services in Ethiopia should be strengthened.

Ethiopia is one of the developing countries with the poorest health status and the health services utilization is generally low with different patterns in different regions of the country. Therefore, the aim of this study was to assess utilization of modern health services and associated factors in Dessie, Ethiopia. A cross sectional study design was employed from January to March, 2015 in Dessie City. The total sample was 420 adults. Adults were selected by stratified random sampling. The strata were made using residence as urban and rural residents. The data was collected using pre-tested, interviewer administered questionnaire. The data was entered into Epi infoTM7 software and exported to Statistical Package for Social Sciences (SPSS) version 20 Software for analysis. Binary logistic regression was used to evaluate independent effect of each variable on modern health service utilization by controlling the effect of others. The strength of association between dependent variable and independent variables was expressed by odds ratio with 95% confidence interval. The overall modern health services utilization rate was 41.8%. Being Female sex, annual income greater than poverty line, poor perception of health status, high perceived severity of illness, two or more than two number of illnesses in the last 12 months prior to the survey and presence of chronic health problem were found to have a significant association with utilization of modern health services. Modern health services utilization was found to be low. Being female sex, annual income above poverty line, having poor perceived health status, having two or more than two illnesses, severe perceived severity of illness and having chronic health problem were found to have a statistically significant association with utilization. Therefore, efforts have to be made to increase utilization of modern health services through establishing systems like health extension workers and health development army.