The ANÌMO Decalogue for a Slow Medicine care: the general recommendations of the nurses of internal medicine for a sober, respectful and equitable care

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Gabriella Bordin

2015-09-01

Full Text Available Following the lead of Slow Medicine, the Association of Nurses of Internal Medicine (ANÌMO saw the opportunity to build, through an analysis of the professional practice, an alliance between health professionals and citizens in order to support and facilitate informed choices. From this revision emerged The Decalogue, a document which summarizes the fundamental pillars of the slow nursing to guarantee a sober respectful and equitable care during the hospitalization.

Human capital flight challenges within an Equitable Health System ...

African Journals Online (AJOL)

Human capital flight challenges within an Equitable Health System. N E Udonwa. Abstract. No Abstract Nigerian Journal of Medicine Vol. 16 (4) 2007: pp. 307-311. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · http://dx.doi.org/10.4314/njm.v16i4.37327 · AJOL African ...

Quality Improvement in Athletic Health Care.

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Lopes Sauers, Andrea D; Sauers, Eric L; Valier, Alison R Snyder

2017-11-01

  Quality improvement (QI) is a health care concept that ensures patients receive high-quality (safe, timely, effective, efficient, equitable, patient-centered) and affordable care. Despite its importance, the application of QI in athletic health care has been limited.   To describe the need for and define QI in health care, to describe how to measure quality in health care, and to present a QI case in athletic training.   As the athletic training profession continues to grow, a widespread engagement in QI efforts is necessary to establish the value of athletic training services for the patients that we serve. A review of the importance of QI in health care, historical perspectives of QI, tools to drive QI efforts, and examples of common QI initiatives is presented to assist clinicians in better understanding the value of QI for advancing athletic health care and the profession. Clinical and Research Advantages:  By engaging clinicians in strategies to measure outcomes and improve their patient care services, QI practice can help athletic trainers provide high-quality and affordable care to patients.

Carework and caring: A path to gender equitable practices among men in South Africa?

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Jewkes Rachel

2011-05-01

Full Text Available Abstract Background The purpose of this study was to examine the relationship between men who engage in carework and commitment to gender equity. The context of the study was that gender inequitable masculinities create vulnerability for men and women to HIV and other health concerns. Interventions are being developed to work with masculinity and to 'change men'. Researchers now face a challenge of identifying change in men, especially in domains of their lives beyond relations with women. Engagement in carework is one suggested indicator of more gender equitable practice. Methods A qualitative approach was used. 20 men in three South African locations (Durban, Pretoria/Johannesburg, Mthatha who were identified as engaging in carework were interviewed. The men came from different backgrounds and varied in terms of age, race and socio-economic status. A semi-structured approach was used in the interviews. Results Men were engaged in different forms of carework and their motivations to be involved differed. Some men did carework out of necessity. Poverty, associated with illness in the family and a lack of resources propelled some men into carework. Other men saw carework as part of a commitment to making a better world. 'Care' interpreted as a functional activity was not enough to either create or signify support for gender equity. Only when care had an emotional resonance did it relate to gender equity commitment. Conclusions Engagement in carework precipitated a process of identity and value transformation in some men suggesting that support for carework still deserves to be a goal of interventions to 'change men'. Changing the gender of carework contributes to a more equitable gender division of labour and challenges gender stereotypes. Interventions that promote caring also advance gender equity.

Telemedicine: The Assessment of an Evolving Health Care Technology.

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Reich, Joel J.

Telemedicine, the use of bidirectional telecommunications systems for the delivery of health care at a distance, could create a more equitable distribution of medical care. Many medical tasks can be performed at a distance although some require the presence of a physician's assistant. Cost-benefit analysis of this service is difficult and requires…

Health care and equity in India.

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Balarajan, Y; Selvaraj, S; Subramanian, S V

2011-02-05

In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, and gender, and are compounded by high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Health-care expenditures exacerbate poverty, with about 39 million additional people falling into poverty every year as a result of such expenditures. We identify key challenges for the achievement of equity in service provision, and equity in financing and financial risk protection in India. These challenges include an imbalance in resource allocation, inadequate physical access to high-quality health services and human resources for health, high out-of-pocket health expenditures, inflation in health spending, and behavioural factors that affect the demand for appropriate health care. Use of equity metrics in monitoring, assessment, and strategic planning; investment in development of a rigorous knowledge base of health-systems research; development of a refined equity-focused process of deliberative decision making in health reform; and redefinition of the specific responsibilities and accountabilities of key actors are needed to try to achieve equity in health care in India. The implementation of these principles with strengthened public health and primary-care services will help to ensure a more equitable health care for India's population. Copyright © 2011 Elsevier Ltd. All rights reserved.

Equity, autonomy, and efficiency: what health care system should we have?

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Menzel, Paul T

1992-02-01

The U.S. has a wide range of options in choosing a health care system. Rational choice of a system depends on analysis and prioritization of the basic moral goals of equitable access to all citizens, the just sharing of financial costs between well and ill, respect for the values and choices of subscribers and patients, and efficiency in the delivery of costworthy care. These moral goals themselves, however, tell us little about what health care system the United States should have. Equitable access does not demand a level and scope of care for the poor equal to that rationally chosen by the middle class, and there are ways within mixed systems, though not easy ways, to achieve a fair distribution of costs between well and ill. Despite pluralistic systems' apparent advantage in allowing subscribers to choose their own forms of rationing, problems in translating serious long-term subscriber choices into actual medical practice may be greater in pluralistic than in unitary systems. Final choice of a system hinges primarily on peculiar historical facts about U.S. political culture, not on moral principle.

Equality, autonomy, and efficiency: what health care system should we have?

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Menzel, P T

1992-02-01

The U.S. has a wide range of options in choosing a health care system. Rational choice of a system depends on analysis and prioritization of the basis moral goals of equitable access to all citizens, the just sharing of financial costs between well and ill, respect for the values and choices of subscribers and patients, and efficiency in the delivery of costworthy care. These moral goals themselves, however, tell us little about what health care system the United States should have. Equitable access does not demand a level and scope of care for the poor equal to that rationally chosen by the middle class, and there are ways within mixed systems, though not easy ways, to achieve a fair distribution of costs between well and ill. Despite pluralistic systems' apparent advantage in allowing subscribers to choose their own forms of rationing, problems in translating serious long-term subscriber choices into actual medical practice may be greater in pluralistic than in unitary systems. Final choice of a system hinges primarily on peculiar historical facts about U.S. political culture, not on moral principle.

South Africa: a 21st century apartheid in health and health care?

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Mooney, Gavin H; McIntyre, Diane E

The current crisis in health and health care in South Africa results from a combination of factors: the legacy of apartheid; issues of poverty, income inequality and AIDS; and the more recent influence of neoliberal economic policies and globalisation. The legacy of apartheid has meant that both health and health care are skewed along racial lines, and 60% of health care expenditure goes largely to the 14% of the population who have private health insurance. A more equitable distribution of health care resources will result from the promised National Health Insurance, the details of which are still being debated. The AIDS epidemic in South Africa was exacerbated by the government not introducing antiretroviral treatment (ART) until the early 2000s. In 2005, it was estimated that more than 5.5 million South Africans were infected with HIV. Now all those with a CD4 count below 200 are eligible for ART. A better health service will not be enough to improve the health of South Africans. A whole-of-government approach is needed to address the persistent problems of poverty and inequality.

Human capital flight challenges within an equitable health system.

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Udonwa, N E

2007-01-01

The issue of human capital flight has been discussed at different forums with a consensus opinion that it has its merits and demerits to equitable health system. Most often one nation becomes a substantial net exporter of talent, leaving the provider nation at risk of depleting its natural supply of talent. This paper looks into the historical perspective of human capital flight or "brain drain", and its burden. It attempts to elucidate the various causes and suggested solutions. The paper's objective is to educate colleagues on the conceptual and contextual imperatives of the issue. Using a convenient sample of key informants who were medical colleagues in Nigeria relevant information was sourced from these colleagues, documents from the postgraduate medical college of Nigeria and the internet on maters relating to human capital flight and brain drain. Every year, thousands of qualified doctors, and other professionals leave Nigeria tempted by significantly higher wages, brighter prospects for employment and education, stability, food security. It appears that the potential exposure to different working conditions, resources and professional environments can be of advantage to the country, should Nigeria be able to recall these professionals. It also appears that necessary economic reforms that make staying at home rewarding, that is--good leadership, and policy planning that seriously looks into rural development, among other issues, are keys ingredients to reversing the trend in order to ensure a more equitable health system.

Equity and resource allocation in health care: dialogue between Islam and Christianity.

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Benn, Christoph; Hyder, Adnan A

2002-01-01

Inequities in health and health care are one of the greatest challenges facing the international community today. This problem raises serious questions for health care planners, politicians and ethicists alike. The major world religions can play an important role in this discussion. Therefore, interreligious dialogue on this topic between ethicists and health care professionals is of increasing relevance and urgency. This article gives an overview on the positions of Islam and Christianity on equity and the distribution of resources in health care. It has been written in close collaboration and constant dialogue between the two authors coming from the two religions. Although there is no specific concept for the modern term equity in either of the two religions, several areas of agreement have been identified: All human beings share the same values and status, which constitutes the basis for an equitable distribution of rights and benefits. Special provisions need to be made for the most needy and disadvantaged. The obligation to provide equitable health services extends beyond national and religious boundaries. Several areas require intensified research and further dialogue: the relationship between the individual and the community in terms of rights and responsibilities, how to operationalize the moral duty to decrease global inequalities in health, and the understanding and interpretation of human rights in regard to social services.

The international right to health: state obligations and private actors in the health care system.

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O'Brien, Paula

2013-09-01

Most health systems have historically used a mix of public and private actors for financing and delivering care. But the last 30 years have seen many rich and middle-income countries moving to privatise parts of their health care systems. This phenomenon has generated concerns, especially about equitable access to health care. This article examines what the international right to the highest attainable standard of health in Art 12 of the International Covenant on Economic, Social and Cultural Rights says about the obligations of states which use private actors in health care. The article involves a close study of the primary documents of the key institutions responsible for interpreting and promoting Art 12. From this study, the article concludes that in mixed public-private health care systems, states not only retain primary responsibility for fulfilling the right to health but are subject to a range of additional specific responsibilities.

Equity in health care financing: The case of Malaysia.

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Yu, Chai Ping; Whynes, David K; Sach, Tracey H

2008-06-09

Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments) independently, and subsequently by combined the financing sources to evaluate the whole financing system. Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO) and a regressive finance source (indirect taxes). Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers can gain an in depth understanding of the equity impact, in order to help

Equity in health care financing: The case of Malaysia

Directory of Open Access Journals (Sweden)

Sach Tracey H

2008-06-01

Full Text Available Abstract Background Equitable financing is a key objective of health care systems. Its importance is evidenced in policy documents, policy statements, the work of health economists and policy analysts. The conventional categorisations of finance sources for health care are taxation, social health insurance, private health insurance and out-of-pocket payments. There are nonetheless increasing variations in the finance sources used to fund health care. An understanding of the equity implications would help policy makers in achieving equitable financing. Objective The primary purpose of this paper was to comprehensively assess the equity of health care financing in Malaysia, which represents a new country context for the quantitative techniques used. The paper evaluated each of the five financing sources (direct taxes, indirect taxes, contributions to Employee Provident Fund and Social Security Organization, private insurance and out-of-pocket payments independently, and subsequently by combined the financing sources to evaluate the whole financing system. Methods Cross-sectional analyses were performed on the Household Expenditure Survey Malaysia 1998/99, using Stata statistical software package. In order to assess inequality, progressivity of each finance sources and the whole financing system was measured by Kakwani's progressivity index. Results Results showed that Malaysia's predominantly tax-financed system was slightly progressive with a Kakwani's progressivity index of 0.186. The net progressive effect was produced by four progressive finance sources (in the decreasing order of direct taxes, private insurance premiums, out-of-pocket payments, contributions to EPF and SOCSO and a regressive finance source (indirect taxes. Conclusion Malaysia's two tier health system, of a heavily subsidised public sector and a user charged private sector, has produced a progressive health financing system. The case of Malaysia exemplifies that policy makers

[Equity issues in health care reform in Argentina].

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Belmartino, Susana

2002-01-01

This article analyzes the historical and contemporary development of the Argentine health care system from the viewpoint of equity, a principle which is not explicitly mentioned in the system's founding documents. However, other values can be identified such as universal care, accessibility, and solidarity, which are closely related to equity. Nevertheless, the political dynamics characterizing the development of the country's health care system led to the suppression of more universalistic approaches, with group solidarity the only remaining principle providing structure to the system. The 1980s financial crisis highlighted the relative value of this principle as the basis for an equitable system. The authors illustrate the current situation with data on coverage under the medical social security system.

[Inequality in primary care interventions in maternal and child health care in Mexico].

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Ramírez-Tirado, Laura Alejandra; Tirado-Gómez, Laura Leticia; López-Cervantes, Malaquías

2014-04-01

To analyze the principal indicators associated with maternal mortality and mortality in children under 1 year of age and evaluate coverage levels and variability among the federative entities of Mexico. Eight interventions in maternal and child primary health care (variables) were studied: complete vaccination series, measles vaccine, and pentavalent vaccine in children under 1 year of age; early breast-feeding; prenatal care with at least one check-up by trained staff; prevalence of contraceptive use among married women of reproductive age; obstetric care in delivery by trained staff; and the administration of tetanus toxoid (TT) to pregnant women. The average and standard deviation of national coverage for each variable was calculated. Within each federative entity the proportion of municipalities with high, medium, and low marginalization was determined. States were ranked by the proportion of municipalities with high marginalization (highest to lowest) and divided into quintiles. Absolute inequality was measured using the observed difference and relative inequality, using the ratio of each variable studied. The average national coverage for the eight variables studied ranged from 86.5% to 97.5%, with administration of TT to pregnant women the lowest and administration of measles vaccine to children under 1 year of age the highest. Obstetric care in delivery, prevalence of contraceptive use, and prenatal checkup were the variables with less equitable coverage. In states with higher levels of marginalization, activities dependent on a structured health system-e.g., obstetric care in delivery-showed lower levels of coverage compared to preventive activities not requiring costly inputs or infrastructure-e.g., early breast-feeding. Interventions exhibiting greater inequity are associated with the lack of medical infrastructure and are more accentuated in federative entities with higher levels of marginalization. Greater public health expenditure is urgently needed

Antenatal and obstetric care in Afghanistan--a qualitative study among health care receivers and health care providers.

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Rahmani, Zuhal; Brekke, Mette

2013-05-06

, especially by poorly educated rural women. Patients frequently complained of being treated disrespectfully, and health care providers correspondingly complained about poor working conditions leading to exhaustion and a lack of compassion. Widespread corruption, including the necessity of personal contacts inside hospitals, was also emphasized as an obstacle to equitable antenatal and obstetric health care.

Health Care Payments in Vietnam: Patients’ Quagmire of Caring for Health versus Economic Destitution

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Andre Pekerti

2017-09-01

Full Text Available In the last three decades many developing and middle-income nations’ health care systems have been financed via out-of-pocket payments by individuals. User fees charges, however, may not be the best approach or thenmost equitable approach to finance and/or reform health services in developing nations. This study investigates the status of Vietnam’s current health system as a result of implementing user fees policies. A recent mandate by the government to increase the universal cover to 100% attempts to tackle inadequate insurance cover, one of the four major factors contributing to the high and increasing probability of destitution for Vietnamese patients (the other three being: non-residency, long stay in hospital, and high cost of treatment. Empirical results however suggest that this may be catastrophic for low-income earners: if insurance cover reimbursement decreases below 50% of actual health expenditures, the probability of Vietnamese falling into destitution will rise further. Our findings provide policy implications and directions to improve Vietnam’s health care system, in particular by ensuring the utilization of health services and financial protection for the people.

Primary health care and public health: foundations of universal health systems.

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White, Franklin

2015-01-01

The aim of this review is to advocate for more integrated and universally accessible health systems, built on a foundation of primary health care and public health. The perspective outlined identified health systems as the frame of reference, clarified terminology and examined complementary perspectives on health. It explored the prospects for universal and integrated health systems from a global perspective, the role of healthy public policy in achieving population health and the value of the social-ecological model in guiding how best to align the components of an integrated health service. The importance of an ethical private sector in partnership with the public sector is recognized. Most health systems around the world, still heavily focused on illness, are doing relatively little to optimize health and minimize illness burdens, especially for vulnerable groups. This failure to improve the underlying conditions for health is compounded by insufficient allocation of resources to address priority needs with equity (universality, accessibility and affordability). Finally, public health and primary health care are the cornerstones of sustainable health systems, and this should be reflected in the health policies and professional education systems of all nations wishing to achieve a health system that is effective, equitable, efficient and affordable. © 2015 S. Karger AG, Basel.

Health care and equity in India

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Balarajan, Yarlini; Selvaraj, S; Subramanian, S V

2011-01-01

India’s health system faces the ongoing challenge of responding to the needs of the most disadvantaged members of Indian society. Despite progress in improving access to health care, inequalities by socioeconomic status, geography and gender continue to persist. This is compounded by high out-of-pocket expenditures, with the rising financial burden of health care falling overwhelming on private households, which account for more than three-quarter of health spending in India. Health expenditures are responsible for more than half of Indian households falling into poverty; the impact of this has been increasing pushing around 39 million Indians into poverty each year. In this paper, we identify key challenges to equity in service delivery, and equity in financing and financial risk protection in India. These include imbalanced resource allocation, limited physical access to quality health services and inadequate human resources for health; high out-of-pocket health expenditures, health spending inflation, and behavioral factors that affect the demand for appropriate health care. Complementing other paper in this Series, we argue for the application of certain principles in the pursuit of equity in health care in India. These are the adoption of equity metrics in monitoring, evaluation and strategic planning, investment in developing a rigorous knowledge-base of health systems research; development of more equity-focused process of deliberative decision-making in health reform, and redefinition of the specific responsibilities and accountabilities of key actors. The implementation of these principles, together with strengthening of public health and primary care services, provide an approach for ensuring more equitable health care for India’s population. PMID:21227492

Promoting an equitable and supportive school climate in high schools: the role of school organizational health and staff burnout.

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Bottiani, Jessika H; Bradshaw, Catherine P; Mendelson, Tamar

2014-12-01

In response to persistent racial disparities in academic and behavioral outcomes between Black and White students, equitable school climate has drawn attention as a potential target for school reform. This study examined differences in Black and White students' experiences of school climate and explored whether indicators of school organizational health and staff burnout moderated differences in students' school experiences by race. Utilizing hierarchical linear modeling with a sample of 18,397 Black students (n=6228) and White students (n=12,169) and 2391 school staff in 53 schools, we found a consistent pattern of racial inequalities, such that Black students reported less positive experiences than White students across three indicators of school climate (caring γ=-0.08, porganizational health and student-reported school climate (e.g., staff affiliation and student-perceived equity, γ=0.07, porganizational health indicators were more strongly associated with positive perceptions of school climate among White students than Black students, translating into greater racial disparities in perceived school climate at schools with greater organizational health (e.g., supportive leadership by race on student-perceived engagement, γ=-0.03, p=.042). We also found negative associations between staff-reported burnout and students' experience of equity, such that the racial gap was smaller in schools with high ratings of burnout (γ=0.04, p=.002). These findings have implications for educators and education researchers interested in promoting school social contexts that equitably support student engagement and success. Copyright © 2014 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

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Phillips, Charles D.

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges. PMID:26740744

The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges.

Science.gov (United States)

Phillips, Charles D

2015-01-01

Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM) grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

The Pediatric Home Care/Expenditure Classification Model (P/ECM: A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

Directory of Open Access Journals (Sweden)

Charles D. Phillips

2015-01-01

Full Text Available Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed. The Pediatric Home Care/Expenditure Classification Model (P/ECM grouped children and youth in the study sample into 24 groups, explaining 41% of the variance in annual home care expenditures. The P/ECM creates the possibility of a more equitable, and potentially more effective, allocation of home care resources among children and youth facing serious health care challenges.

Can ICTs contribute to the efficiency and provide equitable access to the health care system in Sub-Saharan Africa? The Mali experience.

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Bagayoko, C O; Anne, A; Fieschi, M; Geissbuhler, A

2011-01-01

The aim of this study is to demonstrate from actual projects that ICT can contribute to the balance of health systems in developing countries and to equitable access to human resources and quality health care service. Our study is focused on two essential elements which are: i) Capacity building and support of health professionals, especially those in isolated areas using telemedicine tools; ii) Strengthening of hospital information systems by taking advantage of full potential offered by open-source software. Our research was performed on the activities carried out in Mali and in part through the RAFT (Réseau en Afrique Francophone pour la Télémédecine) Network. We focused mainly on the activities of e-learning, telemedicine, and hospital information systems. These include the use of platforms that work with low Internet connection bandwidth. With regard to information systems, our strategy is mainly focused on the improvement and implementation of open-source tools. Several telemedicine application projects were reviewed including continuing online medical education and the support of isolated health professionals through the usage of innovative tools. This review covers the RAFT project for continuing medical education in French-speaking Africa, the tele-radiology project in Mali, the "EQUI-ResHuS" project for equal access to health over ICT in Mali, The "Pact-e.Santé" project for community health workers in Mali. We also detailed a large-scale experience of an open-source hospital information system implemented in Mali: "Cinz@n". We report on successful experiences in the field of telemedicine and on the evaluation by the end-users of the Cinz@n project, a pilot hospital information system in Mali. These reflect the potential of healthcare-ICT for Sub-Saharan African countries.

Adverse or acceptable: negotiating access to a post-apartheid health care contract.

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Harris, Bronwyn; Eyles, John; Penn-Kekana, Loveday; Thomas, Liz; Goudge, Jane

2014-05-15

As in many fragile and post-conflict countries, South Africa's social contract has formally changed from authoritarianism to democracy, yet access to services, including health care, remains inequitable and contested. We examine access barriers to quality health services and draw on social contract theory to explore ways in which a post-apartheid health care contract is narrated, practiced and negotiated by patients and providers. We consider implications for conceptualizing and promoting more inclusive, equitable health services in a post-conflict setting. Using in-depth interviews with 45 patients and 67 providers, and field observations from twelve health facilities in one rural and two urban sub-districts, we explore access narratives of those seeking and delivering - negotiating - maternal health, tuberculosis and antiretroviral services in South Africa. Although South Africa's right to access to health care is constitutionally guaranteed, in practice, a post-apartheid health care contract is not automatically or unconditionally inclusive. Access barriers, including poverty, an under-resourced, hierarchical health system, the nature of illness and treatment, and negative attitudes and actions, create conditions for insecure or adverse incorporation into this contract, or even exclusion (sometimes temporary) from health care services. Such barriers are exacerbated by differences in the expectations that patients and providers have of each other and the contract, leading to differing, potentially conflicting, identities of inclusion and exclusion: defaulting versus suffering patients, uncaring versus overstretched providers. Conversely, caring, respectful communication, individual acts of kindness, and institutional flexibility and leadership may mitigate key access barriers and limit threats to the contract, fostering more positive forms of inclusion and facilitating easier access to health care. Building health in fragile and post-conflict societies requires

Access to health care for undocumented migrant children and pregnant women: the paradox between values and attitudes of health care professionals.

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Ruiz-Casares, Mónica; Rousseau, Cécile; Laurin-Lamothe, Audrey; Rummens, Joanna Anneke; Zelkowitz, Phyllis; Crépeau, François; Steinmetz, Nicolas

2013-02-01

Access to health care for undocumented migrant children and pregnant women confronts human rights and professional values with political and institutional regulations that limit services. In order to understand how health care professionals deal with these diverging mandates, we assessed their attitudes toward providing care to this population. Clinicians, administrators, and support staff (n = 1,048) in hospitals and primary care centers of a large multiethnic city responded to an online survey about attitudes toward access to health care services. Analysis examined the role of personal and institutional correlates of these attitudes. Foreign-born respondents and those in primary care centers were more likely to assess the present access to care as a serious problem, and to endorse broad or full access to services, primarily based on human rights reasons. Clinicians were more likely than support staff to endorse full or broad access to health care services. Respondents who approved of restricted or no access also endorsed health as a basic human right (61.1%) and child development as a priority (68.6%). A wide gap separates attitudes toward entitlement to health care and the endorsement of principles stemming from human rights and the best interest of the child. Case-based discussions with professionals facing value dilemmas and training on children's rights are needed to promote equitable practices and advocacy against regulations limiting services.

Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations.

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Kiima, David; Jenkins, Rachel

2010-06-28

Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care); development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines to accompany the general health policy, tobacco

Human Rights and the Political Economy of Universal Health Care

Science.gov (United States)

2016-01-01

Abstract Health system financing is a critical factor in securing universal health care and achieving equity in access and payment. The human rights framework offers valuable guidance for designing a financing strategy that meets these goals. This article presents a rights-based approach to health care financing developed by the human right to health care movement in the United States. Grounded in a human rights analysis of private, market-based health insurance, advocates make the case for public financing through progressive taxation. Financing mechanisms are measured against the twin goals of guaranteeing access to care and advancing economic equity. The added focus on the redistributive potential of health care financing recasts health reform as an economic policy intervention that can help fulfill broader economic and social rights obligations. Based on a review of recent universal health care reform efforts in the state of Vermont, this article reports on a rights-based public financing plan and model, which includes a new business tax directed against wage disparities. The modeling results suggest that a health system financed through equitable taxation could produce significant redistributive effects, thus increasing economic equity while generating sufficient funds to provide comprehensive health care as a universal public good. PMID:28559677

Mental health policy in Kenya -an integrated approach to scaling up equitable care for poor populations

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Jenkins Rachel

2010-06-01

Full Text Available Abstract Background Although most donor and development agency attention is focussed on communicable diseases in Kenya, the importance of non-communicable diseases including mental health and mental illness is increasingly apparent, both in their own right and because of their influence on health, education and social goals. Mental illness is common but the specialist service is extremely sparse and primary care is struggling to cope with major health demands. Non health sectors e.g. education, prisons, police, community development, gender and children, regional administration and local government have significant concerns about mental health, but general health programmes have been surprisingly slow to appreciate the significance of mental health for physical health targets. Despite a people centred post colonial health delivery system, poverty and global social changes have seriously undermined equity. This project sought to meet these challenges, aiming to introduce sustainable mental health policy and implementation across the country, within the context of extremely scarce resources. Methods A multi-faceted and comprehensive programme which combined situation appraisal to inform planning, sustained intersectoral policy dialogue at national and regional level; establishment of a health sector system for coordination, supervision and training of at each level (national, regional, district and primary care; development workshops; production of toolkits, development of guidelines and standards; encouragement of intersectoral liaison at national, regional, district and local levels; public education; and integration of mental health into health management systems. Results The programme has achieved detailed situation appraisal, epidemiological needs assessment, inclusion of mental health into the health sector reform plans, and into the National Package of Essential Health Interventions, annual operational plans, mental health policy guidelines

Primary health care in rural Malawi - a qualitative assessment exploring the relevance of the community-directed interventions approach

DEFF Research Database (Denmark)

Makaula, Peter; Bloch, Paul; Banda, Hastings T.

2012-01-01

Primary Health Care (PHC) is a strategy endorsed for attaining equitable access to basic health care including treatment and prevention of endemic diseases. Thirty four years later, its implementation remains sub-optimal in most Sub-Saharan African countries that access to health interventions...... is still a major challenge for a large proportion of the rural population. Community-directed treatment with ivermectin (CDTi) and community-directed interventions (CDI) are participatory approaches to strengthen health care at community level. Both approaches are based on values and principles associated...

Health-care users, key community informants and primary health care workers' views on health, health promotion, health assets and deficits: qualitative study in seven Spanish regions.

Science.gov (United States)

Pons-Vigués, Mariona; Berenguera, Anna; Coma-Auli, Núria; Pombo-Ramos, Haizea; March, Sebastià; Asensio-Martínez, Angela; Moreno-Peral, Patricia; Mora-Simón, Sara; Martínez-Andrés, Maria; Pujol-Ribera, Enriqueta

2017-06-13

Although some articles have analysed the definitions of health and health promotion from the perspective of health-care users and health care professionals, no published studies include the simultaneous participation of health-care users, primary health care professionals and key community informants. Understanding the perception of health and health promotion amongst these different stakeholders is crucial for the design and implementation of successful, equitable and sustainable measures that improve the health and wellbeing of populations. Furthermore, the identification of different health assets and deficits by the different informants will generate new evidence to promote healthy behaviours, improve community health and wellbeing and reduce preventable inequalities. The objective of this study is to explore the concept of health and health promotion and to compare health assets and deficits as identified by health-care users, key community informants and primary health care workers with the ultimate purpose to collect the necessary data for the design and implementation of a successful health promotion intervention. A descriptive-interpretive qualitative research was conducted with 276 participants from 14 primary care centres of 7 Spanish regions. Theoretical sampling was used for selection. We organized 11 discussion groups and 2 triangular groups with health-care users; 30 semi-structured interviews with key community informants; and 14 discussion groups with primary health care workers. A thematic content analysis was carried out. Health-care users and key community informants agree that health is a complex, broad, multifactorial concept that encompasses several interrelated dimensions (physical, psychological-emotional, social, occupational, intellectual, spiritual and environmental). The three participants' profiles consider health promotion indispensable despite defining it as complex and vague. In fact, most health-care users admit to having

Shared Housing Arrangements in Germany—An Equitable Alternative to Long Term Care Services beyond Homes and Institutions?

Directory of Open Access Journals (Sweden)

Lorraine Frisina Doetter

2018-02-01

Full Text Available Given the saliency of socio-demographic pressures, the highly restrictive definition of “need for care” characterizing the German long-term care system at its foundations in 1994 has since been subject to various expansionary reforms. This has translated into greater interest in innovative care models that provide more choice and flexibility to beneficiaries. One such model is ‘shared housing arrangements’ (“ambulant betreute Wohngemeinschaften”, where a small group of people rent private rooms, while sharing a common space, domestic support, and nursing care. Using interview and secondary data, this study examines the potential for such arrangements to provide an equitable alternative to care that is accessible to a larger population of beneficiaries than presently seen in Germany.

Sensitizing health-care workers and trainees to create a nondiscriminatory health-care environment for surgical care of HIV-Infected patients

Directory of Open Access Journals (Sweden)

Deeptiman James

2018-01-01

Full Text Available Background: Occupational risk of human immunodeficiency virus (HIV transmission creates barriers in the surgical health care of patients with HIV infection. Poor awareness, prevalent misconceptions, and associated stigma lead to discrimination against HIV-infected patients. This study was carried out to assess effectiveness of a “HIV awareness program” (HAP to educate and motivate health-care workers to provide equitable and ethical health care to HIV-infected patients. Methodology: An interventional study was conducted at a secondary level mission hospital in Central India from April 2014 to August 2015. Change in knowledge, awareness, and attitude following a multimedia “HAP” was analyzed with a “pre- and posttest design.” Seventy-four staffs and trainees participated in the program. Z-test and t-test were used to check the statistical significance of the data. Results: The mean pretest score was 19.31 (standard deviation [SD]: 6.0, 95% confidence interval [CI]: 17.923–20.697 and the mean posttest score was 30.84 (SD: 4.8, 95% CI: 29.714–31.966. This difference was statistically significant at the 5% level with P < 0.001. Conclusions: “HAP” was effective in changing the knowledge, awareness, and attitude of the staffs and trainees of the secondary hospital toward surgical care of HIV-infected patients.

The role of academic health centres in building equitable health systems: a systematic review protocol

Science.gov (United States)

Edelman, Alexandra; Taylor, Judy; Ovseiko, Pavel V; Topp, Stephanie M

2017-01-01

Introduction Academic health centres (AHCs) are complex organisations often defined by their ‘tripartite’ mission: to achieve high standards of clinical care, undertake clinical and laboratory research and educate health professionals. In the last decade, AHCs have moved away from what was a dominant focus on high impact (clinical) interventions for individuals, towards a more population-oriented paradigm requiring networked institutions and responsiveness to a range of issues including distribution of health outcomes and health determinants. Reflective of this paradigm shift is a growing interest in the role of AHCs in addressing health disparities and improving health system equity. This protocol outlines a systematic review that seeks to synthesise and critically appraise the current state of evidence on the role of AHCs in contributing to equitable health systems locally and globally. Methods and analysis Electronic searches will be conducted on a pilot list of bibliographic databases, including Google Scholar, Scopus, MEDLINE, PsycInfo, CINAHL, ERIC, ProQuest Dissertations & Theses, Cochrane Library, Evidence Based Medicine Reviews, Campbell Library and A+ Education, from 1 January 2000 to 31 December 2016. Apart from studies reporting clinical interventions or trials, all types of published peer-reviewed and grey literature will be included in the review. The single screening method will be employed in selecting studies, with two additional reviewers consulted where allocation is unclear. Quality and relevance appraisal utilising Joanna Briggs Institute critical appraisal tools will follow data extraction to a preprepared template. Thematic synthesis will be undertaken to develop descriptive themes and inform analysis. Ethics and dissemination As the review is focused on the analysis of secondary data, it does not require ethics approval. The results of the study will be disseminated through articles in peer-reviewed journals and trade publications as

Telehealth: seven strategies to successfully implement disruptive technology and transform health care.

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Schwamm, Lee H

2014-02-01

"Telehealth" refers to the use of electronic services to support a broad range of remote services, such as patient care, education, and monitoring. Telehealth must be integrated into traditional ambulatory and hospital-based practices if it is to achieve its full potential, including addressing the six domains of care quality defined by the Institute of Medicine: safe, effective, patient-centered, timely, efficient, and equitable. Telehealth is a disruptive technology that appears to threaten traditional health care delivery but has the potential to reform and transform the industry by reducing costs and increasing quality and patient satisfaction. This article outlines seven strategies critical to successful telehealth implementation: understanding patients' and providers' expectations, untethering telehealth from traditional revenue expectations, deconstructing the traditional health care encounter, being open to discovery, being mindful of the importance of space, redesigning care to improve value in health care, and being bold and visionary.

Decentralized health care priority-setting in Tanzania

DEFF Research Database (Denmark)

Maluka, Stephen; Kamuzora, Peter; Sebastiån, Miguel San

2010-01-01

Priority-setting has become one of the biggest challenges faced by health decision-makers worldwide. Fairness is a key goal of priority-setting and Accountability for Reasonableness has emerged as a guiding framework for fair priority-setting. This paper describes the processes of setting health...... care priorities in Mbarali district, Tanzania, and evaluates the descriptions against Accountability for Reasonableness. Key informant interviews were conducted with district health managers, local government officials and other stakeholders using a semi-structured interview guide. Relevant documents...... no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did...

Protecting resources for primary health care under fiscal federalism: options for resource allocation.

Science.gov (United States)

Okorafor, Okore A; Thomas, Stephen

2007-11-01

The introduction of fiscal federalism or decentralization of functions to lower levels of government is a reform not done primarily with health sector concerns. A major concern for the health sector is that devolution of expenditure responsibilities to sub-national levels of government can adversely affect the equitable distribution of financial resources across local jurisdictions. Since the adoption of fiscal federalism in South Africa, progress towards achieving a more equitable distribution of public sector health resources (financial) has slowed down considerably. This study attempts to identify appropriate resource allocation mechanisms under the current South African fiscal federal system that could be employed to promote equity in primary health care (PHC) allocations across provinces and districts. The study uses data from interviews with government officials involved in the budgeting and resource allocation process for PHC, literature on fiscal federalism and literature on international experience to inform analysis and recommendations. The results from the study identify historical incremental budgeting, weak managerial capacity at lower levels of government, poor accounting of PHC expenditure, and lack of protection for PHC funds as constraints to the realization of a more equitable distribution of PHC allocations. Based on interview data, no one resource allocation mechanism received unanimous support from stakeholders. However, the study highlights the particularly high level of autonomy enjoyed by provincial governments with regards to decision making for allocations to health and PHC services as the major constraint to achieving a more equitable distribution of PHC resources. The national government needs to have more involvement in decision making for resource allocation to PHC services if significant progress towards equity is to be achieved.

"The care is the best you can give at the time": Health care professionals' experiences in providing gender affirming care in South Africa.

Directory of Open Access Journals (Sweden)

Sarah Spencer

Full Text Available While the provision of gender affirming care for transgender people in South Africa is considered legal, ethical, and medically sound, and is-theoretically-available in both the South African private and public health sectors, access remains severely limited and unequal within the country. As there are no national policies or guidelines, little is known about how individual health care professionals providing gender affirming care make clinical decisions about eligibility and treatment options.Based on an initial policy review and service mapping, this study employed semi-structured interviews with a snowball sample of twelve health care providers, representing most providers currently providing gender affirming care in South Africa. Data were analysed thematically using NVivo, and are reported following COREQ guidelines.Our findings suggest that, whilst a small minority of health care providers offer gender affirming care, this is almost exclusively on their own initiative and is usually unsupported by wider structures and institutions. The ad hoc, discretionary nature of services means that access to care is dependent on whether a transgender person is fortunate enough to access a sympathetic and knowledgeable health care provider.Accordingly, national, state-sanctioned guidelines for gender affirming care are necessary to increase access, homogenise quality of care, and contribute to equitable provision of gender affirming care in the public and private health systems.

Beneficiaries of conflict: a qualitative study of people's trust in the private health care system in Mogadishu, Somalia.

Science.gov (United States)

Gele, Abdi A; Ahmed, Mohamed Yusuf; Kour, Prabhjot; Moallim, Sadiyo Ali; Salad, Abdulwahab Moallim; Kumar, Bernadette

2017-01-01

In 2005, the World Health Conference called for all nations to move toward universal health coverage, which is defined as "access to adequate health care for all at an affordable price". Despite this, an estimated 90% of Somalia's largely impoverished population use private health care. Therefore, considering that the private health care system is the dominant health care system in Mogadishu, Somalia, exploring the accessibility to, as well as people's trust in, the private sector is essential to help contribute an equitable and affordable health care system in the country. A qualitative study using unstructured interviews was conducted in Mogadishu from August to November of 2016. A purposive sampling approach was used to recruit 23 participants, including seven medical doctors who own private health centers, eight patients, five medical students and three senior officials who work for the Ministry of Health. Data were analyzed using a thematic analysis. Our findings show that the private health care system in Mogadishu is not only unregulated but also expensive, with the cost of health care often unaffordable for the majority of the country's citizens. There is evidence of prescription of inappropriate treatment, tendency to conduct unnecessary laboratory tests, excessive use of higher diagnostic technologies and overcharging - including the widespread practice of further appointments for follow-up - which inflates the costs. The study also found poor patient-provider relationship and widespread distrust of the private health care system. The study findings underline the need for the Somali government to develop regulatory mechanisms and guidelines with the potential to guide the private health care sector to provide equitable and affordable health care to people in Mogadishu. The doctor-patient relationship has been - and remains - a keystone of care; thus, there is an urgent need for guidelines for private health care providers to treat their patients with

Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care.

Science.gov (United States)

Zielinski, Andrzej; Kronogård, Maria; Lenhoff, Håkan; Halling, Anders

2009-09-18

Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC) has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000) listed with public PHC (approx. 120,000) for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB) using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender) and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system.

Barriers to Maori sole mothers’ primary health care access

Directory of Open Access Journals (Sweden)

Lee R

2013-12-01

Full Text Available INTRODUCTION: International research consistently shows that sole mothers experience poorer health and suboptimal health care access. New Zealand studies on sole mothers' health report similar findings. The aim of this exploratory research was to better understand the experiences of Maori sole mothers' access to health services, particularly primary health care, for personal health needs. METHODS: This qualitative study employed a general inductive design informed by a Kaupapa Maori approach, providing guidance on appropriate cultural protocols for recruiting and engaging Maori participants. Distributing written information and snowballing techniques were used to purposively recruit seven Maori sole mothers. Data collection involved semi-structured interviews which were digitally recorded and transcribed verbatim. Data were analysed using general inductive thematic analysis to identify commonalities and patterns in participants' experiences. FINDINGS: The dominant themes that emerged captured and described participants' experiences in accessing health care. The major barrier to access reported was cost. Compounding cost, transport difficulties and location or scheduling of services were additional barriers to health service accessibility. Child-related issues also posed a barrier, including prioritising children's needs and childcare over personal health needs. CONCLUSION: The findings illuminate Maori sole mothers' experiences of accessing health care and the complex socioeconomic inequalities affecting access options and uptake of services. Further investigation of barriers to access is needed. The study has implications for addressing barriers to access at policy, funding and practice levels to improve health outcomes and equitable health care access for Maori sole mothers.

Improving equity in health care financing in China during the progression towards Universal Health Coverage.

Science.gov (United States)

Chen, Mingsheng; Palmer, Andrew J; Si, Lei

2017-12-29

China is reforming the way it finances health care as it moves towards Universal Health Coverage (UHC) after the failure of market-oriented mechanisms for health care. Improving financing equity is a major policy goal of health care system during the progression towards universal coverage. We used progressivity analysis and dominance test to evaluate the financing channels of general taxation, pubic health insurance, and out-of-pocket (OOP) payments. In 2012 a survey of 8854 individuals in 3008 households recorded the socioeconomic and demographic status, and health care payments of those households. The overall Kakwani index (KI) of China's health care financing system is 0.0444. For general tax KI was -0.0241 (95% confidence interval (CI): -0.0315 to -0.0166). The indices for public health schemes (Urban Employee Basic Medical Insurance, Urban Resident's Basic Medical Insurance, New Rural Cooperative Medical Scheme) were respectively 0.1301 (95% CI: 0.1008 to 0.1594), -0.1737 (95% CI: -0.2166 to -0.1308), and -0.5598 (95% CI: -0.5830 to -0.5365); and for OOP payments KI was 0.0896 (95%CI: 0.0345 to 0.1447). OOP payments are still the dominant part of China's health care finance system. China's health care financing system is not really equitable. Reducing the proportion of indirect taxes would considerably improve health care financing equity. The flat-rate contribution mechanism is not recommended for use in public health insurance schemes, and more attention should be given to optimizing benefit packages during China's progression towards UHC.

“The care is the best you can give at the time”: Health care professionals’ experiences in providing gender affirming care in South Africa

Science.gov (United States)

Spencer, Sarah; Meer, Talia

2017-01-01

Background While the provision of gender affirming care for transgender people in South Africa is considered legal, ethical, and medically sound, and is—theoretically—available in both the South African private and public health sectors, access remains severely limited and unequal within the country. As there are no national policies or guidelines, little is known about how individual health care professionals providing gender affirming care make clinical decisions about eligibility and treatment options. Method Based on an initial policy review and service mapping, this study employed semi-structured interviews with a snowball sample of twelve health care providers, representing most providers currently providing gender affirming care in South Africa. Data were analysed thematically using NVivo, and are reported following COREQ guidelines. Results Our findings suggest that, whilst a small minority of health care providers offer gender affirming care, this is almost exclusively on their own initiative and is usually unsupported by wider structures and institutions. The ad hoc, discretionary nature of services means that access to care is dependent on whether a transgender person is fortunate enough to access a sympathetic and knowledgeable health care provider. Conclusion Accordingly, national, state-sanctioned guidelines for gender affirming care are necessary to increase access, homogenise quality of care, and contribute to equitable provision of gender affirming care in the public and private health systems. PMID:28704458

New evidence on financing equity in China's health care reform--a case study on Gansu province, China.

Science.gov (United States)

Chen, Mingsheng; Chen, Wen; Zhao, Yuxin

2012-12-18

In the transition from a planned economy to a market-oriented economy, China's state funding for health care declined and traditional coverage plans collapsed, leaving China's poor exposed to potentially ruinous health care costs. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern China, comparing the equity performance between urban and rural areas at two different points in time. Analysis of whether health care financing contributions were progressive according to income were made using the Kakwani index for each of the four health care financing channels of general taxes, public and private health insurance, and out-of-pocket payments. Two rounds of surveys were conducted, the first in 2003 (13,619 individuals in 3946 households) and the second in 2008 (12,973 individuals in 3958 households). Household socio-economic, health care payment, and utilization information were recorded in household interviews. Low-income households have undertaken a larger share of the health care financing burden in recent years, reflected by negative Kakwani indices, which indicate a regressive system. We found that the indices for general taxation were -0.0024 (urban) and -0.0281 (rural) in 2002, and -0.0177 (urban) and -0.0097 (rural) in 2007. Public health insurance presented different financing distributions in urban and rural areas (urban: 0.0742 in 2002, 0.0661 in 2007; rural: -0.0615 in 2002,-0.1436 in 2007.). Out-of-pocket payments were progressive but not equitable. Public health insurance coverage has expanded but financing equity has decreased. Health care financing policies in China need ongoing reform. Given the inequity of general consumption taxes, elimination of these would improve financing equity considerably. Optimizing benefit packages in public health insurance is

Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care

Directory of Open Access Journals (Sweden)

Kronogård Maria

2009-09-01

Full Text Available Abstract Background Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC. Methods Diagnoses were obtained from electronic PHC records of inhabitants in Blekinge County (approx. 150,000 listed with public PHC (approx. 120,000 for three consecutive years, 2004-2006. The inhabitants were then classified into six different resource utilization bands (RUB using the ACG case-mix system. The mean costs for primary health care were calculated for each RUB and year. Using linear regression models and log-cost as dependent variable the adjusted R2 was calculated in the unadjusted model (gender and in consecutive models where age, listing with specific PHC and RUB were added. In an additional model the ACG groups were added. Results Gender, age and listing with specific PHC explained 14.48-14.88% of the variance in individual costs for PHC. By also adding information on level of co-morbidity, as measured by the ACG case-mix system, to specific PHC the adjusted R2 increased to 60.89-63.41%. Conclusion The ACG case-mix system explains patient costs in primary care to a high degree. Age and gender are important explanatory factors, but most of the variance in concurrent patient costs was explained by the ACG case-mix system.

Equity in health and health care reforms.

Science.gov (United States)

Glick, S M

1999-01-01

In planning healthcare reforms increasing attention has been focused on the issue of equity. Inequities in the provision of healthcare exist even in relatively egalitarian societies. Poverty is still one of the major contributors to ill health and there are many powerful influences in society that continue to thwart the goal of a maximally equitable system for the provision of healthcare. The principles of equity in a healthcare system have been well articulated in recent years. It is incumbent on healthcare professionals who understand the issues to join the efforts towards a more humane and equitable healthcare system in their societies.

[Gender inequity in the access to health care in Chile].

Science.gov (United States)

Vega, Jeanette; Bedregal, Paula; Jadue, Liliana; Delgado, Iris

2003-06-01

In the last two decades, Chile has experienced advances in economical development and global health indicators. However, gender inequities persist in particular related to access to health services and financing of health insurance. To examine gender inequities in the access to health care in Chile. An analysis of data obtained from a serial national survey applied to assess social policies (CASEN) carried out by the Ministry of Planning. During the survey 45,379 and 48,107 dwellings were interviewed in 1994 and in 1998, respectively. Women use health services 1.5 times more often, their salaries are 30% lower in all socioeconomic strata. Besides, in the private health sector, women pay higher insurance premiums than men. Men of less than two years of age have 2.5 times more preventive consultations than girls. This difference, although of lesser magnitude, is also observed in people over 60 years. Women of high income quintiles and users of private health insurance have a better access to preventive consultations but not to specialized care. An improvement in equitable access of women to health care and financing is recommended. Also, monitoring systems to survey these indicators for women should improve their efficiency.

Equitable access to comprehensive surgical care: the potential of indigenous private philanthropy in low-income settings.

Science.gov (United States)

Samad, Lubna; Iqbal, Mehreen; Tariq, Ahson; Shahzad, Wasif; Khan, Aamir J

2015-01-01

Equitable access to surgical care is necessary for improving global health. We report on the performance, financial sustainability, and policy impact of a free-of-cost multispecialty surgical delivery program in Karachi, Pakistan built upon local private philanthropy. We evaluated trends in surgical service delivery, expenditures, and philanthropic donations from Indus Hospital's first 5 years of operation (2007-2012), projected these over the hospital's current expansion phase, compared these to publicly accessible records of other philanthropic hospitals providing surgical care, and documented the government's evolving policies toward this model. Between 2007 and 2012, Indus Hospital treated 40,012 in-patients free of cost, 33,606 (84 %) of them for surgical procedures. Surgical procedures increased fivefold to 9,478 during 2011-2012 from 1,838 during 2007-2008. Bed occupancy increased to 91 % from 65 % over the same period. External surgical missions accounted for less than 0.5 % of patients served. Ninety-eight percent (98 %) of all philanthropic donations--totaling USD 26.6 million over 2007-2012--were locally generated. Zakat (obligatory annual religious alms in the Islamic faith) constituted 34 % of all donations, followed by unrestricted funds (24 %) and donations-in-kind (24 %), buildings (12 %), grants (5 %), and return on investments (1 %). Overall, donations received between 2007 and 2012 increased sevenfold, with Zakat increasing 12-fold. During 2013-2014, the Government of Pakistan provided land lease and annual operational grants totaling USD 9 million. Local philanthropy can sustain and grow the provision of free, high-quality surgical care in low-income settings, and encourage the development of hybrid government-philanthropic models of surgical care.

Health financing: Who pays for equitable health systems? | IDRC ...

International Development Research Centre (IDRC) Digital Library (Canada)

2012-10-24

Oct 24, 2012 ... Countries rich and poor face difficult choices in funding quality health care for ... while 31 member states of the World Health Organization pay less than ... on how poor families are benefiting from services – or being excluded.

New evidence on financing equity in China's health care reform - A case study on Gansu province, China

Directory of Open Access Journals (Sweden)

Chen Mingsheng

2012-12-01

Full Text Available Abstract Background In the transition from a planned economy to a market-oriented economy, China’s state funding for health care declined and traditional coverage plans collapsed, leaving China’s poor exposed to potentially ruinous health care costs. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern China, comparing the equity performance between urban and rural areas at two different points in time. Methods Analysis of whether health care financing contributions were progressive according to income were made using the Kakwani index for each of the four health care financing channels of general taxes, public and private health insurance, and out-of-pocket payments. Two rounds of surveys were conducted, the first in 2003 (13,619 individuals in 3946 households and the second in 2008 (12,973 individuals in 3958 households. Household socio-economic, health care payment, and utilization information were recorded in household interviews. Results Low-income households have undertaken a larger share of the health care financing burden in recent years, reflected by negative Kakwani indices, which indicate a regressive system. We found that the indices for general taxation were −0.0024 (urban and −0.0281 (rural in 2002, and −0.0177 (urban and −0.0097 (rural in 2007. Public health insurance presented different financing distributions in urban and rural areas (urban: 0.0742 in 2002, 0.0661 in 2007; rural: –0.0615 in 2002,���0.1436 in 2007.. Out-of-pocket payments were progressive but not equitable. Public health insurance coverage has expanded but financing equity has decreased. Conclusions Health care financing policies in China need ongoing reform. Given the inequity of general consumption taxes, elimination of these would improve

New evidence on financing equity in China's health care reform - A case study on Gansu province, China

Science.gov (United States)

2012-01-01

Background In the transition from a planned economy to a market-oriented economy, China’s state funding for health care declined and traditional coverage plans collapsed, leaving China’s poor exposed to potentially ruinous health care costs. In reforming health care for the 21st century, equity in health care financing has become a major policy goal. To assess progress towards this goal, this paper examines the equity characteristics of health care financing in a province of northwestern China, comparing the equity performance between urban and rural areas at two different points in time. Methods Analysis of whether health care financing contributions were progressive according to income were made using the Kakwani index for each of the four health care financing channels of general taxes, public and private health insurance, and out-of-pocket payments. Two rounds of surveys were conducted, the first in 2003 (13,619 individuals in 3946 households) and the second in 2008 (12,973 individuals in 3958 households). Household socio-economic, health care payment, and utilization information were recorded in household interviews. Results Low-income households have undertaken a larger share of the health care financing burden in recent years, reflected by negative Kakwani indices, which indicate a regressive system. We found that the indices for general taxation were −0.0024 (urban) and −0.0281 (rural) in 2002, and −0.0177 (urban) and −0.0097 (rural) in 2007. Public health insurance presented different financing distributions in urban and rural areas (urban: 0.0742 in 2002, 0.0661 in 2007; rural: –0.0615 in 2002,–0.1436 in 2007.). Out-of-pocket payments were progressive but not equitable. Public health insurance coverage has expanded but financing equity has decreased. Conclusions Health care financing policies in China need ongoing reform. Given the inequity of general consumption taxes, elimination of these would improve financing equity considerably

Beneficiaries of conflict: a qualitative study of people’s trust in the private health care system in Mogadishu, Somalia

Science.gov (United States)

Gele, Abdi A; Ahmed, Mohamed Yusuf; Kour, Prabhjot; Moallim, Sadiyo Ali; Salad, Abdulwahab Moallim; Kumar, Bernadette

2017-01-01

Background In 2005, the World Health Conference called for all nations to move toward universal health coverage, which is defined as “access to adequate health care for all at an affordable price”. Despite this, an estimated 90% of Somalia’s largely impoverished population use private health care. Therefore, considering that the private health care system is the dominant health care system in Mogadishu, Somalia, exploring the accessibility to, as well as people’s trust in, the private sector is essential to help contribute an equitable and affordable health care system in the country. Methods A qualitative study using unstructured interviews was conducted in Mogadishu from August to November of 2016. A purposive sampling approach was used to recruit 23 participants, including seven medical doctors who own private health centers, eight patients, five medical students and three senior officials who work for the Ministry of Health. Data were analyzed using a thematic analysis. Results Our findings show that the private health care system in Mogadishu is not only unregulated but also expensive, with the cost of health care often unaffordable for the majority of the country’s citizens. There is evidence of prescription of inappropriate treatment, tendency to conduct unnecessary laboratory tests, excessive use of higher diagnostic technologies and overcharging – including the widespread practice of further appointments for follow-up – which inflates the costs. The study also found poor patient–provider relationship and widespread distrust of the private health care system. Conclusion The study findings underline the need for the Somali government to develop regulatory mechanisms and guidelines with the potential to guide the private health care sector to provide equitable and affordable health care to people in Mogadishu. The doctor–patient relationship has been – and remains – a keystone of care; thus, there is an urgent need for guidelines for

Equitable Prices of Single-Source Drugs in Thailand.

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Ngorsuraches, Surachat; Chaiyakan, Kanokkan

2015-08-01

In Thailand, total drug expenditure has grown rapidly. Recently, the Thai government has addressed the issue of drug pricing, but the prices of single-source drugs remain a major challenge. To examine equitable prices of single-source drugs in Thailand. A total of 98 single-source and high-expenditure drugs were examined. Unit prices from the Drug and Medical Supplies Information Center (DMSIC) and National Average Drug Acquisition Cost (NADAC) were used to represent drug prices at the provider level in Thailand and the U.S., respectively. Data for measuring drug affordability, e.g., dose and poverty line, were obtained from Micromedex online and the National Statistical Office (NSO). The U.S. drug prices were adjusted by the Human Development Index (HDI) to be equitable prices for Thailand. Purchasing Power Parity (PPP) was used to convert US currency into Thai baht. All prices in this study were based on the year 2012. Catastrophic, Impoverishment, and WHO/Health Action International (HAI) approaches were used to determine Thai citizens' ability to afford the study drugs. Finally, uncertainty analyses were conducted. From all study drugs, 55 single-source drugs were priced higher than their equitable prices, ranging from 0.38 to 422.36% higher. Among these, 28 items were antineoplastic drugs. The prices of drugs outside the National List of Essential Medicines (NLEM), as well as the country's newer drugs, tended to be higher than their calculated equitable prices. The majority of drugs in Thailand priced higher than equitable prices were unaffordable for most Thai citizens. The uncertainty analyses revealed that almost all results were relatively robust. Most single-source drug prices in Thailand were higher than their equitable prices, and were likely to be unaffordable to Thai citizens.

Considering Accreditation in Gerontology: The Importance of Interprofessional Collaborative Competencies to Ensure Quality Health Care for Older Adults

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Goldberg, Lynette R.; Koontz, Jennifer Scott; Rogers, Nicole; Brickell, Jean

2012-01-01

The health care needs of older adults can be complex and multifaceted. Safe, effective, equitable, and person-centered service provision relies on skilled interprofessional, team-based practice. Too often, students seeking a career specializing in gerontology are not exposed to such interprofessional, team-based learning and practice during their…

A consistent decomposition of the redistributive, vertical, and horizontal effects of health care finance by factor components.

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Hierro, Luis A; Gómez-Álvarez, Rosario; Atienza, Pedro

2014-01-01

In studies on the redistributive, vertical, and horizontal effects of health care financing, the sum of the contributions calculated for each financial instrument does not equal the total effects. As a consequence, the final calculations tend to be overestimated or underestimated. The solution proposed here involves the adaptation of the Shapley value to achieve additive results for all the effects and reveals the relative contributions of different instruments to the change of whole-system equity. An understanding of this change would help policy makers attain equitable health care financing. We test the method with the public finance and private payments of health care systems in Denmark and the Netherlands. Copyright © 2013 John Wiley & Sons, Ltd.

Insiders' Insight: Discrimination against Indigenous Peoples through the Eyes of Health Care Professionals.

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Wylie, Lloy; McConkey, Stephanie

2018-05-07

Discrimination in the health care system has a direct negative impact on health and wellbeing. Experiences of discrimination are considered a root cause for the health inequalities that exist among Indigenous peoples. Experiences of discrimination are commonplace, with patients noting abusive treatment, stereotyping, and a lack of quality in the care provided, which discourage Indigenous people from accessing care. This research project examined the perspectives of health care providers and decision-makers to identify what challenges they see facing Indigenous patients and families when accessing health services in a large city in southern Ontario. Discrimination against Indigenous people was identified as major challenges by respondents, noting that it is widespread. This paper discusses the three key discrimination subthemes that were identified, including an unwelcoming environment, stereotyping and stigma, and practice informed by racism. These findings point to the conclusion that in order to improve health care access for Indigenous peoples, we need to go beyond simply making health services more welcoming and inclusive. Practice norms shaped by biases informed by discrimination against Indigenous people are widespread and compromise standards of care. Therefore, the problem needs to be addressed throughout the health care system as part of a quality improvement strategy. This will require not only a significant shift in the attitudes, knowledge, and skills of health care providers, but also the establishment of accountabilities for health care organizations to ensure equitable health services for Indigenous peoples.

Genuine federalism in the Russian health care system: changing roles of government.

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Chernichovsky, D; Potapchik, E

1999-02-01

The reforms that have affected the Russian health care system since the breakup of the Soviet Union, principally those in the general administration of the Russian Federation, have suffered from inconsistency and the absence of a strategy. The various reforms have caused a shift from a national health system characterized by highly centralized management and control, typical of the totalitarian uniform state, to a highly decentralized but fragmented multitude of state systems. Each of these systems is relatively centralized at the local level and run by local administrations with limited government infrastructure and experience. The role of government in the emerging system, and in particular the role of the federal government, remains ill defined. As a result, there is a grave risk that the Russian health care system may disintegrate as a national system. This undermines (a) the prevailing universal and fairly equitable access to care, (b) stabilization of the system following a long period of transition, and (c) the long-term reform that is required to bring the Russian health care system up to par with the health care systems in other developed countries. A rapid transition to a genuine federal health system with well-articulated roles for different levels of government, in tandem with implementation of the 1993 Compulsory Health Insurance System, is essential for the stabilization and reform of the Russian health care system.

Progressivity of health care financing and incidence of service benefits in Ghana.

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Akazili, James; Garshong, Bertha; Aikins, Moses; Gyapong, John; McIntyre, Di

2012-03-01

The National Health Insurance (NHI) scheme was introduced in Ghana in 2004 as a pro-poor financing strategy aimed at removing financial barriers to health care and protecting all citizens from catastrophic health expenditures, which currently arise due to user fees and other direct payments. A comprehensive assessment of the financing and benefit incidence of health services in Ghana was undertaken. These analyses drew on secondary data from the Ghana Living Standards Survey (2005/2006) and from an additional household survey which collected data in 2008 in six districts covering the three main ecological zones of Ghana. Findings show that Ghana's health care financing system is progressive, driven largely by the progressivity of taxes. The national health insurance levy (which is part of VAT) is mildly progressive while NHI contributions by the informal sector are regressive. The distribution of total benefits from both public and private health services is pro-rich. However, public sector district-level hospital inpatient care is pro-poor and benefits of primary-level health care services are relatively evenly distributed. For Ghana to attain an equitable health system and fully achieve universal coverage, it must ensure that the poor, most of whom are not currently covered by the NHI, are financially protected, and it must address the many access barriers to health care.

Results-based financing for equitable access to maternal and child ...

International Development Research Centre (IDRC) Digital Library (Canada)

Home · What we do ... This project will contribute to increasing equitable access to health services for the poor by strengthening the ... The project will also look at the impact of results-based financing on health providers' motivation and ...

Creating Healthier, More Equitable Communities By Improving Governance And Policy.

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Dubowitz, Tamara; Orleans, Tracy; Nelson, Christopher; May, Linnea Warren; Sloan, Jennifer C; Chandra, Anita

2016-11-01

How can healthier, more equitable communities be created? This is a key question for public health. Even though progress has been made in understanding the impact of social, physical, and policy factors on population health, there is much room for improvement. With this in mind, the Robert Wood Johnson Foundation made creating healthier, more equitable communities the third of four Action Areas in its Culture of Health Action Framework. This Action Area focuses on the interplay of three drivers-the physical environment, social and economic conditions, and policy and governance-in influencing health equity. In this article we review some of the policy and governance challenges confronting decisionmakers as they seek to create healthy communities on a broad scale. We use these challenges as a framework for understanding where the most critical gaps still exist, where the links could be exploited more effectively, and where there are opportunities for further research and policy development. Project HOPE—The People-to-People Health Foundation, Inc.

Micro-level analysis of distributional changes in health care financing in Finland.

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Klavus, J; Häkkinen, U

1998-01-01

In the early 1990s the Finnish economy suffered a severe recession at the same time as health care reforms were taking place. This study examines the effects of these changes on the distribution of contributions to health care financing in relation to household income. Explanations for changes in various indicators of health care expenditure and use during that time are offered. The analysis is based partly on actual income data and partly on simulated data from the base year (1990). It employs methods that allow the estimation of confidence intervals for inequality indices (the Gini coefficient and Kakwani's progressivity index). In spite of the substantial decrease in real incomes during the recession, the distribution of income remained almost unaltered. The share of total health care funding derived from poorer households increased somewhat, due purely to structural changes. The financial plight of the public sector led to the share of total funding from progressive income taxes to decrease, while regressive indirect taxes and direct payments by households contributed more. It seems that, aside from an increased financing burden on poorer households, Finland's health care system has withstood the tremendous changes of the early 1990s fairly well. This is largely attributable to the features of the tax-financed health care system, which apportions the effects of financial and functional disturbances equitably.

Why equity in health and in access to health care are elusive: Insights from Canada and South Africa.

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Benatar, Solomon; Sullivan, Terrence; Brown, Adalsteinn

2017-12-04

Health and access to health care vary strikingly across the globe, and debates about this have been pervasive and controversial. Some comparative data in Canada and South Africa illustrate the complexity of achieving greater equity anywhere, even in a wealthy country like Canada. Potential bi-directional lessons relevant both to local and global public health are identified. Both countries should consider the implications of lost opportunity costs associated with lack of explicit resource allocation policies. While National Health Insurance is attractive politically, Canada's example cannot be fully emulated in South Africa. Short- and medium-term attempts to improve equity in middle-income countries should focus on equitable access to insurance to cover primary health care and on making more use of nurse practitioners and community health workers. In the longer-term, attention is needed to the economic and political power structures that influence health and health care and that ignore the social and societal determinants of sustainable good health locally and globally. This long-term vision of health is needed globally to achieve improvements in individual and population health in a century characterised by limits to economic growth, widening disparities, continuing conflict and migration on a large scale and multiple adverse impacts of climate change.

Horizontal Inequity in Health Care Utilization among the Middle-Aged and Elderly in China.

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Li, Chaofan; Dou, Lei; Wang, Haipeng; Jing, Shanshan; Yin, Aitian

2017-07-26

Equitable utilization of health care is a primary goal of the Chinese health system. This study aimed to examine horizontal inequity in health care utilization and identify the factors resulting in inequity among the middle-aged and elderly in China. The data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). We employed the concentration index (CI) and horizontal inequity (HI) to measure inequity in health care utilization. Non-linear regression models were used to decompose the CI into the contribution of each factor. The CIs for the probability of and total number of outpatient visits were 0.0642 and 0.0780, respectively, and those for inpatient visits were 0.1418 and 0.1471, respectively. The HIs were also significantly positive. Living standard was the most important contributor. The contribution of health insurance varied between plans. This study supported the presence of pro-rich inequity in health care utilization for both probability and frequency among the middle-aged and elderly in China. Narrowing the living standard gap and improving the health insurance benefit package for the elderly should help to resolve these inequities.

The Mexican Revolution and health care or the health of the Mexican Revolution.

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Horn, J J

1985-01-01

Despite a victorious social revolution, a self-proclaimed "revolutionary" government, and a significant post-war economic growth, Mexico has not achieved a just or equitable social system. The Mexican Revolution led to the emergence of a new bureaucratic class whose "trickle-down" development strategy sacrificed social welfare to capital accumulation. Mexican morbidity and mortality patterns resemble those of more impoverished developing nations without revolutionary experience. The patterns of health care in Mexico reflect inequities and contradictions in the society and economy at large and flow from the erosion of the egalitarian aims of the revolution concomitant with the expansion of capitalism and the concentration of the benefits of "modernization" in the hands of privileged elites. Mexico's health problems are symptomatic of a general socio-economic malaise which questions the legitimacy of the Revolution.

Equitable Colorings Of Corona Multiproducts Of Graphs

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Furmánczyk Hanna

2017-11-01

Full Text Available A graph is equitably k-colorable if its vertices can be partitioned into k independent sets in such a way that the numbers of vertices in any two sets differ by at most one. The smallest k for which such a coloring exists is known as the equitable chromatic number of G and denoted by =(G. It is known that the problem of computation of =(G is NP-hard in general and remains so for corona graphs. In this paper we consider the same model of coloring in the case of corona multiproducts of graphs. In particular, we obtain some results regarding the equitable chromatic number for the l-corona product G ◦l H, where G is an equitably 3- or 4-colorable graph and H is an r-partite graph, a cycle or a complete graph. Our proofs are mostly constructive in that they lead to polynomial algorithms for equitable coloring of such graph products provided that there is given an equitable coloring of G. Moreover, we confirm the Equitable Coloring Conjecture for corona products of such graphs. This paper extends the results from [H. Furmánczyk, K. Kaliraj, M. Kubale and V.J. Vivin, Equitable coloring of corona products of graphs, Adv. Appl. Discrete Math. 11 (2013 103–120].

A European late starter: lessons from the history of reform in Irish health care.

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Wren, Maev-Ann; Connolly, Sheelah

2017-12-26

The Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.

Beneficiaries of conflict: a qualitative study of people’s trust in the private health care system in Mogadishu, Somalia

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Gele AA

2017-08-01

Full Text Available Abdi A Gele,1–3 Mohamed Yusuf Ahmed,4 Prabhjot Kour,2 Sadiyo Ali Moallim,5 Abdulwahab Moallim Salad,3 Bernadette Kumar2 1Institute of Nursing and Health Promotion, Department of Health, Oslo and Akershus University College of Applied Science, 2Department for Research, Norwegian Centre for Minority Health Research, Oslo, Norway; 3Center for Health Research, Somali National University, 4Department of Business Management, Simad University, 5Faculty of Medicine, Benadir University, Mogadishu, Somalia Background: In 2005, the World Health Conference called for all nations to move toward universal health coverage, which is defined as “access to adequate health care for all at an affordable price”. Despite this, an estimated 90% of Somalia’s largely impoverished population use private health care. Therefore, considering that the private health care system is the dominant health care system in Mogadishu, Somalia, exploring the accessibility to, as well as people’s trust in, the private sector is essential to help contribute an equitable and affordable health care system in the country.Methods: A qualitative study using unstructured interviews was conducted in Mogadishu from August to November of 2016. A purposive sampling approach was used to recruit 23 participants, including seven medical doctors who own private health centers, eight patients, five medical students and three senior officials who work for the Ministry of Health. Data were analyzed using a thematic analysis.Results: Our findings show that the private health care system in Mogadishu is not only unregulated but also expensive, with the cost of health care often unaffordable for the majority of the country’s citizens. There is evidence of prescription of inappropriate treatment, tendency to conduct unnecessary laboratory tests, excessive use of higher diagnostic technologies and overcharging – including the widespread practice of further appointments for follow-up – which

Incomplete Markets and Imperfect Institutions: Some Challenges Posed by Trust for Contemporary Health Care and Health Policy.

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Schlesinger, Mark; Gray, Bradford H

2016-08-01

As contemporary health policy promotes evidence-based practices using targeted incentives, policy makers may lose track of vital aspects of care that are difficult to measure. For more than a half century, scholars have recognized that these latter aspects play a crucial role in high-quality care and equitable health system performance but depend on the potentially frail reed of providers' trustworthiness: that is, their commitment to facets and outcomes of care not easily assessed by external parties. More recently, early experience with pay for performance in health settings suggests that enhancing financial rewards for the measurable undermines providers' commitment to the unmeasurable, degrading the trustworthiness of their practices. Reformers have looked to revised professional norms or reorganized practice arrangements to bolster the intrinsic motivations required for trustworthiness. We suggest here that these responses are likely to prove inadequate. We propose that they be complemented by a renewed policy-making commitment to nonprofit ownership among health care providers, insurers, and integrated delivery systems. We identify some of the concerns raised in the past with ownership-based policies and propose a set of responses. If these are pursued in combination, they hold the promise of a sustainable ownership-based policy reform for the United States. Copyright © 2016 by Duke University Press.

Is health care financing in Uganda equitable? | Zikusooka | African ...

African Journals Online (AJOL)

Results: Uganda's health sector remains significantly under-funded, mainly relying on private sources of financing, especially out-of-pocket spending. At 9.6 % of total government expenditure, public spending on health is far below the Abuja target of 15% that GoU committed to. Prepayments form a small proportion of ...

Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam

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Liu Xiaoyun

2012-02-01

Full Text Available Abstract Introduction Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Methods Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. Results In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. Conclusions China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance.

Can rural health insurance improve equity in health care utilization? a comparison between China and Vietnam

Science.gov (United States)

2012-01-01

Introduction Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Methods Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. Results In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. Conclusions China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance. PMID:22376290

When health systems are barriers to health care: challenges faced by uninsured Mexican kidney patients.

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Kierans, Ciara; Padilla-Altamira, Cesar; Garcia-Garcia, Guillermo; Ibarra-Hernandez, Margarita; Mercado, Francisco J

2013-01-01

Chronic Kidney Disease disproportionately affects the poor in Low and Middle Income Countries (LMICs). Mexico exemplifies the difficulties faced in supporting Renal Replacement Therapy (RRT) and providing equitable patient care, despite recent attempts at health reform. The objective of this study is to document the challenges faced by uninsured, poor Mexican families when attempting to access RRT. The article takes an ethnographic approach, using interviewing and observation to generate detailed accounts of the problems that accompany attempts to secure care. The study, based in the state of Jalisco, comprised interviews with patients, their caregivers, health and social care professionals, among others. Observations were carried out in both clinical and social settings. In the absence of organised health information and stable pathways to renal care, patients and their families work extraordinarily hard and at great expense to secure care in a mixed public-private healthcare system. As part of this work, they must navigate challenging health and social care environments, negotiate treatments and costs, resource and finance healthcare and manage a wide range of formal and informal health information. Examining commonalities across pathways to adequate healthcare reveals major failings in the Mexican system. These systemic problems serve to reproduce and deepen health inequalities. A system, in which the costs of renal care are disproportionately borne by those who can least afford them, faces major difficulties around the sustainability and resourcing of RRTs. Attempts to increase access to renal therapies, therefore, need to take into account the complex social and economic demands this places on those who need access most. This paper further shows that ethnographic studies of the concrete ways in which healthcare is accessed in practice provide important insights into the plight of CKD patients and so constitute an important source of evidence in that effort.

The consequences of health service privatisation for equality and equity in health care in South Africa.

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Price, M

1988-01-01

The trend towards the privatisation of health services in South Africa reflects a growing use of private sources of finance and the growing proportion of privately owned fee-for-service providers and facilities. Fee-for-service methods of reimbursement aggravate the geographical maldistribution of personnel and facilities, and the competition for scarce personnel resources aggravates the difference in the quality of the public and private services. Thus the growth in demand for these types of providers may be expected to increase inequality of access in these two respects. The potential expansion of medical scheme coverage is shown to be limited to well under 50% of the population, leaving the majority of the population without access to private sector health care. Even for members of the medical schemes, benefits are linked to income, thus clashing with the principle of equal care for equal need. The public funds needed to overcome financial obstacles to access to private providers could be more efficiently deployed by financing publicly owned and controlled health services directly. Taxation also offers the most equitable method of financing health services. Finally, attention is drawn to the dilemma resulting from the strengthening of the private health sector; while in the short term this can offer better care to more people on a racially non-discriminatory basis, in the long term, health care for the population as a whole may become more unequal and for those dependent on the public sector it may even deteriorate.

Health care prioritization in ageing societies: influence of age, education, health literacy and culture.

Science.gov (United States)

Mak, Benise; Woo, Jean; Bowling, Ann; Wong, Florens; Chau, Pui Hing

2011-05-01

To examine how Chinese people in Hong Kong view health care prioritization and to compare the findings with those from a United Kingdom survey. A cross-sectional opinion survey was conducted in Hong Kong and 1512 participants were interviewed. Data show that the highest rankings were accorded to "treatment for children" and "high technology services." Services for the elderly, whether in the community or in hospitals, and including end-of-life care, were ranked among the lowest. This view was also shared by healthcare professionals. Compared with the UK findings, there are stark contrasts in the low ranking of end-of-life care and the high ranking of high technology services among the HK population. It is evident that most people would give priority to the young over the old in distributing a given amount of healthcare services. To meet the needs of ageing societies and to meet the needs of all users equitably, health care policy needs to acknowledge constraints and the needs for prioritization. Both the public and professionals should engage with policy makers in formulating a policy based on cost benefit considerations as well as overall societal view of prioritization that is not based on age alone. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Experiencing 'pathologized presence and normalized absence'; understanding health related experiences and access to health care among Iraqi and Somali asylum seekers, refugees and persons without legal status.

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Fang, Mei Lan; Sixsmith, Judith; Lawthom, Rebecca; Mountian, Ilana; Shahrin, Afifa

2015-09-19

Asylum seekers, refugees and persons without legal status have been reported to experience a range of difficulties when accessing public services and supports in the UK. While research has identified health care barriers to equitable access such as language difficulties, it has not considered the broader social contexts of marginalization experienced through the dynamics of 'othering'. The current study explores health and health care experiences of Somali and Iraqi asylum seekers, refugees and persons without legal status, highlighting 'minoritization' processes and the 'pathologization' of difference as analytical lenses to understand the multiple layers of oppression that contribute to health inequities. For the study, qualitative methods were used to document the lived experiences of asylum seekers, refugees and persons without legal status. Thirty-five in-depth interviews and five focus groups were used to explore personal accounts, reveal shared understandings and enable social, cognitive and emotional understandings of on-going health problems and challenges when seeking treatment and care. A participatory framework was undertaken which inspired collaborative workings with local organizations that worked directly with asylum seekers, refugees and persons without legal status. The analysis revealed four key themes: 1) pre-departure histories and post-arrival challenges; 2) legal status; 3) health knowledges and procedural barriers as well as 4) language and cultural competence. Confidentiality, trust, wait times and short doctor-patient consultations were emphasized as being insufficient for culturally specific communications and often translating into inadequate treatment and care. Barriers to accessing health care was associated with social disadvantage and restrictions of the broader welfare system suggesting that a re-evaluation of the asylum seeking process is required to improve the situation. Macro- and micro-level intersections of accustomed societal

The Affordable Care Act: a case study for understanding and applying complexity concepts to health care reform.

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Larkin, D Justin; Swanson, R Chad; Fuller, Spencer; Cortese, Denis A

2016-02-01

The current health system in the United States is the result of a history of patchwork policy decisions and cultural assumptions that have led to persistent contradictions in practice, gaps in coverage, unsustainable costs, and inconsistent outcomes. In working toward a more efficient health system, understanding and applying complexity science concepts will allow for policy that better promotes desired outcomes and minimizes the effects of unintended consequences. This paper will consider three applied complexity science concepts in the context of the Patient Protection and Affordable Care Act (PPACA): developing a shared vision around reimbursement for value, creating an environment for emergence through simple rules, and embracing transformational leadership at all levels. Transforming the US health system, or any other health system, will be neither easy nor quick. Applying complexity concepts to health reform efforts, however, will facilitate long-term change in all levels, leading to health systems that are more effective, efficient, and equitable. © 2014 John Wiley & Sons, Ltd.

Age bias, but no gender bias, in the intra-household resource allocation for health care in rural Burkina Faso.

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Sauerborn, R; Berman, P; Nougtara, A

1996-10-01

Household survey data, time allocation data, and qualitative interviews were used to examine whether households allocate their resources for health care differently between age and gender groups. Households allocated significantly fewer resources to the health care of sick children compared to that of sick adults. In contrast there were no such differences with regard to gender. The underlying household rationale is to concentrate its resources spent for health care on productive members rather than to spread them equitably among all its sick members. While children are not productive, women were shown to contribute as much to household production as men, hence their health is valued equally with that of men. Unless we understand intra-household biases in resource allocation, policies will be undermined. Further research is needed to test the hypothesis for the households' preference of production maintenance over health maximization.

Challenges of Refugee Health Care: Perspectives of Medical Interpreters, Case Managers, and Pharmacists

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Fabiana Kotovicz

2018-01-01

Full Text Available Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin. Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. Results: Four overarching themes regarding health care for refugee patients were identified: 1 difficulty balancing the dynamic of autonomy versus support for refugees; 2 educational needs of refugee families outpacing available resources; 3 challenges for refugees developing trust; and 4 diversity of cultures, education levels, and experiences among refugee families. Language barriers in accessing health care services and insufficient time to meet educational needs of refugees were major challenges outside of the clinic visit setting. Poor health literacy and difficulties communicating health needs and building trust within the interactive triad of refugee, physician, and interpreter impacted clinic visits. Conclusions: Refugee patients and other participants in refugee care work to navigate a complicated path to equitable health care for a vulnerable population. Continued pursuit of strategies that increase time allocation, education, and support for all parties are needed as we seek to improve health outcomes for newly arrived refugee families.

An assessment of equity in the distribution of non-financial health care inputs across public primary health care facilities in Tanzania.

Science.gov (United States)

Kuwawenaruwa, August; Borghi, Josephine; Remme, Michelle; Mtei, Gemini

2017-07-11

proportional (non dominance), whereas the distribution of oxytocics, anti-retroviral therapy (ART) and anti-hypertensive drugs was pro-rich, with the 45 degree line dominating the concentration curve for ART. This study has shown there are inequities in the distribution of health care inputs across public primary care facilities. This highlights the need to ensure a better coordinated and equitable distribution of inputs through regular monitoring of the availability of health care inputs and strengthening of reporting systems.

Social support needs for equity in health & social care: a thematic analysis of experiences of people with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

OpenAIRE

Leite, Jose Carlos de Carvalho; Drachler, Maria de L.; Killett, Anne; Kale, Swati; Nacul, Luis; McArthur, Maggie; Hong, Chia Swee; O'Driscoll, Lucy; Pheby, Derek; Campion, Peter; Lacerda, Elliana; Poland, Fiona

2011-01-01

Background: Needs-based resource allocation is fundamental to equitable care provision, which can meet the often-complex, fluctuating needs of people with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This has posed challenges both for those providing and those seeking support providers, in building shared understanding of the condition and of actions to address it. This qualitative study reports on needs for equity in health and social care expressed by adults living with CFS/...

Toward More Equitable Primary Health Care in Argentina and Latin ...

International Development Research Centre (IDRC) Digital Library (Canada)

Intersectoral efforts in the healthcare industry are projects and programs involving multiple sectors working together to improve health and well-being. This requires collaboration and coordination between the formal health sector and other sectors such as social welfare, education, environment, transportation, justice, ...

The prospects for national health insurance reform.

Science.gov (United States)

Belcher, J R; Palley, H A

1991-01-01

This article explores the unequal access to health care in the context of efforts by the American Medical Association (AMA) and its allies to maintain a market-maximizing health care system. The coalition between the AMA and its traditional allies is breaking down, in part, because of converging developments creating an atmosphere which may be more conducive to national health care reform and the development of a reformed health care delivery system that will be accessible, adequate, and equitable in meeting the health care and related social service needs of the American people.

Building consensus on key priorities for rural health care in South Africa using the Delphi technique.

Science.gov (United States)

Versteeg, Marije; du Toit, Lilo; Couper, Ian

2013-01-24

South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Response rates ranged from 83% in the first round (n=44) to 64% in the final round (n=34). The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH), governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

Social support needs for equity in health and social care: a thematic analysis of experiences of people with chronic fatigue syndrome/myalgic encephalomyelitis

OpenAIRE

de Carvalho Leite Jose C; de L Drachler Maria; Killett Anne; Kale Swati; Nacul Luis; McArthur Maggie; Hong Chia; O'Driscoll Lucy; Pheby Derek; Campion Peter; Lacerda Eliana; Poland Fiona

2011-01-01

Abstract Background Needs-based resource allocation is fundamental to equitable care provision, which can meet the often-complex, fluctuating needs of people with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME). This has posed challenges both for those providing and those seeking support providers, in building shared understanding of the condition and of actions to address it. This qualitative study reports on needs for equity in health and social care expressed by adults living w...

Beyond accreditation: a multi-track quality-enhancing strategy for primary health care in low- and middle-income countries.

Science.gov (United States)

Saleh, Shadi S; Alameddine, Mohamad S; Natafgi, Nabil M

2014-01-01

Many define an equitable health care system as one that provides logistical and financial access to "quality" care to the population. Realizing that fact, many low- and middle-income countries started investing in enhancing the quality of care in their health care systems, recently in primary health care. Unfortunately, in many instance, these investments have been exclusively focused on accreditation due to available guidelines and existing accrediting structures. A multi-track quality-enhancing strategy (MTQES) is proposed that includes, in addition to promoting resource-sensitive accreditation, other quality initiatives such as clinical guidelines, performance indicators, benchmarking activities, annual quality-enhancing projects, and annual quality summit/meeting. These complementary approaches are presented to synergistically enhance a continuous quality improvement culture in the primary health care sector, taking into consideration limited resources available, especially in low- and middle-income countries. In addition, an implementation framework depicting MTQES in three-phase interlinked packages is presented; each matches existing resources and quality infrastructure. Health care policymakers and managers need to think about accreditation as a beginning rather than an end to their quest for quality. Improvements in the structure of a health delivery organization or in the processes of care have little value if they do not translate to reduced disparities in access to "quality" care, and not merely access to care.

Social inequalities in causes of death amenable to health care in Norway

Directory of Open Access Journals (Sweden)

Camilla Hem

2007-01-01

Full Text Available Objective: Investigate if there are educational inequalities in causes of death considered amenable to health care in Norway and compare this with non-amenable causes. Methods: The study used the concept of “amenable mortality”, which here includes 34 specific causes of death. A linked data file, with information from the Norwegian Causes of Death Registry and the Educational Registry was analyzed. The study population included the whole Norwegian population in two age groups of interest (25-49 and 50-74 years. Information on deaths was from the period 1990-2001. Education was recorded in 1990 and it was grouped in four categories as: basic, lower secondary, higher secondary and higher. In the study men and women were analysed seperately. The analysis was conducted for all amenable causes pooled with and without ischemic heart disease. A Cox proportional hazard regression model was fitted to estimate hazard rate ratios. Results: The study showed educational differences in mortality from causes of death considered amenable to health care, in both age groups and sexes. This was seen both when including and excluding ischemic heart disease. The effect sizes were comparable for amenable and non-amenable causes in both age groups and sexes. Conclusions: This study revealed systematic higher risk of death in lower educational groups in causes of death considered amenable to health care. This indicates potential weaknesses in equitable provision of health care for the Norwegian population. Additional research is needed to identify domains within the health care system of particular concern.

Can "giving preference to my patients" be explained as a role related duty in public health care systems?

Science.gov (United States)

Holm, Søren

2011-03-01

Most of us have two strong intuitions (or sets of intuitions) in relation to fairness in health care systems that are funded by public money, whether through taxation or compulsory insurance. The first intuition is that such a system has to treat patients (and other users) fairly, equitably, impartially, justly and without discrimination. The second intuition is that doctors, nurses and other health care professionals are allowed to, and may even in some cases be obligated to give preference to the interests of their particular patients or clients over the interests of other patients or clients of the system. These two intuitions are in potential conflict. One of the most obvious ways in which to ensure impartiality in a health care system is to require impartiality of all actors in the system, i.e. to give health care professionals a duty to treat everyone impartially and to deny them the 'right' to give their patients preferential treatment. And one of the possible side-effects of allowing individual health care professionals to give preference to 'their clients' is to create inequality in health care. This paper explores the conflict and proposes that it can be right to give preference to 'your' patients in certain circumstances.

Referring Quality Assessment of Primary Health Care for Endocrinology in Rio Grande do Sul, Brazil.

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Monteiro Grendene, Gabriela; Szczecinski Rodrigues, Átila; Katz, Natan; Harzheim, Erno

2015-01-01

This paper presents results of an assessment of the quality research of endocrinology referrals in the public health system in the state of Rio Grande do Sul. From the analysis of 4,458 requests for endocrinology referrals, it was found that 15% of referrals had insufficient information for evaluation and 71% showed no clinical justification for authorization of referencing. The partial results of the study indicated that the lack of information makes it impossible to clinically regulate these requests. The use of referencing protocols associated with telemedicine tools can assist doctors in primary health care in the clinical management and make access to specialized services more equitable and timely.

Enhancing health care equity with Indigenous populations: evidence-based strategies from an ethnographic study.

Science.gov (United States)

Browne, Annette J; Varcoe, Colleen; Lavoie, Josée; Smye, Victoria; Wong, Sabrina T; Krause, Murry; Tu, David; Godwin, Olive; Khan, Koushambhi; Fridkin, Alycia

2016-10-04

Structural violence shapes the health of Indigenous peoples globally, and is deeply embedded in history, individual and institutional racism, and inequitable social policies and practices. Many Indigenous communities have flourished, however, the impact of colonialism continues to have profound health effects for Indigenous peoples in Canada and internationally. Despite increasing evidence of health status inequities affecting Indigenous populations, health services often fail to address health and social inequities as routine aspects of health care delivery. In this paper, we discuss an evidence-based framework and specific strategies for promoting health care equity for Indigenous populations. Using an ethnographic design and mixed methods, this study was conducted at two Urban Aboriginal Health Centres located in two inner cities in Canada, which serve a combined patient population of 5,500. Data collection included in-depth interviews with a total of 114 patients and staff (n = 73 patients; n = 41 staff), and over 900 h of participant observation focused on staff members' interactions and patterns of relating with patients. Four key dimensions of equity-oriented health services are foundational to supporting the health and well-being of Indigenous peoples: inequity-responsive care, culturally safe care, trauma- and violence-informed care, and contextually tailored care. Partnerships with Indigenous leaders, agencies, and communities are required to operationalize and tailor these key dimensions to local contexts. We discuss 10 strategies that intersect to optimize effectiveness of health care services for Indigenous peoples, and provide examples of how they can be implemented in a variety of health care settings. While the key dimensions of equity-oriented care and 10 strategies may be most optimally operationalized in the context of interdisciplinary teamwork, they also serve as health equity guidelines for organizations and providers working in

Bioethical responsibilities of the health authority in health care and biomedical research

Directory of Open Access Journals (Sweden)

Rodrigo A. Salinas

2015-01-01

Full Text Available The reflection on bioethical contents of health policies and their effects on the demands for social justice has been a preferred concern of those who have driven the health reforms that were behind the creation of the National Health Service and, more recently, the regime of health guarantees. In the course of the years, the concern for the vindication of individual rights in the context of health care and research has joined to citizen demands for equitable access to health actions. For this purpose, in 2006 and 2012, specific laws addressing these matters were enacted and in the last year, regulations that make them operative emerged and are being implemented. The wording of the articles of both laws, in the effort to rescue individual rights, raises an imbalance in some respects, with regard to the social impact of their implementation. In certain subjects, its provisions run counter to existing codes of professional ethics in the country and in others; its implementation allows the privatization of the process of ethical review of pharmacological research, which was restricted to public health services. The absence of starting up of the National Bioethics Commission, pending since 2006, has prevented the creation of a pluralistic spaTce for deliberation on these issues and others as provided by law.

Building consensus on key priorities for rural health care in South Africa using the Delphi technique

Directory of Open Access Journals (Sweden)

Marije Versteeg

2013-01-01

Full Text Available Background: South Africa is currently undergoing major health system restructuring in an attempt to improve health outcomes and reduce inequities in access. Such inequities exist between private and public health care and within the public health system itself. Experience shows that rural health care can be disadvantaged in policy formulation despite good intentions. The objective of this study was to identify the major challenges and priority interventions for rural health care provision in South Africa thereby contributing to pro-rural health policy dialogue. Methods: The Delphi technique was used to develop consensus on a list of statements that was generated through interviews and literature review. A panel of rural health practitioners and other stakeholders was asked to indicate their level of agreement with these statements and to rank the top challenges in and interventions required for rural health care. Results: Response rates ranged from 83% in the first round (n=44 to 64% in the final round (n=34. The top five priorities were aligned to three of the WHO health system building blocks: human resources for health (HRH, governance, and finance. Specifically, the panel identified a need to focus on recruitment and support of rural health professionals, the employment of managers with sufficient and appropriate skills, a rural-friendly national HRH plan, and equitable funding formulae. Conclusion: Specific policies and strategies are required to address the greatest rural health care challenges and to ensure improved access to quality health care in rural South Africa. In addition, a change in organisational climate and a concerted effort to make a career in rural health appealing to health care workers and adequate funding for rural health care provision are essential.

"I just answer 'yes' to everything they say": access to health care for deaf people in Worcester, South Africa and the politics of exclusion.

Science.gov (United States)

Kritzinger, Janis; Schneider, Marguerite; Swartz, Leslie; Braathen, Stine Hellum

2014-03-01

To explore whether there are other factors besides communication difficulties that hamper access to health care services for deaf patients. Qualitative methodology using semi-structured interviews with 16 deaf participants from the National Institute for the Deaf in Worcester and 3 Key informants from the Worcester area, South Africa. Communication difficulties were found to be a prominent barrier in accessing health care services. In addition to this interpersonal factors including lack of independent thought, overprotectedness, non-questioning attitude, and lack of familial communication interact with communication difficulties in a way that further hampers access to health care services. These interpersonal factors play a unique role in how open and accepting health services feel to deaf patients. Health care services need to take cognizance of the fact that providing sign language interpreters in the health care setting will not necessarily make access more equitable for deaf patients, as they have additional barriers besides communication to overcome before successfully accessing health care services. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Adolescents' Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms.

Science.gov (United States)

Kemigisha, Elizabeth; Nyakato, Viola N; Bruce, Katharine; Ndaruhutse Ruzaaza, Gad; Mlahagwa, Wendo; Ninsiima, Anna B; Coene, Gily; Leye, Els; Michielsen, Kristien

2018-02-22

Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense-i.e., body image, self-esteem, and gender equitable norms-and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10-14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7-28) and median 22 (IQR: 19, 24, possible range: 5-25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11-44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended.

Beyond UHC: monitoring health and social protection coverage in the context of tuberculosis care and prevention.

Directory of Open Access Journals (Sweden)

Knut Lönnroth

2014-09-01

Full Text Available Tuberculosis (TB remains a major global public health problem. In all societies, the disease affects the poorest individuals the worst. A new post-2015 global TB strategy has been developed by WHO, which explicitly highlights the key role of universal health coverage (UHC and social protection. One of the proposed targets is that "No TB affected families experience catastrophic costs due to TB." High direct and indirect costs of care hamper access, increase the risk of poor TB treatment outcomes, exacerbate poverty, and contribute to sustaining TB transmission. UHC, conventionally defined as access to health care without risk of financial hardship due to out-of-pocket health care expenditures, is essential but not sufficient for effective and equitable TB care and prevention. Social protection interventions that prevent or mitigate other financial risks associated with TB, including income losses and non-medical expenditures such as on transport and food, are also important. We propose a framework for monitoring both health and social protection coverage, and their impact on TB epidemiology. We describe key indicators and review methodological considerations. We show that while monitoring of general health care access will be important to track the health system environment within which TB services are delivered, specific indicators on TB access, quality, and financial risk protection can also serve as equity-sensitive tracers for progress towards and achievement of overall access and social protection.

Reducing maternal mortality in Nigeria: the need for urgent changes in financing for maternal health in the Nigerian health system.

Science.gov (United States)

Ebeigbe, P N

2013-06-01

Nigeria's maternal mortality indices are among the worst in the world. Various approaches aimed at combatting the persistently high maternal mortality rates in the past have been ineffective. The objective of this article was to evaluate the fairness and equitability of financing for maternal health in the Nigerian health system. A review of the performance of the Nigerian Health system with regards to financing for maternal healthcare and comparison with other health systems utilising internationally accepted criteria was done. Household out-of -pocket payment was found to be the largest source of health care financing in the Nigerian health system contributing as much as 65.6 % of total health expenditure. This is in sharp contrast to the performance of more effective health systems like that in South Africa where health care is free for pregnant and breast feeding mothers. The result is that South Africa reports less than a tenth of total maternal mortalities reported from Nigeria annually. The current Nigeria health financing system is not equitable and appears to encourage maternal mortalities since it does not cater for the most vulnerable. There is an urgent need for a review of financing of maternal health in Nigeria to achieve universal access to maternal health care. An urgent overhaul of the currently under performing National Health Insurance scheme or adoption of the simpler system based on funding from taxation with universal access for health care including maternal care and services free at the point of access is suggested.

Designing equitable antiretroviral allocation strategies in resource-constrained countries.

Directory of Open Access Journals (Sweden)

David P Wilson

2005-02-01

Full Text Available Recently, a global commitment has been made to expand access to antiretrovirals (ARVs in the developing world. However, in many resource-constrained countries the number of individuals infected with HIV in need of treatment will far exceed the supply of ARVs, and only a limited number of health-care facilities (HCFs will be available for ARV distribution. Deciding how to allocate the limited supply of ARVs among HCFs will be extremely difficult. Resource allocation decisions can be made on the basis of many epidemiological, ethical, or preferential treatment priority criteria.Here we use operations research techniques, and we show how to determine the optimal strategy for allocating ARVs among HCFs in order to satisfy the equitable criterion that each individual infected with HIV has an equal chance of receiving ARVs. We present a novel spatial mathematical model that includes heterogeneity in treatment accessibility. We show how to use our theoretical framework, in conjunction with an equity objective function, to determine an optimal equitable allocation strategy (OEAS for ARVs in resource-constrained regions. Our equity objective function enables us to apply the egalitarian principle of equity with respect to access to health care. We use data from the detailed ARV rollout plan designed by the government of South Africa to determine an OEAS for the province of KwaZulu-Natal. We determine the OEAS for KwaZulu-Natal, and we then compare this OEAS with two other ARV allocation strategies: (i allocating ARVs only to Durban (the largest urban city in KwaZulu-Natal province and (ii allocating ARVs equally to all available HCFs. In addition, we compare the OEAS to the current allocation plan of the South African government (which is based upon allocating ARVs to 17 HCFs. We show that our OEAS significantly improves equity in treatment accessibility in comparison with these three ARV allocation strategies. We also quantify how the size of the

Health Care System for Children and Adolescents in Slovenia.

Science.gov (United States)

Juričič, Mojca; Truden Dobrin, Polonca; Paulin, Sonja; Seher Zupančič, Margareta; Bratina, Nataša

2016-10-01

Slovenia's health system is financed by a Bismarckian type of social insurance system with a single insurer for a statutory health insurance, which is fully regulated by national legislation and administered by the Health Insurance Institute of Slovenia. The health insurance system is mandatory, providing almost universal coverage (98.5% of the population). Children and adolescents have the right to compulsory health insurance as family members of an insured person until the end of their regular education. Slovenia has a lower number of physicians per capita than both the European Union and the Central and Eastern Europe countries. Slovenia is facing a workforce crisis, as the number of health professionals retiring is not adequately being replaced by new trainees. There is also a net deficit of nurses with university and college degrees. Physicians working with children and adolescents in primary level have a 5-year specialization in pediatrics. Slovenia tends to be in line with the goals for the development of pediatric health care on a primary level in European countries, which are to maintain the achieved level of quality, better and equitable access, and delivery of services, aiming to reduce inequalities in health of children and adolescents and provide for every child and adolescent in the best way possible. Copyright © 2016. Published by Elsevier Inc.

Right of everyone to the enjoyment of the highest attainable standard of physical and mental health : note

NARCIS (Netherlands)

Toebes, Brigit; Puras, Dainus

2017-01-01

Corruption can have a devastating effect on good governance, the rule of law, development and the equitable enjoyment of all human rights, including the right to health. In many countries health care is among the most corrupt sectors, threatening the sustainability of health-care systems worldwide.

An assessment of routine primary care health information system data quality in Sofala Province, Mozambique

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Cuembelo Fatima

2011-05-01

Full Text Available Abstract Background Primary health care is recognized as a main driver of equitable health service delivery. For it to function optimally, routine health information systems (HIS are necessary to ensure adequate provision of health care and the development of appropriate health policies. Concerns about the quality of routine administrative data have undermined their use in resource-limited settings. This evaluation was designed to describe the availability, reliability, and validity of a sample of primary health care HIS data from nine health facilities across three districts in Sofala Province, Mozambique. HIS data were also compared with results from large community-based surveys. Methodology We used a methodology similar to the Global Fund to Fight AIDS, Tuberculosis and Malaria data verification bottom-up audit to assess primary health care HIS data availability and reliability. The quality of HIS data was validated by comparing three key indicators (antenatal care, institutional birth, and third diptheria, pertussis, and tetanus [DPT] immunization with population-level surveys over time. Results and discussion The data concordance from facility clinical registries to monthly facility reports on five key indicators--the number of first antenatal care visits, institutional births, third DPT immunization, HIV testing, and outpatient consults--was good (80%. When two sites were excluded from the analysis, the concordance was markedly better (92%. Of monthly facility reports for immunization and maternity services, 98% were available in paper form at district health departments and 98% of immunization and maternity services monthly facility reports matched the Ministry of Health electronic database. Population-level health survey and HIS data were strongly correlated (R = 0.73, for institutional birth, first antenatal care visit, and third DPT immunization. Conclusions Our results suggest that in this setting, HIS data are both reliable and

Equitable Coloring of Graphs. Recent Theoretical Results and New Practical Algorithms

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Furmańczyk Hanna

2016-09-01

Full Text Available In many applications in sequencing and scheduling it is desirable to have an underlaying graph as equitably colored as possible. In this paper we survey recent theoretical results concerning conditions for equitable colorability of some graphs and recent theoretical results concerning the complexity of equitable coloring problem. Next, since the general coloring problem is strongly NP-hard, we report on practical experiments with some efficient polynomial-time algorithms for approximate equitable coloring of general graphs.

Adolescents’ Sexual Wellbeing in Southwestern Uganda: A Cross-Sectional Assessment of Body Image, Self-Esteem and Gender Equitable Norms

Science.gov (United States)

Kemigisha, Elizabeth; Nyakato, Viola N.; Bruce, Katharine; Ndaruhutse Ruzaaza, Gad; Mlahagwa, Wendo; Ninsiima, Anna B.; Coene, Gily; Leye, Els; Michielsen, Kristien

2018-01-01

Measures of sexual wellbeing and positive aspects of sexuality in the World Health Organization definition for sexual health are rarely studied and remain poorly understood, especially among adolescents in Sub-Saharan Africa. The objective of this study was to assess sexual wellbeing in its broad sense—i.e., body image, self-esteem, and gender equitable norms—and associated factors in young adolescents in Uganda. A cross-sectional survey of adolescents ages 10–14 years in schools was carried out between June and July 2016. Among 1096 adolescents analyzed, the median age was 12 (Inter-Quartile Range (IQR): 11, 13) and 58% were female. Self-esteem and body image scores were high with median 24 (IQR: 22, 26, possible range: 7–28) and median 22 (IQR: 19, 24, possible range: 5–25) respectively. Gender equitable norms mean score was 28.1 (SD 5.2: possible range 11–44). We noted high scores for self-esteem and body image but moderate scores on gender equitable norms. Girls had higher scores compared to boys for all outcomes. A higher age and being sexually active were associated with lower scores on gender equitable norms. Gender equitable norms scores decreased with increasing age of adolescents. Comprehensive and timely sexuality education programs focusing on gender differences and norms are recommended. PMID:29470388

A roadmap and best practices for organizations to reduce racial and ethnic disparities in health care.

Science.gov (United States)

Chin, Marshall H; Clarke, Amanda R; Nocon, Robert S; Casey, Alicia A; Goddu, Anna P; Keesecker, Nicole M; Cook, Scott C

2012-08-01

Over the past decade, researchers have shifted their focus from documenting health care disparities to identifying solutions to close the gap in care. Finding Answers: Disparities Research for Change, a national program of the Robert Wood Johnson Foundation, is charged with identifying promising interventions to reduce disparities. Based on our work conducting systematic reviews of the literature, evaluating promising practices, and providing technical assistance to health care organizations, we present a roadmap for reducing racial and ethnic disparities in care. The roadmap outlines a dynamic process in which individual interventions are just one part. It highlights that organizations and providers need to take responsibility for reducing disparities, establish a general infrastructure and culture to improve quality, and integrate targeted disparities interventions into quality improvement efforts. Additionally, we summarize the major lessons learned through the Finding Answers program. We share best practices for implementing disparities interventions and synthesize cross-cutting themes from 12 systematic reviews of the literature. Our research shows that promising interventions frequently are culturally tailored to meet patients' needs, employ multidisciplinary teams of care providers, and target multiple leverage points along a patient's pathway of care. Health education that uses interactive techniques to deliver skills training appears to be more effective than traditional didactic approaches. Furthermore, patient navigation and engaging family and community members in the health care process may improve outcomes for minority patients. We anticipate that the roadmap and best practices will be useful for organizations, policymakers, and researchers striving to provide high-quality equitable care.

Towards culturally competent health care: language use of bilingual staff.

Science.gov (United States)

Johnson, M; Noble, C; Matthews, C; Aguilar, N

1998-01-01

The presence of diverse language skills within health staff provides opportunities to better meet the needs of a multicultural population. A cross-sectional survey of all staff within the South Western Sydney Area Health Service was undertaken to compare language skills with population needs and examine the context of language use. Thirty-one per cent of staff (n = 964) were bilingual or multilingual, with the predominant languages spoken being Tagalog (Filipino), Cantonese, Hindi, Spanish, Vietnamese and Italian. Thirty-seven per cent of bilingual staff used their language skills at least weekly, predominantly in situations of simple conversation and giving directions. Bilingual staff are a valuable resource for the organisation and the presence of a similar overall proportion of bilingual and bicultural staff may engender tolerance and adaptability in providing care to a diverse population. However, supply does not directly match community demand. This mismatch will continue unless recruitment is focused towards identified language groups. The high proportion of staff who rarely used their language skills (37%) may be due to lack of opportunity or limited need, and suggests that further research needs to examine service models that locate bilingual workers close to client need. This study takes a crucial first step towards realising equitable and culturally appropriate care utilising the principles of productive diversity.

Nigeria Evidence-based Health System Initiative (NEHSI ...

International Development Research Centre (IDRC) Digital Library (Canada)

... efficient and equitable primary health care in two states: Bauchi and Cross River. ... Linking research to urban planning at the ICLEI World Congress 2018. An IDRC delegation will join international delegates and city representatives at the ...

Self-Reported Discrimination in Health-Care Settings Based on Recognizability as Transgender: A Cross-Sectional Study Among Transgender U.S. Citizens.

Science.gov (United States)

Rodriguez, Amanda; Agardh, Anette; Asamoah, Benedict Oppong

2018-05-01

Discrimination has long been tied to health inequality. Rejected by families and communities because of their gender identity and gender-role behavior, transgender individuals are often socially marginalized. This study aimed to assess discrimination in health-care settings among persons self-identifying as transgender in the U.S. in relation to their recognizability as transgender, operationalized as how often they experienced that others recognized them as transgender. Data were obtained from the National Transgender Discrimination Survey (n = 6106 participants, assigned sex at birth = 3608 males, 2480 females, respectively). Binary logistic regressions were performed to examine associations between transgender recognizability and discrimination in health-care settings. Being recognized as transgender to any extent had a significant effect on perceived discrimination in health care. Always recognized as transgender showed significant associations with discrimination in a health-care setting (OR 1.48) and the following individualized health-care settings: social service settings (rape crisis and domestic violence centers, OR 5.22) and mental health settings (mental health clinic and drug treatment program, OR 1.87). Sex work and other street economy, which are known experiential factors affected by discrimination, were also significantly associated with discrimination in health-care settings. Discrimination in health-care settings is pervasive for transgender who are recognized as transgender. Public health efforts to improve access to equitable health care for transgender individuals may benefit from consideration of demographic, experiential, and medical risk factors to more fully understand the source of the seemingly excess risk of discrimination among persons recognized by others as being transgender.

Learning from doing the EquitAble project: Content, context, process, and impact of a multi-country research project on vulnerable populations in Africa

Directory of Open Access Journals (Sweden)

Mac MacLachlan

2014-10-01

Objectives: This article reports on the content, context, process and impact of project EquitAble, funded by the European Commission Seventh Research Framework Programme, which brought together researchers from Ireland, Norway, South Africa, Namibia, Sudan and Malawi. Method: After the 4-year project ended in February 2013, all members of the consortium were asked to anonymously complete a bespoke questionnaire designed by the coordinating team. The purpose of the questionnaire was to capture the views of those who collaborated on the research project in relation to issues of content, context, process and impact of the EquitAble project. Results: Our results indicated some of the successes and challenges encountered by our consortium. Conclusion: We identified contextual and process learning points, factors often not discussed in papers, which typically focus on the reporting of the ‘content’ of results.

Examining the need & potential for biomedical engineering to strengthen health care delivery for displaced populations & victims of conflict.

Science.gov (United States)

Nadkarni, Devika; Elhajj, Imad; Dawy, Zaher; Ghattas, Hala; Zaman, Muhammad H

2017-01-01

Conflict and the subsequent displacement of populations creates unique challenges in the delivery of quality health care to the affected population. Equitable access to quality care demands a multi-pronged strategy with a growing need, and role, for technological innovation to address these challenges. While there have been significant contributions towards alleviating the burden of conflict via data informatics and analytics, communication technology, and geographic information systems, little has been done within biomedical engineering. This article elaborates on the causes for gaps in biomedical innovation for refugee populations affected by conflict, tackles preconceived notions, takes stock of recent developments in promising technologies to address these challenges, and identifies tangible action items to create a stronger and sustainable pipeline for biomedical technological innovation to improve the health and well-being of an increasing group of vulnerable people around the world.

The role of the sickness funds in the Belgian health care market.

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Nonneman, W; van Doorslaer, E

1994-11-01

This article reviews some of the salient features of the Belgian health care finance and delivery system. Special attention is paid to the role played by the third-party payers, i.e. the Health Insurance Associations (HIAs) in administering the compulsory national health insurance program. It is shown how, despite extensive government regulation, the markets for GP, specialist and hospital services exhibit fierce competition of the non-price variety. Next, the paper considers the three problems perceived to be the most pressing ones at present: (i) the problem of raising sufficient revenues to cover the public share of health expenditures; (ii) the (related) cost containment problem; and (iii) the problem of ensuring efficiency through appropriate incentive mechanisms. Finally, two recently proposed options for reform are discussed and complemented with a third proposal based on the ideas of regulated competition. It is concluded that strengthening the role of the third-party payers remains crucial in any attempt to reshape the system to make it efficient and affordable while keeping it equitable.

Shaping Public Health Education, Research, and Policy in the Arab ...

International Development Research Centre (IDRC) Digital Library (Canada)

Shaping Public Health Education, Research, and Policy in the Arab World. While the Arab World has enjoyed substantial economic progress, there has been little improvement in ensuring equitable access to health care. In most countries, the majority of people have limited access to basic health services. These are ...

Essential to increase the use of generics in Europe to maintain comprehensive health care?

Directory of Open Access Journals (Sweden)

Brian Godman

2012-12-01

Full Text Available INTRODUCTION: Reforms have been introduced across Europe to increase prescribing efficiency with existing drugs. These include measures to lower prices of generics as well as increase their prescribing versus originators and patented products in a class or related class. This is essential to maintain comprehensive health care in Europe given continued pressures. The alternative is insufficient funds for new innovative drugs and increasing drug volumes with ageing populations. OBJECTIVE: To review the influence of measures and initiatives to increase the prescribing and dispensing of generics at low prices on ambulatory care prescribing efficiency. In view of this, provide guidance as authorities strive to introduce further reforms to meet their goals. METHODOLOGY: A narrative review of published papers combined with case histories. RESULTS: The different supply- and demand-side measures have reduced generic prices to as low as 2% to 3% of pre-patent loss prices in some cases as well as appreciably enhanced their utilisation. As a result, prescribing efficiency has increased without compromising care. In some cases, the reforms have led to expenditure actually falling despite appreciably increased volumes. CONCLUSIONS: Increasing use of generics at low prices will help maintain the European ideals of comprehensive and equitable health care. However, countries will continually need to learn from each other.

Social support needs for equity in health and social care: a thematic analysis of experiences of people with chronic fatigue syndrome/myalgic encephalomyelitis

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de Carvalho Leite Jose C

2011-11-01

Full Text Available Abstract Background Needs-based resource allocation is fundamental to equitable care provision, which can meet the often-complex, fluctuating needs of people with Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME. This has posed challenges both for those providing and those seeking support providers, in building shared understanding of the condition and of actions to address it. This qualitative study reports on needs for equity in health and social care expressed by adults living with CFS/ME. Methods The participants were 35 adults with CFS/ME in England, purposively selected to provide variation in clinical presentations, social backgrounds and illness experiences. Accounts of experienced needs and needs-related encounters with health and social services were obtained through a focus group (n = 6 and semi-structured interviews (n = 35. These were transcribed and needs related topics identified through data-led thematic analysis. Findings Participants emphasised needs for personalised, timely and sustained support to alleviate CFS/ME impacts and regain life control, in three thematic areas: (1 Illness symptoms, functional limitations and illness management; (2 practical support and social care; (3 financial support. Access of people with CFS/ME to support from health and social services was seen to be constrained by barriers stemming from social, cultural, organisational and professional norms and practices, further heightened for disadvantaged groups including some ethnic minorities. These reduced opportunities for their illness to be explained or associated functional limitations and social disadvantages to be addressed through social support. Participants sought more understanding of bio-psycho-social aspects of CFS/ME, of felt needs of people with CFS/ME and of human rights and disability rights, for providing person-centred, equitable care. Conclusions Changes in attitudes of health practitioners, policy makers and general public

What variables should be considered in allocating Primary health care Pharmaceutical budgets to districts in Uganda?

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Mujasi, Paschal N; Puig-Junoy, Jaume

2015-01-01

A key policy question for the government of Uganda is how to equitably allocate primary health care pharmaceutical budgets to districts. This paper seeks to identify variables influencing current primary health care pharmaceutical expenditure and their usefulness in allocating prospective pharmaceutical budgets to districts. This was a cross sectional, retrospective observational study using secondary administrative data. We collected data on the value of pharmaceuticals procured by primary health care facilities in each district from National Medical Stores for the financial year 2011/2012. The dependent variable was expressed as per capita district pharmaceutical expenditure. By reviewing literature we identified 26 potential explanatory variables. They include supply, need and demand, and health system organization variables that may influence the demand and supply of health services and the corresponding pharmaceutical expenditure. We collected secondary data for these variables for all the districts in Uganda (n = 112). We performed econometric analysis to estimate parameters of various regression models. There is a significant correlation between per capita district pharmaceutical expenditure and total district population, rural poverty, access to drinking water and outpatient department (OPD) per capita utilisation.(P Uganda (Adjusted R(2) = 0.528). All variables in the model are significant (p Uganda are: district outpatient department attendance per capita, total district population, total number of government health facilities in the district and the district human poverty index.

Intervention studies for improving global health and health care: An important arena for epidemiologists

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Gunnar Kvåle

2009-10-01

Full Text Available Marginalised populations in many low- and middle-income countries experience an increasing burden of disease, in sub-Saharan Africa to a large extent due to faltering health systems and serious HIV epidemics. Also other poverty related diseases (PRDs are prevalent, especially respiratory and diarrhoeal diseases in children, malnutrition, maternal and perinatal health problems, tuberculosis and malaria. Daily, nearly 30,000 children under the age of 5 die, most from preventable causes, and 8,000 people die from HIV infections. In spite of the availability of powerful preventive and therapeutic tools for combating these PRDs, their implementation, especially in terms of equitable delivery, leaves much to be desired. The research community must address this tragic gap between knowledge and implementation. Epidemiologists have a very important role to play in conducting studies on diseases that account for the largest share of the global disease burden. A shift of focus of epidemiologic research towards intervention studies addressing health problems of major public health importance for disadvantaged population groups is needed. There is a need to generate an evidence-base for interventions that can be implemented on a large scale; this can result in increased funding of health promotion programs as well as enable rational prioritization and integration between different health interventions. This will require close and synergetic teamwork between epidemiologists and other professions across disciplines and sectors. In this way epidemiologists can contribute significantly to improve health and optimise health care delivery for marginalized populations.

Some Advice for Physicians and Other Clinicians Treating Minorities, Women, and Other Patients at Risk of Receiving Health Care Disparities.

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White, Augustus A; Stubblefield-Tave, Beauregard

2017-06-01

Studies of inequalities in health care have documented 13 groups of patients who receive disparate care. Disparities are partly due to socioeconomic factors, but nonsocioeconomic factors also play a large contributory role. This article reviews nonsocioeconomic factors, including unconscious bias, stereotyping, racism, gender bias, and limited English proficiency. The authors discuss the clinician's role in addressing these factors and reducing their impact on the quality of health care. They indicate the significance of cultural humility on the part of caregivers as a means of amelioration. Based on a review of the clinician's role as well as background considerations in the health care environment, the authors put forward a set of 18 recommendations in the form of a checklist. They posit that implementing these recommendations as part of the patient clinician interaction will maximize the delivery of equitable care, even in the absence of desirable in-depth cross-cultural and psychosocial literacy on the part of the clinician. Trust, mutual respect, and understanding on the part of the caregiver and patient are crucial to optimizing therapeutic outcomes. The guidelines incorporated here are tools to furthering this goal.

[Debate and challenges on the topic of free medical care in Africa: "Back to the Future"?].

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Ridde, Valéry; Blanchet, Karl

2009-01-01

In its 2008 annual report, WHO affirmed the importance of resisting the temptation to depend on direct payment for primary health care. Members of the WHO committee on the social determinants of health as well as of those at the conference on primary health care in Ouagadougou in 2008 reaffirmed the need to make access to health care systems more equitable. Several decades after imposition of direct payment began, convincing data clearly demonstrate its harmful effects on the basic fairness of access to care. Accordingly, the current debate in the field of financial support for health involves the elimination of payments. More precisely, we can finally say that this is a debate about a return to the free care that existed before the widespread implementation of "cost recovery" systems. Here we want to review these discussions and prepare the ground for a debate on possible effective strategies for making health care systems more equitable from the perspective of universal coverage. We will thus note that analyses today must certainly focus more on how to eliminate direct payments than on the reasons to do so, already amply demonstrated. The international community must now undertake to support governments that want to move in this direction and ensure that the process is thoroughly documented so that it can also produce useful knowledge for the formulation of fair public policies.

Building equitable health systems in Latin America | CRDI - Centre ...

International Development Research Centre (IDRC) Digital Library (Canada)

One publication was “Notes for studying primary care within the context of segmented health systems” (article in Spanish with English abstract), which was published in 2010 in Revista de Salud Pública. The paper identifies trends and compares the implementation and performance of PHC in each Southern Cone country, ...

Health equity in the New Zealand health care system: a national survey.

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Sheridan, Nicolette F; Kenealy, Timothy W; Connolly, Martin J; Mahony, Faith; Barber, P Alan; Boyd, Mary Anne; Carswell, Peter; Clinton, Janet; Devlin, Gerard; Doughty, Robert; Dyall, Lorna; Kerse, Ngaire; Kolbe, John; Lawrenson, Ross; Moffitt, Allan

2011-10-20

In all countries people experience different social circumstances that result in avoidable differences in health. In New Zealand, Māori, Pacific peoples, and those with lower socioeconomic status experience higher levels of chronic illness, which is the leading cause of mortality, morbidity and inequitable health outcomes. Whilst the health system can enable a fairer distribution of good health, limited national data is available to measure health equity. Therefore, we sought to find out whether health services in New Zealand were equitable by measuring the level of development of components of chronic care management systems across district health boards. Variation in provision by geography, condition or ethnicity can be interpreted as inequitable. A national survey of district health boards (DHBs) was undertaken on macro approaches to chronic condition management with detail on cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke and diabetes. Additional data from expert informant interviews on program reach and the cultural needs of Māori and Pacific peoples was sought. Survey data were analyzed on dimensions of health equity relevant to strategic planning and program delivery. Results are presented as descriptive statistics and free text. Interviews were transcribed and NVivo 8 software supported a general inductive approach to identify common themes. Survey responses were received from the majority of DHBs (15/21), some PHOs (21/84) and 31 expert informants. Measuring, monitoring and targeting equity is not systematically undertaken. The Health Equity Assessment Tool is used in strategic planning but not in decisions about implementing or monitoring disease programs. Variable implementation of evidence-based practices in disease management and multiple funding streams made program implementation difficult. Equity for Māori is embedded in policy, this is not so for other ethnic groups or by geography. Populations

Determinants of marginalization and inequitable maternal health care in North–Central Vietnam: a framework analysis

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Pauline Binder-Finnema

2015-07-01

Full Text Available Background: Vietnam has achieved great improvements in maternal healthcare outcomes, but there is evidence of increasing inequity. Disadvantaged groups, predominantly ethnic minorities and people living in remote mountainous areas, do not gain access to maternal health improvements despite targeted efforts from policymakers. Objective: This study identifies underlying structural barriers to equitable maternal health care in Nghe An province, Vietnam. Experiences of social inequity and limited access among child-bearing ethnic and minority women are explored in relation to barriers of care provision experienced by maternal health professionals to gain deeper understanding on health outcomes. Design: In 2012, 11 focus group discussions with women and medical care professionals at local community health centers and district hospitals were conducted using a hermeneutic–dialectic method and analyzed for interpretation using framework analysis. Results: The social determinants ‘limited negotiation power’ and ‘limited autonomy’ orchestrate cyclical effects of shared marginalization for both women and care professionals within the provincial health system’s infrastructure. Under-staffed and poorly equipped community health facilities refer women and create overload at receiving health centers. Limited resources appear diverted away from local community centers as compensation to the district for overloaded facilities. Poor reputation for low care quality exists, and professionals are held in low repute for causing overload and resulting adverse outcomes. Country-wide reforms force women to bear responsibility for limited treatment adherence and health insight, but overlook providers’ limited professional development. Ethnic minority women are hindered by relatives from accessing care choices and costs, despite having advanced insight about government reforms to alleviate poverty. Communication challenges are worsened by non

Determinants of marginalization and inequitable maternal health care in North–Central Vietnam: a framework analysis

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Binder-Finnema, Pauline; Lien, Pham T. L.; Hoa, Dinh T. P.; Målqvist, Mats

2015-01-01

Background Vietnam has achieved great improvements in maternal healthcare outcomes, but there is evidence of increasing inequity. Disadvantaged groups, predominantly ethnic minorities and people living in remote mountainous areas, do not gain access to maternal health improvements despite targeted efforts from policymakers. Objective This study identifies underlying structural barriers to equitable maternal health care in Nghe An province, Vietnam. Experiences of social inequity and limited access among child-bearing ethnic and minority women are explored in relation to barriers of care provision experienced by maternal health professionals to gain deeper understanding on health outcomes. Design In 2012, 11 focus group discussions with women and medical care professionals at local community health centers and district hospitals were conducted using a hermeneutic–dialectic method and analyzed for interpretation using framework analysis. Results The social determinants ‘limited negotiation power’ and ‘limited autonomy’ orchestrate cyclical effects of shared marginalization for both women and care professionals within the provincial health system’s infrastructure. Under-staffed and poorly equipped community health facilities refer women and create overload at receiving health centers. Limited resources appear diverted away from local community centers as compensation to the district for overloaded facilities. Poor reputation for low care quality exists, and professionals are held in low repute for causing overload and resulting adverse outcomes. Country-wide reforms force women to bear responsibility for limited treatment adherence and health insight, but overlook providers’ limited professional development. Ethnic minority women are hindered by relatives from accessing care choices and costs, despite having advanced insight about government reforms to alleviate poverty. Communication challenges are worsened by non-existent interpretation systems

Determinants of marginalization and inequitable maternal health care in North-Central Vietnam: a framework analysis.

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Binder-Finnema, Pauline; Lien, Pham T L; Hoa, Dinh T P; Målqvist, Mats

2015-01-01

Vietnam has achieved great improvements in maternal healthcare outcomes, but there is evidence of increasing inequity. Disadvantaged groups, predominantly ethnic minorities and people living in remote mountainous areas, do not gain access to maternal health improvements despite targeted efforts from policymakers. This study identifies underlying structural barriers to equitable maternal health care in Nghe An province, Vietnam. Experiences of social inequity and limited access among child-bearing ethnic and minority women are explored in relation to barriers of care provision experienced by maternal health professionals to gain deeper understanding on health outcomes. In 2012, 11 focus group discussions with women and medical care professionals at local community health centers and district hospitals were conducted using a hermeneutic-dialectic method and analyzed for interpretation using framework analysis. The social determinants 'limited negotiation power' and 'limited autonomy' orchestrate cyclical effects of shared marginalization for both women and care professionals within the provincial health system's infrastructure. Under-staffed and poorly equipped community health facilities refer women and create overload at receiving health centers. Limited resources appear diverted away from local community centers as compensation to the district for overloaded facilities. Poor reputation for low care quality exists, and professionals are held in low repute for causing overload and resulting adverse outcomes. Country-wide reforms force women to bear responsibility for limited treatment adherence and health insight, but overlook providers' limited professional development. Ethnic minority women are hindered by relatives from accessing care choices and costs, despite having advanced insight about government reforms to alleviate poverty. Communication challenges are worsened by non-existent interpretation systems. For maternal health policy outcomes to become effective

The promise of outreach for engaging and retaining out-of-care persons in HIV medical care.

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Bradford, Judith B

2007-01-01

From the beginning of the HIV/AIDS epidemic, outreach workers have been on the frontlines of HIV prevention, working in community venues to increase knowledge and promote behaviors to reduce HIV transmission. As demographics of the HIV-infected population have changed, the need has grown to locate out-of-care individuals and learn how to engage and retain them in HIV care. Through the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) Outreach Initiative, 10 sites across the United States implemented and evaluated enhanced outreach models designed to increase engagement and retention in HIV care for underserved, disadvantaged HIV-infected individuals. Although the models differed in response to local needs and organizational characteristics, all made use of a common conceptual framework, and all used the same data collection and reporting protocols. Study teams enrolled and provided behavioral interventions to HIV-infected individuals who have been noticeably absent from research and from practice. Their interventions incorporated coaching, skills-building, and education, and were successful in reducing or removing structural, financial, and personal/cultural barriers that interfered with equitable access to HIV care. Desired outcomes of increased engagement and retention in HIV health care were achieved. Results demonstrate that interventions to promote equitable access to HIV care for disadvantaged population groups can be built from outreach models. Qualitative and quantitative analysis of the multisite data indicates that further development and evaluation of outreach-based interventions will result in effective tools for reaching HIV-infected individuals who would otherwise remain without needed care.

Trade in health services in the ASEAN region.

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Arunanondchai, Jutamas; Fink, Carsten

2006-12-01

Promoting quality health services to large population segments is a key ingredient to human and economic development. At its core, healthcare policymaking involves complex trade-offs between promoting equitable and affordable access to a basic set of health services, creating incentives for efficiencies in the healthcare system and managing constraints in government budgets. International trade in health services influences these trade-offs. It presents opportunities for cost savings and access to better quality care, but it also raises challenges in promoting equitable and affordable access. This paper offers a discussion of trade policy in health services for the ASEAN region. It reviews the existing patterns of trade and identifies policy measures that could further harness the benefits from trade in health services and address potential pitfalls that deeper integration may bring about.

Assessing the quality of care in a new nation: South Sudan's first national health facility assessment.

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Berendes, Sima; Lako, Richard L; Whitson, Donald; Gould, Simon; Valadez, Joseph J

2014-10-01

We adapted a rapid quality of care monitoring method to a fragile state with two aims: to assess the delivery of child health services in South Sudan at the time of independence and to strengthen local capacity to perform regular rapid health facility assessments. Using a two-stage lot quality assurance sampling (LQAS) design, we conducted a national cross-sectional survey among 156 randomly selected health facilities in 10 states. In each of these facilities, we obtained information on a range of access, input, process and performance indicators during structured interviews and observations. Quality of care was poor with all states failing to achieve the 80% target for 14 of 19 indicators. For example, only 12% of facilities were classified as acceptable for their adequate utilisation by the population for sick-child consultations, 16% for staffing, 3% for having infection control supplies available and 0% for having all child care guidelines. Health worker performance was categorised as acceptable in only 6% of cases related to sick-child assessments, 38% related to medical treatment for the given diagnosis and 33% related to patient counselling on how to administer the prescribed drugs. Best performance was recorded for availability of in-service training and supervision, for seven and ten states, respectively. Despite ongoing instability, the Ministry of Health developed capacity to use LQAS for measuring quality of care nationally and state-by-state, which will support efficient and equitable resource allocation. Overall, our data revealed a desperate need for improving the quality of care in all states. © 2014 John Wiley & Sons Ltd.

Inequity in access to dental care services explains current socioeconomic disparities in oral health: the Swedish National Surveys of Public Health 2004-2005.

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Wamala, Sarah; Merlo, Juan; Boström, Gunnel

2006-12-01

To analyse the effects of socioeconomic disadvantage on access to dental care services and on oral health. Design, setting and outcomes: Cross-sectional data from the Swedish National Surveys of Public Health 2004 and 2005. Outcomes were poor oral health (self-rated oral health and symptoms of periodontal disease) and lack of access to dental care services. A socioeconomic disadvantage index (SDI) was developed, consisting of social welfare beneficiary, being unemployed, financial crisis and lack of cash reserves. Swedish population-based sample of 17 362 men and 20 037 women. Every instance of increasing levels of socioeconomic disadvantage was associated with worsened oral health but, simultaneously, with decreased utilisation of dental care services. After adjusting for age, men with a mild SDI compared with those with no SDI had 2.7 (95% confidence interval (CI) 2.5 to 3.0) times the odds for self-rated poor oral health, whereas odds related to severe SDI were 6.8 (95% CI 6.2 to 7.5). The corresponding values among women were 2.3 (95% CI 2.1 to 2.5) and 6.8 (95% CI 6.3 to 7.5). Nevertheless, people with severe socioeconomic disparities were 7-9 times as likely to refrain from seeking the required dental treatment. These associations persisted even after controlling for living alone, education, occupational status and lifestyle factors. Lifestyle factors explained only 29% of the socioeconomic differences in poor oral health among men and women, whereas lack of access to dental care services explained about 60%. The results of the multilevel regression analysis indicated no additional effect of the administrative boundaries of counties or of municipalities in Sweden. Results call for urgent public health interventions to increase equitable access to dental care services.

Revitalising primary healthcare requires an equitable global economic system - now more than ever.

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Sanders, David; Baum, Fran E; Benos, Alexis; Legge, David

2011-08-01

The promised revitalisation of primary healthcare (PHC) is happening at a time when the contradictions and unfairness of the global economic system have become clear, suggesting that the current system is unsustainable. In the past two decades, one of the most significant impediments to the implementation of comprehensive PHC has been neoliberal economic policies and their imposition globally. This article questions what will be required for PHC to flourish. PHC incorporates five key principles: equitable provision of services, comprehensive care, intersectoral action, community involvement and appropriate technology. This article considers intersectoral action and comprehensiveness and their potential to be implemented in the current global environment. It highlights the constraints to intersectoral action through a case study of nutrition in the context of globalisation of the food chain. It also explores the challenges to implementing a comprehensive approach to health that are posed by neoliberal health sector reforms and donor practices. The paper concludes that even well-designed health systems based on PHC have little influence over the broader economic forces that shape their operation and their ability to improve health. Reforming these economic forces will require greater regulation of the national and global economic environment to emphasise people's health rather than private profit, and action to address climate change. Revitalisation of PHC and progress towards health equity are unlikely without strong regulation of the market. The further development and strengthening of social movements for health will be key to successful advocacy action.

A review of the empirical evidence of the value of structuring and coding of clinical information within electronic health records for direct patient care

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Dipak Kalra

2013-05-01

Full Text Available Background The case has historically been presented that structured and/or coded electronic health records (EHRs benefit direct patient care, but the evidence base for this is not well documented.Methods We searched for evidence of direct patient care value from the use of structured and/or coded information within EHRs. We interrogated nine international databases from 1990 to 2011. Value was defined using the Institute of Medicine’s six areas for improvement for healthcare systems: effectiveness, safety, patient-centredness, timeliness, efficiency and equitability. We included studies satisfying the Cochrane Effective Practice and Organisation of Care (EPOC group criteria.Results Of 5016 potentially eligible papers, 13 studies satisfied our criteria: 10 focused on effectiveness, with eight demonstrating potential for improved proxy and actual clinical outcomes if a structured and/or coded EHR was combined with alerting or advisory systems in a focused clinical domain. Three studies demonstrated improvement in safety outcomes. No studies were found reporting value in relation to patient-centredness, timeliness, efficiency or equitability.Conclusions We conclude that, to date, there has been patchy effort to investigate empirically the value from structuring and coding EHRs for direct patient care. Future investments in structuring and coding of EHRs should be informed by robust evidence as to the clinical scenarios in which patient care benefits may be realised.

Series: Clinical Epidemiology in South Africa. Paper 1: Evidence-based health care and policy in Africa: past, present, and future.

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Young, Taryn; Garner, Paul; Clarke, Mike; Volmink, Jimmy

2017-03-01

Africa has high disease burden and health system challenges but is making progress in recognizing, accepting, and adopting evidence-based health care (EBHC). In this article, we reflect on the developments of the past 2 decades and consider further steps that will help with the translation of reliable research results into the decision making process. There has been a rapid growth in various initiatives to promote EBHC in the African region. These include the conduct and reporting of primary and secondary research, research capacity development and supportive initiatives, access to information, and work with decision makers in getting research into clinical guidelines and health policies. Much, however, still needs to be done to improve the impact on health in the region. A multipronged approach consisting of regionally relevant well-conducted research addressing priority health problems, increased uptake of research in health care policy and practice, dedicated capacity development initiatives to support the conduct as well as use of research, facilitated by wider collaboration, and equitable partnerships will be important. Working together in mutually supporting partnerships is key to advancing both evidence-informed health care practices and better health. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Equity in access to health care in a rural population in Malaysia: A cross-sectional study.

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Lim, Ka Keat; Sivasampu, Sheamini; Mahmud, Fatihah

2017-04-01

To examine the extent of equity in access to health care, their determinants and reasons of unmet need of a rural population in Malaysia. Exploratory cross-sectional survey administered by trained interviewers among participants of a health screening program. A rural plantation estate in the West Coast of Peninsular Malaysia. One hundred and thirty out of 142 adults above 18 years old who attended the program. Percentages of respondents reporting realised access and unmet need to health care, determinants of both access indicators and reasons for unmet need. Realised access associated with need but not predisposing or enabling factors and unmet need not associated with any variables were considered equitable. A total of 88 (67.7%) respondents had visited a doctor (realised access) in the past 6 months and 24.8% (n = 31) experienced unmet need in the past 12 months. Using logistic regression, realised access was associated with presence of chronic disease (OR 6.97, P  RM 2000 per month) (OR 51.27, P population, the latter associated with education level, subjective health status and income. Despite not being generalisable, the findings highlight the need for a national level study on equity in access before the country reforms its health system. © 2016 National Rural Health Alliance Inc.

Equitable Financial Evaluation Method for Public-Private Partnership Projects

Institute of Scientific and Technical Information of China (English)

KE Yongjian; LIU Xinping; WANG Shouqing

2008-01-01

The feasibility study of a public-private partnership (PPP) project is regarded as one of the critical factors for successful implementation,but unfortunately the common financial evaluation methods currently used only represent the benefits of the private sector.There is,therefore,an urgent need to develop an equitable financial evaluation method for PPP projects.This paper presents a comprehensive literature review that examines international practices.An equitable financial evaluation method was then developed taking into account the inherent characteristics of PPP projects using six separate indicators and Monte Carlo simulations.The result for a bridge project in Romania shows that the method combines the viewpoints of all the relevant stakeholders to achieve an equitable financial evaluation of PPP projects.

'Expanding your mind': the process of constructing gender-equitable masculinities in young Nicaraguan men participating in reproductive health or gender training programs.

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Torres, Virgilio Mariano Salazar; Goicolea, Isabel; Edin, Kerstin; Ohman, Ann

2012-01-01

Traditional forms of masculinity strongly influence men's and women's wellbeing. This study has two aims: (i) to explore notions of various forms of masculinities in young Nicaraguan men participating in programs addressing sexual health, reproductive health, and/or gender equality and (ii) to find out how these young men perceive their involvement in actions aimed at reducing violence against women (VAW). A qualitative grounded theory study. Data were collected through six focus groups and two in-depth interviews with altogether 62 young men. Our analysis showed that the informants experienced a process of change, labeled 'Expanding your mind', in which we identified four interrelated subcategories: The apprentice, The responsible/respectful man, The proactive peer educator, and 'The feminist man'. The process showed how an increased awareness of gender inequities facilitated the emergence of values (respect and responsibility) and behavior (thoughtful action) that contributed to increase the informant's critical thinking and agency at individual, social, and political levels. The process was influenced by individual and external factors. Multiple progressive masculinities can emerge from programs challenging patriarchy in this Latin American setting. The masculinities identified in this study show a range of attitudes and behaviors; however, all lean toward more equitable gender relations. The results suggest that learning about sexual and reproductive health does not directly imply developing more gender-equitable attitudes and behaviors or a greater willingness to prevent VAW. It is paramount that interventions to challenge machismo in this setting continue and are expanded to reach more young men.

Accessibility and equity of health and social care services: exploring the views and experiences of Bangladeshi carers in South Wales, UK.

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Merrell, Joy; Kinsella, Faye; Murphy, Fiona; Philpin, Sue; Ali, Amina

2006-05-01

There is a paucity of information regarding the extent and nature of caring provided by minority ethnic communities. The proportion of older people from these communities will dramatically increase in the next 20 years, which will be accompanied by increasing health and social care needs and an increased demand for carers. A qualitative, exploratory study was conducted to identify the health and social care needs of informal carers, who were caring for a dependent adult from a Bangladeshi community in South Wales, UK. This paper focuses on Bangladeshi carers' access to formal support services provided by the statutory, private and voluntary sectors to assist them with their caring responsibilities. The findings are based on data collected using face-to-face, focused interviews with 20 Bangladeshi carers. Purposive and snowball sampling were used to recruit the sample. The data were analysed using thematic content analysis. The dimensions of accessibility and equity of quality of care were drawn upon to aid understanding of the findings. Bangladeshi carers faced a number of barriers in accessing health and social service provision, which impeded uptake of these services. Additionally, there was evidence of inequity in service provision. Recommendations for improving the accessibility of health and social care services are proposed, which may assist in promoting more equitable services for carers from the Bangladeshi community.

The Canadian health care system: a model for American to emulate?

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Naylor, C D

1992-04-01

The American health care system has the world's highest per capita costs and over 30 million citizens uninsured. The neighbouring Canadian system provides coverage for all basic medical and hospital services, at costs per capita that are about US$700 lower. Single-agency public funding allows tighter control of Canadian expenditures, and reduces administrative overheads. Hospitals are run as non-profit private corporations, funded primarily by a fixed annual allocation for operating costs. Most physicians are in private fee-for-service practice, but cannot charge more than the insured tariff negotiated between their provincial government and medical association. This approach, while attractive in its decentralization, tends to separate the funding and management of clinical services. Thus, hospital information systems lag a decade behind the USA, managed care initiatives are few, health maintenance organisations do not exist, and experimentation with alternative funding or delivery systems has been sporadic. Strengths of the system compared to the USA include: higher patient satisfaction, universal coverage, slightly better cost containment, higher hospital occupancy rates, and reduction in income-related rationing with more equitable distribution of services. Weaknesses in common with the United States are: cost escalation consistently outstripping the consumer price index with costs per capita second highest in the world, ever rising consumption of services per capita, inadequate manpower planning and physician maldistribution, poor regional co-ordination of services, inadequate quality assurance and provider frustration. Additional weaknesses include: an emerging funding crisis caused by the massive federal deficit, less innovation in management and delivery of care as compared to the USA, implicit rationing with long waiting lists for some services, and recurrent provider-government conflicts that have reduced goodwill among stakeholders. Thus, while the

Associations among socioeconomic status, patterns of care and outcomes in breast cancer patients in a universal health care system: Ontario's experience.

Science.gov (United States)

Kumachev, Alexander; Trudeau, Maureen E; Chan, Kelvin K W

2016-03-15

The Canadian health care system provides equitable access to equivalent standards of care. The authors investigated to determine whether patients with breast cancer who had different socioeconomic status (SES) received different care and had different overall survival (OS) in Ontario, Canada. Women who were diagnosed with breast cancer between 2004 and 2009 were identified from the Ontario Cancer Registry and linked to provincial databases to ascertain patient demographics, screening, diagnosis, treatment patterns, and survival. SES was defined as neighborhood income by postal code and was divided into income quintiles (Q1-Q5; with Q5 the highest SES quintile). Univariable and multivariable analyses were used to examine the associations between: 1) SES and mammogram screening and breast cancer treatments, and 2) SES and OS. In total, 34,776 patients with breast cancer who had information on disease stage available at diagnosis were identified. Seventy-six percent of women were aged >50 years. Patients with higher SES were more likely to be diagnosed at an earlier stage (Q5 [44.3%] vs Q1 [37.7%]; odds ratio [OR], 1.31; 95% confidence interval [CI], 1.23-1.41; P cancer stage at diagnosis, adjuvant chemotherapy, trastuzumab, radiotherapy and surgery types, higher SES remained associated with better OS (P = .0017). In a universal health care system, higher SES is associated with greater screening and treatments and with better OS after adjusting for screening, cancer stage at diagnosis, and treatments. © 2015 American Cancer Society.

Reforming the health care system: implications for health care marketers.

Science.gov (United States)

Petrochuk, M A; Javalgi, R G

1996-01-01

Health care reform has become the dominant domestic policy issue in the United States. President Clinton, and the Democratic leaders in the House and Senate have all proposed legislation to reform the system. Regardless of the plan which is ultimately enacted, health care delivery will be radically changed. Health care marketers, given their perspective, have a unique opportunity to ensure their own institutions' success. Organizational, managerial, and marketing strategies can be employed to deal with the changes which will occur. Marketers can utilize personal strategies to remain proactive and successful during an era of health care reform. As outlined in this article, responding to the health care reform changes requires strategic urgency and action. However, the strategies proposed are practical regardless of the version of health care reform legislation which is ultimately enacted.

‘Expanding your mind’: the process of constructing gender-equitable masculinities in young Nicaraguan men participating in reproductive health or gender training programs

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Torres, Virgilio Mariano Salazar; Goicolea, Isabel; Edin, Kerstin; Öhman, Ann

2012-01-01

Background Traditional forms of masculinity strongly influence men's and women's wellbeing. Objective This study has two aims: (i) to explore notions of various forms of masculinities in young Nicaraguan men participating in programs addressing sexual health, reproductive health, and/or gender equality and (ii) to find out how these young men perceive their involvement in actions aimed at reducing violence against women (VAW). Design A qualitative grounded theory study. Data were collected through six focus groups and two in-depth interviews with altogether 62 young men. Results Our analysis showed that the informants experienced a process of change, labeled ‘Expanding your mind’, in which we identified four interrelated subcategories: The apprentice, The responsible/respectful man, The proactive peer educator, and ‘The feminist man’. The process showed how an increased awareness of gender inequities facilitated the emergence of values (respect and responsibility) and behavior (thoughtful action) that contributed to increase the informant's critical thinking and agency at individual, social, and political levels. The process was influenced by individual and external factors. Conclusions Multiple progressive masculinities can emerge from programs challenging patriarchy in this Latin American setting. The masculinities identified in this study show a range of attitudes and behaviors; however, all lean toward more equitable gender relations. The results suggest that learning about sexual and reproductive health does not directly imply developing more gender-equitable attitudes and behaviors or a greater willingness to prevent VAW. It is paramount that interventions to challenge machismo in this setting continue and are expanded to reach more young men. PMID:22870066

‘Expanding your mind’: the process of constructing gender-equitable masculinities in young Nicaraguan men participating in reproductive health or gender training programs

Directory of Open Access Journals (Sweden)

Virgilio Mariano Salazar Torres

2012-08-01

Full Text Available Background: Traditional forms of masculinity strongly influence men's and women's wellbeing. Objective: This study has two aims: (i to explore notions of various forms of masculinities in young Nicaraguan men participating in programs addressing sexual health, reproductive health, and/or gender equality and (ii to find out how these young men perceive their involvement in actions aimed at reducing violence against women (VAW. Design: A qualitative grounded theory study. Data were collected through six focus groups and two in-depth interviews with altogether 62 young men. Results: Our analysis showed that the informants experienced a process of change, labeled ‘Expanding your mind’, in which we identified four interrelated subcategories: The apprentice, The responsible/respectful man, The proactive peer educator, and ‘The feminist man’. The process showed how an increased awareness of gender inequities facilitated the emergence of values (respect and responsibility and behavior (thoughtful action that contributed to increase the informant's critical thinking and agency at individual, social, and political levels. The process was influenced by individual and external factors. Conclusions: Multiple progressive masculinities can emerge from programs challenging patriarchy in this Latin American setting. The masculinities identified in this study show a range of attitudes and behaviors; however, all lean toward more equitable gender relations. The results suggest that learning about sexual and reproductive health does not directly imply developing more gender-equitable attitudes and behaviors or a greater willingness to prevent VAW. It is paramount that interventions to challenge machismo in this setting continue and are expanded to reach more young men.

The Contribution of Equitation Science to Minimising Horse-Related Risks to Humans

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Melissa Starling

2016-02-01

Full Text Available Equitation science is an evidence-based approach to horse training and riding that focuses on a thorough understanding of both equine ethology and learning theory. This combination leads to more effective horse training, but also plays a role in keeping horse riders and trainers safe around horses. Equitation science underpins ethical equitation, and recognises the limits of the horse’s cognitive and physical abilities. Equitation is an ancient practice that has benefited from a rich tradition that sees it flourishing in contemporary sporting pursuits. Despite its history, horse-riding is an activity for which neither horses nor humans evolved, and it brings with it significant risks to the safety of both species. This review outlines the reasons horses may behave in ways that endanger humans and how training choices can exacerbate this. It then discusses the recently introduced 10 Principles of Equitation Science and explains how following these principles can minimise horse-related risk to humans and enhance horse welfare.

COMMUNITY HEALTH & PRIMARY HEALTH CARE

African Journals Online (AJOL)

care policy which was intended to make health care which of the two alternative methods of health care available to individuals and families in the financing options of free health or DRF was community at very little or no cost at all. However, preferred by the community members within most health facilities would appear to ...

Health equity in the New Zealand health care system: a national survey

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Doughty Robert

2011-10-01

Full Text Available Abstract Introduction In all countries people experience different social circumstances that result in avoidable differences in health. In New Zealand, Māori, Pacific peoples, and those with lower socioeconomic status experience higher levels of chronic illness, which is the leading cause of mortality, morbidity and inequitable health outcomes. Whilst the health system can enable a fairer distribution of good health, limited national data is available to measure health equity. Therefore, we sought to find out whether health services in New Zealand were equitable by measuring the level of development of components of chronic care management systems across district health boards. Variation in provision by geography, condition or ethnicity can be interpreted as inequitable. Methods A national survey of district health boards (DHBs was undertaken on macro approaches to chronic condition management with detail on cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, stroke and diabetes. Additional data from expert informant interviews on program reach and the cultural needs of Māori and Pacific peoples was sought. Survey data were analyzed on dimensions of health equity relevant to strategic planning and program delivery. Results are presented as descriptive statistics and free text. Interviews were transcribed and NVivo 8 software supported a general inductive approach to identify common themes. Results Survey responses were received from the majority of DHBs (15/21, some PHOs (21/84 and 31 expert informants. Measuring, monitoring and targeting equity is not systematically undertaken. The Health Equity Assessment Tool is used in strategic planning but not in decisions about implementing or monitoring disease programs. Variable implementation of evidence-based practices in disease management and multiple funding streams made program implementation difficult. Equity for Māori is embedded in policy, this is not so

Using Administrative Health Data to Identify Individuals with Intellectual and Developmental Disabilities: A Comparison of Algorithms

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Lin, E.; Balogh, R.; Cobigo, V.; Ouellette-Kuntz, H.; Wilton, A. S.; Lunsky, Y.

2013-01-01

Background: Individuals with intellectual and developmental disabilities (IDD) experience high rates of physical and mental health problems; yet their health care is often inadequate. Information about their characteristics and health services needs is critical for planning efficient and equitable services. A logical source of such information is…

Efficient and equitable HIV prevention: A case study of male circumcision in South Africa

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Verguet Stéphane

2013-01-01

Full Text Available Abstract Background We determine efficient, equitable and mixed efficient-equitable allocations of a male circumcision (MC intervention reducing female to male HIV transmission in South Africa (SA, as a case study of an efficiency-equity framework for resource allocation in HIV prevention. Methods We present a mathematical model developed with epidemiological and cost data from the nine provinces of SA. The hypothetical one-year-long MC intervention with a budget of US$ 10 million targeted adult men 15–49 years of age in SA. The intervention was evaluated according to two criteria: an efficiency criterion, which focused on maximizing the number of HIV infections averted by the intervention, and an equity criterion (defined geographically, which focused on maximizing the chance that each male adult individual had access to the intervention regardless of his province. Results A purely efficient intervention would prevent 4,008 HIV infections over a year. In the meantime, a purely equitable intervention would avert 3,198 infections, which represents a 20% reduction in infection outcome as compared to the purely efficient scenario. A half efficient-half equitable scenario would prevent 3,749 infections, that is, a 6% reduction in infection outcome as compared to the purely efficient scenario. Conclusions This paper provides a framework for resource allocation in the health sector which incorporates a simple equity metric in addition to efficiency. In the specific context of SA with a MC intervention for the prevention of HIV, incorporation of geographical equity only slightly reduces the overall efficiency of the intervention.

Pursuing equity: contact with primary care and specialist clinicians by demographics, insurance, and health status.

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Ferrer, Robert L

2007-01-01

Long-term shifts in specialty choice and health workforce policy have raised concern about the future of primary care in the United States. The objective of this study was to examine current use of primary and specialty care across the US population for policy-relevant subgroups, such as disadvantaged populations and persons with chronic illness. Data from the Medical Expenditure Panel Survey from 2004 were analyzed using a probability sample patients or other participants from the noninstitutionalized US population in 2004 (N = 34,403). The main and secondary outcome measures were the estimates of the proportion of Americans who accessed different types of primary care and specialty physicians and midlevel practitioners, as well as the fraction of ambulatory visits accounted for by the different clinician types. Data were disaggregated by income, health insurance status, race/ethnicity, rural or urban residence, and presence of 5 common chronic diseases. Family physicians were the most common clinician type accessed by adults, seniors, and reproductive-age women, and they were second to pediatricians for children. Disadvantaged adults with 3 markers of disadvantage (poverty, disadvantaged minority, uninsured) received 45.6% (95% CI, 40.4%-50.7%) of their ambulatory visits from family physicians vs 30.5% (95% CI, 30.0%-32.1%) for adults with no markers. For children with 3 vs 0 markers of disadvantage, the proportion of visits from family physicians roughly doubled from 16.5% (95% CI, 14.4%-18.6%) to 30.1% (95% CI, 18.8%-41.2%). Family physicians constitute the only clinician group that does not show income disparities in access. Multivariate analyses show that patterns of access to family physicians and nurse-practitioners are more equitable than for other clinician types. Primary care clinicians, especially family physicians, deliver a disproportionate share of ambulatory care to disadvantaged populations. A diminished primary care workforce will leave

Resource flows for health care: Namibia reproductive health sub-accounts

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Mbeeli Thomas

2011-12-01

Full Text Available Abstract Background Implementing initiatives to achieve the targets of MDG 5 requires sufficient financial resources that are mobilized and utilized in an equitable, efficient and sustainable manner. Informed decision making to this end requires the availability of reliable health financing information. This is accomplished by means of Reproductive Health (RH sub-account, which captures and organizes expenditure on RH services in two-dimensional tables from financing sources to end users. The specific objectives of this study are: (i to quantify total expenditure on reproductive health services; and (ii to examine the flow of RH funds from sources to end users. Methods The RH sub-account was part of the general National Health Accounts exercise covering the Financial Years 2007/08 and 2008/09. Primary data were collected from employers, medical aid schemes, donors and government ministries using questionnaire. Secondary data were obtained from various documents of the Namibian Government and the health financing database of the World Health Organization. Data were analyzed using a data screen designed in Microsoft Excel. Results RH expenditure per woman of reproductive age was US$ 148 and US$ 126 in the 2007/08 and 2008/09 financial years respectively. This is by far higher than what is observed in most African countries. RH expenditure constituted more than 10-12% of the total expenditure on health. Out-of-pocket payment for RH was minimal (less than 4% of the RH spending in both years. Government is the key source of RH spending. Moreover, the public sector is the main financing agent with programmatic control of RH funds and also the main provider of services. Most of the RH expenditure is spent on services of curative care (both in- and out-patient. The proportion allocated for preventive and public health services was not more than 5% in the two financial years. Conclusion Namibia's expenditure on reproductive health is remarkable by the

Resource flows for health care: Namibia reproductive health sub-accounts.

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Mbeeli, Thomas; Samahiya, Muine; Ravishankar, Nirmala; Zere, Eyob; Kirigia, Joses M

2011-12-24

Implementing initiatives to achieve the targets of MDG 5 requires sufficient financial resources that are mobilized and utilized in an equitable, efficient and sustainable manner. Informed decision making to this end requires the availability of reliable health financing information. This is accomplished by means of Reproductive Health (RH) sub-account, which captures and organizes expenditure on RH services in two-dimensional tables from financing sources to end users. The specific objectives of this study are: (i) to quantify total expenditure on reproductive health services; and (ii) to examine the flow of RH funds from sources to end users. The RH sub-account was part of the general National Health Accounts exercise covering the Financial Years 2007/08 and 2008/09. Primary data were collected from employers, medical aid schemes, donors and government ministries using questionnaire. Secondary data were obtained from various documents of the Namibian Government and the health financing database of the World Health Organization. Data were analyzed using a data screen designed in Microsoft Excel. RH expenditure per woman of reproductive age was US$ 148 and US$ 126 in the 2007/08 and 2008/09 financial years respectively. This is by far higher than what is observed in most African countries. RH expenditure constituted more than 10-12% of the total expenditure on health. Out-of-pocket payment for RH was minimal (less than 4% of the RH spending in both years). Government is the key source of RH spending. Moreover, the public sector is the main financing agent with programmatic control of RH funds and also the main provider of services. Most of the RH expenditure is spent on services of curative care (both in- and out-patient). The proportion allocated for preventive and public health services was not more than 5% in the two financial years. Namibia's expenditure on reproductive health is remarkable by the standards of Africa and other middle-income countries. However

Health and legal literacy for migrants: twinned strands woven in the cloth of social justice and the human right to health care.

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Vissandjée, Bilkis; Short, Wendy E; Bates, Karine

2017-04-13

Based on an analysis of published literature, this paper provides an over-view of the challenges associated with delivering on the right to access quality health care for international migrants to industrialized countries, and asks which group of professionals is best equipped to provide services that increase health and legal literacy. Both rights and challenges are approached from a social justice perspective with the aim of identifying opportunities to promote greater health equity. That is, to go beyond the legal dictates enshrined in principles of equality, and target as an ethical imperative a situation where all migrants receive the particular assistance they need to overcome the barriers that inhibit their equitable access to health care. This assistance is especially important for migrant groups that are further disadvantaged by differing cultural constructions of gender. Viewing the topic from this perspective makes evident a gap in both research literature and policy. The review has found that while health literacy is debated and enshrined as a policy objective, and consideration is given to improving legal literacy as a means of challenging social injustice in developing nations, however, no discussion has been identified that considers assisting migrants to gain legal literacy as a step toward achieving not only health literacy and improved health outcomes, but critical participation as members of their adoptive society. Increasing migrant health literacy, amalgamated with legal literacy, aids migrants to better access their human right to appropriate care, which in turn demonstrably assists in increasing social engagement, citizenship and productivity. However what is not evident in the literature, is which bureaucratic or societal group holds responsibility for assisting migrants to develop critical citizenship literacy skills. This paper proposes that a debate is required to determine both who is best placed to provide services that increase health

From decentralization to commonization of HIV healthcare resources: keys to reduction in health disparity and equitable distribution of health services in Nigeria.

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Oleribe, Obinna Ositadimma; Oladipo, Olabisi Abiodun; Ezieme, Iheaka Paul; Crossey, Mary Margaret Elizabeth; Taylor-Robinson, Simon David

2016-01-01

Access to quality care is essential for improved health outcomes. Decentralization improves access to healthcare services at lower levels of care, but it does not dismantle structural, funding and programming restrictions to access, resulting in inequity and inequality in population health. Unlike decentralization, Commonization Model of care reduces health inequalities and inequity, dismantles structural, funding and other program related obstacles to population health. Excellence and Friends Management Care Center (EFMC) using Commonization Model (CM), fully integrated HIV services into core health services in 121 supported facilities. This initiative improved access to care, treatment, support services, reduced stigmatization/discrimination, and improved uptake of HTC. We call on governments to adequately finance CM for health systems restructuring towards better health outcomes.

[The Telehealth Network of the Americas and its role in primary health care].

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Bill, Guillermo; Crisci, Carlos D; Canet, Tomislav

2014-01-01

The need to guarantee equitable access to health regardless of geographic, economic, or technological barriers motivated the Member States of the Organization of American States to create the Telehealth Network of the Americas, coordinated by the Inter-American Telecommunication Committee. The Network focuses on the use of new information and communications technology applied to health, based on the values of respect, equity, and solidarity and mandated by the philosophy of primary health. Its members include government agencies, nongovernmental organizations, university forums, hospital federations, and telecommunications companies, and it has already extended its reach to other continents and to different fields in which telemedicine is being used. Among its first achievements, it has implemented an innovative tool to be used in cases of disaster or limited geographic access. This mobile telemedicine station is housed in a portable case that includes a computer, various digital devices (otoscope, ophthalmoscope, microscope, dermatoscope), a high-resolution digital camera, an X-ray film viewer, and a satellite antenna. With this tool, it is possible to provide specialized support for rural physicians and primary health care workers located far from large urban centers.

What Makes Health Care Special?: An Argument for Health Care Insurance.

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Horne, L Chad

2017-01-01

While citizens in a liberal democracy are generally expected to see to their basic needs out of their own income shares, health care is treated differently. Most rich liberal democracies provide their citizens with health care or health care insurance in kind. Is this "special" treatment justified? The predominant liberal account of justice in health care holds that the moral importance of health justifies treating health care as special in this way. I reject this approach and offer an alternative account. Health needs are not more important than other basic needs, but they are more unpredictable. I argue that citizens are owed access to insurance against health risks to provide stability in their future expectations and thus to protect their capacities for self-determination.

Socioeconomic differences in self-rated oral health and dental care utilisation after the dental care reform in 2008 in Sweden.

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Molarius, Anu; Engström, Sevek; Flink, Håkan; Simonsson, Bo; Tegelberg, Ake

2014-11-18

The aims of this study were to determine self-rated oral health and dental attendance habits among Swedish adults, with special reference to the role of social inequalities, after the Swedish dental care reform in 2008. The study is based on a survey questionnaire, sent to 12,235 residents of a Swedish county, in 2012. The age group was 16-84 years: 5,999 (49%) responded. Using chi-square statistics, differences in prevalence of self-rated oral health and regular dental attendance were analysed with respect to gender, age, educational level, family status, employment status and country of birth. Self-rated poor oral health was analysed by multivarite logistic regression adjusting for the different socio-demographic factors, financial security and having refrained from dental treatment for financial reasons. Three out of four respondents (75%) reported fairly good or very good oral health. Almost 90% claimed to be regular dental attenders. Those who were financially secure reported better oral health. The differences in oral health between those with a cash margin and those without were large whereas the differences between age groups were rather small. About 8% reported that they had refrained from dental treatment for financial reasons during the last three months. Self-rated poor oral health was most common among the unemployed, those on disability pension or on long-term sick leave, those born outside the Nordic countries and those with no cash margin (odds ratios ranging from 2.4 to 4.4). The most important factor contributing to these differences was having refrained from dental treatment for financial reasons. The results are relevant to strategies intended to reduce social inequalities in oral health, affirming the importance of the provision of equitable access to dental care.

20 CFR 222.57 - When an equitably adopted child is dependent.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false When an equitably adopted child is dependent. 222.57 Section 222.57 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT FAMILY RELATIONSHIPS Child Support and Dependency § 222.57 When an equitably adopted child is...

Towards an Equitable Development of Telecommunications ...

African Journals Online (AJOL)

Present and future equitable development of telecommunications services calls for an immediate development of an indigenous telecommunications technology capability in order to effectively and efficiently utilizes the services provided by the country's presently imported telecommunications systems while at the same time ...

Socioeconomic patterns in the use of public and private health services and equity in health care

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Ortega Paloma

2008-09-01

Full Text Available Abstract Background Several studies in wealthy countries suggest that utilization of GP and hospital services, after adjusting for health care need, is equitable or pro-poor, whereas specialist care tends to favour the better off. Horizontal equity in these studies has not been evaluated appropriately, since the use of healthcare services is analysed without distinguishing between public and private services. The purpose of this study is to estimate the relation between socioeconomic position and health services use to determine whether the findings are compatible with the attainment of horizontal equity: equal use of public healthcare services for equal need. Methods Data from a sample of 18,837 Spanish subjects were analysed to calculate the percentage of use of public and private general practitioner (GP, specialist and hospital care according to three indicators of socioeconomic position: educational level, social class and income. The percentage ratio was used to estimate the magnitude of the relation between each measure of socioeconomic position and the use of each health service. Results After adjusting for age, sex and number of chronic diseases, a gradient was observed in the magnitude of the percentage ratio for public GP visits and hospitalisation: persons in the lowest socioeconomic position were 61–88% more likely to visit public GPs and 39–57% more likely to use public hospitalisation than those in the highest socioeconomic position. In general, the percentage ratio did not show significant socioeconomic differences in the use of public sector specialists. The magnitude of the percentage ratio in the use of the three private services also showed a socioeconomic gradient, but in exactly the opposite direction of the gradient observed in the public services. Conclusion These findings show inequity in GP visits and hospitalisations, favouring the lower socioeconomic groups, and equity in the use of the specialist physician. These

Associations of family-centered care with health care outcomes for children with special health care needs.

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Kuo, Dennis Z; Bird, T Mac; Tilford, J Mick

2011-08-01

The objective of this study is to examine the association of family-centered care (FCC) with specific health care service outcomes for children with special health care needs (CSHCN). The study is a secondary analysis of the 2005-2006 National Survey of Children with Special Health Care Needs. Receipt of FCC was determined by five questions regarding how well health care providers addressed family concerns in the prior 12 months. We measured family burden by reports of delayed health care, unmet need, financial costs, and time devoted to care; health status, by stability of health care needs; and emergency department and outpatient service use. All statistical analyses used propensity score-based matching models to address selection bias. FCC was reported by 65.6% of respondents (N = 38,915). FCC was associated with less delayed health care (AOR: 0.56; 95% CI: 0.48, 0.66), fewer unmet service needs (AOR: 0.53; 95% CI: 0.47, 0.60), reduced odds of ≥1 h/week coordinating care (AOR: 0.83; 95% CI: 0.74, 0.93) and reductions in out of pocket costs (AOR: 0.88; 95% CI: 0.80, 0.96). FCC was associated with more stable health care needs (AOR: 1.11; 95% CI: 1.01, 1.21), reduced odds of emergency room visits (AOR: 0.90; 95% CI: 0.82, 0.99) and increased odds of doctor visits (AOR: 1.25; 95% CI: 1.14, 1.37). Our study demonstrates associations of positive health and family outcomes with FCC. Realizing the health care delivery benefits of FCC may require additional encounters to build key elements of trust and partnership.

"A constant struggle to receive mental health care": health care professionals' acquired experience of barriers to mental health care services in Rwanda.

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Rugema, Lawrence; Krantz, Gunilla; Mogren, Ingrid; Ntaganira, Joseph; Persson, Margareta

2015-12-16

In Rwanda, many people are still mentally affected by the consequences of the genocide and yet mental health care facilities are scarce. While available literature explains the prevalence and consequences of mental disorders, there is lack of knowledge from low-income countries on health care seeking behavior due to common mental disorders. Therefore, this study sought to explore health care professionals' acquired experiences of barriers and facilitators that people with common mental disorders face when seeking mental health care services in Rwanda. A qualitative approach was applied and data was collected from six focus group discussions (FGDs) conducted in October 2012, including a total of 43 health care professionals, men and women in different health professions. The FGDs were performed at health facilities at different care levels. Data was analyzed using manifest and latent content analysis. The emerging theme "A constant struggle to receive mental health care for mental disorders" embraced a number of barriers and few facilitators at individual, family, community and structural levels that people faced when seeking mental health care services. Identified barriers people needed to overcome were: Poverty and lack of family support, Fear of stigmatization, Poor community awareness of mental disorders, Societal beliefs in traditional healers and prayers, Scarce resources in mental health care and Gender imbalance in care seeking behavior. The few facilitators to receive mental health care were: Collaboration between authorities and organizations in mental health and having a Family with awareness of mental disorders and health insurance. From a public health perspective, this study revealed important findings of the numerous barriers and the few facilitating factors available to people seeking health for mental disorders. Having a supportive family with awareness of mental disorders who also were equipped with a health insurance was perceived as vital for

Consolidating the social health insurance schemes in China: towards an equitable and efficient health system.

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Meng, Qingyue; Fang, Hai; Liu, Xiaoyun; Yuan, Beibei; Xu, Jin

2015-10-10

Fragmentation in social health insurance schemes is an important factor for inequitable access to health care and financial protection for people covered by different health insurance schemes in China. To fulfil its commitment of universal health coverage by 2020, the Chinese Government needs to prioritise addressing this issue. After analysing the situation of fragmentation, this Review summarises efforts to consolidate health insurance schemes both in China and internationally. Rural migrants, elderly people, and those with non-communicable diseases in China will greatly benefit from consolidation of the existing health insurance schemes with extended funding pools, thereby narrowing the disparities among health insurance schemes in fund level and benefit package. Political commitments, institutional innovations, and a feasible implementation plan are the major elements needed for success in consolidation. Achievement of universal health coverage in China needs systemic strategies including consolidation of the social health insurance schemes. Copyright © 2015 Elsevier Ltd. All rights reserved.

The determinants of long-term care utilization and equity of access to care among older adults in Dong-Ku of Incheon Metropolitan city, South Korea.

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Park, J M

2005-01-01

Under the current health care system, around three percent of the elderly remain uninsured. Based on the 2003 Dong-Ku Health Status Survey and the Aday and Andersen Access Framework, the present study examined the social and behavioral determinants of long-term care utilization and the extent to which equity in the use of long-term care services for the elderly has been achieved. The results indicate that universal health insurance system has not yielded a fully equitable distribution of services. Type of coverage and resource availability do not remain predictors of long-term care utilization. The data suggest that a universal health insurance system exists in South Korea with significant access problems for the population without insurance. Access differences also arise from obstacles in expanding the scope and level of plan benefits due to financial disparity among insurers. Health policy reforms must continue to concentrate on extending insurance coverage to the uninsured and establishing long-term insurance system for the elderly.

Nurse practitioner perceptions of barriers and facilitators in providing health care for deaf American Sign Language users: A qualitative socio-ecological approach.

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Pendergrass, Kathy M; Nemeth, Lynne; Newman, Susan D; Jenkins, Carolyn M; Jones, Elaine G

2017-06-01

Nurse practitioners (NPs), as well as all healthcare clinicians, have a legal and ethical responsibility to provide health care for deaf American Sign Language (ASL) users equal to that of other patients, including effective communication, autonomy, and confidentiality. However, very little is known about the feasibility to provide equitable health care. The purpose of this study was to examine NP perceptions of barriers and facilitators in providing health care for deaf ASL users. Semistructured interviews in a qualitative design using a socio-ecological model (SEM). Barriers were identified at all levels of the SEM. NPs preferred interpreters to facilitate the visit, but were unaware of their role in assuring effective communication is achieved. A professional sign language interpreter was considered a last resort when all other means of communication failed. Gesturing, note-writing, lip-reading, and use of a familial interpreter were all considered facilitators. Interventions are needed at all levels of the SEM. Resources are needed to provide awareness of deaf communication issues and legal requirements for caring for deaf signers for practicing and student NPs. Protocols need to be developed and present in all healthcare facilities for hiring interpreters as well as quick access to contact information for these interpreters. ©2017 American Association of Nurse Practitioners.

Advancing LGBT Health Care Policies and Clinical Care Within a Large Academic Health Care System: A Case Study.

Science.gov (United States)

Ruben, Mollie A; Shipherd, Jillian C; Topor, David; AhnAllen, Christopher G; Sloan, Colleen A; Walton, Heather M; Matza, Alexis R; Trezza, Glenn R

2017-01-01

Culturally competent health care is especially important among sexual and gender minority patients because poor cultural competence contributes to health disparities. There is a need to understand how to improve health care quality and delivery for lesbian, gay, bisexual, and transgender (LGBT) veterans in particular, because they have unique physical and mental health needs as both LGBT individuals and veterans. The following article is a case study that focuses on the policy and clinical care practices related to LGBT clinical competency, professional training, and ethical provision of care for veteran patients in the VA Boston Healthcare System. We apply Betancourt et al.'s (2003) cultural competence framework to outline the steps that VA Boston Healthcare System took to increase cultural competency at the organizational, structural, and clinical level. By sharing our experiences, we aim to provide a model and steps for other health care systems and programs, including other VA health care systems, large academic health care systems, community health care systems, and mental health care systems, interested in developing LGBT health initiatives.

Acceptable care? Illness constructions, healthworlds, and accessible chronic treatment in South Africa.

Science.gov (United States)

Fried, Jana; Harris, Bronwyn; Eyles, John; Moshabela, Mosa

2015-05-01

Achieving equitable access to health care is an important policy goal, with access influenced by affordability, availability, and acceptability of specific services. We explore patient narratives from a 5-year program of research on health care access to examine relationships between social constructions of illness and the acceptability of health services in the context of tuberculosis treatment and antiretroviral therapy in South Africa. Acceptability of services seems particularly important to the meanings patients attach to illness and care, whereas-conversely-these constructions appear to influence what constitutes acceptability and hence affect access to care. We highlight the underestimated role of individually, socially, and politically constructed healthworlds; traditional and biomedical beliefs; and social support networks. Suggested policy implications for improving acceptability and hence overall health care access include abandoning patronizing approaches to care and refocusing from treating "disease" to responding to "illness" by acknowledging and incorporating patients' healthworlds in patient-provider interactions. © The Author(s) 2015.

Diagnosis of compliance of health care product processing in Primary Health Care

Directory of Open Access Journals (Sweden)

Camila Eugenia Roseira

Full Text Available ABSTRACT Objective: identify the compliance of health care product processing in Primary Health Care and assess possible differences in the compliance among the services characterized as Primary Health Care Service and Family Health Service. Method: quantitative, observational, descriptive and inferential study with the application of structure, process and outcome indicators of the health care product processing at ten services in an interior city of the State of São Paulo - Brazil. Results: for all indicators, the compliance indices were inferior to the ideal levels. No statistically significant difference was found in the indicators between the two types of services investigated. The health care product cleaning indicators obtained the lowest compliance index, while the indicator technical-operational resources for the preparation, conditioning, disinfection/sterilization, storage and distribution of health care products obtained the best index. Conclusion: the diagnosis of compliance of health care product processing at the services assessed indicates that the quality of the process is jeopardized, as no results close to ideal levels were obtained at any service. In addition, no statistically significant difference in these indicators was found between the two types of services studied.

Health care operations management

NARCIS (Netherlands)

Carter, M.W.; Hans, Elias W.; Kolisch, R.

2012-01-01

Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully

Holistic health care: Patients' experiences of health care provided by an Advanced Practice Nurse.

Science.gov (United States)

Eriksson, Irene; Lindblad, Monica; Möller, Ulrika; Gillsjö, Catharina

2018-02-01

Advanced Practice Nurse (APN) is a fairly new role in the Swedish health care system. To describe patients' experiences of health care provided by an APN in primary health care. An inductive, descriptive qualitative approach with qualitative open-ended interviews was chosen to obtain descriptions from 10 participants regarding their experiences of health care provided by an APN. The data were collected during the spring 2012, and a qualitative approach was used for analyze. The APNs had knowledge and skills to provide safe and secure individual and holistic health care with high quality, and a respectful and flexible approach. The APNs conveyed trust and safety and provided health care that satisfied the patients' needs of accessibility and appropriateness in level of care. The APNs way of providing health care and promoting health seems beneficial in many ways for the patients. The individual and holistic approach that characterizes the health care provided by the APNs is a key aspect in the prevailing change of health care practice. The transfer of care and the increasing number of older adults, often with a variety of complex health problems, call for development of the new role in this context. © 2017 The Authors. International Journal of Nursing Practice Published by John Wiley & Sons Australia, Ltd.

Oral Health Care Delivery Within the Accountable Care Organization.

Science.gov (United States)

Blue, Christine; Riggs, Sheila

2016-06-01

The accountable care organization (ACO) provides an opportunity to strategically design a comprehensive health system in which oral health works within primary care. A dental hygienist/therapist within the ACO represents value-based health care in action. Inspired by health care reform efforts in Minnesota, a vision of an accountable care organization that integrates oral health into primary health care was developed. Dental hygienists and dental therapists can help accelerate the integration of oral health into primary care, particularly in light of the compelling evidence confirming the cost-effectiveness of care delivered by an allied workforce. A dental insurance Chief Operating Officer and a dental hygiene educator used their unique perspectives and experience to describe the potential of an interdisciplinary team-based approach to individual and population health, including oral health, via an accountable care community. The principles of the patient-centered medical home and the vision for accountable care communities present a paradigm shift from a curative system of care to a prevention-based system that encompasses the behavioral, social, nutritional, economic, and environmental factors that impact health and well-being. Oral health measures embedded in the spectrum of general health care have the potential to ensure a truly comprehensive healthcare system. Published by Elsevier Inc.

Health Care Delivery.

Science.gov (United States)

Starfield, Barbara

1987-01-01

The article reviews emerging health care delivery options for handicapped children. Cost structures, quality of care, and future prospects are considered for Health Maintenance Organizations, Preferred Provider Organizations, Tax Supported Direct Service Programs, Hospital-Based Services, and Ambulatory Care Organizations. (Author/DB)

Equitable access to health insurance for socially excluded children? The case of the National Health Insurance Scheme (NHIS) in Ghana.

Science.gov (United States)

Williams, Gemma A; Parmar, Divya; Dkhimi, Fahdi; Asante, Felix; Arhinful, Daniel; Mladovsky, Philipa

2017-08-01

To help reduce child mortality and reach universal health coverage, Ghana extended free membership of the National Health Insurance Scheme (NHIS) to children (under-18s) in 2008. However, despite the introduction of premium waivers, a substantial proportion of children remain uninsured. Thus far, few studies have explored why enrolment of children in NHIS may remain low, despite the absence of significant financial barriers to membership. In this paper we therefore look beyond economic explanations of access to health insurance to explore additional wider determinants of enrolment in the NHIS. In particular, we investigate whether social exclusion, as measured through a sociocultural, political and economic lens, can explain poor enrolment rates of children. Data were collected from a cross-sectional survey of 4050 representative households conducted in Ghana in 2012. Household indices were created to measure sociocultural, political and economic exclusion, and logistic regressions were conducted to study determinants of enrolment at the individual and household levels. Our results indicate that socioculturally, economically and politically excluded children are less likely to enrol in the NHIS. Furthermore, households excluded in all dimensions were more likely to be non-enrolled or partially-enrolled (i.e. not all children enrolled within the household) than fully-enrolled. These results suggest that equity in access for socially excluded children has not yet been achieved. Efforts should be taken to improve coverage by removing the remaining small, annually renewable registration fee, implementing and publicising the new clause that de-links premium waivers from parental membership, establishing additional scheme administrative offices in remote areas, holding regular registration sessions in schools and conducting outreach sessions and providing registration support to female guardians of children. Ensuring equitable access to NHIS will contribute substantially

An Integrative Behavioral Health Care Model Using Automated SBIRT and Care Coordination in Community Health Care.

Science.gov (United States)

Dwinnells, Ronald; Misik, Lauren

2017-10-01

Efficient and effective integration of behavioral health programs in a community health care practice emphasizes patient-centered medical home principles to improve quality of care. A prospective, 3-period, interrupted time series study was used to explore which of 3 different integrative behavioral health care screening and management processes were the most efficient and effective in prompting behavioral health screening, identification, interventions, and referrals in a community health practice. A total of 99.5% ( P < .001) of medical patients completed behavioral health screenings; brief intervention rates nearly doubled to 83% ( P < .001) and 100% ( P < .001) of identified at-risk patients had referrals made using a combination of electronic tablets, electronic medical record, and behavioral health care coordination.

The Shifting Landscape of Health Care: Toward a Model of Health Care Empowerment

Science.gov (United States)

2011-01-01

In a rapidly changing world of health care information access and patients’ rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities. PMID:21164096

30 CFR 285.540 - How will MMS equitably distribute revenues to States?

Science.gov (United States)

2010-07-01

... 30 Mineral Resources 2 2010-07-01 2010-07-01 false How will MMS equitably distribute revenues to... Financial Assurance Requirements Revenue Sharing with States § 285.540 How will MMS equitably distribute revenues to States? (a) The MMS will distribute among the eligible coastal States 27 percent of the...

[Health care networks].

Science.gov (United States)

Mendes, Eugênio Vilaça

2010-08-01

The demographic and epidemiologic transition resulting from aging and the increase of life expectation means an increment related to chronic conditions. The healthcare systems contemporary crisis is characterized by the organization of the focus on fragmented systems turned to the acute conditions care, in spite of the chronic conditions prevalence, and by the hierarchical structure without communication flow among the different health care levels. Brazil health care situation profile is now presenting a triple burden of diseases, due to the concomitant presence of infectious diseases, external causes and chronic diseases. The solution is to restore the consistence between the triple burden of diseases on the health situation and the current system of healthcare practice, with the implantation of health care networks. The conclusion is that there are evidences in the international literature on health care networks that these networks may improve the clinical quality, the sanitation results and the user's satisfaction and the reduction of healthcare systems costs.

Primary health care service delivery networks for the prevention and management of type 2 diabetes: using social network methods to describe interorganisational collaboration in a rural setting.

Science.gov (United States)

McDonald, Julie; Jayasuriya, Rohan; Harris, Mark Fort

2011-01-01

Adults with type 2 diabetes or with behavioural risk factors require comprehensive and well coordinated responses from a range of health care providers who often work in different organisational settings. This study examines three types of collaborative links between organisations involved in a rural setting. Social network methods were employed using survey data on three types of links, and data was collected from a purposive sample of 17 organisations representing the major provider types. The analysis included a mix of unconfirmed and confirmed links, and network measures. General practices were the most influential provider group in initiating referrals, and they referred to the broadest range of organisations in the network. Team care arrangements formed a small part of the general practice referral network. They were used more for access to private sector allied health care providers and less for sharing care with public sector health services. Involvement in joint programs/activities was limited to public and non-government sector services, with no participation from the private sector. The patterns of interactions suggest that informal referral networks provide access to services and coordination of care for individual patients with diabetes. Two population subgroups would benefit from more proactive approaches to ensure equitable access to services and coordination of care across organisational boundaries: people with more complex health care needs and people at risk of developing diabetes.

Assessing the relevance of indicators in tracking social determinants and progress toward equitable population health in Brazil

Directory of Open Access Journals (Sweden)

Davide Rasella

2016-02-01

Full Text Available Background: The importance of the social determinants of health (SDH and barriers to the access and utilization of healthcare have been widely recognized but not previously studied in the context of universal healthcare coverage (UHC in Brazil and other developing countries. Objective: To evaluate a set of proposed indicators of SDH and barriers to the access and utilization of healthcare – proposed by the SDH unit of the World Health Organization – with respect to their relevance in tracking progress in moving toward equitable population health and UHC in Brazil. Design: This study had a mixed methodology, combining a quantitative analysis of secondary data from governmental sources with a qualitative study comprising two focus group discussions and six key informant interviews. The set of indicators tested covered a broad range of dimensions classified by three different domains: environment quality; accountability and inclusion; and livelihood and skills. Indicators were stratified according to income quintiles, urbanization, race, and geographical region. Results: Overall, the indicators were adequate for tracking progress in terms of the SDH, equity, gender, and human rights in Brazil. Stratifications showed inequalities. The qualitative analysis revealed that many of the indicators were well known and already used by policymakers and health sector managers, whereas others were considered less useful in the Brazilian context. Conclusions: Monitoring and evaluation practices have been developed in Brazil, and the set of indicators assessed in this study could further improve these practices, especially from a health equity perspective. Socioeconomic inequalities have been reduced in Brazil in the last decade, but there is still much work to be done in relation to addressing the SDH.

The Barrie Jones Lecture-Eye care for the neglected population: challenges and solutions.

Science.gov (United States)

Rao, G N

2015-01-01

Globally, pockets of 'neglected populations' do not have access to basic health-care services and carry a much greater risk of blindness and visual impairment. While large-scale public health approaches to control blindness due to vitamin A deficiency, onchocerciasis, and trachoma are successful, other causes of blindness still take a heavy toll in the population. High-quality comprehensive eye care that is equitable is the approach that needs wide-scale application to alleviate this inequity. L V Prasad Eye Institute of India developed a multi-tier pyramidal model of eye care delivery that encompasses all levels from primary to advanced tertiary (quaternary). This has demonstrated the feasibility of 'Universal Eye Health Coverage' covering promotive, preventive, corrective, and rehabilitative aspects of eye care. Using human resources with competency-based training, effective and cost-effective care could be provided to many disadvantaged people.

COMMUNITY HEALTH & PRIMARY HEALTH CARE

African Journals Online (AJOL)

the_monk

Journal of Community Medicine and Primary Health Care. 26 (1) 12-20 .... large proportions of the population work in the poor people use health care services far less than. 19 ... hypertension, cancers and road traffic accidents) below 1 dollar ...

Bridging miles to achieve milestones: Corporate social responsibility for primary health care.

Science.gov (United States)

Gulati, Ruchie

2017-01-01

Sustainable Developmental Goals aim to provide "Good health for all". The task though immense ,requires equitable and efficient distribution of health resources to the community, reached predominantly by the Primary Health Centres. Strengthening these centres is essential to attain the goal. Adequate health financing is one of the important determinants for utilizing the optimal potential of these centres . Pooling funds from alternate financing strategies as Corporate Social Responsibility (CSR) funds may give impetus and facilitate healthcare affordability to the underserved population. This convergence of vision of corporate funding for "basic health services" may bridge the gap arising out of inadequate funding and facilitate "Good Health for all" in India.

Embedding health literacy into health systems: a case study of a regional health service.

Science.gov (United States)

Vellar, Lucia; Mastroianni, Fiorina; Lambert, Kelly

2017-12-01

Objective The aim of the present study was to describe how one regional health service the Illawarra Shoalhaven Local Health District embedded health literacy principles into health systems over a 3-year period. Methods Using a case study approach, this article describes the development of key programs and the manner in which clinical incidents were used to create a health environment that allows consumers the right to equitably access quality health services and to participate in their own health care. Results The key outcomes demonstrating successful embedding of health literacy into health systems in this regional health service include the creation of a governance structure and web-based platform for developing and testing plain English consumer health information, a clearly defined process to engage with consumers, development of the health literacy ambassador training program and integrating health literacy into clinical quality improvement processes via a formal program with consumers to guide processes such as improvements to access and navigation around hospital sites. Conclusions The Illawarra Shoalhaven Local Health District has developed an evidence-based health literacy framework, guided by the core principles of universal precaution and organisational responsibility. Health literacy was also viewed as both an outcome and a process. The approach taken by the Illawarra Shoalhaven Local Health District to address poor health literacy in a coordinated way has been recognised by the Australian Commission on Safety and Quality in Health Care as an exemplar of a coordinated approach to embed health literacy into health systems. What is known about the topic? Poor health literacy is a significant national concern in Australia. The leadership, governance and consumer partnership culture of a health organisation can have considerable effects on an individual's ability to access, understand and apply the health-related information and services available to them

Digital health care--the convergence of health care and the Internet.

Science.gov (United States)

Frank, S R

2000-04-01

The author believes that interactive media (the Internet and the World Wide Web) and associated applications used to access those media (portals, browsers, specialized Web-based applications) will result in a substantial, positive, and measurable impact on medical care faster than any previous information technology or communications tool. Acknowledging the dynamic environment, the author classifies "pure" digital health care companies into three business service areas: content, connectivity, and commerce. Companies offering these services are attempting to tap into a host of different markets within the health care industry including providers, payers, pharmaceutical and medical products companies, employers, distributors, and consumers. As the fastest growing medium in history, and given the unique nature of health care information and the tremendous demand for content among industry professionals and consumers, the Internet offers a more robust and targeted direct marketing opportunity than traditional media. From the medical consumer's standpoint (i.e., the patient) the author sees the Internet as performing five critical functions: (1) Disseminate information, (2) Aid informed decision making, (3) Promote health, (4) Provide a means for information exchange and support--the community concept, and (5) Increase self-care and manage demand for health services, lowering direct medical costs. The author firmly submits the Web will provide overall benefits to the health care economy as health information consumers manage their own health problems that might not directly benefit from an encounter with a health professional. Marrying the Internet to other interactive technologies, including voice recognition systems and telephone-based triage lines among others, holds the promise of reducing unnecessary medical services.

Consumer Directed Health Care

OpenAIRE

John Goodman

2006-01-01

Consumer driven health care (CDHC) is a potential solution to two perplexing problems: (1) How to choose between health care and other uses of money, and (2) how to allocate resources in an industry where normal market forces have been systemically suppressed. In the consumer-driven model, consumers occupy the primary decision-making role regarding the health care that they receive. From an employee benefits perspective, consumer driven health care in the broadest sense may refer to limited e...

Mental health care roles of non-medical primary health and social care services.

Science.gov (United States)

Mitchell, Penny

2009-02-01

Changes in patterns of delivery of mental health care over several decades are putting pressure on primary health and social care services to increase their involvement. Mental health policy in countries like the UK, Australia and New Zealand recognises the need for these services to make a greater contribution and calls for increased intersectoral collaboration. In Australia, most investment to date has focused on the development and integration of specialist mental health services and primary medical care, and evaluation research suggests some progress. Substantial inadequacies remain, however, in the comprehensiveness and continuity of care received by people affected by mental health problems, particularly in relation to social and psychosocial interventions. Very little research has examined the nature of the roles that non-medical primary health and social care services actually or potentially play in mental health care. Lack of information about these roles could have inhibited development of service improvement initiatives targeting these services. The present paper reports the results of an exploratory study that examined the mental health care roles of 41 diverse non-medical primary health and social care services in the state of Victoria, Australia. Data were collected in 2004 using a purposive sampling strategy. A novel method of surveying providers was employed whereby respondents within each agency worked as a group to complete a structured survey that collected quantitative and qualitative data simultaneously. This paper reports results of quantitative analyses including a tentative principal components analysis that examined the structure of roles. Non-medical primary health and social care services are currently performing a wide variety of mental health care roles and they aspire to increase their involvement in this work. However, these providers do not favour approaches involving selective targeting of clients with mental disorders.

Operations management in health care.

Science.gov (United States)

Henderson, M D

1995-01-01

Health care operations encompass the totality of those health care functions that allow those who practice health care delivery to do so. As the health care industry undergoes dramatic reform, so will the jobs of those who manage health care delivery systems. Although health care operations managers play one of the most vital and substantial roles in the new delivery system, the criteria for their success (or failure) are being defined now. Yet, the new and vital role of the operations manager has been stunted in its development, which is primarily because of old and outdated antipathy between hospital administrators and physicians. This article defines the skills and characteristics of today's health care operations managers.

A Research Program on Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH: An International Collaboration

Directory of Open Access Journals (Sweden)

Walter P. Wodchis

2018-05-01

Full Text Available Health and social care systems across western developed nations are being challenged to meet the needs of an increasing number of people aging with multiple complex health and social needs. Community based primary health care (CBPHC has been associated with more equitable access to services, better population level outcomes and lower system level costs. Itmay be well suited to the increasingly complex needs of populations; however the implementation of CBPHC models of care faces many challenges. This paper describes a program of research by an international, multi-university, multidisciplinary research team who are seeking to understand how to scale up and spread models of Integrated CBPHC (ICBPHC. The key question being addressed is “What are the steps to implementing innovative integrated community-based primary health care models that address the health and social needs of older adults with complex care needs?” and will be answered in three phases. In the first phase we identify and describe exemplar models of ICBPHC and their context in relation to relevant policies and performance across the three jurisdictions (New Zealand, Ontario and Québec, Canada. The second phase involves a series of theory-informed, mixed methods case studies from which we shall develop a conceptual framework that captures not only the attributes of successful innovative ICBPHC models, but also how these models are being implemented. In the third phase, we aim to translate our research into practice by identifying emerging models of ICBPHC in advance, and working alongside policymakers to inform the development and implementation of these models in each jurisdiction. The final output of the program will be a comprehensive guide to the design, implementation and scaling-up of innovative models of ICBPHC.

Petroleum and Health Care: Evaluating and Managing Health Care's Vulnerability to Petroleum Supply Shifts

Science.gov (United States)

Bednarz, Daniel; Bae, Jaeyong; Pierce, Jessica

2011-01-01

Petroleum is used widely in health care—primarily as a transport fuel and feedstock for pharmaceuticals, plastics, and medical supplies—and few substitutes for it are available. This dependence theoretically makes health care vulnerable to petroleum supply shifts, but this vulnerability has not been empirically assessed. We quantify key aspects of petroleum use in health care and explore historical associations between petroleum supply shocks and health care prices. These analyses confirm that petroleum products are intrinsic to modern health care and that petroleum supply shifts can affect health care prices. In anticipation of future supply contractions lasting longer than previous shifts and potentially disrupting health care delivery, we propose an adaptive management approach and outline its application to the example of emergency medical services. PMID:21778473

Experiences and Perceptions of Barriers to Health Services for Elderly in Rural Namibia

Directory of Open Access Journals (Sweden)

Gert Van Rooy

2015-07-01

Full Text Available We investigate barriers to accessing health facilities (e.g., transportation and cost of services and health service delivery barriers (e.g., timeliness of services scheduling of appointments, language that the literature suggest are operative. Semistructured interviews were utilized with respondents in three purposefully selected regional research sites in Namibia. All questions were translated into local languages. It is found that although many senior citizens appreciate the use of modern health care and are exempted from paying health care consultation fees, they still prefer to use traditional health medicine because of the long distance to health care facilities, which when they decide to travel translates into high transportation costs. Referrals to hospitals become very expensive. There is a need to consider the unique issues (extended family system affecting access to health care for elderly people in Namibia to achieve equitable access to health care services.

Resilient health care

DEFF Research Database (Denmark)

Hollnagel, E.; Braithwaite, J.; Wears, R. L.

Health care is everywhere under tremendous pressure with regard to efficiency, safety, and economic viability - to say nothing of having to meet various political agendas - and has responded by eagerly adopting techniques that have been useful in other industries, such as quality management, lean...... production, and high reliability. This has on the whole been met with limited success because health care as a non-trivial and multifaceted system differs significantly from most traditional industries. In order to allow health care systems to perform as expected and required, it is necessary to have...... engineering's unique approach emphasises the usefulness of performance variability, and that successes and failures have the same aetiology. This book contains contributions from acknowledged international experts in health care, organisational studies and patient safety, as well as resilience engineering...

Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance.

Science.gov (United States)

Sarkar, Madhurima; Earley, Elizabeth R; Asti, Lindsey; Chisolm, Deena J

This study explores comparative differentials in health care needs, health care utilization, and health status between Medicaid and private/employer-sponsored insurance (ESI) among a statewide population of children with special health care needs (CSHCN) in Ohio. We used data from the 2012 Ohio Medicaid Assessment Survey to examine CSHCN's health care needs, utilization, status, and health outcomes by insurance type. Adjusted multivariable logistic regression models were used to explore associations between public and private health insurance, as well as the utilization and health outcome variables. Bivariate analyses indicate that the Medicaid population had higher care coordination needs (odds ratio [OR] = 1.6; 95% confidence interval [CI], 1.1-2.2) as well as need for mental/educational health care services (OR = 1.5; 95% CI; 1.1-2.0). They also reported higher unmet dental care needs (OR = 2.2; 95% CI, 1.2-4.0), higher emergency department (ED) utilization (OR = 2.3; 95% CI, 1.7-3.2), and worse overall health (OR = 0.6; 95% CI, 0.4-0.7), oral health (OR = 0.4; 95% CI, 0.3-0.5), and vision health (OR = 0.4; 95% CI, 0.2-0.6). After controlling for demographic variables, CSHCN with Medicaid insurance coverage were more likely to need mental health and education services (adjusted odds ratio [AOR] = 1.8; 95% CI; 1.2-2.6), had significantly more ED visits (AOR = 2.3; 95% CI, 1.5-3.5), and were less likely to have excellent overall health (AOR = 0.64; 95% CI, 0.4-0.9), oral health (AOR = 0.43; 95% CI, 0.3-0.7), and vision health (AOR = 0.38; 95% CI, 0.2-0.6) than those with private insurance/ESI. The CSHCN population is a highly vulnerable population. While Ohio's Medicaid provides greater coverage to CSHCN, disparities continue to exist within access and services that Medicaid provides versus the ones provided by private insurance/ESI.

Behavioral health and health care reform models: patient-centered medical home, health home, and accountable care organization.

Science.gov (United States)

Bao, Yuhua; Casalino, Lawrence P; Pincus, Harold Alan

2013-01-01

Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient-Centered Medical Home, the Health Home initiative within Medicaid, and the Accountable Care Organization. To incorporate behavioral health into health reform, policymakers and practitioners may consider embedding in the reform efforts explicit tools-accountability measures and payment designs-to improve access to and quality of care for patients with behavioral health needs.

Health care in the Netherlands.

NARCIS (Netherlands)

Weel, C. van; Schers, H.J.; Timmermans, A.

2012-01-01

This article analyzes Dutch experiences of health care reform--in particular in primary care--with emphasis on lessons for current United States health care reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led health care and

The Obama health care plan: what it means for mental health care of older adults.

Science.gov (United States)

Sorrell, Jeanne M

2009-01-01

Health care was an important issue for both the Obama and McCain election campaigns. Now that Barack Obama is poised to serve as the 44th President of the United States, many health care providers are focused on what Obama's administration will mean for new health care initiatives. This article focuses specifically on aspects of the Obama and Biden health care plan that affects mental health care for older adults.

[Challenges of an integrative and personalised health care for health economics and the insurance system].

Science.gov (United States)

Schoch, Goentje-Gesine; Würdemann, E

2014-11-01

"Stratifying medicine" is a topic of increasing importance in the public health system. There are several questions related to "stratifying medicine". This paper reconsiders definitions, opportunities and risks related to "stratifying medicine" as well as the main challenges of "stratifying medicine" from the perspective of a public health insurance. The application of the term and the definition are important points to discuss. Terms such as "stratified medicine", "personalised medicine" or "individualised medicine" are used. The Techniker Krankenkasse prefers "stratifying medicine", because it usually means a medicine that tailors therapy to specific groups of patients by biomarkers. OPPORTUNITIES AND RISKS: "Stratifying medicine" is associated with various hopes, e. g., the avoidance of ineffective therapies and early detection of diseases. But "stratifying medicine" also carries risks, such as an increase in the number of cases by treatment of disease risks, a duty for health and the weakening of the criteria of evidence-based medicine. The complexity of "stratifying medicine" is a big challenge for all involved parties in the health system. A lot of interrelations are still not completely understood. So the statutory health insurance faces the challenge of making innovative therapy concepts accessible in a timely manner to all insured on the one hand but on the other hand also to protect the community from harmful therapies. Information and advice to patients related to "stratifying medicine" is of particular importance. The equitable distribution of fees for diagnosis and counselling presents a particular challenge. The solidarity principle of public health insurance may be challenged by social and ethical issues of "stratifying medicine". "Stratifying medicine" offers great potential to improve medical care. However, false hopes must be avoided. Providers and payers should measure chances and risks of "stratifying medicine" together for the welfare of the

The Barrie Jones Lecture—Eye care for the neglected population: challenges and solutions

Science.gov (United States)

Rao, G N

2015-01-01

Globally, pockets of ‘neglected populations' do not have access to basic health-care services and carry a much greater risk of blindness and visual impairment. While large-scale public health approaches to control blindness due to vitamin A deficiency, onchocerciasis, and trachoma are successful, other causes of blindness still take a heavy toll in the population. High-quality comprehensive eye care that is equitable is the approach that needs wide-scale application to alleviate this inequity. L V Prasad Eye Institute of India developed a multi-tier pyramidal model of eye care delivery that encompasses all levels from primary to advanced tertiary (quaternary). This has demonstrated the feasibility of ‘Universal Eye Health Coverage' covering promotive, preventive, corrective, and rehabilitative aspects of eye care. Using human resources with competency-based training, effective and cost-effective care could be provided to many disadvantaged people. PMID:25567375

Universal health insurance through incentives reform.

Science.gov (United States)

Enthoven, A C; Kronick, R

1991-05-15

Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

Improving eye care in the primary health care setting

Directory of Open Access Journals (Sweden)

M de Wet

2000-09-01

Full Text Available One of the challenges facing primary health care in South Africa is the delivery of quality eye care to all South Africans. In this regard the role of the primary health care worker, as the first point of contact, is crucial. This paper reports on the problems primary health care workers experience in providing quality eye care in Region B of the Free State. Problems identified by those involved in the study include the cumbersome referral system, the unavailability of appropriate medicine at clinics, the insufficient knowledge of primary health care workers regarding eye conditions and the lack of communication between the various eye care service providers. Suggestions to address the problems identified included more in-service training of primary health care workers regarding eye conditions, liaison with NGO’s providing eye care, decentralisation of services and the establishment of an eye care committee in the region.

Respiratory Home Health Care

Science.gov (United States)

... Us Home > Healthy Living > Living With Lung Disease > Respiratory Home Health Care Font: Aerosol Delivery Oxygen Resources ... Teenagers Living With Lung Disease Articles written by Respiratory Experts Respiratory Home Health Care Respiratory care at ...

Mental health needs and availability of mental health care for children and adolescents with intellectual disability in Berlin.

Science.gov (United States)

Soltau, B; Biedermann, J; Hennicke, K; Fydrich, T

2015-11-01

The increased risk of mental health problems in children and adolescents with intellectual disability (ID) has been reported in several studies. However, almost no research has been conducted on parents' experiences with the general mental health system. We have investigated the prevalence of emotional and behavioural problems in children with ID as well as the availability and quality of mental health care from the parents' point of view. Teachers of specialised schools for ID in Berlin were asked to complete the Teacher's Report Form (TRF) of the Child Behavior Checklist. Information was collected for 1226 children and adolescents aged 6-18 years with mild to profound ID (response 70.5%). The availability and quality of mental health care was assessed by a questionnaire given to parents who had already been seeking help for their children. A total of 330 parents completed the questionnaires (response 62.0%). In addition to univariate analysis, we conducted multiple logistic regressions regarding the psychopathology reported by teachers (TRF-syndrome scales) and difficulties concerning mental health care reported by parents for a paired sample of 308 children. Overall, 52.4% of the children and adolescents with ID had a total problem score on the TRF in the deviant range (47.1% when eliminating four items reflecting cognitive deficits). Compared with the general population normative sample of children, this is a three-time higher prevalence. The most striking problems were thought problems (schizoid and obsessive-compulsive), aggressive behaviour, attention problems and social problems. Parents whose children had more severe behavioural or emotional dysfunction reported more difficulties with the mental health system. From the parents' point of view, mental health professionals frequently did not feel responsible or were not sufficiently skilled for the treatment of children with ID. As a consequence, 96% of all parents were longing for specialised in- and

Marketing health care to employees: the structure of employee health care plan satisfaction.

Science.gov (United States)

Mascarenhas, O A

1993-01-01

Providing cost-contained comprehensive quality health care to maintain healthy and productive employees is a challenging problem for all employers. Using a representative panel of metropolitan employees, the author investigates the internal and external structure of employee satisfaction with company-sponsored health care plans. Employee satisfaction is differentiated into four meaningful groups of health care benefits, whereas its external structure is supported by the traditional satisfaction paradigms of expectation-disconfirmation, attribution, and equity. Despite negative disconfirmation, employees register sufficiently high health care satisfaction levels, which suggests some useful strategies that employers may consider implementing.

Rural health care bypass behavior: how community and spatial characteristics affect primary health care selection.

Science.gov (United States)

Sanders, Scott R; Erickson, Lance D; Call, Vaughn R A; McKnight, Matthew L; Hedges, Dawson W

2015-01-01

(1) To assess the prevalence of rural primary care physician (PCP) bypass, a behavior in which residents travel farther than necessary to obtain health care, (2) To examine the role of community and non-health-care-related characteristics on bypass behavior, and (3) To analyze spatial bypass patterns to determine which rural communities are most affected by bypass. Data came from the Montana Health Matters survey, which gathered self-reported information from Montana residents on their health care utilization, satisfaction with health care services, and community and demographic characteristics. Logistic regression and spatial analysis were used to examine the probability and spatial patterns of bypass. Overall, 39% of respondents bypass local health care. Similar to previous studies, dissatisfaction with local health care was found to increase the likelihood of bypass. Dissatisfaction with local shopping also increases the likelihood of bypass, while the number of friends in a community, and commonality with community reduce the likelihood of bypass. Other significant factors associated with bypass include age, income, health, and living in a highly rural community or one with high commuting flows. Our results suggest that outshopping theory, in which patients bundle services and shopping for added convenience, extends to primary health care selection. This implies that rural health care selection is multifaceted, and that in addition to perceived satisfaction with local health care, the quality of local shopping and levels of community attachment also influence bypass behavior. © 2014 National Rural Health Association.

Reducing inequalities in health and access to health care in a rural Indian community: an India-Canada collaborative action research project.

Science.gov (United States)

Haddad, Slim; Narayana, Delampady; Mohindra, Ks

2011-11-08

Inadequate public action in vulnerable communities is a major constraint for the health of poor and marginalized groups in low and middle-income countries (LMICs). The south Indian state of Kerala, known for relatively equitable provision of public resources, is no exception to the marginalization of vulnerable communities. In Kerala, women's lives are constrained by gender-based inequalities and certain indigenous groups are marginalized such that their health and welfare lag behind other social groups. The goal of this socially-engaged, action-research initiative was to reduce social inequalities in access to health care in a rural community. Specific objectives were: 1) design and implement a community-based health insurance scheme to reduce financial barriers to health care, 2) strengthen local governance in monitoring and evidence-based decision-making, and 3) develop an evidence base for appropriate health interventions. Health and social inequities have been masked by Kerala's overall progress. Key findings illustrated large inequalities between different social groups. Particularly disadvantaged are lower-caste women and Paniyas (a marginalized indigenous group), for whom inequalities exist across education, employment status, landholdings, and health. The most vulnerable populations are the least likely to receive state support, which has broader implications for the entire country. A community based health solidarity scheme (SNEHA), under the leadership of local women, was developed and implemented yielding some benefits to health equity in the community-although inclusion of the Paniyas has been a challenge. The Canadian-Indian action research team has worked collaboratively for over a decade. An initial focus on surveys and data analysis has transformed into a focus on socially engaged, participatory action research. Adapting to unanticipated external forces, maintaining a strong team in the rural village, retaining human resources capable of analyzing

Reducing inequalities in health and access to health care in a rural Indian community: an India-Canada collaborative action research project

Directory of Open Access Journals (Sweden)

Mohindra KS

2011-11-01

Full Text Available Abstract Background Inadequate public action in vulnerable communities is a major constraint for the health of poor and marginalized groups in low and middle-income countries (LMICs. The south Indian state of Kerala, known for relatively equitable provision of public resources, is no exception to the marginalization of vulnerable communities. In Kerala, women’s lives are constrained by gender-based inequalities and certain indigenous groups are marginalized such that their health and welfare lag behind other social groups. The research The goal of this socially-engaged, action-research initiative was to reduce social inequalities in access to health care in a rural community. Specific objectives were: 1 design and implement a community-based health insurance scheme to reduce financial barriers to health care, 2 strengthen local governance in monitoring and evidence-based decision-making, and 3 develop an evidence base for appropriate health interventions. Results and outcomes Health and social inequities have been masked by Kerala’s overall progress. Key findings illustrated large inequalities between different social groups. Particularly disadvantaged are lower-caste women and Paniyas (a marginalized indigenous group, for whom inequalities exist across education, employment status, landholdings, and health. The most vulnerable populations are the least likely to receive state support, which has broader implications for the entire country. A community based health solidarity scheme (SNEHA, under the leadership of local women, was developed and implemented yielding some benefits to health equity in the community—although inclusion of the Paniyas has been a challenge. The partnership The Canadian-Indian action research team has worked collaboratively for over a decade. An initial focus on surveys and data analysis has transformed into a focus on socially engaged, participatory action research. Challenges and successes Adapting to

[A Maternal Health Care System Based on Mobile Health Care].

Science.gov (United States)

Du, Xin; Zeng, Weijie; Li, Chengwei; Xue, Junwei; Wu, Xiuyong; Liu, Yinjia; Wan, Yuxin; Zhang, Yiru; Ji, Yurong; Wu, Lei; Yang, Yongzhe; Zhang, Yue; Zhu, Bin; Huang, Yueshan; Wu, Kai

2016-02-01

Wearable devices are used in the new design of the maternal health care system to detect electrocardiogram and oxygen saturation signal while smart terminals are used to achieve assessments and input maternal clinical information. All the results combined with biochemical analysis from hospital are uploaded to cloud server by mobile Internet. Machine learning algorithms are used for data mining of all information of subjects. This system can achieve the assessment and care of maternal physical health as well as mental health. Moreover, the system can send the results and health guidance to smart terminals.

Toward a 21st-century health care system: Recommendations for health care reform

NARCIS (Netherlands)

K. Arrow (Kenneth); A. Auerbach (Alan); J. Bertko (John); L.P. Casalino (Lawrence Peter); F.J. Crosson (Francis); A. Enthoven (Alain); E. Falcone; R.C. Feldman; V.R. Fuchs (Victor); A.M. Garber (Alan); M.R. Gold (Marthe Rachel); D.A. Goldman; G.K. Hadfield (Gillian); M.A. Hall (Mark Ann); R.I. Horwitz (Ralph); M. Hooven; P.D. Jacobson (Peter); T.S. Jost (Timothy Stoltzfus); L.J. Kotlikoff; J. Levin (Jonathan); S. Levine (Sharon); R. Levy; K. Linscott; H.S. Luft; R. Mashal; D. McFadden (Daniel); D. Mechanic (David); D. Meltzer (David); J.P. Newhouse (Joseph); R.G. Noll (Roger); J.B. Pietzsch (Jan Benjamin); P. Pizzo (Philip); R.D. Reischauer (Robert); S. Rosenbaum (Sara); W. Sage (William); L.D. Schaeffer (Leonard Daniel); E. Sheen; B.N. Silber (Bernie Michael); J. Skinner (Jonathan Robert); S.M. Shortell (Stephen); S.O. Thier (Samuel); S. Tunis (Sean); L. Wulsin Jr.; P. Yock (Paul); G.B. Nun; S. Bryan (Stirling); O. Luxenburg (Osnat); W.P.M.M. van de Ven (Wynand); J. Cooper (Jim)

2009-01-01

textabstractThe coverage, cost, and quality problems of the U.S. health care system are evident. Sustainable health care reform must go beyond financing expanded access to care to substantially changing the organization and delivery of care. The FRESH-Thinking Project (www.fresh-thinking.org) held a

Inequities in utilization of reproductive and maternal health services in Ethiopia.

Science.gov (United States)

Bobo, Firew Tekle; Yesuf, Elias Ali; Woldie, Mirkuzie

2017-06-19

Disparities in health services utilization within and between regional states of countries with diverse socio-cultural and economic conditions such as Ethiopia is a frequent encounter. Understanding and taking measures to address unnecessary and avoidable differences in the use of reproductive and maternal health services is a key concern in Ethiopia. The aim of the study was to examine degree of equity in reproductive and maternal health services utilization in Ethiopia. Data from Ethiopia demographic health survey 2014 was analyzed. We assessed inequities in utilization of modern contraceptive methods, antenatal care, facility based delivery and postnatal checkup. Four standard equity measurement methods were used; equity gaps, rate-ratios, concertation curve and concentration index. Inequities in service utilization were exhibited favoring women in developed regions, urban residents, most educated and the wealthy. Antenatal care by skilled provider was three times higher among women with post-secondary education than mothers with no education. Women in the highest wealth quantile had about 12 times higher skilled birth attendance than those in lowest wealth quantile. The rate of postnatal care use among urban resident was about 6 times that of women in rural area. Use of modern contraceptive methods was more equitably utilized service while, birth at health facility was less equitable across all economic levels, favoring the wealthy. Considerable inequity between and within regions of Ethiopia in the use of maternal health services was demonstrated. Strategically targeting social determinants of health with special emphasis to women education and economic empowerment will substantially contribute for altering the current situation favorably.

Integrating Community Health Workers (CHWs) into Health Care Organizations.

Science.gov (United States)

Payne, Julianne; Razi, Sima; Emery, Kyle; Quattrone, Westleigh; Tardif-Douglin, Miriam

2017-10-01

Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.

Health care employee perceptions of patient-centered care.

Science.gov (United States)

Balbale, Salva Najib; Turcios, Stephanie; LaVela, Sherri L

2015-03-01

Given the importance of health care employees in the delivery of patient-centered care, understanding their unique perspectives is essential for quality improvement. The purpose of this study was to use photovoice to evaluate perceptions and experiences around patient-centered care among U.S. Veterans Affairs (VA) health care employees. We asked participants to take photographs of salient features in their environment related to patient-centered care. We used the photographs to facilitate dialogue during follow-up interviews. Twelve VA health care employees across two VA sites participated in the project. Although most participants felt satisfied with their work environment and experiences at the VA, they identified several areas for improvement. These included a need for more employee health and wellness initiatives and a need for enhanced opportunities for training and professional growth. Application of photovoice enabled us to learn about employees' unique perspectives around patient-centered care while engaging them in an evaluation of care delivery. © The Author(s) 2014.

Effective non-drug interventions for improving outcomes and quality of maternal health care in sub-Saharan Africa: a systematic review.

Science.gov (United States)

Wekesah, Frederick M; Mbada, Chidozie E; Muula, Adamson S; Kabiru, Caroline W; Muthuri, Stella K; Izugbara, Chimaraoke O

2016-08-15

Many interventions have been implemented to improve maternal health outcomes in sub-Saharan Africa (SSA). Currently, however, systematic information on the effectiveness of these interventions remains scarce. We conducted a systematic review of published evidence on non-drug interventions that reported effectiveness in improving outcomes and quality of care in maternal health in SSA. African Journals Online, Bioline, MEDLINE, Ovid, Science Direct, and Scopus databases were searched for studies published in English between 2000 and 2015 and reporting on the effectiveness of interventions to improve quality and outcomes of maternal health care in SSA. Articles focusing on interventions that involved drug treatments, medications, or therapies were excluded. We present a narrative synthesis of the reported impact of these interventions on maternal morbidity and mortality outcomes as well as on other dimensions of the quality of maternal health care (as defined by the Institute of Medicine 2001 to comprise safety, effectiveness, efficiency, timeliness, patient centeredness, and equitability). Seventy-three studies were included in this review. Non-drug interventions that directly or indirectly improved quality of maternal health and morbidity and mortality outcomes in SSA assumed a variety of forms including mobile and electronic health, financial incentives on the demand and supply side, facility-based clinical audits and maternal death reviews, health systems strengthening interventions, community mobilization and/or peer-based programs, home-based visits, counseling and health educational and promotional programs conducted by health care providers, transportation and/or communication and referrals for emergency obstetric care, prevention of mother-to-child transmission of HIV, and task shifting interventions. There was a preponderance of single facility and community-based studies whose effectiveness was difficult to assess. Many non-drug interventions have been

Controversies in faith and health care.

Science.gov (United States)

Tomkins, Andrew; Duff, Jean; Fitzgibbon, Atallah; Karam, Azza; Mills, Edward J; Munnings, Keith; Smith, Sally; Seshadri, Shreelata Rao; Steinberg, Avraham; Vitillo, Robert; Yugi, Philemon

2015-10-31

Differences in religious faith-based viewpoints (controversies) on the sanctity of human life, acceptable behaviour, health-care technologies and health-care services contribute to the widespread variations in health care worldwide. Faith-linked controversies include family planning, child protection (especially child marriage, female genital mutilation, and immunisation), stigma and harm reduction, violence against women, sexual and reproductive health and HIV, gender, end-of-life issues, and faith activities including prayer. Buddhism, Christianity, Hinduism, Islam, Judaism, and traditional beliefs have similarities and differences in their viewpoints. Improved understanding by health-care providers of the heterogeneity of viewpoints, both within and between faiths, and their effect on health care is important for clinical medicine, public-health programmes, and health-care policy. Increased appreciation in faith leaders of the effect of their teachings on health care is also crucial. This Series paper outlines some faith-related controversies, describes how they influence health-care provision and uptake, and identifies opportunities for research and increased interaction between faith leaders and health-care providers to improve health care. Copyright © 2015 Elsevier Ltd. All rights reserved.

Association of functional limitation with health care needs and experiences of children with special health care needs.

Science.gov (United States)

Nageswaran, Savithri; Silver, Ellen Johnson; Stein, Ruth E K

2008-05-01

The goal was to evaluate whether having a functional limitation was associated with health care needs and experiences of children with special health care needs. We used caregivers' responses in the National Survey of Children with Special Health Care Needs (2001). Functional limitation was categorized as severe, some, or no limitation. We performed analyses of the relationships of functional limitation to measures of health care needs and experiences. Children with special health care needs with severe functional limitation were more likely to have received specialized educational services, to have had physician visits, and to have needed health services, compared with those with no limitation. They had significantly greater odds of delayed care, unmet health care and care-coordination needs, referral problems, dissatisfaction, and difficulty using health services, compared with those without limitation. Caregivers of children with special health care needs with severe limitation were twice as likely as those with no limitation to report that providers did not spend enough time, listen carefully, provide needed information, and make family members partners in the child's care. Compared with children with special health care needs without limitation, those with severe limitation had worse health insurance experiences, in terms of insurance coverage, copayments, being able to see needed providers, and problems with health insurance. The impact on families (financial problems, need to provide home care, or need to stop or to cut work) of children with special health care needs with severe functional limitation was much greater than the impact on families of children with special health care needs without limitation. For most measures examined, results for some limitation were between those for severe limitation and no limitation. Functional limitation is significantly associated with the health care needs and experiences of children with special health care needs.

Health Care Efficiencies: Consolidation and Alternative Models vs. Health Care and Antitrust Regulation - Irreconcilable Differences?

Science.gov (United States)

King, Michael W

2017-11-01

Despite the U.S. substantially outspending peer high income nations with almost 18% of GDP dedicated to health care, on any number of statistical measurements from life expectancy to birth rates to chronic disease, 1 the U.S. achieves inferior health outcomes. In short, Americans receive a very disappointing return on investment on their health care dollars, causing economic and social strain. 2 Accordingly, the debates rage on: what is the top driver of health care spending? Among the culprits: poor communication and coordination among disparate providers, paperwork required by payors and regulations, well-intentioned physicians overprescribing treatments, drugs and devices, outright fraud and abuse, and medical malpractice litigation. Fundamentally, what is the best way to reduce U.S. health care spending, while improving the patient experience of care in terms of quality and satisfaction, and driving better patient health outcomes? Mergers, partnerships, and consolidation in the health care industry, new care delivery models like Accountable Care Organizations and integrated care systems, bundled payments, information technology, innovation through new drugs and new medical devices, or some combination of the foregoing? More importantly, recent ambitious reform efforts fall short of a cohesive approach, leaving fundamental internal inconsistencies across divergent arms of the federal government, raising the issue of whether the U.S. health care system can drive sufficient efficiencies within the current health care and antitrust regulatory environments. While debate rages on Capitol Hill over "repeal and replace," only limited attention has been directed toward reforming the current "fee-for-service" model pursuant to which providers are paid for volume of care rather than quality or outcomes. Indeed, both the Patient Protection and Affordable Care Act ("ACA") 3 and proposals for its replacement focus primarily on the reach and cost of providing coverage for

Benchmarking HIV health care

DEFF Research Database (Denmark)

Podlekareva, Daria; Reekie, Joanne; Mocroft, Amanda

2012-01-01

ABSTRACT: BACKGROUND: State-of-the-art care involving the utilisation of multiple health care interventions is the basis for an optimal long-term clinical prognosis for HIV-patients. We evaluated health care for HIV-patients based on four key indicators. METHODS: Four indicators of health care we...... document pronounced regional differences in adherence to guidelines and can help to identify gaps and direct target interventions. It may serve as a tool for assessment and benchmarking the clinical management of HIV-patients in any setting worldwide....

Costs of health care across primary care models in Ontario.

Science.gov (United States)

Laberge, Maude; Wodchis, Walter P; Barnsley, Jan; Laporte, Audrey

2017-08-01

The purpose of this study is to analyze the relationship between newly introduced primary care models in Ontario, Canada, and patients' primary care and total health care costs. A specific focus is on the payment mechanisms for primary care physicians, i.e. fee-for-service (FFS), enhanced-FFS, and blended capitation, and whether providers practiced as part of a multidisciplinary team. Utilization data for a one year period was measured using administrative databases for a 10% sample selected at random from the Ontario adult population. Primary care and total health care costs were calculated at the individual level and included costs from physician services, hospital visits and admissions, long term care, drugs, home care, lab tests, and visits to non-medical health care providers. Generalized linear model regressions were conducted to assess the differences in costs between primary care models. Patients not enrolled with a primary care physicians were younger, more likely to be males and of lower socio-economic status. Patients in blended capitation models were healthier and wealthier than FFS and enhanced-FFS patients. Primary care and total health care costs were significantly different across Ontario primary care models. Using the traditional FFS as the reference, we found that patients in the enhanced-FFS models had the lowest total health care costs, and also the lowest primary care costs. Patients in the blended capitation models had higher primary care costs but lower total health care costs. Patients that were in multidisciplinary teams (FHT), where physicians are also paid on a blended capitation basis, had higher total health care costs than non-FHT patients but still lower than the FFS reference group. Primary care and total health care costs increased with patients' age, morbidity, and lower income quintile across all primary care payment types. The new primary care models were associated with lower total health care costs for patients compared to the

The retailing of health care.

Science.gov (United States)

Paul, T; Wong, J

1984-01-01

A number of striking parallels between recent developments in health care marketing and changes in the retailing industry exist. The authors have compared retailing paradigms to the area on health care marketing so strategists in hospitals and other health care institutions can gain insight from these parallels. Many of the same economic, demographic, technological and lifestyle forces may be at work in both the health care and retail markets. While the services or products offered in health care are radically different from those of conventional retail markets, the manner in which the products and services are positioned, priced or distributed is surprisingly similar.

The Military Health Care System May Have the Potential to Prevent Health Care Disparities.

Science.gov (United States)

Pierre-Louis, Bosny J; Moore, Angelo D; Hamilton, Jill B

2015-09-01

The existence of health disparities in military populations has become an important topic of research. However, to our knowledge, this is the first study to examine health disparities, as related to access to care and health status, among active duty soldiers and their families. Specifically, the purpose of this analysis was to evaluate whether health disparities exist in access to care and health outcomes of patient satisfaction, physical health status, and mental health status according to race, gender, and sponsor rank in the population of active duty soldiers and their family members. In this cross-sectional study, active duty army soldiers and family members were recruited from either one particular army health clinic where they received their health care or from an adjacent shopping center frequented by eligible participants. Data were collected using validated measures to assess concepts of access to care and health status. Statistical analysis, including one-way analysis of variance (ANOVA) was performed to investigate differences in study outcome measures across four key demographic subgroups: race, gender, sponsor rank, and component (active soldier or family member). A total of 200 participants completed the study questionnaires. The sample consisted of 45.5 % soldiers and 54.5 % family members, with 88.5 % reporting a sponsor rank in the category of junior or senior enlisted rank. Mean scores for access to care did not differ significantly for the groups race/ethnicity (p = 0.53), gender (p = 0.14), and sponsor rank (p = 0.10). Furthermore, no significant differences were observed whether respondents were active soldiers or their family members (p = 0.36). Similarly, there were no statistically significant subgroup (race/ethnicity, gender, sponsor rank, or component) differences in mean patient satisfaction, physical health, and mental health scores. In a health equity system of care such as the military health care system, active duty

Managed care: employers' influence on the health care system.

Science.gov (United States)

Corder, K T; Phoon, J; Barter, M

1996-01-01

Health care reform is a complex issue involving many key sectors including providers, consumers, insurers, employers, and the government. System changes must involve all sectors for reform to be effective. Each sector has a responsibility to understand not only its own role in the health care system, but the roles of others as well. The role of business employers is often not apparent to health care providers, especially nurses. Understanding the influence employers have on the health care system is vital if providers want to be proactive change agents ensuring quality care.

Youth with special health care needs: transition to adult health care services.

Science.gov (United States)

Oswald, Donald P; Gilles, Donna L; Cannady, Mariel S; Wenzel, Donna B; Willis, Janet H; Bodurtha, Joann N

2013-12-01

Transition to adult services for children and youth with special health care needs (CYSHCN) has emerged as an important event in the life course of individuals with disabilities. Issues that interfere with efficient transition to adult health care include the perspectives of stakeholders, age limits on pediatric service, complexity of health conditions, a lack of experienced healthcare professionals in the adult arena, and health care financing for chronic and complex conditions. The purposes of this study were to develop a definition of successful transition and to identify determinants that were associated with a successful transition. The 2007 Survey of Adult Transition and Health dataset was used to select variables to be considered for defining success and for identifying predictors of success. The results showed that a small percentage of young adults who participated in the 2007 survey had experienced a successful transition from their pediatric care.

Strengthening of Oral Health Systems: Oral Health through Primary Health Care

Science.gov (United States)

Petersen, Poul Erik

2014-01-01

Around the globe many people are suffering from oral pain and other problems of the mouth or teeth. This public health problem is growing rapidly in developing countries where oral health services are limited. Significant proportions of people are underserved; insufficient oral health care is either due to low availability and accessibility of oral health care or because oral health care is costly. In all countries, the poor and disadvantaged population groups are heavily affected by a high burden of oral disease compared to well-off people. Promotion of oral health and prevention of oral diseases must be provided through financially fair primary health care and public health intervention. Integrated approaches are the most cost-effective and realistic way to close the gap in oral health between rich and poor. The World Health Organization (WHO) Oral Health Programme will work with the newly established WHO Collaborating Centre, Kuwait University, to strengthen the development of appropriate models for primary oral health care. PMID:24525450

Healthcare in Asia: a perspective from primary care at the gateway to a continent.

Science.gov (United States)

Jiwa, Moyez; Othman, Sajaratulnisah; Hanafi, Nik Sherina; Ng, Chirk Jenn; Khoo, Ee Ming; Chia, Yook Chin

2012-01-01

Malaysia has achieved reasonable health outcomes even though the country spends a modest amount of Gross Domestic Product on healthcare. However, the country is now experiencing a rising incidence of both infectious diseases and chronic lifestyle conditions that reflect growing wealth in a vibrant and successful economy. With an eye on an ageing population, reform of the health sector is a government priority. As in other many parts of the world, general practitioners are the first healthcare professional consulted by patients. The Malaysian health system is served by public and private care providers. The integration of the two sectors is a key target for reform. However, the future health of the nation will depend on leadership in the primary care sector. This leadership will need to be informed by research to integrate care providers, empower patients, bridge cultural gaps and ensure equitable access to scarce health resources.

Mothers' health services utilization and health care seeking ...

African Journals Online (AJOL)

Background: data from different studies showed health care behaviour and estimated per capita health care expenditure for the general population, but the specific data for infants at different levels of care are lacking. The objectives of this study were to describe mothers' health service utilization during pregnancy and ...

Health care's ills: A Catholic diagnosis

Science.gov (United States)

Sibley, Angus

2016-01-01

Catholic teaching is emphatic on the need to “guarantee adequate [health] care to all,” as Pope Benedict XVI has stated. America has been slower than other advanced countries in progressing towards this goal. Reasons for this delay can be found in certain attitudes that have long been present in American culture, and have been reinforced by the wave of libertarianism (free-market ideology) that swept the world in the late twentieth century. Catholic theology and social/economic teaching can help us understand the flaws in these attitudes, which involve fundamental philosophical and theological principles, but which are far from academic, since they have serious and very practical consequences. In the light of Catholic teaching, we can look towards a sounder understanding of healthcare needs and effective ways of meeting them. Lay Summary: This article argues that access to healthcare, at least up to the level of basic necessity, falls under the heading of distributive justice. It is a human right owed by the community to each of its citizens. And since rights entail obligations, this right entails an obligation upon each citizen to contribute, as circumstances permit, to the costs, which need to be shared equitably; they cannot be met simply by each individual providing solely for oneself. Also discussed are the problems of excessive costs in healthcare administration and in pharmacological research, as well as harmful tendencies in private-sector firms to over-reward top management and to target maximum (rather than adequate) profits. PMID:28392590

Hope for health and health care.

Science.gov (United States)

Stempsey, William E

2015-02-01

Virtually all activities of health care are motivated at some level by hope. Patients hope for a cure; for relief from pain; for a return home. Physicians hope to prevent illness in their patients; to make the correct diagnosis when illness presents itself; that their prescribed treatments will be effective. Researchers hope to learn more about the causes of illness; to discover new and more effective treatments; to understand how treatments work. Ultimately, all who work in health care hope to offer their patients hope. In this paper, I offer a brief analysis of hope, considering the definitions of Hobbes, Locke, Hume and Thomas Aquinas. I then differentiate shallow and deep hope and show how hope in health care can remain shallow. Next, I explore what a philosophy of deep hope in health care might look like, drawing important points from Ernst Bloch and Gabriel Marcel. Finally, I suggest some implications of this philosophy of hope for patients, physicians, and researchers.

Collaborative HIV care in primary health care: nurses' views.

Science.gov (United States)

Ngunyulu, R N; Peu, M D; Mulaudzi, F M; Mataboge, M L S; Phiri, S S

2017-12-01

Collaborative HIV care between the nurses and traditional health practitioners is an important strategy to improve health care of people living with HIV. To explore and describe the views of nurses regarding collaborative HIV care in primary healthcare services in the City of Tshwane, South Africa. A qualitative, descriptive design was used to explore and describe the views of nurses who met the study's inclusion criteria. In-depth individual interviews were conducted to collect data from purposively selected nurses. Content analysis was used to analyse data. Two main categories were developed during the data analysis stage. The views of nurses and health system challenges regarding collaborative HIV care. The study findings revealed that there was inadequate collaborative HIV care between the nurses and the traditional health practitioners. It is evident that there is inadequate policy implementation, monitoring and evaluation regarding collaboration in HIV care. The study findings might influence policymakers to consider the importance of collaborative HIV care, and improve the quality of care by strengthening the referral system and follow-up of people living with HIV and AIDS, as a result the health outcomes as implied in the Sustainable Development Goals 2030 might be improved. Training and involvement of traditional health practitioners in the nursing and health policy should be considered to enhance and build a trustworthy working relationship between the nurses and the traditional health practitioners in HIV care. © 2017 International Council of Nurses.

Digital technology use among disadvantaged Australians: implications for equitable consumer participation in digitally-mediated communication and information exchange with health services.

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Newman, Lareen; Biedrzycki, Kate; Baum, Fran

2012-05-01

To present research findings on access to, and use of, digital information and communication technologies (ICTs) by Australians from lower income and disadvantaged backgrounds to determine implications for equitable consumer access to digitally-mediated health services and information. Focus groups were held in 2008-09 with 80 residents from lower income and disadvantaged backgrounds in South Australia, predominantly of working- and family-formation age (25 to 55 years). Qualitative analysis was conducted on a-priori and emergent themes to describe dominant categories. Access to, and use of, computers, the Internet and mobile phones varied considerably in extent, frequency and quality within and across groups due to differences in abilities, resources and life experience. Barriers and facilitators included English literacy (including for native speakers), technological literacy, education, income, housing situation, social connection, health status, employment status, and trust. Many people gained ICT skills by trial and error or help from friends, and only a few from formal programs, resulting in varied skills. The considerable variation in ICT access and use within lower income and disadvantaged groups must be acknowledged and accommodated by health initiatives and services when delivering digitally-mediated consumer-provider interaction, online health information, or online self-management of health conditions. If services require consumers to participate in a digitally-mediated communication exchange, then we suggest they might support skills and technology acquisition, or provide non-ICT alternatives, in order to avoid exacerbating health inequities.

Engaging men in health care.

Science.gov (United States)

Malcher, Greg

2009-03-01

Engaging men in health care involves a multifaceted approach that has as its main principle the recognition that men consume health care differently to women. This article identifies barriers to engaging men in health care and offers potential and existing solutions to overcome these barriers in a range of health care settings. The concept of multiple masculinities recognises that not all men can be engaged via a particular technique or strategy. The perception that men are disinterested in their health is challenged and a range of approaches discussed, both in the community and in health care facilities. In the general practice setting opportunities exist for the engagement of men at the reception desk and waiting room, as well as during the consultation. Use of the workplace in engaging men is discussed. Future activities to build the capacity of health care providers to better engage men are identified and the role of policy and program development is addressed.

Primary health care assessment from the users' perspectives: a systematic review.

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Paula, Weslla Karla Albuquerque Silva de; Samico, Isabella Chagas; Caminha, Maria de Fátima Costa; Filho, Malaquias Batista; Silva, Suzana Lins da

2016-04-01

Analyze the evaluation of the attributes of primary care made by users of basic units of Brazilian health by using PCATool instrument adapted to Brazil. A systematic literature review conducted in the PubMed database, IBECS, LILACS, SciELO and BDTD. 4,405 documents were found, selected 23 full texts. After Full reading and application of eligibility criteria, 14 articles were evaluated. The studies showed that primary care performs well in longitudinality attributes, completeness and coordination and worse performance on attributes access first contact, family counseling and community orientation, even in the basic units with the Family Health. The users of basic health units assessed as unsatisfactory attributes considered essential for a health care more equitable and competing for user autonomy and social control. It is inferred that there are still obstacles hindering user access to basic health services and care actions are still being developed without favoring user participation and the community context in which they live. Analisar a avaliação dos atributos da Atenção Básica feita por usuários de unidades básicas de saúde brasileiras, mediante utilização de adaptações do instrumento PCATool para o Brasil. Revisão sistemática da literatura realizada nas bases de dados Medline/PubMed, LILACS, IBECS, SciELO e BDTD. Foram encontrados 4.405 documentos, sendo selecionados 23 textos completos. Após leitura integral e aplicação dos critérios de elegibilidade, 14 artigos foram avaliados. Os estudos apontaram que a Atenção Básica tem bom desempenho nos atributos longitudinalidade, integralidade e coordenação e pior desempenho nos atributos acesso de primeiro contato, orientação familiar e a orientação comunitária, mesmo nas unidades básicas com Saúde da Família. Os usuários das unidades básicas de saúde avaliaram como insatisfatórios atributos considerados fundamentais para uma atenção à saúde mais equânime e concorrente para

Patients’ Online Access to Their Primary Care Electronic Health Records and Linked Online Services: Implications for Research and Practice

Directory of Open Access Journals (Sweden)

Freda Mold

2015-12-01

Full Text Available Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1 Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2 Whether online access to records improves patient safety and health outcomes; (3 Whether record access increases disparities across social classes and between genders; and (4 Improving efficiency. The challenges for practice are: (1 How to incorporate online access into clinical workflow; (2 The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems.

Impact of Home Health Care on Health Care Resource Utilization Following Hospital Discharge: A Cohort Study.

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Xiao, Roy; Miller, Jacob A; Zafirau, William J; Gorodeski, Eiran Z; Young, James B

2018-04-01

As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge. No studies have investigated the utility of home health care within the context of a large and diverse patient population. A retrospective cohort study was conducted between 1/1/2013 and 6/30/2015 at a single tertiary care institution to assess healthcare utilization after discharge with home health care. Control patients discharged with "self-care" were matched by propensity score to home health care patients. The primary outcome was total healthcare costs in the 365-day post-discharge period. Secondary outcomes included follow-up readmission and death. Multivariable linear and Cox proportional hazards regression were used to adjust for covariates. Among 64,541 total patients, 11,266 controls were matched to 6,363 home health care patients across 11 disease-based Institutes. During the 365-day post-discharge period, home health care was associated with a mean unadjusted savings of $15,233 per patient, or $6,433 after adjusting for covariates (p Home health care independently decreased the hazard of follow-up readmission (HR 0.82, p home health care most benefited patients discharged from the Digestive Disease (death HR 0.72, p home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death. These data inform development of value-based care plans. Copyright © 2018 Elsevier Inc. All rights reserved.

Health care reforms.

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Marušič, Dorjan; Prevolnik Rupel, Valentina

2016-09-01

In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

The evolution of the federal funding policies for the public health surveillance component of Brazil's Unified Health System (SUS).

Science.gov (United States)

Pinto, Vitor Laerte; Cerbino Neto, José; Penna, Gerson Oliveira

2014-12-01

Health surveillance (HS) is one of the key components of the Brazilian Unified Health System (SUS). This article describes recent changes in health surveillance funding models and the role these changes have had in the reorganization and decentralization of health actions. Federal law no. 8.080 of 1990 defined health surveillance as a fundamental pillar of the SUS, and an exclusive fund with equitable distribution criteria was created in the Basic Operational Norm of 1996 to pay for health surveillance actions. This step facilitated the decentralization of health care at the municipal level, giving local authorities autonomy to plan and provide services. The Health Pact of 2006 and its regulation under federal decree No. 3252 in 2009 bolstered the processes of decentralization, regionalization and integration of health care. Further changes in the basic concepts of health surveillance around the world and in the funding policies negotiated by different spheres of government in Brazil have been catalysts for the process of HS institutionalization in recent years.

How to ensure equitable access to eye health for children with disabilities

Directory of Open Access Journals (Sweden)

Hannah Kuper

2016-07-01

Full Text Available All children need access to good quality eye care, and this must include children with disabilities. Childhood disability is very common. The World Health Organization (WHO estimates that there are at least 93 million children with disabilities worldwide, which equates to one in twenty children.1 Childhood disability is particularly common in low- and middle-income countries.

Health promotion in supplementary health care: outsourcing, microregulation and implications for care.

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Silva, Kênia Lara; Sena, Roseni Rosângela; Rodrigues, Andreza Trevenzoli; Araújo, Fernanda Lopes; Belga, Stephanie Marques Moura Franco; Duarte, Elysângela Dittz

2015-01-01

to analyze health promotion programs in the supplementary health care. This was a multiple case study with a qualitative approach whose data were obtained from interviews with coordinators of providers contracted by the corporations of health insurance plans in Belo Horizonte, Minas Gerais. The data were submitted to Critical Discourse Analysis. Home care has been described as the main action in the field of health promotion transferred to the providers, followed by management of patients and cases, and the health education.groups. The existence of health promotion principles is questionable in all programs. Outsourcing is marked by a process with a division between cost and care management. Implications of this process occur within admission and interventions on the needs of the beneficiaries. Statements revealed rationalization of cost, restructuring of work, and reproduction of the dominant logic of capital accumulation by the health insurance companies.

Organizing emotions in health care.

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Mark, Annabelle

2005-01-01

To introduce the articles in this special issue, discussing emotion in the in health-care organisations. Discusses such topics as what makes health care different, editorial perspectives, how health care has explored emotion so far, and the impact of emotion on patients and the consequences for staff. Health care provides a setting that juxtaposes emotion and rationality, the individual and the body corporate, the formal and the deeply personal, the public and the private, all of which must be understood better if changes in expectations and delivery are to remain coherent. The papers indicate a shared international desire to understand meaning in emotion that is now spreading across organizational process and into all professional roles within health care.

US health care crisis.

Science.gov (United States)

Cirić, Ivan

2013-01-01

The United States health care is presently challenged by a significant economic crisis. The purpose of this report is to introduce the readers of Medicinski Pregled to the root causes of this crisis and to explain the steps undertaken to reform health care in order to solve the crisis. It is hoped that the information contained in this report will be of value, if only in small measure, to the shaping of health care in Serbia.

Activity-based funding model provides foundation for province-wide best practices in renal care.

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Levin, Adeera; Lo, Clifford; Noel, Kevin; Djurdjev, Ogjnenka; Amano, Erlyn C

2013-01-01

British Columbia has a unique funding model for renal care in Canada. Patient care is delivered through six health authorities, while funding is administered by the Provincial Renal Agency using an activity-based funding model. The model allocates funding based on a schedule of costs for every element of renal care, excluding physician fees. Accountability, transparency of allocation and tracking of outcomes are key features that ensure successful implementation. The model supports province-wide best practices and equitable care and fosters innovation. Since its introduction, the outpatient renal services budget has grown less than the population, while maintaining or improving clinical outcomes. Copyright © 2013 Longwoods Publishing.

"Brave Men" and "Emotional Women": A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain.

Science.gov (United States)

Samulowitz, Anke; Gremyr, Ida; Eriksson, Erik; Hensing, Gunnel

2018-01-01

Despite the large body of research on sex differences in pain, there is a lack of knowledge about the influence of gender in the patient-provider encounter. The purpose of this study was to review literature on gendered norms about men and women with pain and gender bias in the treatment of pain. The second aim was to analyze the results guided by the theoretical concepts of hegemonic masculinity and andronormativity. A literature search of databases was conducted. A total of 77 articles met the inclusion criteria. The included articles were analyzed qualitatively, with an integrative approach. The included studies demonstrated a variety of gendered norms about men's and women's experience and expression of pain, their identity, lifestyle, and coping style. Gender bias in pain treatment was identified, as part of the patient-provider encounter and the professional's treatment decisions. It was discussed how gendered norms are consolidated by hegemonic masculinity and andronormativity. Awareness about gendered norms is important, both in research and clinical practice, in order to counteract gender bias in health care and to support health-care professionals in providing more equitable care that is more capable to meet the need of all patients, men and women.

?A constant struggle to receive mental health care?: health care professionals? acquired experience of barriers to mental health care services in Rwanda

OpenAIRE

Rugema, Lawrence; Krantz, Gunilla; Mogren, Ingrid; Ntaganira, Joseph; Persson, Margareta

2015-01-01

BACKGROUND: In Rwanda, many people are still mentally affected by the consequences of the genocide and yet mental health care facilities are scarce. While available literature explains the prevalence and consequences of mental disorders, there is lack of knowledge from low-income countries on health care seeking behavior due to common mental disorders. Therefore, this study sought to explore health care professionals' acquired experiences of barriers and facilitators that people with common m...

The Duke Elder lecture: the challenge of equitable eye care in Pakistan.

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Khan, M D

2011-04-01

Pakistan, like many other developing countries, is caught in the vicious cycle of poverty, illiteracy, violence, and disease. Right from its inception, it has been facing serious challenges of fast growing population, longevity, unemployment, wars, floods, double burden of diseases including blindness, as well as earthquakes, insurgencies, and political instability. Despite such challenges, the country has managed to reduce the burden of blindness from 1.78% in 1987-88 to 0.9% in 2003.This paper will highlight the methods used to achieve such a difficult goal. The country used the report of the World Health Organization (WHO) temporary consultant as the initial tool for advocacy to obtain political and professional commitment. Results from the first National Blindness Survey 1987-1990 were used as baseline for development of the programme. Under the Ministry of Health, national and provincial committees with respective coordinators were constituted. To ensure access and equity, the national programme was developed on the basis of district comprehensive eye care services. The concept was carefully tested in a laboratory and then piloted in a real district before it was rolled over to the country. Strong national institutes for human resource development, research and development, and service delivery were established. A strong network of high-quality national institutes was set up and run by powerful national non-governmental organizations. The second National Blindness Survey evaluated the achievements of the programme in 2001-2003. National prevalence of blindness was reduced by 100% by improving the uptake of services at the district level, especially by females.

Health Care Utilisation and Attitudes towards Health Care in Subjects Reporting Environmental Annoyance from Electricity and Chemicals

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Frida Eek

2009-01-01

Full Text Available Environmentally intolerant persons report decreased self-rated health and daily functioning. However, it remains unclear whether this condition also results in increased health care costs. The aim of this study was to describe the health care consumption and attitudes towards health care in subjects presenting subjective environmental annoyance in relation to the general population, as well as to a group with a well-known disorder as treated hypertension (HT. Methods. Postal questionnaire (n = 13 604 and record linkage with population-based register on health care costs. Results. Despite significantly lower subjective well being and health than both the general population and HT group, the environmentally annoyed subjects had lower health care costs than the hypertension group. In contrast to the hypertension group, the environmentally annoyed subjects expressed more negative attitudes toward the health care than the general population. Conclusions. Despite their impaired subjective health and functional capacity, health care utilisation costs were not much increased for the environmentally annoyed group. This may partly depend on negative attitudes towards the health care in this group.

Health Care Utilisation and Attitudes towards Health Care in Subjects Reporting Environmental Annoyance from Electricity and Chemicals

Science.gov (United States)

Eek, Frida; Merlo, Juan; Gerdtham, Ulf; Lithman, Thor

2009-01-01

Environmentally intolerant persons report decreased self-rated health and daily functioning. However, it remains unclear whether this condition also results in increased health care costs. The aim of this study was to describe the health care consumption and attitudes towards health care in subjects presenting subjective environmental annoyance in relation to the general population, as well as to a group with a well-known disorder as treated hypertension (HT). Methods. Postal questionnaire (n = 13 604) and record linkage with population-based register on health care costs. Results. Despite significantly lower subjective well being and health than both the general population and HT group, the environmentally annoyed subjects had lower health care costs than the hypertension group. In contrast to the hypertension group, the environmentally annoyed subjects expressed more negative attitudes toward the health care than the general population. Conclusions. Despite their impaired subjective health and functional capacity, health care utilisation costs were not much increased for the environmentally annoyed group. This may partly depend on negative attitudes towards the health care in this group. PMID:19936124

Health Care Utilisation and Attitudes towards Health Care in Subjects Reporting Environmental Annoyance from Electricity and Chemicals

International Nuclear Information System (INIS)

Eek, F.; Merlo, J.; Gerdtham, U.; Lithman, T.

2010-01-01

Environmentally intolerant persons report decreased self-rated health and daily functioning. However, it remains unclear whether this condition also results in increased health care costs. The aim of this study was to describe the health care consumption and attitudes towards health care in subjects presenting subjective environmental annoyance in relation to the general population, as well as to a group with a well-known disorder as treated hypertension (HT). Methods. Postal questionnaire (n = 13 604) and record linkage with population-based register on health care costs. Results. Despite significantly lower subjective well being and health than both the general population and HT group, the environmentally annoyed subjects had lower health care costs than the hypertension group. In contrast to the hypertension group, the environmentally annoyed subjects expressed more negative attitudes toward the health care than the general population. Conclusions. Despite their impaired subjective health and functional capacity, health care utilisation costs were not much increased for the environmentally annoyed group. This may partly depend on negative attitudes towards the health care in this group.

Health care delivery systems.

NARCIS (Netherlands)

Stevens, F.; Zee, J. van der

2007-01-01

A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective,

[Costs of maternal-infant care in an institutionalized health care system].

Science.gov (United States)

Villarreal Ríos, E; Salinas Martínez, A M; Guzmán Padilla, J E; Garza Elizondo, M E; Tovar Castillo, N H; García Cornejo, M L

1998-01-01

Partial and total maternal and child health care costs were estimated. The study was developed in a Primary Care Health Clinic (PCHC) and a General Hospital (GH) of a social security health care system. Maternal and child health care services, type of activity and frequency utilization during 1995, were defined; cost examination was done separately for the PCHC and the GH. Estimation of fixed cost included departmentalization, determination of inputs, costs, basic services disbursements, and weighing. These data were related to depreciation, labor period and productivity. Estimation of variable costs required the participation of field experts; costs corresponded to those registered in billing records. The fixed cost plus the variable cost determined the unit cost, which multiplied by the of frequency of utilization generated the prenatal care, labor and delivery care, and postnatal care cost. The sum of these three equaled the maternal and child health care cost. The prenatal care cost was $1,205.33, the labor and delivery care cost was $3,313.98, and the postnatal care was $559.91. The total cost of the maternal and child health care corresponded to $5,079.22. Cost information is valuable for the health care personnel for health care planning activities.

Health care reforms

Directory of Open Access Journals (Sweden)

Marušič Dorjan

2016-09-01

Full Text Available In large systems, such as health care, reforms are underway constantly. The article presents a definition of health care reform and factors that influence its success. The factors being discussed range from knowledgeable personnel, the role of involvement of international experts and all stakeholders in the country, the importance of electoral mandate and governmental support, leadership and clear and transparent communication. The goals set need to be clear, and it is helpful to have good data and analytical support in the process. Despite all debates and experiences, it is impossible to clearly define the best approach to tackle health care reform due to a different configuration of governance structure, political will and state of the economy in a country.

Children With Special Health Care Needs: Child Health and Functioning Outcomes and Health Care Service Use.

Science.gov (United States)

Caicedo, Carmen

This study describes health, functioning, and health care service use by medically complex technology-dependent children according to condition severity (moderately disabled, severely disabled, and vegetative state). Data were collected monthly for 5 months using the Pediatric Quality of Life Generic Core Module 4.0 Parent-Proxy Report. Health care service use measured the number of routine and acute care office visits (including primary and specialty physicians), emergency department visits, hospitalizations, nursing health care services, special therapies, medications, medical technology devices (MTDs), and assistive devices. Child physical health was different across the condition severity groups. The average age of the children was 10.1 years (SD, 6.2); the average number of medications used was 5.5 (SD, 3.7); the average number of MTDs used was 4.2 (SD, 2.9); and the average number of assistive devices used was 4.3 (SD, 2.7). Severely disabled and vegetative children were similar in age (older) and had a similar number of medications, MTDs, and assistive devices (greater) than moderately disabled children. The advanced practice nurse care coordinator role is necessary for the health and functioning of medically complex, technology-dependent children. Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

The ethical self-fashioning of physicians and health care systems in culturally appropriate health care.

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Shaw, Susan J; Armin, Julie

2011-06-01

Diverse advocacy groups have pushed for the recognition of cultural differences in health care as a means to redress inequalities in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims on both the state and health care providers. These efforts led to federal regulations developed by the U.S. Office of Minority Health requiring health care organizations to provide Culturally and Linguistically Appropriate Services. Based on ethnographic research at workshops and conferences, in-depth interviews with cultural competence trainers, and an analysis of postings to a moderated listserv with 2,000 members, we explore cultural competence trainings as a new type of social technology in which health care providers and institutions are urged to engage in ethical self-fashioning to eliminate prejudice and embody the values of cultural relativism. Health care providers are called on to re-orient their practice (such as habits of gaze, touch, and decision-making) and to act on their own subjectivities to develop an orientation toward Others that is "culturally competent." We explore the diverse methods that cultural competence trainings use to foster a health care provider's ability to be self-reflexive, including face-to-face workshops and classes and self-guided on-line modules. We argue that the hybrid formation of culturally appropriate health care is becoming detached from its social justice origins as it becomes rationalized by and more firmly embedded in the operations of the health care marketplace.

What is the health care product?

Science.gov (United States)

France, K R; Grover, R

1992-06-01

Because of the current competitive environment, health care providers (hospitals, HMOs, physicians, and others) are constantly searching for better products and better means for delivering them. The health care product is often loosely defined as a service. The authors develop a more precise definition of the health care product, product line, and product mix. A bundle-of-elements concept is presented for the health care product. These conceptualizations help to address how health care providers can segment their market and position, promote, and price their products. Though the authors focus on hospitals, the concepts and procedures developed are applicable to other health care organizations.

Employee health benefit redesign at the academic health center: a case study.

Science.gov (United States)

Marshall, Julie; Weaver, Deirdre C; Splaine, Kevin; Hefner, David S; Kirch, Darrell G; Paz, Harold L

2013-03-01

The rapidly escalating cost of health care, including the cost of providing health care benefits, is a significant concern for many employers. In this article, the authors examine a case study of an academic health center that undertook a complete redesign of its health benefit structure to control rising costs, encourage use of its own provider network, and support employee wellness. With the implementation in 2006 of a high-deductible health plan combined with health reimbursement arrangements and wellness incentives, the Penn State Hershey Medical Center (PSHMC) was able to realize significant cost savings and increase use of its own network while maintaining a high level of employee satisfaction. By contracting with a single third-party administrator for its self-insured plan, PSHMC reduced its administrative costs and simplified benefit choices for employees. In addition, indexing employee costs to salary ensured that this change was equitable for all employees, and the shift to a consumer-driven health plan led to greater employee awareness of health care costs. The new health benefit plan's strong focus on employee wellness and preventive health has led to significant increases in the use of preventive health services, including health risk assessments, cancer screenings, and flu shots. PSHMC's experience demonstrates the importance of clear and ongoing communication with employees throughout--before, during, and even after--the process of health benefit redesign.

Optimizing Health Care Environmental Hygiene.

Science.gov (United States)

Carling, Philip C

2016-09-01

This article presents a review and perspectives on aspects of optimizing health care environmental hygiene. The topics covered include the epidemiology of environmental surface contamination, a discussion of cleaning health care patient area surfaces, an overview of disinfecting health care surfaces, an overview of challenges in monitoring cleaning versus cleanliness, a description of an integrated approach to environmental hygiene and hand hygiene as interrelated disciplines, and an overview of the research opportunities and challenges related to health care environmental hygiene. Copyright © 2016 Elsevier Inc. All rights reserved.

Integrated primary health care in Australia

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Gawaine Powell Davies

2009-10-01

Full Text Available Introduction: To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Description of policy: Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Discussion: Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

Integrated primary health care in Australia.

Science.gov (United States)

Davies, Gawaine Powell; Perkins, David; McDonald, Julie; Williams, Anna

2009-10-14

To fulfil its role of coordinating health care, primary health care needs to be well integrated, internally and with other health and related services. In Australia, primary health care services are divided between public and private sectors, are responsible to different levels of government and work under a variety of funding arrangements, with no overarching policy to provide a common frame of reference for their activities. Over the past decade, coordination of service provision has been improved by changes to the funding of private medical and allied health services for chronic conditions, by the development in some states of voluntary networks of services and by local initiatives, although these have had little impact on coordination of planning. Integrated primary health care centres are being established nationally and in some states, but these are too recent for their impact to be assessed. Reforms being considered by the federal government include bringing primary health care under one level of government with a national primary health care policy, establishing regional organisations to coordinate health planning, trialling voluntary registration of patients with general practices and reforming funding systems. If adopted, these could greatly improve integration within primary health care. Careful change management and realistic expectations will be needed. Also other challenges remain, in particular the need for developing a more population and community oriented primary health care.

Practices of depression care in home health care: Home health clinician perspectives

Science.gov (United States)

Bao, Yuhua; Eggman, Ashley A.; Richardson, Joshua E.; Sheeran, Thomas; Bruce, Martha L.

2015-01-01

Objective To assess any gaps between published best practices and real-world practices of treating depression in home health care (HHC), and barriers to closing any gaps. Methods A qualitative study based on semi-structured interviews with HHC nurses and administrators from five home health agencies in five states (n=20). Audio-recorded interviews were transcribed and analyzed by a multi-disciplinary team using grounded theory method to identify themes. Results Routine home health nursing care overlapped with all functional areas of depression care. However, there were reported gaps between best practices and real-world practices. Gaps were associated with perceived scope of practice by HHC nurses, knowledge gaps and low self-efficacy in depression treatment, stigma attached to depression, poor quality of antidepressant management in primary care, and poor communication between HHC and primary care. Conclusions Strategies to close gaps between typical and best practices need to enhance HHC clinician knowledge and self-efficacy with depression treatment and improve the quality of antidepressant management and communication with primary care. PMID:26423098

Towards Sustainable Health Care Organizations

Directory of Open Access Journals (Sweden)

Mauro ROMANELLI

2017-09-01

Full Text Available Health care organizations have to develop a sustainable path for creating public value by seeking legitimacy for building and maintaining public trust with patients as social and economic institutions creating value and sustaining both health and wealth for people and communities within society. Health care organizations having at disposal decreasing resources and meeting increasing demands of citizens are following an unsustainable path. Designing sustainable health care systems and organizations is emerging as a strategic goal for developing the wealth of people and communities over time. Building sustainable organizations relies on valuing human resources, designing efficient and effective processes, using technology for better managing the relationships within and outside organizations. Sustainable health care organizations tend to rediscover the importance of human resource management and policies for effectively improving communication with patients and building trust-based relationships. While processes of accreditation contribute to legitimizing effectiveness and quality of health care services and efficient processes, introducing and using new information and communication technologies (ICTs and informatics helps communication leading to restore trust-based relationships between health care institutions and patients for value creation within society.

Skilled delivery care service utilization in Ethiopia: analysis of rural-urban differentials based on national demographic and health survey (DHS) data.

Science.gov (United States)

Fekadu, Melaku; Regassa, Nigatu

2014-12-01

Despite the slight progress made on Antenatal Care (ANC) utilization, skilled delivery care service utilization in Ethiopia is still far-below any acceptable standards. Only 10% of women receive assistance from skilled birth attendants either at home or at health institutions, and as a result the country is recording a high maternal mortality ratio (MMR) of 676 per 100,000 live births (EDHS, 2011). Hence, this study aimed at identifying the rural-urban differentials in the predictors of skilled delivery care service utilization in Ethiopia. The study used the recent Ethiopian Demographic and Health Survey (EDHS 2011) data. Women who had at least one birth in the five years preceding the survey were included in this study. The data were analyzed using univariate (percentage), bivariate (chi-square) and multivariate (Bayesian logistic regression). The results showed that of the total 6,641 women, only 15.6% received skilled delivery care services either at home or at health institution. Rural women were at greater disadvantage to receive the service. Only 4.5% women in rural areas received assistance from skilled birth attendants (SBAs) compared to 64.1 % of their urban counter parts. Through Bayesian logistic regression analysis, place of residence, ANC utilization, women's education, age and birth order were identified as key predictors of service utilization. The findings highlight the need for coordinated effort from government and stakeholders to improve women's education, as well as strengthen community participation. Furthermore, the study recommended the need to scale up the quality of ANC and family planning services backed by improved and equitable access, availability and quality of skilled delivery care services.

Adherence and health care costs

Directory of Open Access Journals (Sweden)

Iuga AO

2014-02-01

Full Text Available Aurel O Iuga,1,2 Maura J McGuire3,4 1Johns Hopkins Bloomberg School of Public Health, 2Johns Hopkins University, 3Johns Hopkins Community Physicians, 4Johns Hopkins University School of Medicine, Baltimore, MD, USA Abstract: Medication nonadherence is an important public health consideration, affecting health outcomes and overall health care costs. This review considers the most recent developments in adherence research with a focus on the impact of medication adherence on health care costs in the US health system. We describe the magnitude of the nonadherence problem and related costs, with an extensive discussion of the mechanisms underlying the impact of nonadherence on costs. Specifically, we summarize the impact of nonadherence on health care costs in several chronic diseases, such as diabetes and asthma. A brief analysis of existing research study designs, along with suggestions for future research focus, is provided. Finally, given the ongoing changes in the US health care system, we also address some of the most relevant and current trends in health care, including pharmacist-led medication therapy management and electronic (e-prescribing. Keywords: patient, medication, adherence, compliance, nonadherence, noncompliance, cost

Advancing adolescent health and health services in Saudi Arabia: exploring health-care providers' training, interest, and perceptions of the health-care needs of young people

Directory of Open Access Journals (Sweden)

AlBuhairan FS

2014-09-01

Full Text Available Fadia S AlBuhairan,1–3 Tina M Olsson3,4 1Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 4School of Social Work, Lund University, Lund, Sweden Background: Adolescent health is regarded as central to global health goals. Investments made in adolescent health and health services protect the improvements witnessed in child health. Though Saudi Arabia has a large adolescent population, adolescent health-care only began to emerge in recent years, yet widespread uptake has been very limited. Health-care providers are key in addressing and providing the necessary health-care services for adolescents, and so this study was conducted with the aim of identifying opportunities for the advancement of knowledge transfer for adolescent health services in Saudi Arabia. Methods: This Web-based, cross-sectional study was carried out at four hospitals in Saudi Arabia. Physicians and nurses were invited to participate in an online survey addressing their contact with adolescent patients, and training, knowledge, and attitudes towards adolescent health-care. Results: A total of 232 professionals participated. The majority (82.3% reported sometimes or always coming into contact with adolescent patients. Less than half (44%, however, had received any sort of training on adolescent health during their undergraduate or postgraduate education, and only 53.9% reported having adequate knowledge about the health-care needs of adolescents. Nurses perceived themselves as having more knowledge in the health-care needs of adolescents and reported feeling more comfortable in communicating with adolescents as compared with physicians. The majority of participants were interested in gaining further skills and knowledge in adolescent health-care and agreed or strongly agreed that adolescents have

Primary health care in rural Malawi - a qualitative assessment exploring the relevance of the community-directed interventions approach

Directory of Open Access Journals (Sweden)

Makaula Peter

2012-09-01

Full Text Available Abstract Background Primary Health Care (PHC is a strategy endorsed for attaining equitable access to basic health care including treatment and prevention of endemic diseases. Thirty four years later, its implementation remains sub-optimal in most Sub-Saharan African countries that access to health interventions is still a major challenge for a large proportion of the rural population. Community-directed treatment with ivermectin (CDTi and community-directed interventions (CDI are participatory approaches to strengthen health care at community level. Both approaches are based on values and principles associated with PHC. The CDI approach has successfully been used to improve the delivery of interventions in areas that have previously used CDTi. However, little is known about the added value of community participation in areas without prior experience with CDTi. This study aimed at assessing PHC in two rural Malawian districts without CDTi experience with a view to explore the relevance of the CDI approach. We examined health service providers’ and beneficiaries’ perceptions on existing PHC practices, and their perspectives on official priorities and strategies to strengthen PHC. Methods We conducted 27 key informant interviews with health officials and partners at national, district and health centre levels; 32 focus group discussions with community members and in-depth interviews with 32 community members and 32 community leaders. Additionally, official PHC related documents were reviewed. Results The findings show that there is a functional PHC system in place in the two study districts, though its implementation is faced with various challenges related to accessibility of services and shortage of resources. Health service providers and consumers shared perceptions on the importance of intensifying community participation to strengthen PHC, particularly within the areas of provision of insecticide treated bed nets, home case management for

[Strengthening primary health care: a strategy to maximize coordination of care].

Science.gov (United States)

de Almeida, Patty Fidelis; Fausto, Márcia Cristina Rodrigues; Giovanella, Lígia

2011-02-01

To describe and analyze the actions developed in four large cities to strengthen the family health strategy (FHS) in Brazil. Case studies were carried out in Aracaju, Belo Horizonte, Florianópolis, and Vitória based on semi-structured interviews with health care managers. In addition, a cross-sectional study was conducted with questionnaires administered to a sample of FHS workers and services users. Actions needed to strengthen primary health care services were identified in all four cities. These include increasing the number of services offered at the primary health care level, removing barriers to access, restructuring primary services as the entry point to the health care system, enhancing problem-solving capacity (diagnostic and therapeutic support and networking between health units to organize the work process, training, and supervision), as well as improving articulation between surveillance and care actions. The cities studied have gained solid experience in the reorganization of the health care model based on a strengthening of health primary care and of the capacity to undertake the role of health care coordinator. However, to make the primary care level the customary entry point and first choice for users, additional actions are required to balance supplier-induced and consumer-driven demands. Consumer driven demand is the biggest challenge for the organization of teamwork processes. Support for and recognition of FHS as a basis for primary health care is still an issue. Initiatives to make FHS better known to the population, health care professionals at all levels, and civil society organizations are still needed.

Reducing Ex-offender Health Disparities through the Affordable Care Act: Fostering Improved Health Care Access and Linkages to Integrated Care

Directory of Open Access Journals (Sweden)

Lacreisha Ejike-King

2014-04-01

Full Text Available Despite steadily declining incarceration rates overall, racial and ethnic minorities, namely African Americans, Latinos, and American Indians and Alaska Natives, continue to be disproportionately represented in the justice system. Ex-offenders commonly reenter communities with pressing health conditions but encounter obstacles to accessing care and remaining in care. The lack of health insurance coverage and medical treatment emerge as the some of the most reported reentry health needs and may contribute to observed health disparities. Linking ex-offenders to care and services upon release increases the likelihood that they will remain in care and practice successful disease management. The Affordable Care Act (ACA offers opportunities to address health disparities experienced by the reentry population that places them at risk for negative health outcomes and recidivism. Coordinated efforts to link ex-offenders with these newly available opportunities may result in a trajectory for positive health and overall well-being as they reintegrate into society.

How to achieve care coordination inside health care organizations

DEFF Research Database (Denmark)

Prætorius, Thim; C. Becker, Markus

2015-01-01

Understanding how health care organizations can achieve care coordination internally is essential because it is difficult to achieve, but essential for high quality and efficient health care delivery. This article offers an answer by providing a synthesis of knowledge about coordination from...

Health Care Reform: a Socialist Vision

Directory of Open Access Journals (Sweden)

Martha Livingston

2010-04-01

Full Text Available At first glance, it doesn't seem as though socialism and health-care reform have a whole lot to do with each other. After all, the most visible "left" position in the current discussion of health-care reform merely advocates for the government to assume the function of national insurer, leaving the delivery of health care - from its often-questionable content to its hierarchical relationships - firmly in place. As such, a single payer, Medicare-for-All insurance program is a modest, even tepid reform. Those of us on the left who have been active in the single payer movement have always seen it as a steppingstone toward health-care justice: until the question of access to care is solved, how do we even begin to address not only health care but also health inequities? How, for example, can working-class Americans, Americans of color, and women demand appropriate, respectful, humane, first-rate care when our ability to access any health-care services at all is so tightly constrained?

Gender disparities in health care.

Science.gov (United States)

Kent, Jennifer A; Patel, Vinisha; Varela, Natalie A

2012-01-01

The existence of disparities in delivery of health care has been the subject of increased empirical study in recent years. Some studies have suggested that disparities between men and women exist in the diagnoses and treatment of health conditions, and as a result measures have been taken to identify these differences. This article uses several examples to illustrate health care gender bias in medicine. These examples include surgery, peripheral artery disease, cardiovascular disease, critical care, and cardiovascular risk factors. Additionally, we discuss reasons why these issues still occur, trends in health care that may address these issues, and the need for acknowledgement of the current system's inequities in order to provide unbiased care for women in the future. © 2012 Mount Sinai School of Medicine.

Gender and communication style in general practice: differences between women's health care and regular health care.

NARCIS (Netherlands)

Brink-Muinen, A. van den; Bensing, J.M.; Kerssens, J.J.

1998-01-01

Objectives: differences were investigated between general practitioners providing women's health care (4 women) and general practitioners providing regular health care (8 women and 8 men). Expectations were formulated on the basis of the principles of women's health care and literature about gender

Health care law versus constitutional law.

Science.gov (United States)

Hall, Mark A

2013-04-01

National Federation of Independent Business v. Sebelius, the Supreme Court's ruling on the Patient Protection and Affordable Care Act, is a landmark decision - both for constitutional law and for health care law and policy. Others will study its implications for constitutional limits on a range of federal powers beyond health care. This article considers to what extent the decision is also about health care law, properly conceived. Under one view, health care law is the subdiscipline that inquires how courts and government actors take account of the special features of medicine that make legal or policy issues especially problematic - rather than regarding health care delivery and finance more generically, like most any other economic or social enterprise. Viewed this way, the opinions from the Court's conservative justices are mainly about general constitutional law principles. In contrast, Justice Ruth Bader Ginsburg's dissenting opinion for the four more liberal justices is just as much about health care law as it is about constitutional law. Her opinion gives detailed attention to the unique features of health care finance and delivery in order to inform her analysis of constitutional precedents and principles. Thus, the Court's multiple opinions give a vivid depiction of the compelling contrasts between communal versus individualistic conceptions of caring for those in need, and between health care and health insurance as ordinary commodities versus ones that merit special economic, social, and legal status.

Discrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery.

Science.gov (United States)

Jaffee, Kim D; Shires, Deirdre A; Stroumsa, Daphna

2016-11-01

The transgender community experiences health care discrimination and approximately 1 in 4 transgender people were denied equal treatment in health care settings. Discrimination is one of the many factors significantly associated with health care utilization and delayed care. We assessed factors associated with delayed medical care due to discrimination among transgender patients, and evaluated the relationship between perceived provider knowledge and delayed care using Anderson's behavioral model of health services utilization. Multivariable logistic regression analysis was used to test whether predisposing, enabling, and health system factors were associated with delaying needed care for transgender women and transgender men. A sample of 3486 transgender participants who took part in the National Transgender Discrimination Survey in 2008 and 2009. Predisposing, enabling, and health system environment factors, and delayed needed health care. Overall, 30.8% of transgender participants delayed or did not seek needed health care due to discrimination. Respondents who had to teach health care providers about transgender people were 4 times more likely to delay needed health care due to discrimination. Transgender patients who need to teach their providers about transgender people are significantly more likely to postpone or not seek needed care. Systemic changes in provider education and training, along with health care system adaptations to ensure appropriate, safe, and respectful care, are necessary to close the knowledge and treatment gaps and prevent delayed care with its ensuing long-term health implications.

20 CFR 222.34 - Relationship resulting from equitable adoption.

Science.gov (United States)

2010-04-01

... 20 Employees' Benefits 1 2010-04-01 2010-04-01 false Relationship resulting from equitable adoption. 222.34 Section 222.34 Employees' Benefits RAILROAD RETIREMENT BOARD REGULATIONS UNDER THE RAILROAD RETIREMENT ACT FAMILY RELATIONSHIPS Relationship as Child § 222.34 Relationship resulting from...

Health care of youth aging out of foster care.

Science.gov (United States)

2012-12-01

Youth transitioning out of foster care face significant medical and mental health care needs. Unfortunately, these youth rarely receive the services they need because of lack of health insurance. Through many policies and programs, the federal government has taken steps to support older youth in foster care and those aging out. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Pub L No. 110-354) requires states to work with youth to develop a transition plan that addresses issues such as health insurance. In addition, beginning in 2014, the Patient Protection and Affordable Care Act of 2010 (Pub L No. 111-148) makes youth aging out of foster care eligible for Medicaid coverage until age 26 years, regardless of income. Pediatricians can support youth aging out of foster care by working collaboratively with the child welfare agency in their state to ensure that the ongoing health needs of transitioning youth are met.

The Impact of Health Insurance on Health Care Provision in ...

African Journals Online (AJOL)

This study assesses the impact of the NHIS scheme in promoting access to health care. It identifies a need for all stakeholders to engage in the active promotion of awareness on health insurance as option of health care provisioning. It argues that health insurance can make health care more accessible to a wider segment ...

What Contributes Most to High Health Care Costs? Health Care Spending in High Resource Patients.

Science.gov (United States)

Pritchard, Daryl; Petrilla, Allison; Hallinan, Shawn; Taylor, Donald H; Schabert, Vernon F; Dubois, Robert W

2016-02-01

U.S. health care spending nearly doubled in the decade from 2000-2010. Although the pace of increase has moderated recently, the rate of growth of health care costs is expected to be higher than the growth in the economy for the near future. Previous studies have estimated that 5% of patients account for half of all health care costs, while the top 1% of spenders account for over 27% of costs. The distribution of health care expenditures by type of service and the prevalence of particular health conditions for these patients is not clear, and is likely to differ from the overall population. To examine health care spending patterns and what contributes to costs for the top 5% of managed health care users based on total expenditures. This retrospective observational study employed a large administrative claims database analysis of health care claims of managed care enrollees across the full age and care spectrum. Direct health care expenditures were compared during calendar year 2011 by place of service (outpatient, inpatient, and pharmacy), payer type (commercially insured, Medicare Advantage, and Medicaid managed care), and therapy area between the full population and high resource patients (HRP). The mean total expenditure per HRP during calendar year 2011 was $43,104 versus $3,955 per patient for the full population. Treatment of back disorders and osteoarthritis contributed the largest share of expenditures in both HRP and the full study population, while chronic renal failure, heart disease, and some oncology treatments accounted for disproportionately higher expenditures in HRP. The share of overall expenditures attributed to inpatient services was significantly higher for HRP (40.0%) compared with the full population (24.6%), while the share of expenditures attributed to pharmacy (HRP = 18.1%, full = 21.4%) and outpatient services (HRP = 41.9%, full = 54.1%) was reduced. This pattern was observed across payer type. While the use of physician

Challenges in mental health care in the Family Health Strategy

Directory of Open Access Journals (Sweden)

Consuelo Helena Aires de Freitas

2011-06-01

Full Text Available Objective: To discuss the practice of mental health care performed by healthcare professionals from the Family Health Strategy in Fortaleza-CE, Brazil. Methods: This is a critical and reflective study conducted in six Basic Health Units in Fortaleza-Ce. The study subjects were 12 health workers of the following professions: doctor, nurse, community health agents and technical and/or nursing assistant. Semi-structured interviews, systematic observationand questionnaire were used for data collection. The empirical analysis was based on an understanding of the discourses through critical hermeneutics. Results: It was evident that the mental health services are developed by some health workers in the ESF, such as, matrix support, relational technologies, home visits and community group therapy. However, there is still deficiency in training/coaching by most professionals in primary care, due to anenduring model of pathological or curative health care. Conclusion: Mental health care is still occasionally held by some workers in primary care. However, some progresses are already present as matrix support, relational technologies in health care, home visits andcommunity therapy.

Health Care Performance Indicators for Health Information Systems.

Science.gov (United States)

Hyppönen, Hannele; Ronchi, Elettra; Adler-Milstein, Julia

2016-01-01

Health Information Systems (HISs) are expected to have a positive impact on quality and efficiency of health care. Rapid investment in and diffusion of HISs has increased the importance of monitoring the adoption and impacts of them in order to learn from the initiatives, and to provide decision makers evidence on the role of HISs in improving health care. However, reliable and comparable data across initiatives in various countries are rarely available. A four-phase approach is used to compare different HIS indicator methodologies in order to move ahead in defining HIS indicators for monitoring effects of HIS on health care performance. Assessed approaches are strong on different aspects, which provide some opportunities for learning across them but also some challenges. As yet, all of the approaches do not define goals for monitoring formally. Most focus on health care structural and process indicators (HIS availability and intensity of use). However, many approaches are generic in description of HIS functionalities and context as well as their impact mechanisms on health care for HIS benchmarking. The conclusion is that, though structural and process indicators of HIS interventions are prerequisites for monitoring HIS impacts on health care outputs and outcomes, more explicit definition is needed of HIS contexts, goals, functionalities and their impact mechanisms in order to move towards common process and outcome indicators. A bottom-up-approach (participation of users) could improve development and use of context-sensitive HIS indicators.

Attending Unintended Transformations of Health Care Infrastructure

DEFF Research Database (Denmark)

Wentzer, Helle; Bygholm, Ann

2007-01-01

Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background of theor......Introduction: Western health care is under pressure from growing demands on quality and efficiency. The development and implementation of information technology, IT is a key mean of health care authorities to improve on health care infrastructure. Theory and methods: Against a background...

The Oral Health Care Manager in a Patient-Centered Health Facility.

Science.gov (United States)

Theile, Cheryl Westphal; Strauss, Shiela M; Northridge, Mary Evelyn; Birenz, Shirley

2016-06-01

The dental hygienist team member has an opportunity to coordinate care within an interprofessional practice as an oral health care manager. Although dental hygienists are currently practicing within interprofessional teams in settings such as pediatric offices, hospitals, nursing homes, schools, and federally qualified health centers, they often still assume traditional responsibilities rather than practicing to the full extent of their training and licenses. This article explains the opportunity for the dental hygiene professional to embrace patient-centered care as an oral health care manager who can facilitate integration of oral and primary care in a variety of health care settings. Based on an innovative model of collaboration between a college of dentistry and a college of nursing, an idea emerged among several faculty members for a new management method for realizing continuity and coordination of comprehensive patient care. Involved faculty members began working on the development of an approach to interprofessional practice with the dental hygienist serving as an oral health care manager who would address both oral health care and a patient's related primary care issues through appropriate referrals and follow-up. This approach is explained in this article, along with the results of several pilot studies that begin to evaluate the feasibility of a dental hygienist as an oral health care manager. A health care provider with management skills and leadership qualities is required to coordinate the interprofessional provision of comprehensive health care. The dental hygienist has the opportunity to lead closer integration of oral and primary care as an oral health care manager, by coordinating the team of providers needed to implement comprehensive, patient-centered care. Copyright © 2016 Elsevier Inc. All rights reserved.

Diaspora, disease, and health care.

Science.gov (United States)

Wick, Jeannette Y; Zanni, Guido R

2007-03-01

When groups of people relocate from their homelands to other nations, especially if the movement is involuntary, minority populations are created in the countries that receive them. The issues related to these diaspora and diasporic communities--any groups that have been dispersed outside their traditional homelands--are financial, social, historical, political, or religious. In health care, issues include heritable diseases, cultural barriers, patients' health care beliefs, and unique disease presentations. In long-term care, many residents and health care providers have relocated to the United States from other countries.

Have out-of-pocket health care payments risen under free health care policy? The case of Sri Lanka.

Science.gov (United States)

Pallegedara, Asankha; Grimm, Michael

2018-04-26

Compared to its neighbors, Sri Lanka performs well in terms of health. Health care is provided for free in the public sector, yet households' out-of-pocket health expenditures are steadily increasing. We explore whether this increase can be explained by supply shortages and insufficient public health care financing or whether it is rather the result of an income-induced demand for supplementary and higher quality services from the private sector. We focus on total health care expenditures and health care expenditures for specific services such as expenses on private outpatient treatments and expenses on laboratory and other diagnostic services. Overall, we find little indication that limited supply of public health care per se pushes patients into the private sector. Yet income is identified as one key driver of rising health care expenditures, ie, as households get richer, they spend an increasing amount on private services suggesting a dissatisfaction with the quality offered by the public sector. Hence, quality improvements in the public sector seem to be necessary to ensure sustainability of the public health care sector. If the rich and the middle class increasingly opt out of public health care, the willingness to pay taxes to finance the free health care policy will certainly shrink. Copyright © 2018 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

An exploration of equitable science teaching practices for students with learning disabilities

Science.gov (United States)

Morales, Marlene

In this study, a mixed methods approach was used to gather descriptive exploratory information regarding the teaching of science to middle grades students with learning disabilities within a general education classroom. The purpose of this study was to examine teachers' beliefs and their practices concerning providing equitable opportunities for students with learning disabilities in a general education science classroom. Equitable science teaching practices take into account each student's differences and uses those differences to inform instructional decisions and tailor teaching practices based on the student's individualized learning needs. Students with learning disabilities are similar to their non-disabled peers; however, they need some differentiation in instruction to perform to their highest potential achievement levels (Finson, Ormsbee, & Jensen, 2011). In the quantitative phase, the purpose of the study was to identify patterns in the beliefs of middle grades science teachers about the inclusion of students with learning disabilities in the general education classroom. In the qualitative phase, the purpose of the study was to present examples of instruction in the classrooms of science education reform-oriented middle grades science teachers. The quantitative phase of the study collected data from 274 sixth through eighth grade teachers in the State of Florida during the 2007--2008 school year using The Teaching Science to Students with Learning Disabilities Inventory. Overall, the quantitative findings revealed that middle grades science teachers held positive beliefs about the inclusion of students with learning disabilities in the general education science classroom. The qualitative phase collected data from multiple sources (interviews, classroom observations, and artifacts) to develop two case studies of reform-oriented middle grades science teachers who were expected to provide equitable science teaching practices. Based on their responses to The

Health system challenges to integration of mental health delivery in primary care in Kenya--perspectives of primary care health workers.

Science.gov (United States)

Jenkins, Rachel; Othieno, Caleb; Okeyo, Stephen; Aruwa, Julyan; Kingora, James; Jenkins, Ben

2013-09-30

Health system weaknesses in Africa are broadly well known, constraining progress on reducing the burden of both communicable and non-communicable disease (Afr Health Monitor, Special issue, 2011, 14-24), and the key challenges in leadership, governance, health workforce, medical products, vaccines and technologies, information, finance and service delivery have been well described (Int Arch Med, 2008, 1:27). This paper uses focus group methodology to explore health worker perspectives on the challenges posed to integration of mental health into primary care by generic health system weakness. Two ninety minute focus groups were conducted in Nyanza province, a poor agricultural region of Kenya, with 20 health workers drawn from a randomised controlled trial to evaluate the impact of a mental health training programme for primary care, 10 from the intervention group clinics where staff had received the training programme, and 10 health workers from the control group where staff had not received the training). These focus group discussions suggested that there are a number of generic health system weaknesses in Kenya which impact on the ability of health workers to care for clients with mental health problems and to implement new skills acquired during a mental health continuing professional development training programmes. These weaknesses include the medicine supply, health management information system, district level supervision to primary care clinics, the lack of attention to mental health in the national health sector targets, and especially its absence in district level targets, which results in the exclusion of mental health from such district level supervision as exists, and the lack of awareness in the district management team about mental health. The lack of mental health coverage included in HIV training courses experienced by the health workers was also striking, as was the intensive focus during district supervision on HIV to the detriment of other

Health care entrepreneurship: financing innovation.

Science.gov (United States)

Grazier, Kyle L; Metzler, Bridget

2006-01-01

Entrepreneurship is often described as the ability to create new ventures from new or existing concepts, ideas and visions. There has been significant entrepreneurial response to the changes in the scientific and social underpinnings of health care services delivery. However, a growing portion of the economic development driving health care industry expansion is threatened further by longstanding use of financing models that are suboptimal for health care ventures. The delayed pace of entrepreneurial activity in this industry is in part a response to the general economy and markets, but also due to the lack of capital for new health care ventures. The recent dearth of entrepreneurial activities in the health services sector may also due to failure to consider new approaches to partnerships and strategic ventures, despite their mutually beneficial organizational and financing potential. As capital becomes more scarce for innovators, it is imperative that those with new and creative ideas for health and health care improvement consider techniques for capital acquisition that have been successful in other industries and at similar stages of development. The capital and added expertise can allow entrepreneurs to leverage resources, dampen business fluctuations, and strengthen long term prospects.

Private sector in public health care systems

OpenAIRE

Matějusová, Lenka

2008-01-01

This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market o...

Dealing with Health and Health Care System Challenges in China: assessing health determinants and health care reforms

NARCIS (Netherlands)

H. Zhang (Hao)

2017-01-01

markdownabstractThis dissertation investigates the challenges faced by China around 2010 in two domains – population health and the health care system. Specifically, chapters 2 and 3 are devoted to health challenges, explaining the female health disadvantage in later life and assessing the effect

"Once the government employs you, it forgets you": Health workers' and managers' perspectives on factors influencing working conditions for provision of maternal health care services in a rural district of Tanzania.

Science.gov (United States)

Mkoka, Dickson Ally; Mahiti, Gladys Reuben; Kiwara, Angwara; Mwangu, Mughwira; Goicolea, Isabel; Hurtig, Anna-Karin

2015-09-14

irresponsible administrative system was reported to result in the delay in responding to the health workers' claims timely and that there is no transparency and fairness in dealing with health workers' financial claims. Informants also reported on the non-existence of a formal motivation scheme and a free avenue for voicing and sharing health workers' concerns. Other challenges reported were lack of a clear strategic plan for staff career advancement and continuous professional development to improve health workers' knowledge and skills necessary for providing quality maternal health care. Health workers working in rural areas are facing a number of challenges that affect their working conditions and hence their overall performance. The government and its decentralized organs should be accountable to create conducive working and living environments, respond to health workers' financial claims fairly and equitably, plan for their career advancement and create a free avenue for voicing and sharing concerns with the management. To achieve this, efforts should be directed towards improving the governance of the human resource management system that will take into account the stewardship role of the government in handling human resource carefully and responsibly.

Behavioral Health and Health Care Reform Models: Patient-Centered Medical Home, Health Home, and Accountable Care Organization

OpenAIRE

Bao, Yuhua; Casalino, Lawrence P.; Pincus, Harold Alan

2013-01-01

Discussions of health care delivery and payment reforms have largely been silent about how behavioral health could be incorporated into reform initiatives. This paper draws attention to four patient populations defined by the severity of their behavioral health conditions and insurance status. It discusses the potentials and limitations of three prominent models promoted by the Affordable Care Act to serve populations with behavioral health conditions: the Patient Centered Medical Home, the H...

Rationalising health care in india : Challenges & strategies

Directory of Open Access Journals (Sweden)

K I Mathai

2014-01-01

Full Text Available An overview of health care delivery in India is essential, if we are to plan and to improve health care delivery and the indices of health in the coming decades. The health sector in India is a mix of private and government services. While some health care indices appear dismal, several others, including life expectancy are heartening. A balance between regulation and free enterprise is possibly the best option. In this paper we provide a glimpse of health and health related statistics & a n overview of the public health care delivery systems. In the end, we offer suggestion on rationalisation of health care delivery to provide maximum services for the majority of our population within the budget of an optimal health care system outlay

Health federalism: the role of health care professionals in Nepal.

Science.gov (United States)

Dulal, R K

2009-01-01

Nepal has entered from its unitary system into a new "Federal Democratic Republic State". The current constitution presents basic health care services as a fundamental right. The Ministry for Health and Population has been providing resources to meet health demands, but managers are wrestling to meet these demands. Persistent disparities between rural and urban and across regions resulted inferior health outcomes, e.g., life expectancy in an urban district like Bhaktapur is 71 years, whereas in the rural district of Mugu it is 44 years. The poor health and poor access to health care in the past systems prompted people to seek a different model. Ultimately, all political parties except one have agreed on federalism. The exact number of federal states that are going to be created is unknown. In federalism, all federated states have to assume certain relationships between the locality, the region, and the nation that apply not only in politics but in health care too. Managing changes in health care organization during the transitional period and after restructuring the unitary Nepal into federal states should be carefully planned. In case, if new system also fails to deliver necessary health care services, the possibility of igniting of dissatisfaction, public unrest and even disintegration cannot be ignored. In order to outline a structure and give life to a health care system under federalism, health care professionals need to engage themselves seriously.

Health care need

DEFF Research Database (Denmark)

Hasman, Andreas; Hope, Tony; Østerdal, Lars Peter

2006-01-01

The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precis......The argument that scarce health care resources should be distributed so that patients in 'need' are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can...... be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need...

“Fair” community benefits and equitable land governance | IDRC ...

International Development Research Centre (IDRC) Digital Library (Canada)

“Fair” community benefits and equitable land governance ... In several regions, women are resisting displacement and making claims to land through ... Cambridge, UK, in collaboration with the Community Legal Education Center, Cambodia; ... Birth registration is the basis for advancing gender equality and children's rights.

Health care utilization

DEFF Research Database (Denmark)

Jacobsen, Christian Bøtcher; Andersen, Lotte Bøgh; Serritzlew, Søren

An important task in governing health services is to control costs. The literatures on both costcontainment and supplier induced demand focus on the effects of economic incentives on health care costs, but insights from these literatures have never been integrated. This paper asks how economic cost...... containment measures affect the utilization of health services, and how these measures interact with the number of patients per provider. Based on very valid register data, this is investigated for 9.556 Danish physiotherapists between 2001 and 2008. We find that higher (relative) fees for a given service...... make health professionals provide more of this service to each patient, but that lower user payment (unexpectedly) does not necessarily mean higher total cost or a stronger association between the number of patients per supplier and the health care utilization. This implies that incentives...

Solidarity as a national health care strategy.

Science.gov (United States)

West-Oram, Peter

2018-05-02

The Trump Administration's recent attempts to repeal the Affordable Care Act have reignited long-running debates surrounding the nature of justice in health care provision, the extent of our obligations to others, and the most effective ways of funding and delivering quality health care. In this article, I respond to arguments that individualist systems of health care provision deliver higher-quality health care and promote liberty more effectively than the cooperative, solidaristic approaches that characterize health care provision in most wealthy countries apart from the United States. I argue that these claims are mistaken and suggest one way of rejecting the implied criticisms of solidaristic practices in health care provision they represent. This defence of solidarity is phrased in terms of the advantages solidaristic approaches to health care provision have over individualist alternatives in promoting certain important personal liberties, and delivering high-quality, affordable health care. © 2018 John Wiley & Sons Ltd.

The Future of Home Health Care

Science.gov (United States)

Landers, Steven; Madigan, Elizabeth; Leff, Bruce; Rosati, Robert J.; McCann, Barbara A.; Hornbake, Rodney; MacMillan, Richard; Jones, Kate; Bowles, Kathryn; Dowding, Dawn; Lee, Teresa; Moorhead, Tracey; Rodriguez, Sally; Breese, Erica

2016-01-01

The Future of Home Health project sought to support transformation of home health and home-based care to meet the needs of patients in the evolving U.S. health care system. Interviews with key thought leaders and stakeholders resulted in key themes about the future of home health care. By synthesizing this qualitative research, a literature review, case studies, and the themes from a 2014 Institute of Medicine and National Research Council workshop on “The Future of Home Health Care,” the authors articulate a vision for home-based care and recommend a bold framework for the Medicare-certified home health agency of the future. The authors also identify challenges and recommendations for achievement of this framework. PMID:27746670

Health care expenditure for hospital-based delivery care in Lao PDR

Directory of Open Access Journals (Sweden)

Douangvichit Daovieng

2012-01-01

Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family

Health Care Personnel Perception of the Privacy of Electronic Health Records.

Science.gov (United States)

Saito, Kenji; Shofer, Frances S; Saberi, Poune; Green-McKenzie, Judith

2017-06-01

: Health care facilities are increasingly converting paper medical records to electronic health records. This study investigates the perception of privacy health care personnel have of electronic health records. A pilot tested, anonymous survey was administered to a convenience sample of health care personnel. Standard summary statistics and Chi-square analysis were used to assess differences in perception. Of the 93% (96/103) who responded, 65% were female and 43% white. The mean age was 44.3 years. Most (94%) felt that Medical Record privacy was important and one-third reported they would not seek care at their workplace if Electronic Health Records were used. Efforts to assure and communicate the integrity of electronic health records are essential toward reducing deterrents for health care personnel to access geographically convenient and timely health care.

Health Literacy and Communication Quality in Health Care Organizations

Science.gov (United States)

Wynia, Matthew K.; Osborn, Chandra Y.

2011-01-01

The relationship between limited health literacy and poor health may be due to poor communication quality within health care delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen health care organizations nationwide distributed a survey to 5,929 patients. All patients completed seven items assessing patient-centered communication. One third also completed three items assessing health literacy. The majority of patients had self-reported health literacy challenges, reporting problems learning about their medical condition because of difficulty understanding written information (53%), a lack of confidence in completing medical forms by themselves (61%), and needing someone to help them read hospital/clinic materials (57%). Logistic regression models showed that, after adjustment for patient demographic characteristics and health care organization type, patients with limited health literacy were 28–79% less likely than those with adequate health literacy to report their health care organization “always” provides patient-centered communication across seven communication items. Using a scaled composite of these items, limited health literacy remained associated with lower reported communication quality. These results suggest that improving communication quality in health care organizations might help to address the challenges facing patients with limited health literacy. They also highlight that efforts to address the needs of patients with limited health literacy should be sensitive to the range of communication challenges confronting these patients and their caregivers. PMID:20845197

Planning for health care transitions: results from the 2005-2006 National Survey of Children With Special Health Care Needs.

Science.gov (United States)

Lotstein, Debra S; Ghandour, Reem; Cash, Amanda; McGuire, Elizabeth; Strickland, Bonnie; Newacheck, Paul

2009-01-01

Many youth with special health care needs have difficulties transferring to adult medical care. To address this, the Maternal and Child Health Bureau has made receipt of transition services a core performance outcome for community-based systems of care for youth with special health care needs. In this article we describe the results for the transition core outcome from the 2005-2006 National Survey of Children With Special Health Care Needs. We also describe changes in the measurement strategy for this outcome since the first National Survey of Children With Special Health Care Needs in 2001. In the nationally representative, cross-sectional 2005-2006 National Survey of Children With Special Health Care Needs, parent or guardian respondents of 18198 youth with special health care needs (aged 12-17) were asked if they have had discussions with their child's health care providers about (1) future adult providers, (2) future adult health care needs, (3) changes in health insurance, and (4) encouraging their child to take responsibility for his or her care. All 4 components had to be met for the youth to meet the overall transition core outcome. Those who had not had transition discussions reported if such discussions would have been helpful. Overall, 41% of youth with special health care needs met the core performance outcome for transition. Forty-two percent had discussed shifting care to an adult provider, 62% discussed their child's adult health care needs, and 34% discussed upcoming changes in health insurance. Most (78%) respondents said that providers usually or always encourage their child to take responsibility for his or her health. Non-Hispanic black or Hispanic race/ethnicity, lower income level, not speaking English, and not having a medical home reduced the odds of meeting the transition core outcome. Current performance on the transition core outcome leaves much room for improvement. Many parents feel that having transition-related discussions with their

Voluntary program promotes equitable and expedited remediation of contaminated properties

Energy Technology Data Exchange (ETDEWEB)

Wolfenden, A.K.; Cambridge, M. [California Environmental Protection Agency, Sacramento, CA (United States). Dept. of Toxic Substances Control

1995-12-31

In California, the California Environmental Protection Agency (Cal/EPA) has developed a more equitable and expedited approach for the redevelopment of sites contaminated with hazardous substances. Senate Bill 923 enacted in 1994, established the Expedited Remedial Action Program (ERAP) under Chapter 6.85 of the California Health and Safety Code. This bill responds to a nationwide demand to reform Superfund laws and promote the restoration of blighted and contaminated parcels--often referred to as Brownfields. The program was designed as an alternative to CERCLA, which has come under criticism for being inefficient, unfair and restricting opportunities for effective cleanups. Cal/EPA`s Department of Toxic Substances Control will implement this pilot program. This pilot program, which will eventually comprise 30 sites, provides incentives for voluntary remediation by addressing key economic issues associated with the remediation and redevelopment of contaminated properties.

Who benefits from public health financing in Zimbabwe? Towards universal health coverage.

Science.gov (United States)

Shamu, Shepherd; January, James; Rusakaniko, Simbarashe

2017-09-01

Zimbabwe's public health financing model is mostly hospital-based. Financing generally follows the bigger and higher-level hospitals at the expense of smaller, lower-level ones. While this has tended to perpetuate inequalities, the pattern of healthcare services utilisation and benefits on different levels of care and across different socioeconomic groups remains unclear. The purpose of this study was therefore to assess the utilisation of healthcare services and benefits at different levels of care by different socioeconomic groups. We conducted secondary data analysis of the 2010 National Health Accounts survey, which had 7084 households made up of 26,392 individual observations. Results showed significant utilisation of health services by poorer households at the district level (concentration index of -0.13 [CI:-0.2 to -0.06; p < .05]), but with mission hospitals showing equitable utilisation by both groups. Provincial and higher levels showed greater utilisation by richer households (0.19; CI: 0.1-0.29; p < .05). The overall results showed that richer households benefited significantly more from public health funds than poorer households (0.26; CI: 0.2-0.4; p < .05). Richer households disproportionately benefited from public health subsidies overall, particularly at secondary and tertiary levels, which receive more funding and provide a higher level of care.

An interdisciplinary model for mapping the Normative diffusion of fair and equitable benefit-sharing

OpenAIRE

Parks, Louisa; Morgera, Elisa

2015-01-01

Fair and equitable benefit-sharing is emerging in various areas of international environmental law (biodiversity, oceans, climate change, water, food and agriculture), as well as in international processes on human rights and corporate accountability. Benefit-sharing seeks to fairly and equitably allocate economic as well as socio-cultural and environmental advantages arising from the conservation and sustainable use of natural resources, or from their regulation, among different stakeholders...

[Intercultural health care policy from the perspective of health care providers and Mapuche clients].

Science.gov (United States)

Alarcón, Ana María; Astudillo, Paula; Barrios, Sara; Rivas, Edith

2004-09-01

Intercultural health is becoming an emergent topic in the design of health care programs for Mapuche people of Chile. This process faces important challenges such as the scarce theoretical support about the meaning of intercultural health and their practical consequences for providers and clients. To explore the perception in providers and Mapuche clients about intercultural health. A survey performed in 11 counties with the highest concentration of Mapuche people, of the IX region of Chile. The perception about the development of a new health policy specially designed for Mapuche patients was surveyed in 399 Mapuche patients and 64 providers of primary health care centers. Mapuche clients considered, as the main regional challenges, the indifference and discrimination of health care teams towards Mapuche patients, aggravated by the indifference of authorities. Providers considered that the main problem was a lack of knowledge about Mapuche culture and skills to deal with this ethnic group. Patients and providers agreed on the need to use Mapuche dialect in health care attentions, to coordinate actions with traditional healers and to accept ethnical therapeutic practices. There is scarce agreement between providers and Mapuche clients about the need for an special intercultural health policy, its contents, and the regional conditions for its implementation and development.

Promoting oral health care among people living in residential aged care facilities: Perceptions of care staff.

Science.gov (United States)

Villarosa, Amy R; Clark, Sally; Villarosa, Ariana C; Patterson Norrie, Tiffany; Macdonald, Susan; Anlezark, Jennifer; Srinivas, Ravi; George, Ajesh

2018-04-23

This study aimed to look at the practices and perspectives of residential aged care facility (RACF) care staff regarding the provision of oral health care in RACFs. Emphasis has been placed on the provision of adequate oral health care in RACFs through the Better Oral Health in Residential Aged Care programme. Endorsed by the Australian government, this programme provided oral health education and training for aged care staff. However, recent evidence suggests that nearly five years after the implementation of this programme, the provision of oral care in RACFs in NSW remains inadequate. This project utilised an exploratory qualitative design which involved a focus group with 12 RACF care staff. Participants were asked to discuss the current oral health practices in their facility, and their perceived barriers to providing oral health care. The key findings demonstrated current oral health practices and challenges among care staff. Most care staff had received oral health training and demonstrated positive attitudes towards providing dental care. However, some participants identified that ongoing and regular training was necessary to inform practice and raise awareness among residents. Organisational constraints and access to dental services also limited provision of dental care while a lack of standardised guidelines created confusion in defining their role as oral healthcare providers in the RACF. This study highlighted the need for research and strategies that focus on capacity building care staff in oral health care and improving access of aged care residents to dental services. © 2018 John Wiley & Sons A/S and The Gerodontology Association. Published by John Wiley & Sons Ltd.

The evolution of the federal funding policies for the public health surveillance component of Brazil's Unified Health System (SUS

Directory of Open Access Journals (Sweden)

Vitor Laerte Pinto Junior

2014-12-01

Full Text Available Health surveillance (HS is one of the key components of the Brazilian Unified Health System (SUS. This article describes recent changes in health surveillance funding models and the role these changes have had in the reorganization and decentralization of health actions. Federal law no. 8.080 of 1990 defined health surveillance as a fundamental pillar of the SUS, and an exclusive fund with equitable distribution criteria was created in the Basic Operational Norm of 1996 to pay for health surveillance actions. This step facilitated the decentralization of health care at the municipal level, giving local authorities autonomy to plan and provide services. The Health Pact of 2006 and its regulation under federal decree No. 3252 in 2009 bolstered the processes of decentralization, regionalization and integration of health care. Further changes in the basic concepts of health surveillance around the world and in the funding policies negotiated by different spheres of government in Brazil have been catalysts for the process of HS institutionalization in recent years.

Self-care as a health resource of elders

DEFF Research Database (Denmark)

Høy, Bente; Wagner, Lis; Hall, Elisabeth O.C.

2007-01-01

into self-care as a significant health resource of elders with different health status. It suggests that an elder's self-care ability is determined by the interaction of various sub-resources and conditions and emphasizes the constantly evolving nature of self-care. The framework may be of use in clinical......AIM: To review the literature related to self-care and health promotion for elders and to develop an understanding of self-care as a health resource. BACKGROUND: Self-care may improve health and prevent illness and disabilities in elders. Although studies of self-care are numerous, the significance...... of the concept as a health resource for elders lacks clarity. Before 1989, research focused principally on medical self-care at the expense of health care, and self-care was seen more as supplementary to professional health care rather than as a health-promoting approach in health care. METHOD...

COMMUNITY HEALTH & PRIMARY HEALTH CARE

African Journals Online (AJOL)

adedamla

Background: The well-being of women and children is one of the major determinants ... The Sample for the study were women recruited from 11 primary health care ... respondents educational level and knowledge of preconception care (X =24.76, ... single adult or married couple) are in an optimal state .... The major site for.

planning for gender equitable services delivery in a decentralised ...

International Development Research Centre (IDRC) Digital Library (Canada)

Sarah Ssali

Services Delivery in Uganda. – Services offered. – Participation. – Decision making process. – Actors. – Issues. • Post-Conflict Situations in Uganda. – Challenges from Conflict. – Decentralisation in Post conflict settings. – Planning for gender equitable services delivery. • Recommendations (Policy). • Research Gaps ...

48 CFR 52.250-5 - SAFETY Act-Equitable Adjustment.